The Humanion Arkive Year Delta 2018-19
September 24: 2018-September 23:2019
The Arkives
First Published: September 24: 2015




























Europe Arkive Year Delta 2018-19

September 24: 2018- September 23: 2019

The Humanion


Europe Arkive Year Delta 2018-19

Q-Delta 2018: || October || November || December ||


Housing Costs Have Exacerbated Income Inequality in Germany: Or How the Rich Gets Richer and Poor Poorer: Ratio: 27>39:16<14=12:02: Or Poor Gets 12% Poorer While the Rich Gets 02% Richer




|| October 24: 2018: UCL News || ά. Changes in housing costs have dramatically exacerbated the rise in income inequality in Germany since the mid-1990s, according to new UCL research. It found that 20 per cent of those with the lowest incomes, the bottom fifth, saw their share of household income spent on housing rise from 27 per cent in 1993 to 39 per cent in 2013. In contrast, 20 per cent of those with the highest incomes, the top fifth, experienced a decline in housing costs from 16 per cent in 1993 to 14 per cent in 2013.

The study was led by Professor Christian Dustmann, UCL Centre for Research and Analysis of Migration with Professors Bernd Fitzenberger and Markus Zimmermann, Humboldt University Berlin. The researchers found that the rise in income inequality was aggravated when real disposable income, after housing costs, is taken into account. Inequality between the net household income of those on middle incomes compared to the bottom ten per cent, 50:10 ratio, increased by 22 percentage point between 1993 and 2013 before housing costs were deducted. However, this increased threefold to 62 per cent after housing costs were deducted.

The main reason is a steep increase in housing expenditure for those, who rent property, which stands in contrast to the favourable development of mortgage rates, that benefited homeowners. This has exacerbated the increase in income inequality because homeowners are mainly located at the upper part of the distribution and those, who rent are concentrated further down.

Other factors, that contribute to these trends are changes in household structure, the rising number of single households and residential mobility toward larger cities. Rising housing costs in conjunction with declining real incomes at the lower end of the income distribution result in a particular strong decline in consumption and savings possibilities among low-income households.

The research, also, shows that younger birth cohorts spend more on housing and save less than older birth cohorts did at the same age. Professor Dustmann said, “In comparison to the US and the UK, developments in housing expenditures in Germany are relatively modest but the strong rise in inequality of after-housing disposable income has worrying consequences for savings rates, which fell for those 20 percent with the lowest incomes from 02 per cent in 1993 to -01 per cent in 2013.”

Professor Fitzenberger said, ‘’It is concerning that a large and growing share of low-income individuals does not save, in particular as Germany’s strict mortgage regulations reduce the possibility of wealth accumulation through housing property for the less well-off. Rising inequality in savings is, therefore, even, more likely to contribute to higher wealth inequality in the future.”:::ω.

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IEA Praises Finland’s Strong Climate Policies and Ambitious Targets Relating to Phasing Out Coal and Halving the Oil Demands















|| October 23: 2018 || ά. The International Energy Agency:IEA states in its in-depth review that Finland has adopted strong climate policies and ambitious 2030 targets for halving oil demand and phasing out coal use, among others actions. However, the IEA reminds the Finnish Government of the need to focus on cost-effective measures to achieve this goal. Finland targets, for example, that 30% of transport fuels come from renewable sources.

This means that, as a leader in advanced bio-fuels, Finland needs to ensure that the new bio-fuels obligation can be met with sustainable feedstocks. It should, also, encourage investments in the production of new bio-fuels for long-distance transport, such as, freight, shipping and aviation. “Finland aims at reducing car ownership by fostering a shift from personally-owned modes of transportation towards mobility solutions, that are consumed as a service. This is commendable but should not come at the expense of an increase of total transport emissions.

Taking a holistic approach to the decarbonisation of the transport sector will require higher efficiency of vehicles and of the transport system as a whole, as well as, more zero-emission mobility.” said the IEA Deputy Executive Director Mr Paul Simons as he presented the report in Tampere today, October 23 as part the World Energy Council’s Energy Day and the Energy 2018 event.

“The IEA review delivers, once again, an in-depth assessment of Finland’s energy policy and gives us recommendations, that will play a key role, when we prepare measures to mitigate climate change and tackle the challenges of energy security.” says Mr Kimmo Tiilikainen, Finland’s Minister of the Environment, Energy and Housing, commenting on the IEA recommendations.

“Finland will continue to search for ways to tackle long-term climate challenges in the energy sector, at the same time, bearing in mind our goals regarding environmental sustainability, security of energy supply and competitiveness.” he said.

“The IEA recommends that we adopt determined efforts to reach our energy and climate targets for 2050, review our taxation and support schemes for transport and combined heat and power production, promote the energy efficiency of vehicles, zero-transmission mobility and new fiscal instruments in the transport sector and foster dialogue with our Nordic and Baltic neighbours. In many respects, we have already initiated measures corresponding with these recommendations and there will be more initiatives in the future,” said Mr Tiilikainen.

The IEA reviews its member countries’ energy policies every five years and gives recommendations for new policy measures. The emphasis of the 2018 in-depth review of Finland’s energy policy was on emissions reductions in sectors not included in the EU Emissions Trading System, especially, transport and the sustainable use of forest bio-mass and the future of combined heat and power production as part of the electricity sector’s transformation.

IEA’s In-depth Review: Finland 2018


Vilhartti Hanhilahti: Special Adviser to the Minister of the Environment, Energy and Housing: Tele: +358 40 836 4823

Riku Huttunen: Director General: Ministry of Economic Affairs and Employment: Tele:  +358 50 3431 6519

Katja Tuokko: Senior Adviser: Ministry of Economic Affairs and Employment: Tele: +358 50 465 5533 :::ω.

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Huge Variations Between Countries in Time for Reimbursement Decisions on New Cancer Drugs: This State of Affairs Is Not Acceptable While Those Waiting for These Medicines are Suffering and Paying the Price
















|| October 21: 2018 || ά. Some European countries take more than twice as long as others to reach health technology assessment:HTA decisions to reimburse new cancer drugs following their approval by the European Medicines Agency:EMA. The average decision time is longer than one year in some countries, according to a study to be reported at the European Society for Medical Oncology:ESMO 2018 Congress, taking place in Munich, Germany. Once the EMA has approved a new treatment, many countries evaluate its benefit and cost-effectiveness through a systematic health technology assessment process as part of making a decision on whether to reimburse use of the treatment for routine patient care.

Researchers identified all new cancer drugs approved for solid tumours by the EMA between January 2007 and December 2016. They, then, tracked the time between EMA approval for each of the drugs and HTA decisions being taken by health authorities in four European countries: England, France, Germany and Scotland. Results for 47 drugs approved for 77 solid tumour indications showed that the median time from EMA approval to HTA decisions was two to three times longer in England, 405 days and Scotland, 384 days compared to Germany, 209 days and France, 118 days.

“In contrast to the centralised approval of anti-cancer drugs by the EMA, the time to HTA decisions remains a national responsibility.” said Study Co-author Dr Kerstin Vokinger, Senior Research Scientist at the University Hospital of Zurich, Switzerland, and an Affiliated Researcher at Harvard Medical School, Boston, USA. “Among other things, the different amount of resources invested in such assessments and different national regulations regarding HTA systems, may, lead to variation in the time from EMA approval to HTA decisions in different countries.”

Commenting on the findings, Dr Bettina Ryll, the Founder of Melanoma Patient Network Europe and the Chair of the ESMO Patient Advocacy Working Group, said, “We, in melanoma, still mourn the lives we lost due to the tardy and inconsistent introduction of approved innovative therapies. It is a country's responsibility to ensure sufficient administrative capacity so that processes like HTA, that were put in place for the benefit of society, do not start harming citizens. And we need more pragmatic approaches to reducing uncertainty, simply letting patients die while waiting for data to mature is not a civilised option.”

The Study found that health authorities, generally, made decisions much more quickly for drugs ranked as being of ‘highest benefit’ on the ESMO Magnitude of Clinical Benefit Scale:ESMO-MCBS compared to those with less clinical benefit. However, the variation in time from EMA approval to HTA decisions remained between different countries for these ‘highest benefit’ drugs.

The ESMO Magnitude of Clinical Benefit Scale uses a rational, structured and consistent approach to grade the magnitude of clinical benefit, that can be expected from anti-cancer treatments. ‘Lowest benefit’ refers, for example, to drugs increasing median progression-free survival by a few weeks, whereas the category of ‘highest benefit’ is given to drugs improving long-term survival in the neo-adjuvant setting.

In France, the median time to an HTA decision on ‘highest benefit’ drugs was 154 days compared to 198 days for drugs of less benefit. Faster HTA decisions for ‘highest benefit’ cancer drugs were, also, made in Germany and England but the time to HTA decisions was much longer in England, median 302 days, than in France or Germany, 203 days.

Further analysis showed that, nearly, all cancer drugs ranked as being of ‘highest benefit’ on the ESMO-MCBS were approved for reimbursement by all four countries: Germany, 100%, Scotland, 95%, England, 92% and France, 90%. In addition, the researchers found high concordance between ESMO-MCBS and scores health regulators gave in HTA procedures for cancer drugs of ‘highest benefit’.

“Our study shows that there is a high concordance between ESMO Magnitude of Clinical Benefit Scale and HTA scores for the categorisation of ‘highest benefit’. Therefore, the ESMO Magnitude of Clinical Benefit Scale could serve different countries as a helpful tool to assess the clinical value of anticancer drugs.” suggested Dr Vokinger.

Commenting on the findings for ESMO, Professor Elisabeth de Vries, Medical Oncologist at the University Medical Cenre Groningen, Groningen, The Netherlands, the Chair of the ESMO-MCBS Working Group, said, “It is reassuring that in the countries studied, anti-cancer drugs with greatest clinical benefit on ESMO-MCBS, version 1.1, are associated with faster times to HTA decisions and, nearly, all are approved for reimbursement.”

Noting the variation in times to final decisions, she suggested, “Hopefully, this information can be helpful to raise the interest of HTA agencies in their performance and timeframes.”

“Data were analysed only for England, France, Germany and Scotland. This means data for HTA procedures and reimbursement decisions were reported for only part of Europe, with no countries included from Southern or Eastern Europe. Insights into these procedures in other European countries, might be, of interest.” said Professor Elisabeth de Vries.

Dr Vokinger said that the research group now planned to expand research in this area. “Among other things, we plan to include more countries for assessing HTA decisions and to explore access to new cancer medicines by individual patients.”

About the European Society for Medical Oncology:ESMO: ESMO is the leading professional organisation for medical oncology. With 18,000 members representing oncology professionals from over 150 countries worldwide, ESMO is the society of reference for oncology education and information. ESMO is committed to offer the best care to people with cancer, through fostering integrated cancer care, supporting oncologists in their professional development, and advocating for sustainable cancer care worldwide. :::ω.

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Unhealthy Food Marketing to Children: Policies to Limit Junk Food Advertisements Aimed at Children Fall Short: New Report Finds




|| October 18: 2018: University of Liverpool News || ά. A new Report finds that many existing policies and regulations aimed at tackling food marketing to children are markedly insufficient, meaning children continue to be exposed to commercial messages promoting foods high in fats, salt and sugar. The Report, prepared by researchers from the University of Liverpool and the Open University in collaboration with the World Health Organisation:WHO, Europe, found that around half of the 53 countries in the Region have taken some steps to limit marketing of high fat, salt and sugar:HFSS foods to children.

A few countries have adopted legally binding rules, which, specifically, restrict HFSS food marketing in certain media, at certain times. Others are attempting to address the challenge of digital marketing. However, many countries still report no action and an overwhelming preference for self-regulation by the food and advertising industries remains, an approach, that is, often, found wanting by independent review. In addition, the evidence suggests that the impact of existing policies on reducing children’s exposure to HFSS food marketing has been limited, something, that is exacerbated by changing media usage and the increasingly integrated nature of marketing across a number of different media and platforms.

In May 2010, the World Health Assembly unanimously adopted the set of recommendations on the marketing of foods and non-alcoholic beverages to children. These recommendations urge countries to reduce the impact on children of the marketing of energy-dense, highly processed HFSS foods and beverages. However, the Report finds that implementation of the set of recommendations continues to be patchy, despite unequivocal evidence that HFSS food marketing has a harmful impact on children’s eating behaviours and body weight and repeated commitments made by countries to halt the rise of childhood obesity by 2025.

The Report identifies existing loopholes in policies, ongoing challenges and factors, that countries need to consider in order to effectively limit the harmful impact that HFSS food marketing has on children’s health and rights.

Drawing on the most authoritative evidence, the Report offers guidance to help countries formulate policies in line with the set of recommendations. In particular, the Report encourages countries to consider the following points:

:: Most existing action focuses on broadcast advertising only, despite clear evidence that children are exposed to marketing through many other avenues: in the digital sphere, via product display and through packaging and sponsorship of HFSS foods. Countries, therefore, need to adopt a more comprehensive approach to HFSS food marketing regulation.

:: Existing regulations, typically, limit their scope to child-oriented programming and focus, primarily, on advertising, leaving a broad range of programmes, media and marketing techniques to which children are exposed, unregulated. Countries should, therefore, ensure that they focus on establishing policies to, effectively, reduce children’s actual exposure to HFSS food marketing rather than policies based on the classification of content or media.

:: Existing rules, typically, only seek to protect children up to a certain age, typically, 12 or 13 years, even, though, a growing body of evidence suggests that adolescents are, also, negatively affected by HFSS food marketing. The scope of rules should be extended to protect all children

:: Countries have not always adopted effective food categorisation systems to determine what foods should not be marketed to children. They should ensure that they use existing or develop new, evidence-based nutrient-profiling systems, that, effectively, identify unhealthy food according to nutritional quality

:: Countries have failed to, effectively, regulate cross-border marketing at a regional level; they should reflect on how better co-operation and harmonisation could avoid weakening national HFSS food marketing restrictions and could strengthen efforts to address the global issue of food marketing in digital media.

Dr Emma Boyland, who conducted the research on behalf of the University of Liverpool, said, “The evidence is clear that children are exposed to a lot of food marketing and that exposure negatively affects their food choices and consumption. Given the high levels of childhood overweight and obesity across Europe, it is crucial that governments follow the WHO guidelines and enact regulations, that will, meaningfully, restrict the volume of persuasive food marketing, that children see.”

Read the Report:::ω.

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Financial Impacts of Cancer Found to Intensify Disease Burden Among German Patients




|| October 16: 2018 || ά. A study, conducted in Germany, draws attention to the fact that the socio-economic burden of cancer is real in Europe too and not only in the context of the US healthcare system, where it has been associated with higher morbidity and mortality. The results to be presented at the ESMO 2018 Congress in Munich show that income loss is the main source of perceived financial hardship and that this is associated with adverse psychological effects in patients.

The work, also, highlights the absence of clear definitions and valid instruments with which to examine this issue. Professor Eva Winkler, the Study Author, a Medical Oncologist at the National Centre for Tumour Diseases:NCT in Heidelberg, explained the background, “We conducted a systematic literature review of the tools used to measure the subjective financial burden of cancer patients: of the 39 studies we found, most, came from the USA and the instruments they used were either not transferable to the German context or not sufficiently focused on the subject.”

Study Co-author Dr Katja Mehlis from the NCT said, “We were, however, able to identify three broad dimensions, through which subjective financial burden could be assessed: material aspects, psychological effects and behavioural changes, such as, support seeking and coping strategies. Based on this, we developed our own, yet,  non-validated set of questions covering income, cancer-related out of pocket costs, distress and lifestyle changes.”

A total of 247 patients, 122 diagnosed with neuro-endocrine tumours and 125 treated for colorectal cancer, responded to the survey between November 2016 and March 2017. The results brought to light financial impacts in a significant proportion of patients: 80.6% of respondents stated that they faced higher out of pocket costs related to their illness.

Although, most medical costs in Germany are covered by a person’s health insurance, patients do have to contribute co-payments for prescription drugs. Cancer patients, may, additionally, face travel expenses to get to the hospital or medical centre, as well as, potentially, having to pay for care, housekeeping or childcare. For over three quarters of the patients, who responded to the survey, disease-related out of pocket costs amounted to less than 200 euros monthly.

Cancer-related income loss was reported by 37.2% of survey participants. “In our study, this effect was more serious than out of pocket costs, as the suffered losses exceeded 800 euros per month in, almost, half of cases. They were, mainly, due to patients being unable to work or forced to reduce their working hours.” said Dr Mehlis.

The analysis further showed that high financial loss relative to income was significantly associated with a lower estimation of patients’ quality of life and more distress. “The financial impacts, that a majority of these patients experienced seem to have contributed to the burden of their disease: the bigger the loss was in proportion to their previous income level, the more negatively they rated their personal situation.” Professor Winkler observed.

“More research is needed to determine what actions are necessary at the system level, for example, an extension of the period of eligibility for sickness benefits or at the individual level, like targeted consulting and support services.” she said. “To do this, we will need a valid instrument to measure ‘subjective financial burden’ in the German context, based on a precise definition of the concept.” 

Dr. Dirk Arnold of Asklepios Tumorzentrum in Hamburg, Germany, ESMO, said, “There have been efforts in Germany, including, by national entities like the Federal Joint Committee and the Robert Koch Institute, to look at the costs of oncology treatment for cancer patients but they have focused only on drug and procedure-related expenses. With this new study, we can see not just that the financial implications of a cancer diagnosis are much broader but, also, that the monetary losses associated with this disease have significant psychosocial consequences.

We should draw lessons from these findings: just as cancer patients receive consultations about lifestyle issues, like nutrition, so too, should the financial aspect, somehow, be integrated into the social counselling programmes we offer them.

The fact that medical expenses for patients in Germany and Europe, more generally, are relatively low compared to other parts of the world, should not lead us to underestimate the importance of their perceived financial burden and leave them alone with it. It would be interesting to see, if, assessments of this burden in other European countries produce similar results.

Alleviating the financial burden of cancer: is one of ESMO’s key commitments: earlier this year, ESMO issued a paper on this subject in the context of the implementation of the 2017 World Health Assembly Resolution on Cancer prevention and control.”

This paper is the first to articulate the response and commitment oncologists to advance global cancer control through the framework of the 2017 WHA Cancer Resolution and Universal Health Coverage. It addresses key topics like cancer prevention, timely access to treatment and care, palliative and survivorship care, as well as, comprehensive data collection through robust cancer registries. The authors, also, offer a concrete set of actions and policy recommendations for improving patient care.

ESMO’s commitment to lessening the burden of cancer is not new: sustainable cancer care is one of the three pillars of the Society’s 2020 Vision, and various initiatives have been launched in this field over the years. Among other things, ESMO contributed in 2016 to the revision of the WHO Model List of Essential Medicines, the list of vital medicines, that should be available to patients everywhere for free or at affordable prices and added 16 anti-cancer drugs, including, targeted therapies. With the introduction of its own classification tool, the ESMO Magnitude of Clinical Benefit Scale, the Society provided a standardised, evidence-based approach to evaluating cancer medicines, thus helping to guide health systems in their decision-making and resource allocation. In collaboration with the Economist Intelligence Unit:EIU, ESMO also published in 2017 a report on the shortage of inexpensive cancer medicines in Europe, raising awareness for a critical issue that has immediate consequences for patient care and treatment outcomes.

The Paper: Financial toxicity in German cancer patients. How does a chronic disease impact the economic situation?’ was presented by Professor Eva Winkler during the Poster Display Session on Monday, October 22, 12:45 to 13:45, CEST in the Poster Area Networking Hub, Hall A3. Annals of Oncology, Volume 29 Supplement 8 October 2018.

About the European Society for Medical Oncology:ESMO: ESMO is the leading professional organisation for medical oncology. With 18,000 members representing oncology professionals from over 150 countries worldwide, ESMO is the society of reference for oncology education and information. ESMO is committed to offer the best care to people with cancer, through fostering integrated cancer care, supporting oncologists in their professional development, and advocating for sustainable cancer care worldwide.::ω.

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Europeans Accept Climate Change is Happening But are Not Very Worried About It: But Pro-Green Policy-Measures Have Strong Support: Public Awareness of the Science of Climate Change Must Not Be Taken for Granted and Public Bodies Must Take on This Task of Public Education




|| September 26: 2018 || ά. A majority of Europeans think that climate change is happening but do not have strong concern about the issue, according to the latest European Social Survey:ESS. The results show that, while most Europeans think the consequences of climate change will be bad, many only feel a moderate responsibility to reduce climate change and think that personal efforts will not be very effective.

However, support for renewable energy sources and energy efficiency regulation are high across Europe, with a majority in all countries, who want that a large amount electricity is generated from renewable sources. The Report, ‘European Attitudes Towards Climate Change and Energy’ was authored by a team of external academics, led by Professor Wouter Poortinga from Cardiff University and fielded in 23 countries during 2016:17.

A great majority of respondents in each country think that the world’s climate is changing, that this is, at least, partly due to human activity and that the consequences of climate change will be bad. However, just over a quarter, 28%, of respondents across Europe stated that they were very or extremely worried about climate change. Concern was highest in Portugal, 51% and Spain, 48% and lowest in Russia, 14%, Poland, 15% and Estonia, 15%.

Perhaps, unsurprisingly, people indicated more concern over the affordability of energy, with 40% across Europe claiming to be very or extremely worried. Concern about the affordability of energy is, particularly, widespread in Spain, 70% and Portugal, 68%, the two countries, that, also, have the highest levels of concern about climate change. Conversely, fewer than 15% of respondents in Sweden, Iceland, Switzerland and Norway indicated concern over the cost of energy.

Looking at personal responsibility to reduce climate change on a scale of 0-10, where 0 represents no responsibility and 10 means a great deal responsibility, the mean score was only slightly above the scale mid-point of 05. Feelings of personal responsibility to mitigate climate change were highest in France and Switzerland with mean scores close to 07 on a 0-10 scale and lowest in the Czech Republic and Russia, both with a mean score lower than 04.

When asked whether they could reduce their energy use, many respondents did not feel very confident that they could do so, especially, those in Hungary, the Czech Republic and Russia. And it, also, appears that people do not think that it is highly likely that limiting their energy use would help to reduce climate change. 

The authors found that people, who feel personally responsible to help reduce climate change, also, feel more confident that they could save energy and think that doing so would be effective in reducing climate change. Respondents were asked how much electricity should be generated from a number of fossil, nuclear and renewable energy sources.

The vast majority of respondents in the European Union and European Free Trade Association area indicated support for renewable energy sources. Around three-quarters think that a large or very large amount should be generated from wind and solar power. In contrast, coal and nuclear are highly unpopular sources of electricity generation, with only around 10% of respondents thinking a large or very large amount of electricity should be generated from them.

The European Social Survey, also, assessed support for different environmental policies to reduce climate change. The results show that the use of public money to subsidise renewable energy is, particularly, popular, with 76% of respondents favouring this policy. More than half of those surveyed are in favour of a ban on sales of the least energy-efficient household appliances, while only one in five are against this policy.

In contrast, only 30% of respondents are in favour of increasing fossil fuel taxes, while 40% are somewhat or strongly against this policy.

The Report: European attitudes to climate change and energy was authored by Wouter Poortinga: Cardiff University, Stephen Fisher: University of Oxford, Gisela Böhm: University of Bergen, Linda Steg: University of Groningen, Lorraine Whitmarsh: Cardiff University and Charles Ogunbode: University of Bergen. :::ω. 

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