The accelerating digital transformation of healthcare systems highlights the growing importance of digital equity within a sustainable digital health economy. This chapter examines access, digital literacy, infrastructure, policy inclusion, and socio-economic disparities shaping the use of digital health tools. Using interdisciplinary literature and critical discourse analysis from a critical realist perspective, it explores key enablers and barriers across patients, providers, and policymakers, and identifies practical directions for equitable and sustainable digital health strategies.
Background Countries in the Western Balkans (WBCs) fall behind the European Union in implementing effective health promotion. This study explores the key components of national health promotion policies and action plans in Albania, Federation of BiH, and the Republic of Srpska, Montenegro, North Macedonia, and Serbia, with the aim of describing key action trends, gaps, and challenges, and recommendations for health promotion implementation improvement.Methods Within the framework of the "Western Balkan Strategic Partnership for Health Protection" (WASP) project, implemented in five WBCs on behalf of the Global Health Protection Programme (GHPP), 2023-2025, and using the" Ottawa Charter for Health Promotion" a descriptive observational study was employed, combining data and information provided from the desk review of national legal frameworks, country-specific reports and consultative meetings to describe health promotion policies and action plans implementation in the period from 2010 to 2022.Results WBCs highlight diverse national priorities, such as promoting education and healthy lifestyles (e.g., Albania, Serbia, Federation of BiH, and the Republic of Srpska), addressing health inequalities (e.g., Federation of BiH, and the Republic of Srpska, Serbia), and digital health systems. The strategies and action plans of WBCs have common health promotion goals, and challenges. Community engagement and enforcement of public health policies are insufficient. Preventive care services are notably underdeveloped in rural areas with inadequate healthcare infrastructure. Although legal frameworks show that there is commitment to health promotion, putting action plans into practice is still a challenge, especially when it comes to involving communities and focusing on prevention. Budget transparency and working together across the region could also be improved to better tackle health inequalities and build stronger health systems.Conclusion While WBCs demonstrate growing political commitment to health promotion, substantial gaps remain in translating strategies into sustainable action. Strengthening intersectoral collaboration, improving monitoring systems, securing stable financing, and expanding community participation are crucial for advancing equitable, prevention-oriented health systems across the region.
BACKGROUND:Monitoring food marketing that reaches children is key to effective implementation of any regulation. The Best-ReMaP European Union Joint Action aimed to test the feasibility of using monitoring protocols (developed by the World Health Organization's Regional Office for Europe [WHO-Euro]) in the public health sector, to inform EU-wide monitoring plans. In Republic of Srpska, BiH, we piloted the WHO 'CLICK' Framework step, 'L - Landscape of campaigns', created to assess the nature of digital food and beverage marketing that children are potentially exposed to when using their preferred digital media. METHODS:This mixed methods pilot study analysed 235 Instagram and Facebook posts from 10 brands/products popular among children in Republic of Srpska, and 24 videos of two YouTube influencers, between January-April 2023. The WHO Nutrient Profile Model (1st edition, 2015) was used to assess ads' eligibility to be marketed to children. With WHO-Euro monitoring Protocols we assessed the promotional techniques (ad's creative power) used by brands and YouTube influencers. Finally, we assessed feasibility at every step of the process. RESULTS:Research capacity and coding were among the main identified challenges in the pilot. Our learnings contributed to updates of the WHO Protocols and the EU- framework guidance. Regarding the food marketing landscape, the most frequently advertised food categories on social media and in YouTube Influencers' content were cakes, sweet biscuits and pastries (31% and 22.7% respectively) and chocolate and sugar confectionery (27.5% and 14.7% respectively). None of the social media ads were eligible to be marketed to children and only of 2 of the 24 YouTube influencers' marketing instances were eligible. Most ads featured elements potentially appealing to teens, 88% on Facebook and 72% on Instagram. The most frequently used persuasive appeals on social media were reference to holidays, travel, or adventure (23%), followed by taste (12.5%) and premium/contest (11.5%). YouTube influencers predominantly presented branded foods (62.5%). Only one influencer video featured a marketing disclosure. Food cue contexts varied between the two influencers, depending on their target groups. One mostly posted videos filmed at home, with child appeals and referred positively to the food featured; the other presented food as a secondary object and in neutral rather than positive contexts. CONCLUSION:The WHO-Euro 'landscape' Protocol is a feasible tool for Member States to evaluate digital food marketing. Facilitators were: capacity/resources, access to a knowledge/experience exchange, and regular protocol updates. The analysis shows that in Republic of Srpska, BiH, powerful marketing of unhealthy foods appealing to children takes place on children's favoured social media platforms and via influencers with child-appealing content. Mandatory, government-led restrictions, accompanied by regular monitoring are needed to protect children's health.
Healthy eating in preschools is a very important but challenging goal that can benefit from an adequate institutional and system approach. Five years ago, the Ministry of Education and Culture in the Republic of Srpska, Bosnia and Herzegovina, adopted a policy for healthy eating in preschools in the form of a rulebook and standards, whose use was not mandatory. The aim of this research was to determine the practices, perceptions, and experiences of preschool personnel related to the implementation of the abovementioned rulebook and standards. We applied a qualitative research method and conducted six focus groups: three with teachers (n = 37) and three with managers in preschools (n = 19). The qualitative data were analyzed according to the Framework Method. We found that the practice of healthy eating in public preschool settings involves a certain number of facilitators and ongoing challenges. While there are no doubts that the existing rulebook and standards are facilitating efforts in establishing healthy eating in preschools, their implementation has not been an easy-going process, and they have encountered resistance that has appeared at several levels. The participants perceived cookers as resistant and “old-fashioned” in preparing meals, which was found to be a significant challenge that requires education training and ongoing supervision with support. Experiences with limited financial resources and rigid public procurement procedures make it difficult to obtain desired food items. All the participants agreed that long-term commitment is needed to achieve the full implementation of policy recommendations, together with tripartite and convergent education programs for personnel, parents, and children. Promoting proper nutrition in preschools requires a holistic approach that addresses both feasibility and attitudes toward policies, continuous education for staff, creative strategies for implementing new eating habits, and overcoming financial challenges. Collaboration with parents and community stakeholders is crucial in creating a supportive environment for healthy eating habits in preschool settings.
Abstract Background The global repercussions of the COVID-19 pandemic extend beyond reported fatalities, imprinting a lasting effect on global health. The COVID-19 pandemic has presented substantial issues, encompassing not only direct infections but also excess mortality. The death rates in the Federation of Bosnia and Herzegovina (FB&H) have been significantly affected by the pandemic, leading to a need for a thorough analysis of the elements that contribute to this phenomenon. Mortality in Federation of Bosnia and Herzegovina age 15 - 44 Methods The objective of this study was to quantitatively assess the rise in overall excess mortality rates in the FB&H region for the years 2020, 2021, and 2022. We employed data from the FB&H mortality record, along with population statistics and official COVID-19 death counts, to emphasize the often underestimated number of deaths. Our objective was to offer a thorough comprehension of the actual scale of the pandemic. Mortality in Federation of Bosnia and Herzegovina age above 65 Results During the initial three years of the pandemic, FB&H encountered three separate instances of heightened mortality from any cause, accounting for 18 % of the overall excess mortality during the period of 2020–2022. The biggest burden was recorded among adults aged 45–74, with 22.4% falling within the 45–64 age group, 22.1% within the 65–74 age group, and 19.4% within the 75–84 age group. Children under 15 years old did not exhibit any excess mortality. Conclusion COVID-19-related mortality in FB&H are significantly underreported, especially among younger persons. This statement highlights the pressing necessity to enhance civil registration and vital statistics, while pushing for the implementation of comprehensive surveillance systems for all causes of mortality. These measures are of utmost importance in improving the surveillance of forthcoming pandemics and effectively addressing other significant public health occurrences. Disclosures Sinisa Skocibusic, Medicopharmacia: Travel grant to ECCMIDs
