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27 January 2025 | Country Update
Changes in reimbursement for cervical cancer screening -
03 September 2024 | Country Update
New tobacco control policies to reduce tobacco use -
22 February 2024 | Country Update
New roles given to pharmacists to improve vaccination coverage
5.1. Public health
The communities are responsible for health promotion and disease prevention. They are also responsible for the funds related to the prevention of substance abuse, vaccination, screening campaigns, nutrition plans, initiatives regarding oral health in schools and tobacco cessation programmes. Nevertheless, a number of decisions directly related to public health are taken by the Federal Government. For instance, the level of taxes on tobacco and alcohol, which are intended to reduce consumption, are determined by the Federal authorities. The Inter-ministerial Conference on Public Health plays an important role in the coordination of prevention policies (see Box5.1). Recent reform measures in the field of prevention are described in Box5.2 and in Section 6.1.
The Flemish community
Care and Health (Zorg en Gezondheid) is the Flemish agency regulating and supporting public health initiatives. The policy framework for the organization of preventive health care in the Flemish community was first described in the decree of 21 November 2003 (Flemish Agency for Care and Health, 2019b). Targets on the following topics have been developed: healthier living, suicide prevention, cancer screening and vaccination (Flemish Agency for Care and Health, 2019d). Additionally, other priorities exist and are defined during health conferences (Flemish Agency for Care and Health, 2019a). The health conferences consist of representatives of the Flemish Government, experts, target groups and local health networks (Logos). Fifteen Logos lead the health promotion work at district level. They are composed of existing local initiatives and structures, and are meant to include all health and welfare workers (Logo, 2019). For support with health promotional activities, the Flemish Government appeals to the Flemish Institute for Healthy Living (before 2017 known as the Flemish Institute of Health Promotion and Sickness Prevention). With advice, ready-made packages and training, the institute supports professionals and their organizations in the health sector, schools, workplaces and local governments. It focuses on mental health, healthy eating, physical activity and reducing tobacco use, and it supports the Logos. The Flemish Government organizes four screening programmes in the Flemish community: detection of colorectal cancer, cervical cancer, breast cancer and neonatal anomalies (Bevolkingsonderzoek.be, 2019).
The French community and the Walloon region
In a political agreement following the 6th State Reform, the French-speaking parties decided to transfer most of the public health policy competences from the French community to the Walloon region and the French Community Commission (or COCOF). The Walloon Government decided to simplify the proceedings and create a single Walloon agency in 2016, the Agency for Quality of Life (AVIQ). AVIQ is responsible for major policies related to well-being and health, support for older people, disability and family allowance (AVIQ, 2019c). The Walloon Government has defined health objectives in the Walloon Plan for Prevention and for Health Promotion (2018–2030) (AVIQ, 2019d). These objectives relate to several themes:
- diet and physical activity;
- prevention of substance abuse, and promotion of good mental health and overall well-being;
- chronic disease prevention;
- prevention of infectious diseases including vaccination policy; and
- injury prevention and safety promotion.
The Walloon decree on prevention and on health promotion of 2 May 2019 introduced the following actors:
- Centres of expertise in health promotion that, among other things, provide scientific information useful for the implementation of the plan;
- Local centres for health promotion (Centre Local de Promotion de la Santé) that, in particular, accompany the actors of their territory in the development of health promotion in their projects;
- Operationalization centres in preventive medicine, which pilot programmes of preventive medicine; and
- Other operators who implement thematic actions contributing to the achievement of the health objectives of the plan.
In the Walloon region, breast cancer and colorectal cancer screenings are organized by the Community Reference Centre for Cancer Screening (Centre Communautaire de Référence).
The Brussels-Capital region
As a result of the 6th State Reform, Iriscare was created in 2017. It is competent for providing assistance to older people and people with disabilities, homes for older people and nursing homes, reception centres, home-based care, wheelchairs, primary care, etc. in Brussels (Iriscare, 2019). Additionally, the Flemish Community Commission (VGC), the French Community Commission (COCOF) and the Joint Community Commission (GGC-COCOM) have competences in well-being and health in the region of Brussels-Capital (Be.Brussels, 2018a). There is also a Brussels Health Plan – Growing up and living in good health (COCOM, 2019a) and a strategic plan for health promotion 2018–2022 of the Brussels French-speaking government (COCOF, 2019). In Brussels, screening programmes are organized for the detection of colorectal cancer (pilot phase) and breast cancer.
The German-speaking community
In the German-speaking community, expert opinions from the Council for Health Promotion (Beirat für Gesundheitsförderung) were used by the Government to define the global concept of health promotion, consisting of a structural level (improving infrastructure, health promotion networks and coordination between health care organizations) and an individual level (age-specific information and self-responsibility) (Ostbelgien, 2019a). The focus is on the following topics: health literacy, nutrition, physical activity, mental health, substance abuse, vaccinations, environment and health, and dental health. In addition, over the next couple of years, health promotion will be focused on the socially disadvantaged population (Ostbelgien, 2019b). Also in the German-speaking community, a public service institution was created: the Agency for Autonomous Life (Dienststelle für ein Selbstbestimmtes Leben). The agency informs, advises and assists citizens in a dependency situation due to age, or physical or mental disability (see Ostbelgien (2019c) for details). The German-speaking community collaborates with the Community Reference Centre for Cancer Screening for breast cancer and colorectal cancer screening.
Family and child health care
Three different institutions (Kind en Gezin/Opgroeien[9] for the Flemish community, Office de la Naissance et de l’Enfance for the French community and Kind und Familie/Kaleido for the German-speaking community) are in charge of the organization of preventive medical, psychosocial and parenting/pedagogical services for parents-to-be and families with young children. In addition to this, they provide consultations for children up to 6 years old as well as childhood immunizations.
The vaccination coverage has been lower in Wallonia and Brussels than in Flanders for a long time, but the latest figures show that this gap is narrowing (in Wallonia; no figure for Brussels), except concerning the second dose of measles vaccination (see Devos et al. (2019) for details).
Notification and surveillance of disease outbreaks
A doctor or head of clinical laboratory is obliged to report all infectious diseases subject to a notification to Care and Health in Flanders (Flemish Agency for Care and Health, 2019c), COCOM in Brussels-Capital region (COCOM, 2019b), AVIQ in Wallonia (AVIQ, 2019b) and to the ministry of health in the German-speaking community. The list of notifiable diseases differs between the regions – see Gerkens & Merkur (2010) for additional details. The prevention of foodborne disease outbreaks is the concern of the Federal Agency for the Safety of the Food Chain (FASFC, 2020).
Sciensano has a dual task with regard to disease outbreaks and routine surveillance. It detects and rapidly identifies pathogens that are present or (re-)emerging, along with their prevention and treatment, and develops effective tools for the collection of information, which are used to assess the scale and impact of infectious diseases on public health (Sciensano, 2020a, 2020c).
- 9. In January 2020, a merger of Opgroeien combined the forces of Child and Family, Youth Welfare and part of the Flemish Agency for Persons with Disabilities. Opgroeien will take shape from January 2020. ↰
Authors
References
In 2024, two important measures were decided to reduce tobacco use and will enter into force in the future:
- From 31 December 2024, the ban on smoking in enclosed public places will be extended to various outdoor locations, such as adventure parks, zoos, playgrounds, children’s farms and sports areas. Smoking bans will have to be clearly and adequately indicated. Smoking areas may be set up, but they must be out of sight. Smoking bans also apply within a 10-metre radius at the entrances and exits of certain public places (care centres, homes for older people, hospitals, crèches, schools, libraries), even outside opening hours and during private parties.
- From 1 April 2025, the display of tobacco products will be forbidden, meaning that tobacco products (cigarettes, cigars, electronic cigarettes and similar products such as filters or cigarette paper) can no longer be visible at points of sale.
Authors
References
FPS Public Health (2024). Legislative changes concerning the ban on smoking in places accessible to the public. Brussels: FPS Public Health (https://www.health.belgium.be/fr/news/wetswijziging-betreffende-het-rookverbod-op-publiek-toegankelijke-plaatsen (in French) / https://www.health.belgium.be/nl/news/wetswijziging-betreffende-het-rookverbod-op-publiek-toegankelijke-plaatsen (in Dutch)
FPS Public Health (2024). Legislative changes concerning the ban on smoking in places accessible to the public. Brussels: FPS Public Health (https://www.health.belgium.be/fr/news/nouvelle-interdiction-dexposition-le-tabac-ne-sera-plus-visible-dans-les-magasins-partir-d (in French) / https://www.health.belgium.be/nl/news/nieuw-uitstalverbod-tabak-niet-meer-zichtbaar-winkels-vanaf-april-2025 (in Dutch)
To improve vaccination coverage, pharmacists working in a community pharmacy are authorized to prescribe and administer vaccines against COVID-19 since 12 March 2022 (Law of 2022) and vaccines against influenza from 15 October 2023 up to 1 January 2025 (with the possibility of extension). They must have undertaken and passed the specific training for this purpose. With this authorization also comes the possibility of prescribing and administering adrenaline subcutaneously or intramuscularly in the event of anaphylactic shock.
Despite an appeal put forward by the association of medical unions to annul the law of 2022, the Constitutional Court rejected it on 22 February 2024.
Authors
References
BS-MB (11 March 2022). Law of 28 February 2022 on the vaccination and administration by pharmacists practising in pharmacies open to the public, of vaccines authorised as part of COVID-19 prophylaxis. Belgisch Staatsblad-Moniteur Belge (https://etaamb.openjustice.be/fr/loi-du-28-fevrier-2022_n2022040449.html, accessed March 2024)
BS-MB (27 December 2023). Royal Decree of 18 December 2023 extending the effects of the Law of 9 October 2023 amending the Law of 10 May 2015 on the exercise of the healthcare professions. Belgisch Staatsblad-Moniteur Belge (https://etaamb.openjustice.be/fr/arrete-royal-du-18-decembre-2023_n2023048458.html, accessed March 2024)