History, principles and legacy of European Paediatric Association, the Union of National European Paediatric Societies and Associations (EPA-UNEPSA).
The European Paediatric Association (EPA) is a pan-European scientific association which is the Union of National European Paediatric Societies and Associations (EPA-UNEPSA). The main objective of EPA-UNEPSA is to encourage scientific co-operation between not-for-profit national European paediatric scientific societies and associations and between European paediatricians working in primary, secondary and tertiary paediatric care in Europe, in order to promote child health and comprehensive paediatric care.
Founded 44 years ago, it now represents over 50 National European Paediatric Societies and Associations and operates on a non-profit basis. Its General Assembly is made by the Presidents of the major national paediatric societies active in the Nations of geographic Europe, and currently represents more than three-quarters of all European countries, working closely with the major international organisations, including WHO, UN, EMA and the Council of Europe.
History and legacy of EPA/UNEPSA
Since 1976, EPA-UNEPSA has been trying to establish scientific collaboration among paediatricians and experts involved in the care of individuals in their developmental years. Such activity involved almost two generations of European paediatricians. During the international conference on the nutrition of infants and children in August 1975 in Montreux, Switzerland, 11 delegates of different European national paediatric societies decided to found UNEPSA. On June 20, 1976, the official foundation of UNEPSA took place in the St Sophia Children’s Hospital in Rotterdam, the Netherlands, and the constitution was ratified by 18 representatives of national paediatric societies in Europe.
Since the immediate years after its foundation, the activities of EPA-UNEPSA were characterised by a tremendous efficiency, with friendly interaction between the active members to promote communication among paediatric centres in Europe. EPA-UNEPSA continuously aimed to enhance primary, secondary, and tertiary paediatric care of all European children. Achieving the goal, EPA-UNEPSA relied on the principal challenges of international social responsibility with respect to children by initiating a strategy and basis for collection of demographic data, communication, confidentiality, cooperation, and consensus of all decision makers. In 1987, Bertil Lindquist and Klaus Betke gave a critical review of the achievements of UNEPSA during the first 10 years. The two main achievements during these initial years were: the integration of European paediatrics into worldwide paediatrics as represented by the International Paediatric Association (IPA), and the stimulation of professional contact between paediatricians from Eastern and Western Europe. This was a key issue during the time in which the iron curtain had descended across the European continent. The merit of the UNEPSA pioneers was that they created the basis for future communication and cooperation among European paediatricians which has characterised the profile of the Society ever since and currently.
Managing the health care of infants, children, and adolescents in Europe requires balancing clinical aims, research findings, and socioeconomic goals within an international environment characterised by cultural and economic complexity and large disparity in availability, affordability, and accessibility of paediatric care.
Mission and Objectives
The mission of EPA-UNEPSA is to provide a common platform for all general paediatricians in Europe, with the aim to promote the child’s rights to health, equity and social justice by science, research, public healthcare and education. EPA-UNEPSA is in fact strongly committed to offer to the general paediatricians the necessary tools in order to be up-to-date and feel empowered to achieve their personal professional endeavors. A number of key objectives characterise the activities of EPA-UNEPSA in a common effort with its over 50 national member societies.
EPA-UNEPSA works closely with other major international organisations, including WHO, UN, EMA and the Council of Europe in order to fulfill the common objective of encouraging scientific co-operation and promoting child health and comprehensive paediatric care. EPA-UNEPSA cooperates with these international constituencies particularly to encourage education of patients, families and care givers by translating specialist knowledge to generalists and works to improve the quality of paediatric patient care in all European countries by excellent clinical research and by implementing research into practice. The European Paediatric Association strongly supports the concept of “working and learning together”. It embraces diversity and fosters the exchange of experiences and co-operation amongst paediatricians and health professionals caring for children enabling the exchange of experiences and the sharing of best practices, in the spirit of ‘learning across borders and languages’.
Future Strategies of EPA-UNEPSA
EPA-UNEPSA develops its future plans in collaboration with its member societies. Their common projects are based on building bridges among European pediatricians and other medical and nonmedical experts by learning across borders and respecting geographical, political, and national idiosyncrasies. Expanding on planning, performing, and publishing studies on child health care services in Europe will be in the center of all EPA-UNEPSA activities. Special emphasis will be given to implementing theory into practice in all European countries and attracting experts in childcare who like to work with EPA for the improvement of child health care on a European level.
In the most recent years EPA-UNEPSA focused on adapting to the new era in paediatrics by establishing continuous communication with those societies and associations offering health care to children (eg, general practitioners, family physicians, specialists, nurses, psychologists, parents’ organisations) and inviting them to the EUROPAEDIATRICS congresses (the flagship biannual international congress of EPA-UNEPSA) for active exchanges of ideas.
EPA-UNEPSA also expanded to study diversity of paediatric health care in Europe and provided information on the provision of adequate, affordable, accessible, available diagnostic, and therapeutic care, as well as equity, efficacy, and efficiency of paediatric care for all paediatricians in Europe.1 One of the most recent challenges has turned out to be the provision of a basis for rational use of essential drugs, their safety and distribution, as well as the use of high-tech medicine.
EPA-UNEPSA aims at providing a panel for discussions for paediatricians to provide evidence-based practice guidelines that are based on scientific findings. However, EPA-UNEPSA is well aware that their national application may depend on country-specific priorities influencing appropriate use and updating. Last, but not least, EPA-UNEPSA and the other two main European paediatric organisations (European Confederation of Primary Care Paediatricians, and European Academy of Paediatrics) have reached a high level of international communication, cooperation, and consensus to further the paediatric care of children.
The concept of diversity and the promotion of joint efforts to improve child health
Disparity is increasing according to the latest figures on the gradient in European societies. In addition, nationalistic ideas are becoming more socially acceptable. These developments will in particular need a strong coherence and solidarity among all European paediatricians to advocate for all children and for high-quality, cross-border care, as many of the smaller European countries can neither build up their own centres, nor will they have the volume of cases to conduct sound research in many areas of paediatrics and adolescent medicine.
Gathering, sharing and exchanging valuable information regarding the different European health care systems is a key element to best develop appropriate and adequate health care programs at European level. To help the process, EPA-UNEPSA in collaboration with the Journal of Paediatrics, has recently promoted a study on the diversity of Child Health Care in Europe. Experts belonging to all EPA-UNEPSA member societies contributed to the editorial project.2
Diversity means understanding that each individual or nation is unique and recognising this individual or national difference. These variations can manifest themselves in the dimensions of mentality, ethnicity, sex, culture, socioeconomic status, religious beliefs, political beliefs, and medical care. The medical field of paediatrics is characterised by the diversities, variations, and heterogeneities of child health care services provided in 53 European countries with more than 200 million children below 18 years of age. The report provides information on geography, history, demography, economy, technology, and most importantly, the behaviour and culture of other people and nations. Identifying, comparing and interpreting differences in the infrastructure of countries and the variations in processes affecting lifestyles and healthcare, may lead to overcome problems by developing appropriate solutions.
The European Paediatricians speaking with one voice initiative
Despite frequent public statements regarding the importance of adequately supporting child healthcare, in reality, paediatric care in Europe is traditionally not sufficiently prioritised by national authorities involved in the key decisional processes related to children’s health. Consequently, the responsibility for children’s primary care is frequently transferred to health care professionals other than paediatricians who have received limited paediatric training. Key decisions regarding this important aspect of child health are based on changing political visions and policies of single nations and frequently are impacted by economic contingencies. This is despite the evidence that primary paediatric care provided by paediatricians achieves important public health goals, such as less hospitalisation of children, higher vaccination rates, and reduced prescription of antibiotics.
Today’s children and families live in a period of rapid social change. During the last few years important cultural trends and social-economic factors have affected the provision of paediatric health care in Europe, including changes in the paediatric patient population, paediatrician workforce, and nature of paediatric practice. The increasing demand from the National European paediatric organisations is that European Paediatrics will become able to speak with one voice, advocating properly for European children’s health. Such important request by their members, has become urgent and unavoidable for the European paediatric organisations.
To this regard important progresses have been made by EPA/UNEPSA toward establishing one joint organisation that is able to unify the efforts of the European paediatricians. In fact, key talks have been promoted by EPA/UNEPSA and are currently in progress on this topic among the three main European paediatric organisations: EPA-UNEPSA, the European Academy of Paediatrics (EAP) and the European Confederation of Primary Care Paediatricians (ECPCP). During recent months, the three organisations effectively discussed the importance for European paediatricians to speak with one voice on behalf of children and advocate for their health and wellbeing, and a seminal achievement has been reached between two of them.
In May of 2019 EPA/UNEPSA and the European Confederation of Primary Care Paediatricians (ECPCP), representing 22 Primary Care paediatric societies of 18 different European Nations and over 30.000 European paediatricians signed a fundamental partnership memorandum of understanding,3 which marks an important step for European paediatricians toward the goal of speaking with one voice (Table 2). These two European paediatric societies together represent more than 200 000 European paediatricians working in primary, secondary, and tertiary paediatric care and their agreement represents a key step toward the goal of unifying the voice of European paediatricians and their ability to advocate for children and their needs.
In conclusion, EPA-UNEPSA strongly believes that collaboration among national European paediatric societies and international constituencies is essential in order to promote and develop child health and comprehensive child health services in Europe. Paediatric organisations must become partners with others, or they will become increasingly irrelevant to the health of children.
1 Ehrich JH, Tenore A, del Torso S, Pettoello-Mantovani M, Lenton S, Grossman Z. Diversity of Pediatric Workforce and Education in 2012 in Europe: A Need for Unifying Concepts or Accepting Enjoyable Differences? J Pediatr. 2015 Aug;167(2):471-6.e4. doi: 10.1016/j.jpeds.2015.03.031. Epub 2015 Apr 25.
2 Ehrich J, Namazova-Baranova L, Pettoello-Mantovani M. Introduction to “Diversity of Child Health Care in Europe: A Study of the European Paediatric Association/Union of National European Paediatric Societies and Associations”. J Pediatr. 2016 Oct;177S:S1-S10
3 Namazova-Baranova L, Carrasco-Sanz A, Vural M, Huss G, Mestrovic J, Barak S, Hoey H, Werner A, Schuhmacher M, Pettoello-Mantovani M. European Pediatricians: Speaking with One Voice to Advocate for Children and Their Health. J Pediatr. 2019 Aug;211:227-228