Conference Report (English)

Baltic Sea Parliamentary ConferenceBaltic Sea Region –A Role Model for Innovationin Social- and Healthcare24th Baltic Sea ParliamentaryConference24Baltic Sea Region –A Role Model forInnovation in Social-and Healthcare24th Baltic Sea ParliamentaryConferenceRostock, 30 August 2015 – 1 September 20152Baltic Sea Region – A Role Model for The Baltic Sea Parliamentary Conference (BSPC)Innovation in Social- and Healthcare was established in 1991 as a forum for political24th Baltic Sea Parliamentary Conference dialogue between parliamentarians from theBaltic Sea Region. BSPC aims at raising aware-ness and opinion on issues of current political© Landtag Mecklenburg-Vorpommern, interest and relevance for the Baltic Sea Region.Schwerin 2015 It promotes and drives various initiatives andText: Kim Kleine efforts to support a sustainable environmental,Editing: Bodo Bahr, Kim Kleine social and economic development of the BalticLayout: produktionsbüro TINUS Sea Region. It strives at enhancing the visibilityPhotos: Landtag Mecklenburg-Vorpommern of the Baltic Sea Region and its issues in a widerPrint: produktionsbüro TINUS European context.Copies: 300 BSPC gathers parliamentarians from 11Printed on environmentally-friendly paper national parliaments, 11 regional parliamentsPrinted in Germany and 5 parliamentary organizations around theBaltic Sea. The BSPC thus constitutes aunique parliamentary bridge between all theEU- and non-EU countries of the Baltic SeaRegion.BSPC external interfaces include parlia-mentary, governmental, sub-regional andother organizations in the Baltic Sea Regionand the Northern Dimension area, amongthem CBSS, HELCOM, the NorthernDimension Partnership in Health and SocialWell-Being (NDPHS), the Baltic Sea LabourForum (BSLF), the Baltic Sea States Sub-re-gional Cooperation (BSSSC) and the BalticDevelopment Forum.BSPC shall initiate and guide politicalactivities in the region; support andstrengthen democratic institutions in the par-ticipating states; improve dialogue betweengovernments, parliaments and civil society;strengthen the common identity of the BalticSea Region by means of close co-operationbetween national and regional parliaments onBaltic Sea Parliamentary Conference the basis of equality; and initiate and guidewww.bspc.net political activities in the Baltic Sea Region,endowing them with additional democraticBodo Bahr legitimacy and parliamentary authority.Head of BSPC Secretariat The political recommendations of thebb@bspc.net annual Parliamentary Conferences areexpressed in a Conference Resolutionadopted by consensus by the Conference. Theadopted Resolution shall be submitted to theBSPC Secretariat governments of the Baltic Sea Region, thec/o Lennéstraße 1 CBSS and the EU, and disseminated to other19053 Schwerin relevant national, regional and local stake-Germany holders in the Baltic Sea Region and itsPhone (+49) 385 525 2777 neighbourhood.3INTRODUCTIONLadies and Gentlemen,The 24th Baltic Sea Parliamentary Conference took place in Ros-tock, the largest city in Mecklenburg-Vorpommern. With its Han-seatic centre, the large harbour, the sandy beaches ofWarnemünde, the nearby forests and – most importantly – thedirect access to the sea, the venue provided the perfect atmospherefor a true Baltic Sea Conference. 190 parliamentarians, experts,and officials gathered in Hohe Düne to discuss “The Baltic SeaRegion as a Role Model for Innovation in Social- and Healthcare”.The Baltic Sea Region already is home to stable healthcare systems,which affect the health of about 85 million people. The region fea-tures a variety of innovative universities with world class generalscience and with a strong focus on life sciences. We have well-edu-cated, skillful and motivated human resources – more than 5 mil-lion employees working in healthcare and related industries. Fur-ther we boast a strong healthcare, pharmaceutical and medtechindustry. However, the region also shows signs of certain dispari-ties with a view to some of these parameters. This year’s conferencetherefore dealt both with fostering the position of the Baltic SeaRegion as a Role Model for Innovation in Social- and Healthcareas well as with aligning the capacities of the different systems asmuch as possible. We strived to find answers to these challenges inour four sessions “Cooperation in the Baltic Sea Region”,“Cross-border Cooperation in Healthcare”, “Health and Econ-omy”, and “Sustainable and Accessible Social and Health Care”.4I am grateful that we managed to agree on a resolution full of con-crete demands, relevant ideas and recommendations. We haveproven that on the eve of the BSPC’s Silver Jubilee the BSPC is ascommitted as ever to open inter-parliamentary dialogue, in theinterest of the well-being of the people in the region. This carriesspecial significance, as the challenges that lie ahead are manifold.With this year’s resolution we have already addressed a number ofcurrent issues, including the demographic change in the regionwith all its consequences for the social- and healthcare systems, thesituation in Ukraine, as well as the refugee crisis in Europe. It isparamount that we carry on the banner of continued communica-tion and cooperation.Let me thank all the speakers and participants who contributed tothe success of the conference. Please allow me to address specialthanks to the Prime Minister of Mecklenburg-Vorpommern, MrErwin Sellering, for the warm welcome given to the conferenceparticipants.I also thank my staff - the administration of the Landtag Mecklen-burg-Vorpommern - for the perfect preparation and execution ofthe conference, and also to all who have contributed to its success.Finally, let me thank the Head of the BSPC Secretariat, Mr BodoBahr, for guiding me through all the BSPC practice, and for hisprecious advice.Entrusting the BSPC Presidency to Mr Jānis Vucāns, the Presidentof the BSPC in 2015–16, I wish him plenty of success and satis-faction, and I very much look forward to our future encounters.Sylvia Bretschneider,President of the Landtag Mecklenburg-VorpommernChairman of the BSPC 2014-155ContentsOpening of the Conference ............................ 7Session oneCooperation in the Baltic Sea Region ................... 11Session twoCross-border Cooperation in Healthcare ................. 33Session threeHealth and Economy – Paving the Way forInnovation in Social- and Healthcare .................... 45Session fourSustainable and Accessible Social- and Healthcare –at the Crossroads of Healthcare Provision,the Demographic Shift and Shrinking Budgets ............ 67Closing of the 24th BSPC ............................. 91Annexes:Conference Resolution .............................. 95Programme . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103List of Participants ................................. 1096 Opening of the ConferenceOpening of the Conference 7Opening of the ConferenceMs Sylvia Bretschneider – President of the Landtag Mecklenburg-Vor-pommern and Chair of the BSPC„Opening Words”Ms Sylvia Bretschneider, President of Mecklenburg-Vorpommernand Chair of the BSPC welcomed all participants to the city ofRostock and to the 24th Baltic Sea Parliamentary Conference,extending a particularly warm welcome to Jānis Vucāns, MP fromLatvia and the host of the upcoming Silver Jubilee in Riga in2016. She then expressed her hope for a constructive conferenceheld in the spirit of friendship and harmony, so close to the seathat connects the members of the BSPC.Ms Bretschneider highlighted that there are many challenges fac-ing the social- and healthcare sector such as an ageing population,inequalities in healthcare, an increase in lifestyle-related diseasesand financial pressures on the service systems. She expressed thewish to discuss these challenges from different perspectives, com-bining the different traditions and experiences of the memberstates to come to the best possible solutions. She pointed out thatthe Baltic Sea Region possesses profound knowledge on the sub-ject and that it should be its ambition to become a role model forinnovation in social- and healthcare. In order to make its demandsheard, the BSPC members would have to work in close coopera-tion with its respective governments.8 Opening of the ConferenceThe Chair finally expressed optimism regarding the draft resolu-tion and the concrete plans for future joint initiatives it alreadycontained. She regarded this as an opportune starting point formore in-depth cooperation. She concluded by wishing the partici-pants a very successful conference and by yielding the floor to thePrime Minister of Mecklenburg-Vorpommern, Erwin Sellering.„Words of welcome”Mr Erwin Sellering, Prime Minister of Mecklenburg-Vorpommern,welcomed the participants to the state. Mr Sellering underlinedthe warm relationship between the state and its regional partners,one of many reasons being that the countries in the Baltic SeaRegion formed an important source of employment and invest-ment to Mecklenburg-Vorpommern. The state was keen to investin its relationships across the Baltic Sea, which took shape in con-nections between universities, municipalities, and sport clubs allalong the region.He pointed out that healthcare had been an important theme forthe state of Mecklenburg-Vorpommern for over 15 years. It hadbeen the goal of the state to create within its borders the besthealthcare region within Germany, and it had been this ambitionthat had made the healthcare sector one of the most importanteconomic driving forces. The gross value added was currently at15 percent making it comparable to industries like tourism orfood production. Mr Sellering lauded the brainpower, especially inthe life sciences, that made it possible to push the state to thehighest echelons of healthcare in the country.He then mentioned the cooperation in the Baltic Sea Region; inthe form of healthcare region ScanBalt, infection prevention pro-ject HICARE, the cross-border telemedicine opportunities and thehealthcare partnership of the Northern Dimension. Another eventthat helped strengthen the international cooperation was thenational trade conference on the healthcare industry held for thepast ten years in Rostock, which since 2007 had been organisedwith a partner country, almost always from the Baltic Sea Region.Opening of the Conference 9Mr Erwin Sellering – Prime Minister of Mecklenburg-VorpommernMr Sellering pointed out that it was very useful to come togetherand find solutions, thereby making the Baltic Sea Region a modelregion for innovation in social- and healthcare. One of the keyquestions: how could healthcare be organised in such a way thathigh quality services would be accessible to the people living insparsely populated areas? He reminded the representatives that theanswer to such questions would not be found in a single goodthought or project, but that many good ideas and projects wouldbe necessary.One of the critical factors would be the continued involvement ofRussia in this dialogue. Not just from an economic perspective,but in the light of peaceful coexistence. Cooperation shouldinvolve all parties, only then could it be profitable for everyone.10 Session oneSession one 11Session oneCooperation in theBaltic Sea RegionMs Sylvia Bretschneider –President of the Landtag Mecklenburg-Vorpommern„Report from the Chair of the BSPC”Ms Sylvia Bretschneider, President of the Landtag Mecklen-burg-Vorpommern refreshed the three core goals of the BSPC’smission statement: to raise awareness and opinion on commonpolitical issues, to promote and drive initiatives and to enhance thevisibility of the Baltic Sea Region. She expressed the belief thatmajor progress had been made on all three points.An example of such progress was the meeting of the StandingCommittee at the European Parliament in January 2015. Ms Bret-schneider considered it a great victory that the Standing Commit-tee had successfully contributed to keeping „health” in the ActionPlan of the EU Strategy for the Baltic Sea Region.12 Session oneAnother example was the intensified cooperation with the North-ern Dimension Partnership in Public Health and Social Well-Be-ing (NDPHS), the effects of which could be seen at a NDPHSside event to the BSPC Conference, „Health is Wealth and Wealthis Health”, highlighting the association between health and theeconomy.The BSPC was more than just health. Its core identity alsoinvolved cooperation, protection of the Baltic Sea, maritime issuesand tourism. The BSPC Chair then took the opportunity to wel-come Mr Harry Liiv, Chair of HELCOM and made an honoura-ble mention of Ms Christina Gestrin, former Chair of the BSPCand longstanding observer together with Ms Bretschneider atHELCOM. Cooperation between Ms Bretschneider and MsGestrin had resulted in a letter to the International MaritimeOrganisation (IMO), urging to maintain 1 January 2018 as thestarting date for the prohibition of discharging sewage by shipsinto the Baltic Sea, as well as to continue efforts to improve andmodernise wastewater treatment capacity throughout the BalticSea Region.The topic was also discussed during the Pan-European Dialogue inCruise Tourism in Brussels in March 2015. This in order toinvolve this branch, which was affected by this resolution. Sheunderlined that an EU-wide concept for the setting up of portreception facilities would be paramount, and that correspondingfunding should be made available.Finally, she mentioned her participation in the Baltic Sea TourismForum, its new orientation towards cultural tourism, and how cul-ture contributed to economic development. She applauded thistheme being set as a priority by the CBSS’s Polish Presidency, whoseSteering Group would meet in Gdansk in September this year. This,Ms Bretschneider argued, was of great interest to the new BSPCWorking Group, since tourism was a blooming industry.All the aforementioned fields, in which the BSPC had been active,showed how state and non-state, national and regional actors allworked for the common good of the region. There was a need fordialogue to resolve political differences, not armed forces.Session one 13Mr Raul Mälk – Ambassador of Estonia„Report from the Outgoing Chair of the CBSS”Mr Mälk, Ambassador of Estonia and Outgoing Chair of theCBSS recalled that last year the BSPC welcomed the new long-term priorities of the CBSS, and that it had adopted a documentdescribing the manner in which the CBSS would work to reachthe aims of the CBSS 2008 Vilnius summit paper. The main taskof the Estonian presidency was to implement these documents andto do this efficiently, impact-driven and result-based. This task hadto be performed in a changed international climate, where devel-opments had resulted in the loss of trust: the first cancelled PrimeMinisters meeting in its history, no meeting of foreign ministersand abandoned project ideas. Mr Mälk underlined however, thatalthough there had been a pause in dialogue, there was a continua-tion in the practical work of CBSS.He further stressed the difficulty to find public money for regionalprojects. For the term 2013-2015 CBSS had €1 million, which itused to provide funding for 18 projects and hundreds of Baltic SeaRegion actors.During the Estonian Presidency, there were five meetings of theCommittee of Senior Officials, which were used to discuss work-ing groups, expert groups and networks. The end of the EstonianPresidency saw the approval to prolong the mandate for the ExpertGroup on Maritime Policy for another three years. A newapproach for the activities of the Expert Group on SustainableDevelopment was agreed upon.14 Session oneThe CBSS has echoed the call of the BSPC to cooperate anddivide labour fairly across the north, stressing the need for open,broad and trust-building dialogue between existing institutions. Assuch, a regular meeting between the four formats in the NorthernRegion was held last September: CBSS, the Arctic Council, theBarents Euro-Arctic Council and the Nordic Council of Ministers.Northern Dimension partnerships were also represented. Therewas much contact with the BSPC Standing Committee and sup-port for the Baltic Sea NGO Forum.The CBSS Secretariat played a role in three areas of the EU Strategyfor the Baltic Sea Region. An important working method was organ-ising round tables. The first priority was “Regional Identity”. Therehad been much cooperation on these matters, on different levels: par-liamentary, regionally, and with local authorities and NGOs. TheCBSS had launched the Baltic Sea Youth Dialogue in cooperationwith the German Körber Foundation in order to include youth inthis particular process. Furthermore, the project “Common Map forCulture Tourism in the Baltic Sea Region” had been funded by theCBSS and led by the Association NORDEN, to establish a sustaina-ble platform for cooperation in the sphere of culture tourism andupdate information on cultural and historic heritage in the region.Furthermore, a decision had been made to commission an independ-ent evaluation of the EuroFaculty concept, which nears its end at thePskov University in Russia. The first CBSS Summer University hadbeen held at the Swedish Södertörn University. The BalticLab projecthad been continued, which involved the creative industries.Session one 15The second priority was “Sustainable and Prosperous Region”. Animportant event had been the adoption of the VASAB Tallinn dec-laration, which would promote cooperation between cities,improve accessibility within the region, and enhance maritime spa-tial planning by implementing the Regional Baltic Maritime Spa-tial Planning Roadmap 2013-2020.However, more had been done to further a sustainable future forthe Baltic Sea Region. Mr Mälk informed the BSPC members thatthe CBSS established the Climate Dialogue and the “Green Tech-nology and Alternative Fuels Platform in Baltic Sea Shipping”. Italso continued the Baltic Sea Maritime Dialogue with regionalactors. A study had been prepared on the Evaluation of Low-Car-bon Development policy implementation, paving the way for dis-cussions on the UN Sustainable Development goals. Furthermore,the CBSS had participated in the Agroforum 2015 in Tartu, Esto-nia, organising two events and thereby contributing to the devel-opment of environmentally friendly cultivation methods and bestagricultural practices, a goal that the BSPC itself had adopted inits 23rd Conference resolution.The third priority was the “Safe and Secure Region”. The CBSSExpert Group on Cooperation for Children at Risk had engageditself with alternative care and children’s rights, the handling ofcross-border child protection and child-friendly justice standards.The Tallinn Recommendations and Action Plan on AlternativeCare and Family had been adopted.16 Session oneThe CBSS Task Force against Trafficking in Human Beings haddeveloped guidelines and recommendations to counter labourexploitation, paying special attention to self-regulation of private sec-tor actors. Finally, the heads of Civil Protection had paid attention tofire prevention, and the heads of Border Services had dealt with athreat assessment, and finding stolen vehicles, amongst others.Mr Mälk concluded his speech by expressing his gratitude to theBSPC for a wonderful cooperation during the Estonian Presidency.„Report from the Incoming Chair of the CBSS”Mr Czyż, Ambassador of Poland and Incoming Chair of the CBSSwished the BSPC a productive meeting on behalf of the PolishPresidency of the CBSS and expressed gratitude for the opportu-nity to inform the Conference about the plans and priorities of thePolish Presidency of the CBSS.He offered the opinion that the BSPC, as the vox populi of theregion, together with the CBSS, plays an essential role in definingand implementing a common vision of the region’s future. Thetopic of health perfectly reflects the basic needs and expectationsof people living in the Baltic Sea Region. Although challengingtimes are upon the region, it has great potential for growth, whichshould be used fully. The smart utilisation of new growth perspec-tives stemming from Baltic cooperation, globalisation, Europeanintegration and the increasing accessibility of the Arctic, form themain challenge currently facing the region.Mr Czyż further stressed that although the Polish Presidency comesin times of duress for the region, caused by for instance the crisis inUkraine, this challenge also forms a test for regional confidence andmutual understanding, making the need for cooperation withinframeworks such as the BSPC or CBSS ever more clear. In fact, itshould become a role model for regional cooperation.The long-term priorities would remain unchanged: Sustainableand Prosperous Region, Regional Identity and Safe and SecureRegion. The usefulness of CBSS will become further apparent as aplatform for intergovernmental coordination with and monitoringof regional development strategies and formats, offering practicalSession one 17Mr Michal Czyż – Ambassador of Polandsupport. Although witnessing a very successful cooperation sys-tem, the Polish ambassador saw room for more regional coherenceand synergy and expressed the wish to enhance close cooperationwith, for instance, the Northern Dimension, the EU Strategy forthe Baltic Sea Region, the Nordic Council of Ministers, BarentsEuro Arctic Council, the Arctic Council and others, for instanceby establishing a structured dialogue.Mr Czyż further noted that discussing the Project Support Facilitywould be crucial in order to strengthen CBSS’ ability to imple-ment projects.The motto of the Polish Presidency would be “Strength in Diver-sity”, combining the multitude of historical, social, economic andcultural backgrounds into what the Ambassador called the “Baltic-ness” and thus applying a macro-regional perspective in order toharness the region’s potential. Ideally, a common Baltic spacewould be created, collectively overcoming the bottlenecks thathamper the daily lives of its citizens.Since the Polish Presidency of CBSS coincides with its chairing ofthe National Coordinators of the EU Strategy for the Baltic SeaRegion, at least three joint meetings will be organised on subjectsof joint importance.The Ambassador further reported that under the long-term goal of“Sustainability and Prosperous Region”, the Polish Presidency will18 Session onepursue a new agenda in areas where the CBSS is already active,such as climate change, regional implementation of the UN Sus-tainable Development Goals, the BSR Maritime Transport System,diversifying Energy Sources and Efficiency, and an increased coop-eration in science, research and innovation, as well as in tourism.The latter will be discussed during the 8th Baltic Sea TourismForum in Gdansk-Malbork in September 2015. The Baltic SeaRegion Energy Cooperation will discuss public-private partner-ships during a conference in Warsaw in November. Finally, MrCzyż announced the opportunity for more cooperation in the sci-ence sector during the Baltic Science Network.The Polish Presidency had rechristened “Regional Identity” as“Creativity”. It sees this as a driver of development in the regionand believes that the cultural sector, or culture as part of the eco-nomic sector, will be responsible for the creation of a great numberof jobs. A seminar on the potential of the computer gaming indus-try will be held in Krakow in November.“Safe and Secure Region” will be further developed by enhancingthe cooperation potential of civil protection services. This willinvolve the improvement of environmental monitoring, includinga focus on nuclear security. It will also include a continued fightagainst human trafficking and an even stronger support for theprotection of children.Mr Czyż concluded his speech by stressing the need for in-depthreflection on the future of Baltic cooperation in the light of achanging global environment, and by expressing gratitude for theopportunity to present Polish plans for the upcoming year.Mr Dohrmann, Member of the European Parliament, drew atten-tion to the fact that the Action Plan of the EU Strategy for theBaltic Sea Region had recently been revised, in consultation withmember states and stakeholders. The main aim had been to focusmore on the three main objectives of the Strategy:1. Save the Sea2. Connect the Region3. Increase ProsperityAs a result, the revised Action Plan now consisted of 13 policy areas(including amongst others bio-economy, culture and education) andfour horizontal actions (e.g. the need for capacity building).Session one 19Mr Jørn Dohrmann – MEP, Chair of the Delegation Responsible forthe Baltic Sea Region (SINEEA Delegation)The reduction of human influence on the climate would remain apriority, and the delegate expressed the wish that this goal could beincorporated in the innovative solutions aimed to transform theeconomy, making it more efficient and resilient.Furthermore, the role of regional organisations had become part ofthe Action Plan, in an attempt to enhance coherence of coopera-tion in the region and contribute to a better division of labouramong existing networks.The Action Plan would by no means be set in stone, but should beseen as an evolving policy tool, able to adapt to changing needswithin the region. The EU Strategy for the Baltic Sea Region is thefirst macro-strategy of the EU and its successes in tackling com-mon challenges and pooling expertise and resources are therefore asource of inspiration. Mr Dohrmann stressed the need for politicalcommitment and encouraged the delegates to ensure the mobilisa-tion of resources, including human resources, as well as to improvecommunication and visibility of the strategy.Although the Strategy had been devised within the EU, it couldonly be pursued in cooperation with external partners in theregion. An exceptionally successful platform had been the North-ern Dimension, an equal partnership between the EU, Russia,Norway and Iceland. Examples would be: public health, the envi-ronment, social well-being, transport, logistics and cultural func-tion. The CBSS, the Nordic Council of Ministers and HELCOM20 Session onehad been equally important for a macro-regional cooperation.Additionally, Mr Dohrmann mentioned that in the light of Rus-sia’s adoption of its own Strategy for Social and Economic Devel-opment of the North-Western Federal District, the search for syn-ergies, dialogue and the exchange of experiences had become allthe more important, despite increasingly tense relations.Touching upon the theme of the conference – health – the speakeracknowledged the role played by the Northern Dimension Part-nerships on Health and Social Well-being as coordinator for thisparticular policy area within the EU Strategy, praising it as beingparticularly stable and productive. The revised Action Plan paidparticular importance to health and supported the on-going pro-jects in, for instance, studies on antimicrobial resistance or impactreduction of various diseases in the region.Two aspects would be crucial for success: political commitment tothe Strategy, and the will to transform the commitment into con-crete action. In this light, the speaker asked the participants tomake this a priority, and ensure that enough resources would beallocated to its implementation, in addition to active participationby the stakeholders. He ended his speech with a plea to raiseawareness of the Northern Dimension and Baltic Sea cooperationin order to ensure its future success.Session one 21Ms Valentina Pivnenko – MP for the Russian Federation„Strategy of Socio-Economic Development of theNorth-West Federal District”Ms Valentina Pivnenko, member of the Duma of the Russian Fed-eration, opened that in recent years, the Baltic Sea Region had been alocomotive for growth, both in Europe and in Russia. The countrieshad had solid production potential and a rich resource base, and theeconomies of the region had intertwined strongly, thus forming aproductive macro-region. The countries were furthermore boundtogether by geopolitics, history and the economy. It would be impor-tant to keep this in mind when creating a strategy for the region.The last strategy for the North-Western district of the Russian Feder-ation had come to an end this year, Ms Pivnenko reminded, and itwould have to be given a new shape for a new time period. How-ever, international circumstances had changed, forcing Russia toreorient itself rather than continue down the known path.The economic situation, both internally and externally and espe-cially in the North-Western district, had made it necessary to updatethe current goals and to see by what means these new targets couldbe achieved. The main goals would be to achieve social stability andprosperity, to ensure competitiveness of businesses and to keep aneye on the budget.The Russian Federation would have to determine which industrieswould be most effective in achieving the wider goals of the govern-22 Session onement and would have to monitor how the regional strategies would betranslated into actions. In order to coordinate this, the North-Westernstrategic partnership was created, in which over 65 organisationsworked together including local and regional government and univer-sities, and to which over half a million applications had been filed forprojects that cover all possible economic sectors of the region.Regarding foreign trade Ms Pivnenko mentioned that price changesin key export areas had an effect on changes in production and thatRussia would have to adapt to this. This would include a new focuson import substitution and on the establishment of national produc-tion alternatives, which she recognised, could take years. Russia recog-nised the need to modernise its economy and to become competitive.She then moved on to discuss the Arctic, a part of the North-West-ern district where 1,5 million people lived and which was rich innatural resources. 70 percent of Russia’s submerged oil reserves and80 percent of its submerged gas reserves could be found in this area.The State therefore saw a need to create infrastructure to access theseresources. One project that was in development was the BELKO-MUR railroad, which would stretch from the White Sea to the UralMountains, and was nicknamed the “Silk Road of the North”. Rus-sia’s partnership with China had resulted in investments in this pro-ject and would become an important reason for transport opportu-nities to be consolidated and strengthened.The importance of the relationship with Europe could be witnessedin many significant areas of cooperation. The use of major ports onthe Russian Baltic Sea coast, the use of its important trade corridors,and improving and simplifying customs agreements formed exam-ples. Regarding the energy sector, the delegate stressed that the clos-ing of the Latvian nuclear power facility Ignalina in 2009 had led topressure on energy supply, which had led Russia to build the nuclearenergy facility Baltiiskaya near Neman, ensuring energy supply forthe Baltic Area. She then expressed regret at the fact that the impor-tance of environmental health had not always been prioritised in thepast, but that great advances were being made today. The protectionof the environment was then described as one of the most promisingfields of cooperation between the EU and Russia.Finally, Ms Pivnenko addressed the role of Russia in the Ukraine.She explained that the efforts of the Russian Federation were gearedtowards stopping the bloodshed, and to working together to makethe Agreement of Minsk reality. She added that Russia had receivedover a million refugees from the Ukraine, which enjoyed the samerights as Russian citizens.Session one 23Mr Harry Liiv – Chair of HELCOM„Report on the HELCOM Baltic Sea Action Plan”Mr Harry Liiv, Chair of HELCOM, wanted to shed light on theprogress of the HELCOM Baltic Sea Action Plan and its targets toreduce pollution and under water noise.Eutrophication is one of the largest problems in the Baltic Sea andhence the focus of a large part of the work done by HELCOM.An important step in tackling this problem is monitoring the bal-ance of nutrients like nitrogen and phosphorous, so that it can bedetermined if action plans are actually effective. At this point,there is a wide variety. Some basins, like the Kattegat, the DanishStraits and Bothnian Sea have never exceeded their limits, whereasothers, like The Gulf of Riga and the Gulf of Finland have grownfar beyond them.The aim is to reduce such nutrients to acceptable levels. In order tokeep the nutrient levels in check, it is necessary to upgradenational standards for nutrient contents in manure, and nutrientbookkeeping at farm level. It will allow for more detailed analysisand planning. For this to be successful, it is important to exchangebest practices amongst the Baltic Sea countries.In addition to harmful substances from the agricultural sector,heavy metals resulting from amongst others the pharmaceuticalindustry munition are a risk for both the Baltic Sea and humanhealth. In 2013 it was agreed that analysis would take place on this24 Session onematter, and its impact on the degradation of the marine environ-ment. The first results are expected early 2016.A new area of focus for HELCOM is marine litter. A significantamount of (household) litter is entering the marine environmentthrough rivers and beaches. In 2013 the goal was set to substan-tially reduce the litter by 2025. This will be one of the Estonianpriorities during its leadership of HELCOM, and the matter hasbeen adopted as part of the HELCOM resolution. In order toachieve this goal, it is necessary to cooperate closely with the exist-ing waste management plans of the different countries. Mr Liivtherefore asked the parliamentarians for support for such meas-ures.The speaker then addressed underwater noise. Off coast windfarms and shipping are human causes of underwater noise that canhave a negative effect on marine bio-diversity. In 2013 measureswere agreed upon to tackle this issue, and HELCOM has contrib-uted to this by creating a roadmap for the next three years. Thegoal is to build a knowledge base on underwater noise and therebyhopefully being able to tackle the issue with precise measures.Some of the recent activities of HELCOM were adressed. In 2014a key topic of cooperation was the expulsion of amongst other sul-phur and nitrogen during maritime activities. This resulted in theestablishment of a new subgroup of HELCOM. The aim is to findcommon ground for the future. The HELCOM report on illegaldischarges observed a reduction of polluting spills. The joint pro-cedures on chemical response are currently under review. Finally,Mr Livv addressed the danger of contaminated wreckage for theBaltic Sea, including older wrecks.As early as 2007, HELCOM tabled port reception for sewage asan important issue, leading to the introduction of an internationallaw banning discharge from passenger ships at sea. In order for theban to become effective, adequate sewage disposal systems have tobe maintained in ports, but there is no Baltic-wide definition ofthe term „adequate”. Mr Liiv noted that most visits had relativemodest sewage delivery, but that a lacking adequacy should not bean obstacle for a new law to come into force.Session one 25Ms Daria Akhutina – General Director of the Baltic Sea NGOForum and Network„Report from the Baltic Sea NGO Forum and Net-work”Ms Daria Akhutina, General Director of the Baltic Sea NGOForum and Network, explained that the Baltic Sea NGO Forumand Network was a network of Non Governmental Organisations,Civil Society Organisations, and eleven CBSS states across the Bal-tic Sea Region. It held its 13th Baltic Sea NGO Forum on 10 and11 of June 2015 in Tallinn, Estonia, bringing together over 120representatives of civil society organisations, the CBSS, the NordicCouncil of Ministers and other public authorities for cross-borderdialogue. The representatives had discussed the importance ofdeeper and wider inclusion; to ensure that civil society organisa-tions could influence and participate in decision-making, therebystrengthening the democratic processes across the Baltic SeaRegion. The participants of the conference in Tallinn had partici-pated in plenary sessions and debates, as well as ten different work-shops. Topics discussed included:- Base for sustainable development – NGOs providing energysustainability and energy security in the Baltic Sea Region- Social inclusion and dialogue – NGOs actions for major socialinclusion in the Baltic Sea Region- “Whole Baltic Sea Region Must Live” – NGOs for sustainable,safe, comfortable and innovative communities26 Session one- Life-long learning and civic education – NGOs for betteremployment- Cooperation in the field of combatting human trafficking inthe Baltic Sea Region- European Year for Development 2015 – Thinking globally,acting locally- Youth as future of the Baltic Sea Region- Unique and common cyberspace for CSOs and NGOs of theBaltic Sea Region- Funding aspects of civil society development in the Baltic SeaRegion: Era of individualistic support – a loss or benefit- Human rights and cultural diversity in the Baltic Sea Region.This resulted in the adoption of a Final Statement, which was sentto the BSPC.Focus lay on the renewed long-term priorities of the CBSS and thepriorities of its Estonian Presidency, on the implementation of theEU Strategy for the Baltic Sea Region and on the UN Post-2015Development Agenda on sustainable development. Furthermore,it lay on the European Year for Development 2015, fundamentaland human rights in the region and best practices of CSOs andcooperation in the Baltic Sea Region.The Forum called upon all states to respect democratic rule anddevelopment and to allow independent organisations to offer theirinput. Ms Akhutina pointed out that CSOs had a large wealth ofknowledge and experiences readily available for exchange andcooperation. She stressed that the Baltic Sea NGO Forum andNetwork and the BSPC had had a strong history on cooperationthat lent itself as a base for future successes.However, it was time for less talk and more action, Ms Akhutinastated, and she called on all partners, from citizens to govern-ments, to get involved. During its meeting, the Forum had rec-ognised that cooperation between NGOs should be strength-ened. This included securing funding for important projects,and preserving the flexibility to allocate these funds where nec-essary. The NGO Forum had proposed to create a common plat-form for NGOs, based on joint initiatives surrounding the EUStrategy for the Baltic Sea Region and the Strategy for theSession one 27Development for the North-Western District of the RussianFederation in 2020.Ms Akhutina then conferred the wishes of the new Polish presi-dency to the delegates. She concluded by impressing upon thedelegates that in a world that had become explosive, fostering peo-ple-to-people contact is essential to facilitate trust and communi-cation.DiscussionMr Höskuldur Thórhallsson – President of the Nordic Councilnoted that Iceland had no real proximity to the Baltic Sea, but thatIceland was involved in its interests. Iceland had been the first torecognise the new Baltic States after the Cold War. Mr Thórhalls-son warned that peace should not be taken for granted and thatthe Nordic Council rejected the situation in Crimea as well as theacts of extremists such as during attacks in Copenhagen. He thentouched upon the refugee situation. Europe used to have a ring offriends, he quoted, but was now surrounded by a ring of fire. Heargued that members should be more united within Europe.Mr Höskuldur Thórhallsson – President of the Nordic Council28 Session oneMr Thomas Stritzl – MP German BundestagAttempts to go back to the zero-sum game within Europe woulddo no good. Furthermore, he shared the opinion that Russia andUkraine would benefit from de-escalation. The Baltic Sea was notunaffected by the situation in Russia. Mr Thórhallsson stressedthe need to discuss northern cooperation including Russia.Mr Thomas Stritzl, Member of the German Bundestag wished todraw the attention of the attendees to the ammunition found inthe seabed of the Baltic Sea. He stressed that it endangered tour-ism and transportation. Although progress had been made, captur-ing these old pieces of ammunition had not gone forward in a suf-ficient pace, he claimed. Mr Stritzl argued that a common goalshould be formed to develop an international ammunition grid inorder to assess the danger, type and condition of these ammuni-tions and that testing should be done fast. Mr Stritzl then men-tioned that HELCOM had been correct in addressing the dangerof medication in the Baltic Sea, but continued that what was truefor medication should be true for ammunition.Mr André Brie, Member of Parliament of Mecklenburg-Vorpom-mern, stressed that it was important to maintain the social andcultural character of the region and to strive for peaceful coopera-tion. As a frequent visitor to the Middle East, Mr Brie had cometo appreciate the importance of peace. He stressed that nationalistinterests should not be allowed to threaten the idea behindEurope. Instead, he argued, it was necessary to express solidaritywith the refugees, and to push for a region where people can livetogether in peace.Session one 29Mr André Brie – MP Mecklenburg-VorpommernMr Jörgen Petterson, Member of Parliament of the Åland Islands,spoke that all countries surrounding the Baltic Sea were dependenton it for trade, pleasure and food. For the Åland Islands this waseven more important, because the sea surrounded it. The BSPCcontinued to be of high importance for Åland society to share expe-riences and create awareness. The Islands had become good at find-ing compromises, as complete unanimity was generally unlikely.Still, through discussion and exchanges, real differences could bemade in important areas. Mr Pettersson reminded the participantsthat they were a Baltic family, and this should not be forgotten.Mr Jörgen Pettersson – MP Åland Islands30 Session oneMs Annette Holmberg-Jansson, Member of Parliament of theÅland Islands, worried about the toxic algae surrounded the ÅlandIslands. She argued that the waste water levels were too high,resulting in the algae, which formed deep concerns for the citizens.Ms Holmberg-Jansson argued that HELCOM would have to bestrengthened in order to protect the marine environment.Mr Franz Thönnes, Member of the German Bundestag, thanked thePresident of the Landtag Mecklenburg-Vorpommern and the Headof Secretariat of the BSPC for the excellent preparation and execu-tion of the conference, and the Polish ambassador for depicting thePolish long-term goals during its presidency. The German Bunde-stag would like to strengthen and support the Polish in achievingthese goals. Mr Thönnes furthermore reasoned that everyone shouldcontribute in their our own way to make sure that the Minsk agree-ment would be implemented. Mr Thönnes agreed that parliamen-tarians should not be slapped with travel bans, and that dialogueshould be free to occur wherever. Parliamentarians especially shouldbe able to congregate and create dialogue. Next year would be the25th jubilee of the BSPC, 25 years of cooperation. The Baltic Seahad become the sea that connects, not divides. Putting it in terms ofhealth: relations in the Baltic Sea Region did not need a bad cold.Ms Saara-Sofia Síren, Member of Parliament of Finland openedthat protecting of the sea was also a question of health. Protectingthe sea was a matter of tourism. A sea that was used as a dumpingground would not make an attractive tourist attraction. All portsMr Franz Thönnes – MP German BundestagSession one 31Ms Saara-Sofia Síren – MP Finlandin Finland offered free waste disposal, Ms Síren noted, provingthat it was possible. She concluded by conveying that Finland’snew government saw protection of sea and ecological status as animportant spear point.Mr Oleg Nilov, Member of the Duma of the Russian Federation,objected that in discussing health, drugs were not discussed as amajor threat. The topic was absent from the draft resolution. MrNilov stressed that it was time to combat this number one dangerhurting young people. He further expressed wonder at why thiswas not a discussed topic and suggested putting it on the agendafor the conference in Hamburg, arguing that the city had experi-ence with the threat of drugs. There was an epidemic of drug con-sumption, he argued, and a need for the development of a pro-gramme combatting this issue existed.Ms Sonia Steffen, Member of the German Bundestag, offered thatduring a visit of the German Minister for the Environment, BalticSea pollution was discussed. She considered it common knowledgethat cruise ships polluted a great deal. She continued that she was onthe board of the maritime museum in Stralsund and was proud ofthe research conducted there, especially research involving countingnumber of porpoises in the Baltic Sea, which was roughly 550. MsSteffen expressed hope that they would not go extinct. Noise pollu-tion should be reduced for their sake, she argued.Ms Tatiana Zakharenkova, Member of Parliament of the City of St.Petersburg, expressed frustration that her country had been32 Session oneattacked and incriminated, regarding its support for the war inUkraine. She argued that the twentieth century had bestowedupon Russia an especially thorough understanding of the impactof war. Two World Wars had impacted her country. No state hadlost more during these wars, she argued. Decades without war hadled to a new social agreement for the people of Russia: peoplewould even deal with personal right violations as long as therewould be no war, Ms Zakharenkova claimed. With that back-ground in mind, it was hard for her to believe that Russia couldsupport war in Ukraine. She further noted that Russia providinghumanitarian aid was driven by rational arguments. Not providingit would only result in a flood of refugees. Ms Zakharenkovastressed that Russian gas was going through Ukraine and that therewas great pressure on the Russian budget because of the war. Therewould be no benefit for Russia, and no one would benefit fromfurther escalation, the delegate from St. Petersburg concluded.Session two 33Session twoCross-border Cooperationin HealthcareMs Rimantė Šalaševičiūtė – Minister for Health of LithuaniaMs Rimantė Šalaševičiūtė, Minister of Health of Lithuania, was thank-ful for the opportunity to inform the delegates about the innovationsin the healthcare sector in Lithuania. She called the smart manage-ment and technological innovations designed for early diagnosticsand treatment a great good in an ageing European society, during atime where life expectancy was going up but resources for healthcareare limited. Ms Šalaševičiūtė spoke of the challenges that will have tobe conquered, such as legal, ethical, and economic obstacles.Lituania has considerable scientific, practical and infrastructuralpotential for innovation development, in part thanks to Europeaninvestments, she continued. This has resulted in solutions foreHealth, the development of university studies into biomedicine, bio-informatics and health informatics as well as innovative models forthe provision of care in five priority areas: stroke diagnostics and treat-ment, infarction, traumatology, child health and oncology.34 Session twoThe Lithuanian government prioritises the acceleration of thedevelopment of such innovations, but it also recognises that coop-eration between the sciences, the state, business and practicalhealthcare are paramount, since such innovations require a diversesource of financing.Future investments (of approximately €600 million) will be dedi-cated to amongst others smart specialisation of stem cells, lasertechnology and in developing safer and healthier foods. In order toassess the progress made in innovation, the Minister of Healthestablished the Board for Assessment of Healthcare Technologiesin 2014, which has the goal to coordinate and develop healthcaretechnology assessment, implementation and application.The Lithuanian government has prioritised amongst others thedevelopment of services and products of bio banks, which willcollect and store human samples in addition to functioning as aresearch centre. It will also develop its potential in eHealth, aswell as its promising future in the area of lasers, which will allowfor progress in imaging technology. Finally, it hopes to competeglobally in the market for biotechnology, including biopharma-ceuticals.Lithuania has decided to cluster certain medical establishments, tomake cooperation more fluid. Areas where this is successful are:cardiology, stroke diagnostics, neonatology, intensive care andoncology. It has also appointed national reference centres, whichwill provide the opportunity to participate in international net-works and share best practices.In the area of healthcare services, the government will furthermorebe open to integrate complementary medicine into the existingsystem. Additionally, it will carefully monitor the development,introduction and implementation of new medical technologies,and has established a governmental body this spring to keepabreast with new developments. It will also extend the spectrum ofinnovative healthcare services to be reimbursed from the Compul-sory Health Insurance Fund. Finally, it will strive to make innova-tive medicine accessible and to reduce the prices of generic medi-cation.All in all, the Lithuanian government has stated that it is eager tocooperate on the international plane and very willing to share itsbest practices, for instance in the field of eHealth and antibioticsmanagement.Session two 35Mr Dmitry Kostennikov – Vice-minister for Health, the RussianFederationMr Dmitry Kostennikov, Vice-minister for Health of the RussianFederation, lauded the organisation of the conference, conveyedgreetings from the Russian minister and thanked for the opportu-nity to speak. He stressed that the Baltic Sea Parliamentary Con-ference is of importance to the Russian Federation, especially tomaintain good neighbourly relations. They are neighbours withwhom Russia shares many circumstances, such as history, climate,tourism, and labour migration. There are many shared healthcareproblems too, and there must be a combined effort to combatthem, giving HIV/Aids and tuberculosis as examples of infectiousdiseases that could benefit from such joint efforts, but also men-tioning the fight against tobacco and alcohol abuse and promotinga healthy lifestyle as themes worthy of cooperation.He exemplified the active regional cooperation, especially in theNorth-Western federal district of Russia. Archangelsk has beeninvolved in many projects aiming to provide primary medical careand psychiatric care. It has also aimed to combat infectious dis-eases. 27 seminars, 18 conferences, and 19 working groups wereheld in the company of twelve delegations that hoped to benefitfrom mutual exchange on healthcare. Murmansk has been activein the Baltic Sea Area on combatting infections diseases with aprogramme focussing on tuberculosis.The minister then gave an overview of projects currently underwayin Russia. For one, the country is looking to establish best practicesin primary healthcare and to ensure lifelong learning for the medicalprofessionals. Another priority lies with fighting HIV/Aids, and the36 Session twominister expressed great progress here, mentioning that a majority ofchildren from mothers with HIV are now born healthy. The minis-ter also noted a downward trend in tuberculosis, where a decrease of30 percent was witnessed since 2005 and the mortality from the dis-ease has been decreased by a factor of two.Antibiotic resistance forms a new threat in the region. The RussianFederation has formed an intersectorial group of experts fromhealthcare and agriculture with the aim to monitor the use of anti-biotics.This year the President declared his intention to combat car-dio-vascular diseases, including paying attention to lifestyle choicesthat might cause such illnesses, the speaker announced. A projectin the North-Western district aims to combat the early mortalityfrom cardiovascular disease. Directly related is the attempt toreduce the use of tobacco. Russia has banned public smoking,including in the workplace, as well as the advertising and openlydisplaying of tobacco products. The level of tobacco use has sunk16-17 percent since the beginning of this programme. The mainSession two 37Ms Annette Widman Mauz – Parliamentary State Secretary at theGerman Federal Ministry for Healthaudience for anti-smoking and anti-alcohol programmes are teen-agers.Finally, the minister touched upon the accessibility of healthcare.After a 30-year break, Russia has re-started a programme of large-scale prophylactic medical exams, using mobile units, looking atrisk factors and early detection of diseases. The introduction oftelemedicine and eHealth has had a good impact, but at themoment is mostly oriented at doctor-to-doctor contact. Russiaexplores how it can be applied between doctors and patients,which would help in sparsely populated areas.With regard to human rights and healthcare, the ministerremarked: all people that have a medical emergency on Russiansoil now have the right to receive free medical care. Approximately300,000 people have applied for this, mostly refugees fromUkraine, according to the speaker.Ms Annette Widman Mauz, Parliamentary State Secretary at theGerman Federal Ministry for Health, stated that the Baltic SeaRegion is being confronted with difficult political and health chal-lenges. She then singled out the demographic changes, non-com-municable diseases like cancer and diabetes as well as infectiousdiseases like HIV/Aids and especially tuberculosis.In 2013 alone, approximately 360,000 new cases of tuberculosiswere reported in the European region, a disease that is difficult tocure, especially in its multiresistant form. The European region has38 Session twothe highest prevalence of multiresistant tuberculosis in the world, afact that proves that a cooperative effort to combat this disease isnecessary. Conditions have to be created that will allow access tohigh quality healthcare for all those who need it. Sparsely popu-lated areas with a low density of healthcare providers, but also by alack of trained medical personnel or the lack of funds can formchallenges to such access.Germany will take its chairmanship of the G7 as an opportunityto discuss health in general, and antibiotic resistance in particular.In October the G7 ministers of health will come together in Berlinto discuss Ebola and antibiotic resistance.The speaker then continued to praise the influence of the NorthernDimension Partnership in Public Health and Social Well-being(NDPHS) – currently chaired by Germany – for its cross-borderefforts in achieving high quality healthcare and for its cooperationwith international organisations such as the WHO, the InternationalOrganisation for Migration and the International Labour Organisa-tion. She noted that the NDPHS is the coordinator for the imple-mentation of the health section of the EU Baltic Sea Strategy. Itsgoals are to develop tailor-made concepts that can be easily adoptedSession two 39Dr Nedret Emiroglu – Deputy Director, WHO Regional Office forEuropeby partner states, as well as to encourage cooperation and mutualexchange of best practice. Priorities will lie with HIV/Aids, tubercu-losis, the combating of antibiotic resistance, non-communicable dis-eases like heart disease and chronic diseases, but also on the abuse ofalcohol and drugs and health in the work environment. In this light,the exchange of best practice will take place, and a project will bedeveloped that will allow medical personnel to shadow their col-leagues from partner states on the work floor.Ms Widman Mauz underlined her belief in international coopera-tion and exchange, and the potential it caries, for instance in drugand alcohol policy. She singled out an example of a HIV/Aids pro-ject for youth in Finland, Latvia, Poland and Russia where the par-ticipants had remarked that it was their first opportunity to speakon equal footing with adults on the subject matter. Another EUfunded project was organised to combat the use of broadbandantibiotics, on which a conference will be held in November thisyear. Finally, she underlined the importance of the involvement ofpolitics in all areas across the board, not just the health ministries.Ms Nedret Emiroglu, Deputy Director for the WHO RegionalOffice for Europe, passed on the apologies from Ms SuzanneJacob, the head of the WHO’s Office for Europe, who could notmake it to the conference. She then expressed her joy of seeinghealth on the agenda, and praised its timeliness. The WHO sees alot of opportunity for cross-border collaboration, and she waspleased that some speakers had already touched upon this earlierduring the conference. She then expressed her wish to discuss the40 Session twoEuropean Health Policy Framework for Health and Well-being,the Global Antimicrobial Resistance Action Plan and the Post-2015 Development Agenda.“Health 2020” is the health policy framework for health andwell-being in Europe, which has been adopted by all 53 memberstates in the European Area of the WHO. It is a value based,action-oriented framework, which aims to obtain its goals with awhole-of-society and a whole-of-government approach. It is avery relevant framework for the European countries, which isproven by the fact that more than half of the member states useit in order to chisel out their own health policies. The frameworkaims to improve health and inequalities in health, but also toencourage leadership. It furthermore addresses a broad range oftechnical health areas and most importantly determinates forhealth, including the economic, social or environmental. DrEmiroglu then called upon the delegates’ leadership, which sheinsisted would be instrumental in order to achieve awhole-of-government approach, to successfully engage societyand to make a difference.Session two 41The WHO monitors the actual implementation of health policycompared to targets and indicators. Six of the indicators are espe-cially important, from which Dr Emiroglu singled out three: theWHO witnesses premature mortality despite life expectancyincreasing in the region; it sees a decreasing trend in healthcareinequities, but still there are large diversions between states andwithin states; and a new concept of well-being. Dr Emiroglustressed that there is a role for everyone to play in order to achievethe goals set out.Another important matter that offers itself for cross-border collabora-tion is health security. The international community has seen manythreats recently, such as the Ebola and polio. Dr Emiroglu emphasisedthat the International Health Regulations are the most important toolwith which the international community should respond to all publichealth threats. Not just communicable diseases, even chemical ornuclear events should be considered within the framework. Shereminded her audience that the framework is a legally binding docu-ment that entered into force in 2007 and that there is a full commit-ment with 55 signatory parties in the European region alone.42 Session twoShe furthermore reminded the participants that all levels of gov-ernment should be involved in detecting a threat. Screening, animportant step in detecting any public health threat on time, isdone in collaboration with local authorities. Then there is thecoordination of international response, especially relevant for theBSPC. Finally, there is the necessity to build the core capacities ofthe countries in order to be able to respond in time. If anything,maintaining good health is a team effort.Dr Emiroglu continued her speech by noting that she did notneed to convince her audience that antimicrobial resistance hasbecome a large global health threat costing many lives. Multidrugresistant tuberculosis is becoming a significant threat. The interna-tional community needs to take concerted actions in order to beable to combat it successfully. Unfortunately, very few new antibi-otics are being newly developed which could result in the worldentering an era without antibiotics. Europe has led the charge inbringing this issue to the table globally.The Post-2015 Development Agenda will be discussed in New Yorkin September 2015 to continue the development agenda beyond themillennium goals. The millennium goals have been extremely suc-cessful in combatting poverty and poor health. A document named„Transforming our World” will be the starting point for negotiationsin New York. The angle will be different from the millennium goals,putting people at its heart and the planet and partnerships as essen-tial elements. The development agenda underlines the importance ofnational ownership and the universality, the importance of thedevelopment goals regardless of their development status. Humanrights are another important element.Sixteen thematic goals and one goal on partnership have beenformed. Health is one of the development goals, and is consideredas a foundation for development. This goal will focus amongstothers on mother and child health, and non-communicable dis-eases. Health is also a target in other development goals.Two years ago, Mr Bo Könberg, Former Minister for Health of Swe-den, was asked by the Secretary General of the Nordic Council ofMinisters to write a report about health cooperation in the Nordiccountries. He had come to speak at the BSPC Annual Conference inorder to inform the delegates about its results. The requested healthreport mirrored a similar report about defence, published four yearsearlier. Taking a close look at what could be a model for his work,Mr Könberg explained that he appreciated the brevity of this defencereport, striving for preciseness in his own research. Since the releaseSession two 43Mr Bo Könberg – Former Minister for Health, SwedenAuthor of the report: „The Future Nordic Cooperation on Health”of the report last year, a debate has started. Not just in the media butalso with the responsible ministers of the Nordic Council.Mr Könberg’s work has resulted in fourteen proposals, the mostimportant of which involves the growing antibiotic resistance.Since the discovery of Fleming’s penicillin, twenty new forms ofantibiotics have been discovered, but in the last thirty years thishas stagnated to only two new types. In 2015, some 50,000 peoplein Europe and North America will die as a result of antibioticresistance, compared to 200,000 globally, the expert argued.This sheds a light on the use and abuse of antibiotics in differentparts of the world. Mr Könberg demonstrated his point by showinga diagram, describing the use of antibiotics around Europe. Thecountry with the highest use of antibiotics, has a use that is threefoldcompared to the countries that uses it least, namely the Netherlandsand Estonia. Mr Könberg therefore recommended reducing the pre-scription to this exemplary lowest level within five years.The speaker also expressed his belief that there should be economicincentives for pharmaceutical companies. States will ask the phar-maceutical industry to produce a product that they will then wantto use as little as possible, making this a very unattractive task. Inaddition to the financial incentives, Mr Könberg called for moreNordic pharmaceutical cooperation.Moving on from antibiotic resistance, the speaker went on toexpress hope that politicians will discuss the European directive on44 Session twopatient mobility, and that there should be more mobility than theEuropean directive indicates. He further applauded more coopera-tion on health technology, including eHealth, and suggested thedevelopment for a Nordic search tool called “My Patient”.There have been various positive developments since the spring of2014, when the report came out. The British government intendsto award a prize of £ 10 million for the development of a newantibiotic. Mr Könberg found this sum to be relatively conserva-tive, but expresseed his hope for positive results. For instance, inSeptember US President Obama ordered an action plan to banveterinary bonuses on the prescription of antibiotics for livestock.Furthermore, the O’Neill report was published, claiming that cet-eris paribus approximately ten million people might die of the con-sequences before 2050. A WHO action plan was put forward inthe spring of 2015. A Nordic action plan includes opening a dia-logue with fellow ministers of development and foreign affairs.Mr Könberg concluded that of the fourteen proposals he made inthe report, five were treated during the meeting of the ministers inOctober 2014: specialised treatment, rare diagnosis, psychiatry, theexchange with Nordic officials, and cooperation on health prepar-edness. Mr Könberg concluded that the timeframe for the achieva-bility of the recommendations in his report is five to ten years.Session three 45Session threeHealth and Economy –Paving the Way for Innovation inSocial- and Healthcare„eHealth – the European Dimension”Mr Günther Oettinger, European Commissioner for Digital Econ-omy and Society, underlined that Europe consists of more thanjust the European Union, and that is why the Commissionerrelayed the European Commission’s excitement in seeing regionalnetworks such as the BSPC, comprised of new member states ofthe EU and important neighbouring countries. The Commissionerconsidered the cooperation and the forming of common goalsbetween neighbouring states to be good policy that would be ben-eficial for its citizens and the respective economies. He claimedthat there are not enough such regional networks, sketching animage of a Mediterranean Union with strong ties to the Maghreb.Mr Günther Oettinger – European Commissioner for DigitalEconomy and Society46 Session threeThe digital revolution, through which the global community cur-rently lives, follows in the footsteps of other revolutions such asthe printing press, the steam locomotive, electricity and the com-puter, the Commissioner continued. The results of the current rev-olution are services which are reliant on data. This is quickly shift-ing away from services only provided by the IT sector and tele-communications, and is rapidly moving towards the digitisation ofthe „real” economy, with online media and autonomous driving.Healthcare is currently going through similar digitisation, withmHealth, eHealth and digital operations.These developments are becoming increasingly important in coun-tries where not only age rises, but so do the expectations of thehealthcare sector, the Commissioner argued. The growth of theimportance of the healthcare sector is a large opportunity. It willbecome an important part of creating value for the economy, ofjob creation in different branches and it will result in populationsliving a longer, healthier life. It forms a risk too, however, becauseit is unclear who is going to foot the bill. Coming up with a goodstrategy will be important, Mr Oettinger stressed, because digitisa-tion will influence the healthcare sector in major ways.The Commissioner was more than aware that with data comespower. In the last two years, more data has been collected and pro-cessed than in the entire history of mankind before that. The valuechain starts with Research and Development, which is why it isimportant to define clever R&D projects and ensure good net-Session three 47works between the research institutions, which belong to the pub-lic sector in nature. However, the Commissioner realised that thiswould not be enough, and that there has to be an accelerationfrom a research initiative to practical, applicable innovation. Hebelieved Europe to be in good shape when it comes to innovatingpower, but warned that the ambitions of the Asians and the Amer-icans should not be underestimated, underlining that it would beeasy to fall behind if Europeans do not network their capabilities.A new challenge is faced when it comes to offering patient ser-vices, he stressed. Patients are sensitive towards their health data,and fear hacking, which is why offering such services requires con-fidence in their reliability. Health and disease are the summit ofprivacy. As such, cyber security is crucial in this context.Looking at this from the positive side, if health security is properlyarranged then the anonymous use of so much data could form awealth of information to base further research on and thereby cre-ating the ability to treat patients better in the future, Mr Oettingerargued. With this goal in mind, the Commissioner believedEurope required a European data security culture.A step in the right direction would be the Information SecureActive Network, which is legislation in the European Parliamentand European Council that ensures that destruction of data andunsolicited access would become much more difficult in Europethan anywhere else in the world. Mr Oettinger underlined thathuman dignity is part and parcel of the understanding of apatient’s privacy. For digitalised health to work, it is paramountthat data cannot be abused but only used to serve. Mobile health-care will serve the patient better and will be more efficient, theCommissioner posited.Mr Oettinger then continued by discussing the cross-border chal-lenges of healthcare. Exemplfying his point, he pointed to theEuropean Single Market for goods and services. The borders havebecome porous and customs have become more flexible. As such,the single market has created great cost advantage.It would therefore be odd to realise that in this digitalised worldEurope still does not have a single digital market. There is largevariation in regulation and standards, and there are problems withgeo-blocking. The national health services, although they are beingdigitised, are still bound by national borders. Therefore, the Euro-pean Union suggests a single European digital market, and invitesits neighbours to get involved in this, even if they are not member48 Session threestates. Since citizens are mobile, healthcare would have to bemobile too. For this to function, doctors would need to haveaccess to medical information across Europe, with the patient’sconsent.The Commissioner further supported his statement by claimingthat a software designer creating a health app currently would haveto invest his development costs, only to face 28 different licensesupon distribution, not one European license. Mr Oettinger arguedthat this is the advantage of Americans, who have one market andone language. Not only would a common market benefit Euro-pean patients, it would also be an important step to preventingEuropean talent to drift off to Silicon Valley.Session three 49Mr Oettinger then moved on to the importance of a reliable andhigh-speed network everywhere in Europe, claiming that datatransmission is most important for the healthcare system, wherespeed can save lives. He argued that Europe needs to invest in digi-tal infrastructure, in Pan-European data transmission and that thiswould even be more important than investing in physical infra-structure. The revolution in 5G would be a large breakthrough forhealthcare services; it would offer a safe network for medical datatransmission. The Commissioner singled out role models along theBaltic Sea, such as Estonia and Finland, but showed understandingfor the fact that not everyone across Europe is in the same positionyet. Mr Oettinger advised those countries who are still developingto copy from such role models, and to learn from their mistakes.50 Session threeFinally, he touched upon life long learning. Continuing educationis especially important in the digital age, the Commissionerimpressed upon the representatives. Dealing with the latest inno-vations requires basic digital skills, which should be taught. It isthe job of politicians to encourage learning in professionals andpatients alike.„Towards a Leading Health Region”Dr Horst Klinkmann, President of BioCon Valley, fervourouslyopened his speech by claiming that the importance of health hadbeen underlined often during the conference, but that it was notenough to just set objectives, concrete actions were needed. TheBaltic Sea Strategy was launched during the last term of the Euro-pean Parliament, creating the Baltic Sea Health Region, one of itsflagship initiatives. The initiative showed great potential, despitehaving room for improvement, the speaker claimed. Dr. Klink-mann, on behalf of BioCon Valley, expressed that the organisationwould like to work with ideas set forth by the European Union,but that it would need more than just objectives. Most impor-tantly, it would need active support.Support for the Baltic Sea Health Model Region hopefully finds itsfoundation in the common need for increased cooperation andcomparability. Encouraging the introduction of a commoneHealth innovations ecosystem, based on a cooperation platformfor eHealth initiatives is an example of a potentially fruitful meas-ure. Furthermore, by establishing a reliable transnational methodof measurement, it would be possible to ensure global comparabil-ity of health economies and measure the performance and theimpact of the healthcare systems via economic growth andemployment. Finally, this could be achieved by support for thecurrent initiative to turn the Baltic Sea Region into a testingground for health products and services, as per the ScanBalt strat-egy 2015-2018.In order to demonstrate his past successes in furthering healthcarein this European region, Dr. Klinkmann wished to speak of howthe health economy was further developed in Mecklenburg-Vor-pommern. The chart shown by the speaker demonstrated thatalthough Mecklenburg-Vorpommern had not always had a highposition when it came to health economy, it had stepped up itsSession three 51Prof. Dr. Dr. Horst Klinkmann – President of BioCon Valleyefforts in recent years and was now leading the way in Germany.In 2014 there was a gross added value of 10,4 percent, in a rela-tively sparsely populated state. This compared to 7,4 percent in thewhole of Germany. In order to achieve this, the state parliamenthad actively invested in the further development of the healthcaresector, where now over 100,000 people were active.Mecklenburg-Vorpommern is the number one health region inGermany, and this has to do with the fact that it has the right soft-ware and hardware, Dr Klinkmann argued. It holds 34 hospitals,61 recognised rehabilitation centres and two universities (Rostockand Greifswald) with an excellent reputation for life sciences andmedicine. The state also has a flourishing life sciences sector, with3,600 people employed at 120 different enterprises. A state-basedorganisation has been set up, involving the so-called “triple helix”of politicians, industry and researchers. It deals with differentthemes in healthcare: life science; healthcare services; healthy age-ing; health tourism and nutrition for health; all dealing with theadvancement of the health economy. The board of this organisa-tion has created a master plan to invest €450 million up to 2020,in order to remain in the number one spot.The speaker then offered to share some ideas that could functionas tools for the representatives to become more active. The first wasthe National Conference on Health Economy, organised locallywith the assistance of the German federal government . It openedup for participation by the Baltic Sea states, which are now partnercountries. Recently, the conference focussed on terminology,52 Session threeworking on definitions for health tourism, health economy andothers. The speaker claimed that these definitions were now beingused in the European Commission. Dr Klinkmann invited theparticipants to join, thereby creating an international conferenceas a component of the National Conference.Other opportunities for involvement would include ScanBalt, thelargest life science network, or involvement in creating a strategyregarding antibiotic resistance, in HICARE, in Baltic Amber, or inSt. Luke’s health path, which stretches from the Netherlands toPoland, and has the potential to be turned into an EU project.Dr Klinkmann then continued to argue that in an increasinglyglobalised world, it would not be wise to focus merely on westernmedicine. It would be possible to use non-western medical systemsin Europe, but it should be done with ownership and familiarityin order to prevent misuse. He expressed the wish to set up aEuropean institute that would allow for interaction with othermedical systems.„The Baltic Sea Region as One Test Site for Develop-ment of Healthcare Products and Services”Dr Jaanus Pikani, Vice President of ScanBalt, offered that ScanBaltstarted more than ten years ago, and was co-founded by BioConValley. It was founded to create visibility and to counteract frag-mentation around the Baltic Sea. It is a triple helix organisation,including government, the private sector and academia. Currentlyit encompasses over 3,000 health related organisations, including50 university clinics, 60 universities involved in health and lifesciences, as well as 50 health clusters and health networks and 75science parks.One of the main challenges it currently hopes to solve is thedemographic shift and the inequalities regarding services offeredaround the Baltic Sea. These differences can be witnessed in thedifference in healthcare provisions between rural and urban areas,which causes brain drain around the Baltic Sea. Additionally, con-cerns focus on the rising costs of healthcare and the length of wait-ing lists.Session three 53Dr Jaanus Pikani – Vice President of ScanBaltTrends witnessed by ScanBalt are increasing digitalisation result-ing in a large amount of data, as well as an increase in healthtechnologies. Although this was generally seen by Dr Pikani as apositive trend, he recognised that it could also cause trouble forsmaller and midsized companies, since it would be more difficultfor them to maintain security and it would make it difficult forthem to stay competitive in a globalised environment. Dr Pikaniargued that cooperation around the Baltic Sea could mitigatesuch trouble.The Vice-President of ScanBalt then continued that scientists,politicians and society face two problems when discussing medi-cal innovation. One is the founding principle of medicine, whichis “do no harm”, which makes the threshold for testing newinnovations very high. The second is that the sector is very con-servative. The medical industry is very guarded with their ideas,and can be unwilling to share these with the rest of the industryand society. European support could offer some incentive toshare new discoveries. The Baltic Region has become a testingground for new innovations, according to the speaker.Such new health products and services would futhermore havegreat potential in providing positive change for patients(improvement of services offered), for the regions (developmentof research and innovation structures as well as economic bene-fits) and rural areas (better accessibility). In a few years the firstsuccesses can be reported, Dr Pikani promised.54 Session threeAnother project by ScanBalt is attempting to mobilise differentregions for smart specialisation in eHealth so that challenges canbe jointly addressed. It requires a high level of ambition by actorsto tackle some of these issues and therefore requires a jointapproach. The project is related to Baltic Sea eHealth LivingLabs and offers quality assured access to data as well as infra-structure.Considering the finances, ScanBalt has been able to turn everyeuro invested into fifteen euros for its investors. It is an accelera-tor, a think tank, a matchmaker and a communication tool. DrPikani upheld that ScanBalt helps its members implement theideas that come from the region.„The Economic Footprints of the Healthcare Sector in theBaltic Sea Region”Dr Dennis Ostwald, CEO of WifOR spoke that Wifor had con-ducted a research, originally commissioned by the German Min-istry of Economics, to discover which footprints the healthcareindustry leaves on the national economy. The conducted researchresulted in a shift in paradigms: the healthcare system was notapproached as a cost factor, but as an economic factor responsi-ble for job creation. As a result, the researchers managed to shiftthe perspective so that healthcare is now considered as a motorfor job creation, not just a drain on the national budget.Dr Ostwald then offered some basic facts about the Baltic to hisaudience. The region is home to approximately 85 million inhab-itants, which amounts to almost 20 percent of the population ofthe European Union. Prosperity is generally increasing in thearea; the GDP growth per capita has gone up 4,5 percent.The impact of the healthcare industry on the region was lessclear, Dr Ostwald argued. The researchers decided to take Ger-many as a blueprint for the rest of Europe. They then looked atthe healthcare industry in terms of certain GDP categories, andwere therefore able to say exactly how much healthcare contrib-utes to the economy. Thereby, they hoped to broaden the scopeof the value-based considerations of the German economy. Byusing official statistical data and sound methodology, researchersSession three 55Dr Dennis A. Oswald – CEO WifORat WifOR hoped to strengthen the argument of health economycontributing to the overall economy and thereby drawing atten-tion to this fact, so that healthcare would no longer be seen asmerely a financial drain on society.Dr Ostwald then aimed to clarify that the total of sold goods orservices is a misleading indicator if one hopes to explain thegrowth of an economy. Value added is a much more useful indi-cator if one hopes to explain the importance of a certain sectorin relation to the rest of the economy. Considering all factors,there are direct, indirect and induced effects, and together theyform the sum of the economic footprint.The footprint of healthcare on the German economy should notbe underestimated. 14,8 percent of the German working popula-tion works in healthcare, 11,1 percent of Germany’s gross valueadded comes from healthcare and healthcare forms 7,4 percentof the overall German export. The minister of economics SigmarGabriel would therefore rightfully see this as an increasinglyimportant branch of industry. One million new jobs were cre-ated in this industry since 2008, not counting the two millionindirect jobs, and ten million induced jobs. Besides jobs directlyrelated to the healthcare sector, trade, medical sales and realestate profit from the growing healthcare sector too. The indus-trial healthcare sector for instance, forms about a tenth of theoverall sector. It is responsible for 8,9 percent of value added, 4,2percent of employment and no less than 80,1 percent of exportsin the healthcare sector.56 Session threeSuch numbers can be extrapolated to the Baltic Sea Region as awhole: some €260 billion are created by the Baltic Sea Regionhealthcare sector, which is approximately the GDP of Denmark.Some seven million people have gainful employment in thehealthcare sector, which is approximately the employment in allsectors of Finland’s and Sweden’s economy combined. Thehealthcare sector is very significant economically, the speakerargued.Dr Ostwald concluded his speech by stressing an important mes-sage for his audience: communicate that countries should not justlook at healthcare as necessary expenditure, but also as economicgrowth. There is room for further research, the speaker noted,expressing the wish to quantify the economic strength of the BalticSea Region healthcare system. He finally remarked that knowingthe economic significance of a region still says nothing about thepotential results patients. Researching the health benefit footprintin the Baltic region was another goal on the horizon.„Battling the Spread of Multi-Resistant Bacteria”Dr Martin Mielke, Head of Department of Infections Diseases atthe Robert Koch Institute, opened his speech by arguing thatduring the battle against antimicrobial resistance, three conceptsare crucial: responsibility, knowledge and awareness of the prob-lem. If these conditions are not met, even the smallest success isunlikely, the speaker warned.Dr Mielke claimed that enormous awareness exists for theimportance of modern healthcare and the resistance of antimi-crobial bacteria and patient safety. He continued that his col-leagues were impressed by the fact that in Germany, a hospitalthat was threatened by clusters of antimicrobial resistant bacteriafor a longer period of time, would be accused in the media,harming the hospital ́s reputation. It has become very importantfor hospitals to prevent the spread of these antimicrobial resist-ant bacteria, if for no other reason than for an economic one.He highlighted that there will be no modern healthcare withouteffective antimicrobial agents. This fact is especially dangerousfor the treatment of vulnerable patient groups like neonates,Session three 57Prof Dr Martin Mielke – Head of Department of Infections Diseasesat the Robert Koch Instituteelderly and the very ill. Modern medicine may offer manyopportunities for healing, but it relies on many devises that are arisk for infections, like sepsis and pneumonia, which are the twomain diseases that will no longer be treatable if not for antimi-crobial agents. As such, the future of modern medicine hinges onthe successful battle against antimicrobial resistance.The problems with antimicrobial resistance can be differentiatedby the bacteria that are afflicted by antimicrobial resistance. Mostof the important bacteria come from the human microbial flora,but the manner in which the bacteria spread differ very much.Methicillin resistant staphylococcus aureus for instance, resideson the skin and in the respiratory tract and is transferred frompatient to patient differently from those bacteria that reside inthe gut. Multiresistant tuberculosis in turn travels via dropletsand via the air. These different manners in which these bacteriabehave has implications for the distribution of the problem inEurope and therefore on the best way to combat it. It is thereforeimportant that the industry focuses on the most problematicbacteria and on the specific ways to combat them, Dr Mielkeargued.Bacteria that take advantage of the use of antimicrobial agentsform another problem. Clostridium difficile, as it is called,resides in the gut and takes advantage when antimicrobial agentssuppress all other gut bacteria. Its importance increased over thelast years, not just in hospitals, but also among the general popu-lation. As such, it forms a major new subject for research.58 Session threeDr Mielke continued to what is being done globally to combatantimicrobial resistance and some of the obstacles it still faces.Objective II of the Northern Dimension Partnership Strategy2020 focuses on the containment of antimicrobial resistance inline with other regional and global strategies. A key point inmany of these global action plans is surveillance, but it hasproven that the protocol for this surveillance is much too com-plicated, causing bad results. Modern data collection shouldmake this much easier.The second key point is the correct use of antimicrobial drugs,which will still require a lot of education. Even in highly devel-oped countries like Germany, doctors need a lot of help in thecorrect use of antimicrobials. Furthermore, there is a continuedneed for infection control, which will be largely based on thesharing of best practice guidelines. Finally, there needs to begreat awareness for the use of antimicrobial drugs in the foodanimal industry. Only if these objectives are met can combattingantimicrobial resistance be successful.There is already a lot of awareness, but this awareness has to besustained, Dr Mielke argued. The speaker lauded the existence ofthree awareness days: Hand Hygiene Day, Antimicrobial Resist-ance Day and Patient Safety Day, designed to further create andmaintain awareness. Patient safety interests patients a lot, andhospital websites more often inform the public and hence per-form infection control.Dr Mielke then returned to the point of proper use. Theimproper use of antimicrobial agents is one of the most impor-tant causes for antimicrobial resistance in the world, he argued.As such, studying this is extremely important, but the structuresfor data collection are not well founded. The proper use also dif-fers greatly within countries. Within Germany there are greatdifferences in the use and misuse of antimicrobials. To a degreethis can be explained by population density, however the exactreason for the differences is not known. In Mecklenburg-Vor-pommern, the use of antimicrobials is comparatively low if com-pared to the Western states.An indicator of the proper use of antimicrobials is the distribu-tion and amount of resistance in different groups of bacteria indifferent locations. For a long time, the Baltic Sea Region hastaken advantage of the excellent healthcare systems in Scandina-via, but this is no longer the case for the gut bacteria. The regionnow witnesses an influx of these antimicrobial resistant bacteriaSession three 59from the Eastern part of Europe, because the bacteria are not justdistributed by direct contact but also by the ingestion of contam-inated food. If the hospitals are then not equipped to deal withsuch a case, the contamination will spread via the medicalmachines and on the intensive care. The so-called Gram NegativeBacteria require a different approach from the Gram PositiveBacteria.In order to create these different approaches, a lot of researchstructures have been developed in the last years. A lot of researchis done in the United States, which has a large pharmaceuticalindustry. A very useful result is the report of the TransatlanticTaskforce on Antimicrobial Resistance.Rapid diagnosis is one of the fields of innovation that requires alot of attention and improvement, according to the speaker. Atthis point, the diagnosis of resistant sepsis and pneumonia hingeson the astute responses of the doctors. There is a great need forbiomarkers so early detection can take place. Early rapid bedsidetests are also necessary. Increasing the optimal skin and mucosalantiseptics for surgery and ICU is still a very important factor,although it is no longer a new claim. Furthermore, new treat-ments and vaccinations should be developed. The speaker con-cluded by informing the audience that the German Centre forResearch into Infection Diseases is now looking into the preven-tion of implant infection, which is especially important in thelight of an ageing society.60 Session threeDiscussionMr Dietmar Eiffler, Member of Parliament of Mecklenburg-Vor-pommern, claimed that he had followed the discussion aboutcross-border cooperation in the healthcare industry very closelyand had concluded that the industry, with its diversity on anational and international level, played a crucial role. He contin-ued that the healthcare economy was extremely important forMecklenburg-Vorpommern, since one in seven employees wereactive in it. Mr Eiffler recognised that the healthcare system isindependent of the fortunes of the economy as a whole, whichcontributed to the appeal for Mecklenburg-Vorpommern. Thespeaker also recognised the opportunities offered by cooperation inthe Baltic Sea Region. The region should market its healthcare sec-tor and extract its potential, he claimed. He argued that an impor-tant component would be holding joint conferences in whichstakeholders could exchange opinions and devise strategies. MrEiffler offered the National Trade Conference of Healthcare as anexample, a platform for professionals from Germany and abroad.He offered that the actors around the Baltic Sea should consideroffering such a platform for the entire Baltic and Nordic Region.Session three 61Mr Dietmar Eiffler – MP Mecklenburg-VorpommernMr Axel Jonsson, Member of Parliament of the Åland Islands,asked his audience to imagine a Polish woman, living in Swe-den, sending her blood tests to Åland Island, consulting herdoctor in her Polish home town, using Norwegian technology.This is what Mr Jonsson imagined as his ideal for borderlesscooperation. The region had the network in the form of Scan-Balt, it had technology such as Norwegian and EstonianeHealth and it had the have political will. He then wonderedwhat was still lacking. In Mr Jonsson’s opinion the missing linkwas formed by a lack of uniform standards. Different securitystandards, different journal systems and diagnostic systems, theform an important obstacle. However, the speaker continued,the largest obstacle was money. In discussing borderless coopera-tion, it was still not clear how the costs would be divided. MrJonsson concluded that the Baltic Sea Region has all it takes tobe successful, but that it has to find a way to handle the divisionof costs between its countries.Mr Julian Barlen, MP for Mecklenburg-Vorpommern, wanted tostress a single but important task of cooperation: setting up orstrengthening cross-border rescue services, especially in rural areaswith weak infrastructure. The lives of citizens should not be in thebalance as a result of borders, the speaker argued. The actorsaround the Baltic Sea should be able to guarantee the fastest possi-ble emergency services, regardless of its country of origin. In someborder regions, fiscal and insurance obstacles would still have to beovercome. Mr Barlen implored the representatives that they shouldlearn from each other, but also from other border regions.62 Session threeMr Atis Lejiņš, Member of Parliament of Latvia, felt compelled torespond to Ms Zakharenkova contribution. He reminded his audi-ence that the World War II had started with the Molotov-Ribben-trop Pact, which had destroyed almost five countries. He contin-ued that there had been a military parade with the Red Army andthe Nazi Army in its wake. In general, Mr Lejiņš remarked, smallstates suffered most in wars. The big states, however, got to writehistory, which was why it could be said the Soviet Union sufferedso much. How much did the Baltic States suffer, the speaker won-dered. He then praised the German attempt since the War to cometo terms with its past. Mr Lejiņš noted that he country was now afriend, and ally and much respected globally. He juxtaposed thisto the Russian attitude, offering that Mr Putin had stated the Mol-otov-Ribbentrop had been in Russia’s legitimate interest at thetime. Continuing with the MH17 investigation, Mr Lejiņšexpressed his regret that the Russian veto had blocked the estab-lishment of an international tribunal. The speaker concluded witha remark about the Latvian health expenditure in the budget: Lat-via would not decrease its health expenditure, while it wouldincrease investment in defence.Mr Wolfgang Waldmüller, Member of Parliament of Mecklen-burg-Vorpommern, wished to comment on Commissioner Oetting-er’s speech. He agreed that the digital agenda and expanding thebroadband network would need to be looked at through the lens ofthe BSPC and the digitisation of the healthcare sector. He alsoagreed that eHealth could be a large help in accessing healthcare insparsely populated areas. Mr Waldmüller offered an example of a tel-eradiology network in Western-Pomerania, for which fast speedMr Wolfgang Waldmüller – MP Mecklenburg-VorpommernSession three 63broadband was necessary. The BSPC should do everything to realisethe digitalisation agenda, the speaker argued, especially because ofthe cross-border dimension. The speaker was of the opinion that byjoining forces, the Baltic Sea Region could provide greater weigth atthe European Union in enhancing its digitalisation. Brussels, afterall, assumed the individual countries would have done their expan-sion homework before asking for help.Mr Pjotr Bauć, Member of Parliament of Poland, said that thePomeranian region in Poland wanted to build an eHealth system forits entire region within the EU timeframe 2014-2020, hoping tooffer a better service provision and a more streamlined healthexpenditure this way. As such, Mr Bauć started a tender related toeHealth. The project so far had several stages. The first stage was theconstruction of a partnership between NGOs, hospitals and otherbranches of the medical sector. Then, a mission would have to becrafted, which would revolve around the excellent treatment of thepatient. Then, priorities would have to be set. Mr Bauć expressedthe wish to build a tool for the primary physician, allowing him tolead and accompany his patient from the very beginning to the veryend of the health cycle. Once the tender would be completed MrBauć hoped to launch it, ideally together with foreign partners. Heaimed that local authorities would contribute approximately 15 per-cent to the development of the project, that medical experts wouldprovide the scientific know how and the educational models, andthat IT experts would provide systems and databases compatiblewith medical diagnostic systems. Mr Bauć expressed his delight inwitnessing the multitude of project and initiatives in the region andhoped to find contacts for his tender.64 Session threeSession three 6566 Session threeSession four 67Session fourSustainable and AccessibleSocial- and Healthcare –at the Crossroads of HealthcareProvision, the Demographic Shiftand Shrinking BudgetsMs Sylvia Bretschneider – President of the Landtag Mecklenburg-Vorpommern„Opening Words”Ms Sylvia Bretschneider, President of the Landtag Mecklen-burg-Vorpommern, opened the second day of plenary sessions ofthe 24th Baltic Sea Parliamentary Conference with a speech com-memorating the outbreak of the Second World War, which startedon 1 September 1939 by the German invasion of Poland, exactly 76years ago. The President led off with an anecdote of a Polish boywatching the fighter planes overhead, and moments later, savingyoung girls and women from the rubble left they behind. Nearly 60million more were killed world wide before the war ended. The warwas a development of atrocities that had already started in 1933 andresulted in the annihilation of large parts of the world population.68 Session fourMs Bretschneider called to commemorate the victims of these atroci-ties, including their families. The horrors of war still shock us to thisday, she said. Reports of the war were being passed on by witnessesstill alive today. The President reminded that such stories were a warn-ing not to forget and that they remind people about their responsibil-ities to prevent war. The end of the war did not automatically deliverfreedom, justice and self-determination to all, and it was clear thatpeople still faced challenges in society. People must learn from theirhistory and maintain an awareness of the events of that war. Mostimportantly, they should let this awareness guide political and socialactions. The children’s children of the War generation would nolonger be able to absorb the eyewitness accounts first hand, but it wasimportant that they felt the responsibility of human rights and dig-nity. There were many memorials and museums that helped peopleshoulder the burden of placing this heritage firmly in its collectivememory and awareness. The President then offered that a museumwas currently being built in Gdansk, which would offer an interna-tional perspective on the war, and stimulate debate. In Mecklen-burg-Vorpommern, students had met survivors of the holocaust forthe last twenty years. They also explored the work of musicians, workthat had been rejected by the Nazi regime. As a result of the work, acentre for ostracised music had been established in Rostock. In such away, the music was heard again and recognised after all these years.It was important to build bridges between the persecution, theflood of refugees and the injustice then, and occurrences in presentday, the President spoke. Self-reflection was important and it wasnecessary that people asked themselves why such conflicts were stilloccuring today, including in European countries such as Ukraine.She urged the representatives to wonder why European countrieshad such trouble accepting refugees, as if it had learned nothingfrom its own history. She furthermore questioned why faith was sooften used as a pretext for economic gain. She acknowledged thatfinding the answers is uncomfortable. This is why the younger gen-eration got to demand democratic behaviour from the generationsbefore them, rather than letting history repeat itself.The Baltic Sea had to remain a sea of peace, the President statedforcefully. The surrounding countries had to and would achievethis goal by affirming its common identity and by respectingself-determination, independence and human rights. She thenunderlined that these states had to work together to find solutions.It was alright to be tough, as long as proceedings were fair. ThePresident then urged the representatives to seek answers and learnfrom history. To bear responsibility for the well-being of all citi-zens, and to uphold the memory of those who suffered then.Session four 69Ms Bretschneider then led the representatives into song:We shall overcomeWe shall overcomeWe shall overcome, some dayOh, deep in my heartI do believeWe shall overcome some dayWe’ll walk hand in handWe’ll walk hand in handWe’ll walk hand in hand, some dayOh, deep in my heartI do believeWe’ll walk hand in hand, some dayWe shall live in PeaceWe shall live in PeaceWe shall live in Peace, some dayOh, deep in my heartI do believeWe shall live in Peace, some day70 Session four„Demographic Challenges and Care”Ms Manuela Schwesig, German Federal Minister for Families, Sen-ior Citizens, Women and Youth opened her keynote speech byreminding the representatives that the Baltic Sea was shared byeleven states which used it for trade, tourism and winning energy,but which also joined forces to protect its environment. Together,they shared a long history, but its peacetime past was relativelyyoung. It was where the Second World War broke out, and wherethe Iron Curtain hung right down the Baltic Sea Region. Today,however, the states looked for common solutions to commonproblems, exemplified in the Baltic Sea Parliamentary Conference.Regarding the demographic shirft, the minister acknowledged thatGermany has trouble with low birth rates. This is a topic that itregularly discussed with Japan, which faces a similar issue. Germa-ny’s rural areas grow older and drain quickly. As a consequence,the German government has instated ten different workinggroups, charged with finding solutions to the demographic shifts.Ms Schwesig expressed her enthusiasm for the attempt to findconcrete steps, and for the different angles from which the differ-ent partners view the issues.Closely connected, from the minister’s viewpoint, is the currentrefugee crisis. This topic is not just a matter for the German HomeOffice, she resolutely stated, but a European issue, a chance todemonstrate that the Union is serious about common Europeanvalues. Although the Mediterranean and not the Baltic Sea formsthe centre of this crisis, it is upon the North to ask how it can helpand if it can become the new home for so many refugees. Europeand Russia have a lot of experience with crisis and war, and shouldbe able to offer perspective. The refugees are not just a burden;they can be a counter-effect to the steady ageing of Germany, evenif solutions of integration are not necessarily found overnight. MsSchwesig challenged her audience and her countrymen to be morecourageous, more open and to think more strategically.The minister then changed the subject and to the role of youngfamilies as part of the changing demographic build-up of Ger-many. She acknowledged that many things were changing duringthe demographic shift, and that politics would have to react. Forinstance, it is not enough to educate young people, they will needsupport in taking the step to form a family, especially if they wantto have a career and perhaps need to take care of sick relatives atthe same time.Session four 71Ms Manuela Schwesig – German Federal Minister for Families,Senior Citizens, Women and YouthMs Schwesig stressed that the current middle generation faces a lot ofpressure in trying to figure out how to balance work and family life.Especially considering that this generation will have to work for a longerperiod in their lives. In dealing with this challenge, she proposed “Part-nerschaftlichkeit”, a partnership between spouses, balancing the homelife and the financial responsibilities between the two parties. Althoughshe realised that the help of businesses is undeniably important, theGerman state governs many efforts that will help relieve the pressure onthe middle generation. One proposal from minister Schwesig: “Familyworking hours”, a workweek of 30-35 hours for each partner, leavingboth with more time for the family. If both partners work after the birthof a child, they can even be eligible for a financial bonus. The legal rightto a kindergarten spot and an increased flexibility of kindergarten hoursallows parents further to (re-) enter the working life.Another form of support for German families is the ability for theGerman middle generation to take responsibility for the care oftheir sick relatives without harming their career. Two thirds ofGerman patients are cared for in their own home, and one third iscared for by relatives. Those relatives now have ten days paid leaveto allow them to respond to a healthcare emergency in the family,and are then able to reduce their working hours for a period oftwo years, during which they can care for a sick relative all thewhile levelling out their loss of pay with an interest free loan.Finally, Ms Schwesig strongly underlined that not all elderly peo-ple are in need of nursing, but rather that they can form a helpfulrelief for the overburdened middle generation, for instance byovertaking care for the grandchildren.72 Session four„Report on the proceedings of the Working Group”Ms Olaug Bollestad, Member of Parliament of Norway and Chairof the BSPC Working Group on Innovation in Social- andHealthcare presented the final report on behalf of the WorkingGroup. The region faces many similar challenges, she noted, suchas an ageing population, health inequalities, a growth in life-stylerelated diseases and financial pressure on the healthcare systems.The goal of the Working Group was to raise political attention tothese issues, exchanges best practices and knowledge, and formrecommendations for the betterment of these challenges.The group consisted of fourteen representatives from nine coun-tries in the region. It held a total of six meetings and a study trip.1. In Riga, where the mandate was reconfirmed and the scopeand method were discussed.2. In Tromsø, to discuss eHealth and telemedicine3. In Birstonas, to discuss the first set of recommendations andcomplete a study tour of rehabilitation resorts.4. In Copenhagen, to visit the Steno diabetes clinic and discusshealthcare in the Nordic countries.5. In Tampere, to further discuss diabetes and other lifestyle-re-lated diseases.6. In Åland, to discuss the final recommendations.The study trip to Norway involved a visit to the HUNT researchinstitution, where one of the largest health studies is being per-formed, and to Levanger, to hear how the municipality workedwith its health policy and used art and music to treat patients withdementia in the Norwegian Competence Centre for Arts andHealth. Additionally, the members have completed so-calledhomework to gain more insight into demography, ethics and strat-egies for innovation in the respective countries.The final report resulted in three sets of recommendations. Thefirst set concerns cross-border cooperation within healthcare. It isdeemed by the Working Group that this cooperation should beexpanded and deepened. The NDPHS should be supported, andcross-border initiatives such as ScanBalt should be further devel-oped. The Könberg report should be expanded to involve theSession four 73Ms Olaug Bollestad – MP Norway and Chair of the BSPC WorkingGroup on Innovation in Social- and Healthcareentire Baltic Sea Region, so as to gain a comparable overview ofthe status of healthcare in the region.Innovative practices should be spread so that the region becomes arole model for healthcare.The second set of recommendations surrounds health economy. Itsuggests that the region should use already existing strategies suchas the ScanBalt strategy to further innovation in the region. Earlyintervention and prevention should be strengthened, including astronger prevention policy towards alcohol, tobacco and drug use,but also warning for lifestyle-related diseases. Support must bemustered for cost-reducing policies improving life quality such assports.Finally, the last set of recommendations is centred around sustain-able and accessible social- and healthcare. This fundamentallystates that healthcare should be accessible for everyone, but alsothat people need to raise more responsibility for their own well-be-ing. Accessibility also encompasses rural and urban areas, as well asdifferent socio-economic groups. Large-scale studies, such as theHUNT study, are recommendable. Finally, Ms Ollestad concludedperhaps most importantly, health should be taken into account inall policy considerations.74 Session fourMs Madara Muizniece and Mr Maximilian Priebe – Representativesfrom the BSPC Youth Forum„Kiel Week Youth Forum on Innovation inSocial- and Healthcare”Mr Maximilian Priebe and Ms Madara Muizniece, Representativesfrom the BSPC Youth Forum, thanked for the honour of represent-ing the perspective of the youth on the Baltic Sea Region issues. MsMuizniece continued to explain that the Baltic Sea Youth Forum inKiel had been an event designed for youth from around the regionto discuss the topics at hand at the BSPC. The existence of thisforum was exactly for the reason Ms Schwesig had already pointedout: to integrate youth into the demographic change and to build alink between civil society and politics. The speakers expressed theirpride on the impact the Youth Forum had on the 24th BSPC resolu-tion. The Forum had discussed two topics during its last meeting:that no health plan should exclude mental health, and that addinglife to years not years to life was important, especially regarding theaccessibility of healthcare. A resolution constructed by the YouthForum entailed nine key points, among which were the following:• the importance of promoting a healthy lifestyle especially inyouth,• the labelling on food products should be improved, focussingon European best practices,• a tax reduction on healthy food and a tax increase onunhealthy food should be considered,• the forum called on the member states for reform the socialsecurity system and including a new approach towards inte-grating immigrants into the labour market.Session four 75Mr Priebe then moved on to discuss the potential of the Forumitself, but also spoke of potential improvements. Most young par-ticipants did not merely come „fresh” from civil society, butalready had backgrounds in party politics. Casting a wider net insociety and hoping for a more diverse group of young participantscould cause a structural problem within the forum since the bal-ance between real work and the youth perspective conflicts, MrPriebe argued. He furthermore tabled the issue that the YouthForum had a poor oversight of already existing youth structures aswell as their own results. A poor Baltic Youth narrative existed,which could be solved by reinstating a Baltic Youth Secretary.RoundtableIn order to adequately reflect the spirit of the roundtable, the fullspectrum of the answers given to the questions asked is givenbelow.The following experts participated in the roundtable:Ms Olaug Bollestad, MP Norway and Chair of the WorkingGroup on Innovation in Social- and HealthcareMr Jörg Heydorn, MP Mecklenburg-Vorpommern and Chair ofthe Study Commission on Ageing in Mecklenburg-VorpommernMs Riitta Työläjärvi, Senior Advisor on Health and Social Policy,Finnish Confederation of Salaried Employees STTKDr. Björn Ekman, Researcher in Health Economics Division ofSocial Medicine and Global Health (SMGH) of the Departmentof Clinical Sciences, Lund UniversityProf. Dr. Marek Zygmunt, Supervisory Board of BioCon ValleyMs Susanne Kluge, medical journalist and television presentermoderated the roundtable.Ms Kluge thanked the attendees for allowing her to guide theroundtable and introduced the subject: sustainable and accessiblesocial- and healthcare. She brought earlier discussions to the atten-76 Session fourtion, where examples were given of challenges that were turnedinto opportunities. Ms Kluge then expressed the wish to focus onthe positive alignments and best practice examples that werealready present in the region and that could be learned from. Suc-cess could be found in details, Ms Kluge remarked, details thatonly could be unfolded through attentive discussion. She thencontinued by introducing her panellists.After being asked to provide an example of best practice andexplain its attractiveness, Ms Työläjärvi spoke of a health and socialservices region in the east of Finland, which owned its success to acomplete integration of health and social services. Different typesof medical professionals were involved in an impressive network,providing all-round medical support to the region. These profes-sionals each had their own area of expertise and good ideas. Com-bining these ideas and this expertise lead to the continuous devel-opment of the healthcare system. By streamlining different spe-cialties, nurses had not only been able to involve their patientsmore in the healing process, the work had also become more costeffective.Ms Kluge offered that this is exactly what all parties would like tosee happen: quality going up and costs coming down.Dr Ekman replied that although he did not doubt that EastFinland made a good example on its own, reducing costs wouldSession four 77not be enough. Health was much more important than that.With this in mind, he wanted to offer a tangent that could behelpful in the current context. According to a Harvard profes-sor, most of the medical research proved to be false. In a recentglobal attempt to replicate studies in behavioural psychology,they had only managed to replicate half. Extrapolating this toeconomics, Dr Ekman offered that most of the hypothesestested in his field were of no use to anyone. According to DrEkman, it was important to communicate the useful studies,which definitely exist.Ms Kluge then questioned Dr Zygmunt on the theme of self-re-sponsibility, inviting him to share his opinion on increasing thelevel of self-responsibility. Dr Zygmunt offered that he believedclaiming that most research is useless was rather dangerous,instead stating that such research had brought mankind furtherand that it had decreased mortality. Dr Zygmunt then calledfor open-mindedness towards testing medicine and technology,first at university level, and then at hospital level.Dr Zygmunt continued on the topic of self-responsibility that inhis field of cross-border cooperation he had seen a number ofsuccesses, for instance in the cooperation with the Germanregion of Vorpommern and the Polish region of Pomerania inthe screening of new-borns. The University of Greifswald and themedical school of Szczecin had cooperated in order to test new-78 Session fourborns for a list of conditions, which had initially divergedbetween the countries. Now both regions tested for example forcystic fibrosis, which was very treatable. After five years of thisbottom-up approach, insurance companies had decided to payfor this new batch of tests.Upon being asked for his view, Mr Heydorn offered that thisarea is not covered in his immediate line of work, but that it wasrather the responsibility of the Study Commission on Ageing atthe Landtag Mecklenburg-Vorpommern to deal with ensuringmobility, healthcare provision for the elderly and communityinvolvement. It was also their task to create conditions thatwould allow people to grow older in comfort not just in urbanareas but also in a rural environment. Mr Heydorn stated thatthe burden of responsibility had to do with where one wants tolive. Urban areas have higher accessibility. Presumably it wouldnot be possible to offer the same range of services everywhere,making it a matter of self-responsibility.Session four 79Providing an example of self-responsibility, Mr Heydorn cited citi-zens organising bus transportation to the doctor. He then won-dered why such civic action was possible in some places and not inothers? How could a government activate and accommodate peo-ple so that they would take such responsibility?Ms Kluge asked what, according to Mr Heydorn experiences,drove people to act: pressure or volunteerism. According to theMP, social involvement was absolutely necessary, but that it wouldbe doomed to fail if people do not have the capabilities to makesomething happen. There existed a consensus in the Landtag’sStudy Commission that people could not simply be thrown intothe deep end, but that they had to be helped to help themselves.Turning to Ms Bollestad, the moderator claimed that Norway haddecided to opt for prevention, which could be considered theopposite of self-responsibly. She asked if the MP from Norwayconsidered voluntary action or pressure from the governmentthrough legislation to be the best solution. Ms Bollestad repliedshe believed in a combination of both, claiming that good politicswanted to benefit its people, but also wanted to keep an eye on thecosts. In the cardiovascular clinic where Ms Bollestad used to beemployed as a nurse, she had seen increasingly younger peoplecome in with cardiac disease and cancer. She recognised this wasnot only very troubling for the patients, but it was also a great costfactor for the state. Returning to the subject of pressure versusself-regulation, the MP recalled that one of the bigger discussionsin Norway had been about a ban on smoking, which had beenfiercely objected by the public. The law had been enacted anyway,and today 94 percent of the people supported it. Sometimes a statehad to make unpopular decisions for the betterment of publichealth, for instance with sugar, alcohol and smoking. Since theban had been enacted, smoking had gone down from 22 to 15percent, including youth smoking. As a politician, one should notjust think about the next four years or about popularity.Ms Työläjärvi then offered her belief that public institutions shouldprovide patients with amongst others IT solutions that allowedthem to contact a medical specialist, like a nurse, when needed.Although heroic surgeries were very impressive, it was better tohave the nurse prevent the disease before the patient landed in thecardiac surgeon’s office.Ms Kluge remarked that in Norway, eHealth already functionedon a good level and helped people with informing themselves onhealth and with taking responsibility. The Germans did not seem80 Session fourconvinced about the successes in their country. Ms Kluge thenwondered what the difference is between successful Norway andunconvinced Germany.Ms Bollestad noted that the difference could lie with the fact thatNorway also has strong laws on privacy and on ethical use. Therewas clarity about how the gathered information was being used,and by whom. Norwegians were willing to use the digital servicesoffered, but they rightfully wanted to know how the state usedtheir data.Dr Ekman then returned to an earlier remark by Mr Heydorn,namely that some initiatives worked in one place and not another.He argued that health was very individual. Personal medical ser-vices were equally individual. A physician wanted to provide a fit-ting solution for the patient in front of him. Healthcare systems ingeneral were so broad and all encompassing that they stoppedworking on an individual level. In different contexts, services pro-vided would vary. With regard to eHealth, Dr Ekman argued thatthis was a relatively new service, probably with a promising future,but that it was difficult to promise this for sure. It was hard to pre-dict how eHealth would develop in the future.Dr Zygmunt then referred to the remarks made by Ms Bollestadregarding eHealth. He stressed that it was key to differentiateSession four 81between telemedicine within a country and across the border.There were wonderful networks in Germany, which did not seemto work if hospitals hoped to reach out across the border, becausethe systems were not compatible. This was not always a problem ofmoney; the systems came from different cultures, values, and back-grounds. Reaching out to Poland was not a problem in the end,but then the next issue arose: as long as the services were paid forby the EU everything worked, but the moment this stopped, fig-uring out the reimbursement became a problem.Ms Kluge wondered if this problem was caused by communica-tion, by misconnecting technology or by financial issues.Dr Zygmunt answered that the technical issue should not be aproblem, at least not for long. Good communication was obvi-ously very important. He then commented that the resolutionhad shaped up to be a very useful document, thanking theinput provided by the representatives, arguing that it encom-passed issues which needed solutions as soon as possible. Hetook the provision of cross-border emergency services as anexample of a service that still did not work despite the fact thanmany preconditions were already in place. In some areas a jointhospital would be a very good solution, for instance for theinhabitants of Usedom, services could be provided closer andfaster. But the different institutions would have to talk aboutorganisation, and money.82 Session fourMs Kluge laboured under the impression that there was a generalagreement that a conversation was needed, but that they wereunsure who had to talk to whom and which party should start.Ms Bollestad provided an example for the need of such conversa-tion from the Working Group, namely on the topic of borrelia,which formed a problem for several countries surrounding the Bal-tic Sea. She insisted that mere cross-border treatment of the prob-lem is not enough, and lobbied that the issue would be discussedwith other, non-neighbouring countries battling the issue, likeCanada, but also with the pharmaceutical industry and hospitals.The moderator then noted that Finland had dealt with borrelia,since it had one of the highest infection levels of approximately 70percent. She then asked Ms Työläjärvi, how her country hadresponded to this. Ms Työläjärvi responded that indeed Finlandhad areas where the frequency was extremely high, and that com-batting this required vigilance on all levels, from healthcare pro-viders to politicians and patients. An active attitude and accept-ance of the size of the problem were necessary in order for actionto be effective. Responding to the question if experts from othercountries had come to Finland for help in combatting their ownoutbreak, Ms Työläjärvi answered that although there were cul-tural differences from country to country, she was a believer in theexchange of experiences. A country that faced trouble could takethe best elements of a solution and apply it in such a way that it fitSession four 83its cultural circumstances. If not for any other reason than that itsaved money not having to reinvent the wheel.Ms Kluge then asked Dr Zygmunt if he believed there was a signifi-cant exchange amongst healthcare professionals on the main ques-tions in healthcare. Dr Zygmunt offered that it was of the highestimportance not just to gather anecdotal information about experi-ences, but also to do more scientific research into cross-border coop-eration in healthcare. Currently, there were only a few small studies,which were not representative. Their results could not be applied toother areas. There was no data available on the costs of for instancecross-border emergency services. There was an incomplete picture,which had to be resolved in order for any potential cooperation togo forward. This problem was most likely to be solved bottom up,so encouraging people to come up with proposals.Ms Kluge then turned to Dr Ekman, and asked him if people arein fact fearful to communicate with each other and if so, wherebravery could come from.Dr Ekman replied that a good example could be found with theSingaporeans, who had managed to create a hospital system thatwas both public and of the highest quality, in a very short periodof time. The key had been self-reflection. The Singaporeansacknowledged that many mistakes had been made, but rather thansweeping them under the rug, they had chosen to learn fromthem. Dr Ekman encouraged the audience to learn from what mayvery well be an ocean the size of the Baltic Sea filled with mistakes,which he considered mechanisms for learning.Dr Zygmunt added that in creating links with each other and com-municating with each other, there was an important role for trans-lators. BioCon Valley and organisations like it played an importantrole as a bridge between systems, not just for translation but alsofor networking. Systems and institutions sometimes needed a thirdparty to help them understand each other. If this happened topdown or bottom up depended on the activity, although generallyspeaking bottom up activities were more effective.Mr Heydorn offered his opinion on the matter by stating that merelycommunicating with each other was not always sufficient, thatadapting systems to the neighbours’ systems would be necessary. Heremarked that Aachen managed cross-border emergency serviceswith the Netherlands and Belgium whereas Mecklenburg-Vorpom-mern had trouble sending ambulances across the Polish border,because the systems were incompatible. Mr Heydorn argued that it84 Session fourwas clear to both parties what would be needed, and that timeshould not be wasted explaining to each other what was wanted.Now it would be a matter of organising systems so that healthcarewishes can become reality, like calling an ambulance from the near-est location, be it Germany or Poland. Local and national institu-tions had to be able to communicate with each other. It would benecessary to invest in order to guarantee quality of service.Ms Silke Gajek – MP Mecklenburg-VorpommernMs Silke Gajek MP from Mecklenburg-Vorpommern, intervenedin order to discuss two topics. Ms Gajek offered that hidden bythe phrase “quality of life”, the economisation of life was often dis-cussed. She praised the notion that changing mind-sets would becrucial if politicians ever hope to combat problems rather thansymptoms of problems. For example: Germany had a problemwith childhood obesity. In Mecklenburg-Vorpommern, the schoolsoffered school meals, which Ms Gajek confessed she supported ini-tially, assuming that they would help in teaching school childrenabout healthy nutrition. However, she had now observed that themeals provided had little to do with healthy or even tasty food.The parliamentarian asked the panellists about their experienceswith both the food issue, and with exercise as prevention.Ms Bollestad offered that while she had been mayor of a Norwe-gian municipality, the officials considered health prevention in allSession four 85aspects of governing, including deciding the location of schoolsand kindergartens. It was considered if it would be possible for thechild to walk or bike to school. It was considered how a par-ent-teacher conference could be used to instruct parents abouthealthy lifestyles. All that would be needed to „raise” a citizen withgood health. This was not a finished project, the MP remarked,but the Norwegians were building it stone by stone.Dr Ekman explained that he grew up in Sweden, where he got agood school lunch everyday, compared to his own children thatwent to school in Denmark and ate the meal they brought fromhome. He also argued that Denmark had introduced the policywhere children had to exercise each day, but the speaker addedthat although the intent was good, this did not seem to work inpractice. The speaker concluded that school lunch or no schoollunch, it probably made no great difference in the grand scheme ofthings. What was important was that prevention strategies weretargeted to the group of children that needed it the most.Ms Työläjärvi added that Finland had a long tradition of healtheducation in schools and of school meals. This was not just impor-tant for the child’s good health, but also a factor in equality inworking life, since it was still mostly the mother who was bur-dened with what her children ate during the day. Ms Työläjärvithen remarked on the economisation arguing that although costefficiency would be important, sustainability and human dignitywere also important. She stressed that social services were not thereto save money, it was there to help people and make them produc-tive in the economy.Ms Holmberg-Jansson from the Åland Islands intervened in thediscussion to add that the Åland Islands invested a significantamount of money and effort into the production of food inschools, not only making sure that it was healthy, but that it wasecologically and locally produced. Plans to cut spending were metwith large protests from the parents. The MP then argued thatlocally produced food not only made students perform better inthe PISA test, it taught them about the value of good food. Shethen continued about tuberculosis and borreliossis, explaining that70 percent of people were now vaccinated against TBE, and thatthis level should be at 85 percent in 2020. She argued that cooper-ation is key, and there was no need to reinvent the wheel.Ms Waldinger-Thieringer from Schleswig-Holstein was given thefloor to argue that in spite of the comments of Dr Ekman, shebelieved that the Danish law requiring one hour of exercise a day for86 Session fourchildren was a very good idea. Exercise helped children concentrateand helped with health. In the Schleswig-Holstein state assemblyMs Waldinger-Thieringer had pushed for milk and fruit in schools,but teachers, who resisted the extra administration that would havebeen involved, largely rejecting the idea. She continued that lunchwas perhaps not even the most important issue, but rather that therewere children that went to school without breakfast.The next speaker allowed to take the floor, Mr Priebe, rejected thenotion that the quality of food in schools was to blame. In hisschool food was of good quality, locally and socially produced. Theproblem, he insisted, was that most students had more interest ineating fast food. Personal experience from France led Mr Priebe tobelieve that making the school meal mandatory would not be thesolution either. He continued that offering these services was nohelp at all if students are not aware of what the state was trying todo, or why they were trying to do it. Pressuring them would notwork, he stated, so what would be the alternatives?Responding to the question if a “fat tax” would offer a solution,Ms Bollestad offered that in Norway a tax for sugar had been consid-ered, as it already existed for smoking and alcohol. The high price oftobacco had caused the number of young people smoking to go down,so taxing and forbidding selling tobacco to young people helped.Ms Annette Holmberg-Jansson – MP Åland IslandsSession four 87Ms Jette Waldinger-Thieringer – MP Schleswig-HolsteinDr Ekman then contradicted this statement, arguing that althoughtaxation was a very useful tool for combatting smoking and drink-ing, it was very difficult to instate with unhealthy food, becausedeciding which products were taxed higher was not easy.Ms Kluge then asked Mr Heydorn if taxation would be a good toolto lever pressure. Mr Heydorn answered that this was not necessar-ily his field of research but that although the idea sounded goodon the surface, forcing children to eat certain types of food mightprove not to be enforceable. Prevention was much more impor-tant, not just for children but also for parents. It had to be furtherkept in mind that different social groups had different susceptibil-ity for information. By law children could demand food bynational standards, but forcing people to eat healthy would not bethe solution. Creating awareness of the importance of healthy foodand exercise was crucial.Ms Työläjärvi added that although Finland did have these taxes onalcohol and tobacco, enforcing a sugar or a fat tax would be diffi-cult to enforce. Drawing a line between one product and another88 Session fourcould be arbitrary, and it caused false competition. Lawsuits wouldinevitably ensue. She then argued that if psychologists could makeus buy pretty much anything, they should focus on making us buyhealthy food.Ms Bollestad argued that cooperation was crucial here, not just toshare good ideas but to offer consistency. High taxes in Norwaywere not useful if the products were cheap across the border. Sheonce more underlined that working together is crucial, also incombatting drug use and in making telemedicine work, but that ithad to start somewhere. She argued that all countries face the sameissues.Mr Spolītis from Latvia appreciated the input from Mr Priebe inhighlighting that meals in schools were not necessarily consumedthe way they were intended. Mr Spolītis argued that Latvia wantedto expand its offers of free meals, but realised that it had to takeinto consideration that although young children could be pres-sured into eating at school, older children that had their own willcannot. The speaker proposed a ceiling where children were„forced”’ to eat in school, and beyond that age children should beeducated about bad food, and in this shaming campaigns for fastfood chains should not be shied away from. After all, such sham-ing was also used on packets of cigarettes.Mr Veiko Spolītis – MP LatviaSession four 89Ms Bretschneider concluded the round table and informed the rep-resentatives that during the discussion she had had a last look atthe resolution and was happily surprised that all the issues dis-cussed during the roundtable also appeared in the resolution. Shereminded the audience that many programmes and strategiesexisted, be it at the WHO, the EU, CBSS, HELCOM or anotherorganisation. She stressed that the BSPC was an important organi-sation in steering the dialogue and deciding in which directionpolicy should be developed. She concluded that she was convincedthat the BSPC would make its mark upon the future of the discus-sion.90 Closing of the 24th BSPCClosing of the 24th BSPC 91Closing of the 24th BSPCMs Sylvia Bretschneider, the Chair of the BSPC, announced a voteon the adoption of the resolution of the 24th Baltic Sea Parliamen-tary Conference. She reminded the representatives that decisionscould only be made by unanimous consent. The first vote was togrant observer status to the South East European CooperationProcess. The motion was adopted without abstentions. The secondvote concerned a change in the rules of procedure regarding theSecretary General, the BSPC account and the list of observers, thedetails of which could be found in a distributed document. Themotion was adopted without abstentions.The Chair then moved on to the vote on the resolution. Shethanked the delegations for their input and hard work. Ms Bret-schneider remarked that she had been with the BSPC since 2002,and noted that coming to a mutual agreement on a resolutionused to be more difficult, because the mutual level of distrust usedto be much higher. The trust had grown over years of cooperation.The Chair reminded the attendees that the drafting committee hadunanimously recommended the resolution and that a unanimousadoption by all members of the conference would be necessary.The resolution was then unanimously adopted by the members.Mr Jānis Vucāns, Vice-President of the Baltic Assembly and Incom-ing Chair of the BSPC, thanked the hosts and Ms Bretschneider inparticular for the successful 24th edition of the BSPC. He expressedgreat pride at Latvia’s opportunity to host the Silver Jubilee of theConference, 25 years after the Iron Curtain fell. The country hap-pily would take over the baton from its partner city Rostock.The incoming Chairman reminded the delegates of the impor-tance of protecting its citizens’ interests by furthering their welfare,safety and competitiveness. Therefore, he proposed the focus forthe 25th anniversary meeting to lie on what he called the corner-stone for the well-being of the region: education and the labourmarket. Mr Vucāns proposed to strive to answers questions con-cerning the most effective correlation between the labour marketand the education sector, investment in skill development andtraining of employees and how to deal with youth unemploymentand the mobility of the labour force.Mr Vucāns further praised the topic of the new Working Group:tourism, and its focus on all adjoining themes, such as culture, eco-nomics, the labour market, but also maritime and coastal tourism.92 Closing of the 24th BSPCThe speaker concluded his statement by stressing the importanceof cooperation in times of tension. He expressed pride in hostingthe 25th conference exactly 25 years after East and West had foundClosing of the 24th BSPC 93each other again. He reminded the delegates of the main goal as anelected representative: to keep up dialogue; to conduct an activepeace policy; and to establish the Baltic Sea as a Sea of Peace.94 Staff of the Landtag Mecklenburg-VorpommernAnnex 1 95Annex 1Conference ResolutionAdopted by the 24th Baltic Sea Parliamentary Conference (BSPC)The participants, elected representatives from the Baltic SeaRegion States*, assembling in Rostock, Mecklenburg-Vorpom-1mern, 30 August – 1 September 2015,welcome, against the background of the crisis in Ukraine, theagreements concluded in Minsk, which may lead to a peacefulsolution of the conflict, and insist on their thorough and unwaver-ing implementation and appeal to the parties to provide compre-hensive support to the work of the OSCE;expect all Baltic Sea States to make every effort to ensure that theBaltic Sea region will continue to be a region of intensive co-oper-ation and good, peaceful neighbourliness. To this end, they willuse all the opportunities of parliamentary, governmental and socialexchange and dialogue. For this reason, they also call for a resump-tion of the ministerial meetings of the Council of Baltic Sea States(CBSS). This will foster the dialogue and strengthen cooperation;discussing Cooperation in the Baltic Sea Region, Cross-BorderCooperation in Health Care, Health and Economy – Paving theWay for Innovation in Social and Health Care, and Sustainableand Accessible Social and Health Care – at the Crossroads ofHealth Care Provision, the Demographic Shift and ShrinkingBudgets;reiterating their support for the Council of Baltic Sea States(CBSS), welcoming the new long-term priorities of the CBSS, aswell as the efforts of the Polish CBSS Presidency to improve coher-* Parliaments ofDenmark, Estonia, Europe, Finland, Federal Republic of Germany, Free and HanseaticCity of Hamburg, Free Hanseatic City of Bremen, Iceland, Latvia, Leningrad Region,Lithuania, Mecklenburg-Vorpommern, Norway, Poland, Federal Assembly of the RussianFederation, City of St. Petersburg, Schleswig-Holstein, Sweden, Åland Islands, BalticAssembly, Nordic Council96 Annex 1ence in Baltic Sea regional cooperation, and acknowledging theprogress and achievements of CBSS in fields such as sustainableeconomic growth, clean shipping, labour market mobility, researchand development, transport and communications, cultural herit-age, trafficking in human beings, and civil security, and supportthe CBSS practical approach to the implementation of the newCBSS long term priorities;expressing against the background of the current situation theirsolidarity with the refugees which are forced to flee their home-lands, being aware of the big challenge to secure a safe residence;call on the governments in the Baltic Sea Region, the CBSS, theWorld Health Organisation (WHO) and the European Union(EU);to ensure the decent treatment of the refugees especially concern-ing housing and healthcare;Regarding Cooperation in the Baltic Sea Region, to1. strengthen the cooperation in the Baltic Sea Region includingthe Northern Dimension and the EU Strategy for the Baltic SeaRegion and other regional actors for a stable foundation of rela-tions and encourage further development of the structural dia-logue and cooperation between each and every regional organiza-tion and format leading to creation of a common Baltic coopera-tion space;2. support any cooperation that marks the Baltic Sea Region as amodel region with equal access to health for all and with a specialobligation to support the dissemination and development ofhealth and well-being by playing a key role in the realization of thenew sustainable development goals of the United Nations;3. reaffirm the pursuit of the entire region to co-operation aimedat becoming a role model region with a sustainable economy, capa-ble of boosting competitiveness and opening up new opportunitiesfor business and employment;4. co-operate in order to strengthen the Baltic Sea Region as animportant competitive knowledge region with an excellent highereducation and research infrastructure;Annex 1 975. encourage co-operation in the fields where mutual benefits andsynergies e.g. between the EU Strategy for the Baltic Sea Region andthe Strategy for the socio-economic development of the North-WestFederal district of Russia can only be achieved by identifying com-mon priorities and by developing respective regional strategies andaction plans;6. evaluate the effects and promote the extension of the new regula-tions on SECA (Sulphur Emission Control Area), in force since 1January 2015, to other sea basins, including outside of the EU, andsupport efficient enforcement of these regulations on ships, regardlessof which flag they might fly, to ensure the improvement of the envi-ronment, human health and to secure the competitiveness of theshipping sector in the region;7. promote close cooperation between cruise operators, ports andother coastal tourism stakeholders such as in the recently launchedPan-European Cruise Dialogue and actively participate in transna-tional projects to unlock the full potential for sustainable bluegrowth in the maritime and coastal tourism sectors;8. continue work to upgrade reception facilities for sewage in passen-ger ports to ensure a timely activation of the special area status of theBaltic Sea under Marpol Annex IV of the International MaritimeOrganization, with the aim to hinder the release of untreated sewagefrom passenger ships in the future and to reaffirm the commitmentfor the continued improvement and modernization of the wastewater treatment capacity throughout the entire Baltic Sea Region, incompliance with the stricter threshold values agreed by HELCOM;9. enhance macro-regional capacity to respond to major emergenciesbased on all-hazards approach and joint, cross-border preparations toprotect lives, health and wellbeing of citizens;10. strengthen and further develop HELCOM as the main coordi-nating body in the effort to protect the Baltic marine environment,and to strongly support the implementation of the Baltic Sea ActionPlan (BSAP), and to stress the importance of BSAP as the environ-mental pillar of the EU Strategy for the Baltic Sea Region;11. deepen the political exchange among young people in the BalticSea Region and to support the permanent establishment of a BalticSea Youth Forum;12. support the Nordic Bioeconomy Initiative by the NordicCouncil of Ministers;98 Annex 1Regarding Cross-border Co-operation in Health Care, to13. expand, strengthen and deepen cross-border cooperation insocial and health care and the strategic planning of health servicesand continue with strong effort the development of a “Baltic SeaHealth Region”, to decrease inequality and lift the general welfareas a common challenge all Baltic Sea Region Countries face;14. support the Northern Dimension Partnership in Public Healthand Social Wellbeing (NDPHS) as a highly valued and innovativeregional network, significantly contributing to the improvement ofpeoples’ health and social wellbeing in the Northern Dimensionarea, the new NDPHS Strategy 2020 and its Action Plan, as wellas the Policy Area “Health” of the EU Strategy for the Baltic SeaRegion;15. support the EU ́s cross-border co-operation programmes andother relevant programmes as tools contributing to strengtheningcross-border and regional co-operation in health care in the BalticSea Region;16. launch and develop concrete transnational health care andsocial wellbeing initiatives, such as ScanBalt or the WHO’sHealthy Cities project and to foster the development of the BalticSea Health Region by further strategies and transnational projects,e.g. by a joint antibiotics strategy, by connecting the fields ofhealth, tourism, information and communications technology(ICT) and natural resources;17. spread innovative and best practices throughout the Baltic SeaRegion so to become a model region in health care;18. co-operate on research and sustainable strategies for promotionof cultivation and production of healthy and organic food;19. make workplaces safer and healthier and thus more productiveand recognize the important work of trade unions to promote aculture of risk prevention to improve working conditions through-out the region;20. improve transnational cooperation and medical specializationin the treatment of rare diseases, bearing in mind the cost-effectiveusage of medical equipment;Annex 1 9921. regulate transnational emergency care in a way that the fastestpossible healthcare provision can be guaranteed regardless of thehealthcare providers ́ country of origin;22. intensify exchanges of experience and co-operation with theaim of fighting antimicrobial resistance as one of the main globalchallenges in health care, to implement research in this area, andsupport and intensify all efforts to develop and implement a globalaction plan on antimicrobial resistance by WHO;23. reduce the usage of antibiotics – general – and for agriculture(livestock farming) to an absolute minimum in order to preventfurther increase of antimicrobial resistance;24. strive to introduce the same standards on a high level in thetreatment of contagious infectious diseases throughout the BalticSea Region;25. broaden the scope of the Könberg report to the entire BalticSea Region, in order to gain a comparable overview of the status ofhealth and care in the Baltic Sea Region;26. commission a regular report on the status of health includingdisaggregated data and analysis for different population groupssuch as children, youth and senior citizens and particularly mar-ginalized groups in the countries of the Baltic Sea Region, in orderto coordinate issues, definitions and emphases as a step forward interms of comparability of different systems within the region andmap commonly shared challenges ahead;Regarding Health and Economy, to27. appreciate that, whereas economic prosperity is good forhealth, good health outcomes also favour economic growth anddevelopment. To that end, recognize the importance of health andsocial wellbeing for the economy and other policy areas and viceversa and consider health aspects in all policies;28. improve support for the development of innovations in healthcare in order to prevent a brain drain;100 Annex 129. support the ScanBalt Strategy 2015-2018 and use synergieswith existing strategies;30. develop measures to improve the situation of the medical andcare professions through – for example - eHealth;31. improve conditions to support the development of innovationsin health care, including in the fields of eHealth and telemedicine,whilst ensuring that investments in eHealth support the adoptionof standards and drive interoperability across the health sector toleverage the “eHealth European Interoperability Framework”(eEIF) and observe the joint European initiatives, such as the“Guidelines under eHealth Network” of the responsible memberstate authorities;32. further strengthen measures for collaborative implementationof a joint eHealth Innovation ecosystem based on a Baltic SeaRegion cooperation platform for eHealth initiatives built on smartspecialization and mobilize regional resources based on alreadyexisting structures and internationally recognized standards;33. improve the conditions to include eHealth and telemedicine inthe standard care;34. improve early intervention to strengthen good public healththrough social investment such as vaccine programs, and takestrong measures to reduce consumption of alcohol, tobacco andillicit drugs, and work towards stronger prevention of diabetes IIand other lifestyle illnesses;35. support the usage of cost-reducing methods for better qualityof life, including cultural and physical health-related activities intreatment;36. improve the national labelling relevant for a healthy lifestyleincluding labelling accessible to different population groups suchas child-sensitive and child-specific labelling;37. foster development of health-related services within the tour-ism strategies of the Baltic Sea Region countries;38. ensure global comparability of health economy and measurethe performance and the impact of the health care systems via eco-nomic growth and employment by establishing a first reliabletransnational method like “economic footprint of health econ-omy”;Annex 1 10139. check the possibility to establish a “Baltic Health Forum”, toensure and improve a sustainable exchange and networking in thispolicy field around the Baltic Sea;Regarding Sustainable and Accessible Social and Health Care, to40. ensure affordable health care for everyone and emphasize thefocus on the needs of patients with due regard to age and genderand to warrant equal and affordable access to high-quality healthservices throughout the whole Baltic Sea Region;41. ensure that a positive economic development in the regionpromotes high standards in health care and social wellbeing;42. take strong measures to ensure equitable availability, access anduse of social welfare and health care services, e.g. between urbanand rural areas, between socio-economic groups and with dueregard to age and gender;43. develop and strengthen strategies addressing demographicchange, such as the European Innovation Partnership on Activeand Healthy Ageing and especially considering public services withregard to rural peripheral areas;44. install geriatric health care centres and modify social rehabilita-tion centres to ensure health care in rural areas as well as improv-ing age-appropriate medicine;45. ensure integrated services for children consolidating healthcare and social care services in a child-sensitive way;46. ensure support services for families, pregnant women and pro-spective parents in support of families and parenthood, provide anintegrated package of services to families with children in order toencourage childbirth, childcare and child rearing with a view tocounteracting the current demographic trends and investing infamilies and fostering child-friendly communities and societies;47. encourage patient responsibility for people living in the BalticSea Region;48. raise awareness especially amongst the youth in a healthier life-style and to work on making education in healthy lifestyle manda-tory in all schools and all school levels, a database on best practice102 Annex 1examples on how to improve education and awareness should becreated;49. carry out studies with the aim of developing prevention strate-gies in health care, such as the North-Trøndelag Health Study(HUNT);50. establish a first aid system for mental health problems as therecognition, awareness and diagnostic of mental problems are stillunderdeveloped;51. support activities on Non-Governmental Organizations focus-sing on non-formal education for example in culture, sports, vol-unteering and music in order to fight against stigmatization of dis-advantaged groups;52. create incentives to improve the conditions of the nursing andcare professions and to work towards intensified professional andvocational training for people employed in the health sector to sig-nificantly facilitate a cost-effective health system in the region andfoster understanding of the health sector as a cross-cutting issue;53. fully recognize the social partners in the social and health careprofessions, protect their activities and ensure that social partnersand trade unions will be involved in the regulatory and implemen-tation process on health issues as early as possible;54. carefully consider both physical and psycho-social risks atwork place, against the background of a rising retirement age,strive for good working conditions, wellbeing and a sustainablework-life balance within the labour force of the Baltic Sea Region;55. strive to establish laws for patients’ rights in all the countries ofthe Baltic Sea Region and mechanisms to ensure that those rightsare fulfilled;56. establish a Working Group on Sustainable Tourism – withfocus on cultural, economic and labour market, maritime andcoastal tourism as well as ecological aspects and as a central pillarof maritime spatial planning and with a view to developing syner-gies with the policy area “Tourism” under the EU Strategy for theBaltic Sea Region - to submit a first report at the 25th BSPC;57. welcome with gratitude the kind offer of the Parliament ofLatvia to host the 25th Baltic Sea Parliamentary Conference in Rigaon 28 - 30 August 2016.Annex 2 103Annex 2The 24th Baltic Sea Parliamentary ConferenceRostock, 30 August 2015 – 1 September 2015„Baltic Sea Region –A Role Model for Innovationin Social- and Healthcare”PROGRAMMESaturday, 29 AugustVenue: Rostock, Yachting & Spa ResortHohe DüneShuttle services from Hamburg Fuhlsbütteland Berlin Tegel airports as well as fromRostock Main Station to hotelAccommodation & registration of participants(at the hotel)15:00 – 18:00 Possibility for delegation andparty group meetings104 Annex 2Sunday, 30 August09:00 – 11:00 Registration of participants (at the hotel)10:00 – 12:00 Meeting of the BSPC DraftingCommittee, thereafter lunch buffet(Kongresszentrum Hohe Düne,Rotunde – second floor)10:45 – 12:15 „Health is wealth and wealth is health”,thereafter lunch buffet(Kongresszentrum Hohe Düne,Salon 19 – first floor)Organised by the NDPHS Secretariat incooperation with the BSPC, this NDPHS eventwill provide an overview of the very strongassociation between health and the economy &other policy areas.12:15 – 13:15 Meeting of the BSPC Standing Committee(Kongresszentrum Hohe Düne,Rotunde – second floor)14:00 – 18:00 Harbour Tour andReception at the Town Hallgiven by the Lord Mayor of theHanseatic Town of RostockGuided Tour of Rostock Old Town(Meeting point: Hotel Lobby, departurefrom the Anleger Hohe Düne)20:00 – 22:00 Reception hosted by Mr Erwin Sellering,Prime Minister of Mecklenburg-Vorpommern(Kurhaus – Meeting point: Hotel Lobby,departure by bus from the hotel at 19:15)Annex 2 105Monday, 31 August8:00 – 9:30 Registration of participants(Kongresszentrum Hohe Düne,Ballsaal Foyer – ground floor)9:30 Cultural introductionOpeningChair: Ms Sylvia Bretschneider, President ofthe Landtag Mecklenburg-VorpommernVice-Chair: Mr Jānis Vucāns, MP, Latvia- Opening words byMs Sylvia Bretschneider,Chair of the BSPC- Welcome by Mr Erwin Sellering,Prime Minister ofMecklenburg-Vorpommern10:00 FIRST SESSIONCooperation in the Baltic Sea RegionChair – Mr Ryszard Górecki, MP, PolandVice-Chair – Ms Giedrė Purvaneckienė,MP, Lithuania· R eport from the BSPC Chair,Ms Sylvia Bretschneider· R eport from the Council of the Baltic SeaStates (CBSS):- Outgoing CBSS Chair, Committeeof Senior Officials, Mr Raul Mälk,Ambassador of Estonia- C urrent CBSS Chair, Committee ofSenior Officials, Mr Michał Czyż,Ambassador of Poland· M r Jørn Dohrmann, MEP, Chair of theDelegation responsible for the Baltic SeaRegion (SINEEA Delegation)· M s Valentina Pivnenko, MP, Russia,„Strategy of socio-economic development of theNorth-West Federal District”· M r Harry Liiv, Chair of HELCOM, „Reporton the HELCOM Baltic Sea Action Plan”· M s Daria Akhutina, General Director,“Report from the Baltic Sea NGO Forum andNetwork”Discussion12:00 Coffee Break106 Annex 212:30 SECOND SESSIONCross-border Cooperation in HealthcareChair – Ms Valentina Pivnenko, MP,Russian FederationVice-Chair – Mr Franz Thönnes, MP, Germany· Ms Rimantė Šalaševičiūtė,Minister for Health, Lithuania· Mr Dmitry Kostennikov, Vice-Ministerfor Health, State-Secretary, Russia· Ms Annette Widmann-Mauz,Parliamentary State Secretary at the FederalMinistry for Health, Germany· Dr. Nedret Emiroglu,Deputy Director, WHO RegionalOffice for Europe· Mr Bo Könberg,former Minister for Health, Sweden andAuthor of the report „The Future Nordic Co-operation on Health”Discussion14:00 Lunch Buffet(Restaurant „Brasserie”)15:00 THIRD SESSIONHealth & Economy – Paving the Way forInnovation in Social- and HealthcareChair – Mr Pyry Niemi, MP, Sweden,Nordic CouncilVice-Chair – Mr Karl-Johan Fogelström,MP, Åland Islands· M r Günther Oettinger,European Commissioner for DigitalEconomy & Society, „eHealth – the EuropeanDimension”· P rof. Dr. Dr. Horst Klinkmann,President BioCon Valley, „Towards a LeadingHealth Region”· D r. Jaanus Pikani,Vice-President ScanBalt, „The Baltic SeaRegion as one test site for development of healthcare products and services”· D r. Dennis A. Ostwald,WifOR, „The economic footprints of thehealthcare sector in the Baltic Sea Region”· P rof. Dr. Martin Mielke,Head of the Department of InfectiousDiseases at The Robert Koch Institute,„Battling the Spread of Multi-Resistant Bacteria”DiscussionAnnex 2 10717:00 – 19:00 Meeting of the BSPC Drafting Committee (ifnecessary)(Kongresszentrum Hohe Düne,Rotunde – second floor)19:15 – 20:15 „Martynas and the SinChronic Quartet”Accordion meets string quartet(Bootshalle)Martynas, world champion virtuosoaccordion and Prizewinner of the FestivalMecklenburg-Vorpommern20:30 Dinner hosted by Ms Sylvia Bretschneider,President of the LandtagMecklenburg-Vorpommern(Kongresszentrum Hohe Düne,Sonnendeck – first floor)Tuesday, 1 September08:00 Meeting of the BSPC Drafting Committee (ifnecessary)(Kongresszentrum Hohe Düne,Rotunde – second floor)09:00 FOURTH SESSIONSustainable and Accessible Social- andHealthcare - At the Crossroads of HealthcareProvision, the Demographic Shift andShrinking BudgetsChair – Mr Per Rune Henriksen, MP, NorwayVice-Chair – Ms Carola Veit,President of the Hamburg ParliamentKeynote Speech· M s Manuela Schwesig, Federal Minister forFamilies, Senior Citizens, Women & Youths,„Demographic Challenges and Care”Innovation in Social- and Healthcare· M s Olaug Bollestad,MP, Norway, Chair of the BSPC WorkingGroup on Innovation in Social andHealthcare· M s Madara Muizniece andMr Maximilian Priebe,Representatives from the BSPC back-to-backevent „Kiel Week Youth Forum on Innovationin Social- and Healthcare”108 Annex 2Coffee Break10:30 – 11:00 Roundtable moderated by Susanne Kluge,Television Presenter and Medical Journalist· M s Olaug Bollestad,MP, Norway, Chair of the BSPC WorkingGroup on Innovation in Social andHealthcare· M r Jörg Heydorn,MP, Chair of the Study Commission onAgeing in Mecklenburg-Vorpommern· M s Riitta Työläjärvi,Senior Advisor Health and Social Policy,Finnish Confederation of Salaried EmployeesSTTK· M r Björn Ekman,PhD, Researcher, Health EconomicsDivision of Social Medicine and GlobalHealth (SMGH), Department of ClinicalSciences, Lund University· P rof. Dr. Marek Zygmunt,Supervisory Board of BioCon ValleyDiscussion12:00 CLOSING OF THE 24th BSPCChair – Ms Sylvia Bretschneider, President of theLandtag Mecklenburg-Vorpommern,Chair of the BSPCVice-Chair – Mr Jānis Vucāns, MP, Latvia, Vice-Chair of the BSPC- Administrative Matters- Adoption of the Conference Resolution- A ddress by the incoming Chair of the BSPC2015-2016- Presentation of next year’s host country13:00 Lunch, thereafter shuttleto Hamburg Fuhlsbüttel and Berlin Tegelairports as well as to Rostock Main StationLegal Notice: By participation in the BSPC annual conference, youagree to the publication of photos that were taken during this event.Annex 3 109Annex 3List of ParticipantsMember Parliaments and Parliamentary OrganizationsBaltic AssemblyDr. Giedrė Purvaneckienė PresidentJānis Vucāns Vice President of theBaltic Assembly, ViceChairman of theBSPC, Head of theLatvian delegationRomualds Razuks Vice-ChairmanLatvian Delegation,Member PresidiumBaltic AssemblyMarika Laizāne-Jurkāne Secretary GeneralEuropean ParliamentJørn Dohrmann MP, SINEEA-DelegationAmelia Padurariu Secretary of theSINEEA DelegationFederal Assembly of the Russian FederationValentina Pivnenko MP, Head of RussianDelegationOleg Nilov MPYulia Guskova AdvisorAnna Zhiltsova AdvisorEkaterina Jordan AssistantSvetlana Shelest Interpreteur110 Annex 3Nordic CouncilHöskuldur Thórhallsson PresidentWille Rydman MPJóhanna María Sigmundsdóttir MPBritt Bohlin Secretary GeneralNicolai Stampe Qvistgaard Senior AdvisorTorkil Sørenson International AdvisorJan Widberg Director of Minister ́sOffice in LatviaParliament of ÅlandJörgen Petterson MPAnnette Holmberg-Jansson MPAxel Jonsson MPNiclas Slotte Legal Advisor,Secretary ofDelegationParliament of BremenSülmez Dogan Vice President of theParliament of BremenAntje Grotheer MPParliament of DenmarkKarin Gaarsted MPAnnette Lind MPCaroline Maier MPMagdaleneKamilla Kjelgaard AssistantAnnex 3 111Parliament of EstoniaHelir-Valdor Seeder Vice President of theParliamentAadu Must MPAndre Sepp MPEne Rongelep Senior AdvisorParliament of FinlandHanna Kosonen MPRiitta Myller MPWille Rydman MPSaara-Sofia Sirén MPMika Laakson Secretary forInternational AffairsParliament of the Federal Republic of GermanyFranz Thönnes MP, Head of theDelegationHerbert Behrens MPFrank Junge MPSonja Steffen MPPeter Stein MPThomas Stritzl MPNicole Tepasse Secretary ofDelegationTorsten Schneider Delegation Secretariat112 Annex 3Parliament of the Free and Hanseatic City of HamburgCarola Veit President of theHamburg ParliamentDr. Kurt Duwe MPSören Schumacher MPMichael Westenberger MPJohannes Düwel DirectorUlfert Kaphengst Head of DepartmentPublic Relations andProtocolMarco Wiesner Deputy Head ofDepartment PublicRelations andProtocolParliament of LatviaJānis Vucāns Vice President of theBaltic Assembly, ViceChairman of theBSPC, Chairman ofthe LatviandelegationRomualds Razuks Vice-ChairmanLatvian Delegation,Member PresidiumBaltic AssemblyAtis Lejiņš MPVeiko Spolītis MPJuris Viļums MPIngrīda Sticenko Senior AdvisorLinda Kalniņa Project coordinator,Saeima protocoldevisionParliament of LithuaniaIrena Siauliene MPLinas Balsys MPRaimundas Paliukas MPAnnex 3 113Parliament of Mecklenburg-VorpommernSylvia Bretschneider Chair of BSPC,President of theLandtagMecklenburg-Vorpommern, MPJulian Barlen MPDr. André Brie MPDietmar Eifler MPSilke Gajek MPJörg Heydorn MPDetlef Müller MPJochen Schulte MPWolfgang Waldmüller MPManfred Dachner MPArmin Tebben DirectorDirk Zapfe Leader President’sOfficeStefan Janssen Unit Leader ProtocolGeorg Strätker Unit Leader EU andLegal AffairsCommitteeParliament of NorwayPer Rune Henriksen MP, Head ofDelegationOlaug Bollestad MPSonja Mandt MPBente Stein Mathisen MPMichael Tetzschner MPBjørn Andreassen Senior AdvisorMarianne Seip Political AdvisorJulie Helmersvik Brevik Advisor114 Annex 3Parliament of SwedenPyry Niemi MP, Head of SwedishDelegationPer-Ingvar Johnsson MPRickard Persson MPSuzanne Svensson MPCecilia Widegren MPPetra Sjöström International SeniorAdviserParliament of PolandRyszard Górecki Head of the PolishDelegation, Memberof Polish SenatePiotr Bauć MPPiotr Koperski Secretary of theDelegationParliament of the City of St. PetersburgTatiana Zakharenkova MPVatanyar Yagya International AdvisorParliament of Schleswig-HolsteinBernd Heinemann Vice President of theLandtag Schleswig-Holstein, Head ofDelegationAngelika Beer MPAstrid Damerow MPDr. Ekkehard Klug MPRegina Poersch MPBernd Voß MPJette Waldinger-Thiering MPJutta Schmidt-Holländer Unit Leader,AdministrationAnnex 3 115Legislative Assembly of The Leningrad RegionAleksandr Petrov MP, Head of theDelegation – theChairman of theStanding Commissionon Health and SocialPolicyLudmilla Teptina Deputy to theChairman of theStanding Commissionon Health and SocialPolicyBSPC and ObserversBSPC – Baltic Sea Parliamentary ConferenceBodo Bahr Head of theBSPC SecretariatBaltic Sea ForumJürgen Schmidt Member of theBoard BSFBSSSC Brussels AntennaJanne Tamminen Head of OfficeCBSS - Council of the Baltic Sea StatesMichał Czyż Ambassador forPolandRaul Mälk Ambassador forEstoniaGudmundur Arni Stefánsson Ambassador forIcelandJan Lundin Director General ofthe CBSS SecretariatDr. Iris Kempe Senior Advisor116 Annex 3HELCOM- Helsinki CommissionHarry Liiv ChairmanHelsinki - Uusimaa Region, Uusimma Region CouncilOssi Savolainen Regional MayorAssociation for cooperation with BSC “Norden”,NGO Forum NetworkDaria Akhutina General DirectorNDPHS SecretariatMarek Maciejowski DirectorWiebke Seemann Project AssistantRegion SkaͦneStefan Lamme Member of theRegional AssemblyBengt Stavenow E-Health StrategistSpeakers and other ParticipantsBioCon ValleyProf. Dr. Dr. Klinkmann PresidentHorstLars Bauer ManagerBirgit Pscheidl Manager forInternational AffairsThomas Karopka Project ManagerChamber of Industry and Commerce NeubrandenburgDr. Wolfgang Blank DirectorChamber of Industry and Commerce SchwerinStefanie Scharrenbach Area ManagerRegional Politics,InternationalAnnex 3 117Embassy of the Republic of LithuaniaRamūnas Misiulis First EmbassyCounselorEIZ – Europäisches Integrationszentrum Rostock – EuropeanIntegration Centre RostockMandy Kröppelien ChairPeter Boldt Coordinator BMBFProject SilversurferJana Kasten Member of the BoardEuropean CommissionGünther Oettinger Commissioner forDigital Economy &SocietyEUCC – EU Coastal and Marine UnionNardine Stybel ManagerFederal Ministry for Families, Senior Citizens, Women & YouthManuela Schwesig Federal MinisterFinnish Confederation of Salaried Employees STTKRiitta Työläjärvi Senior Advisor Healthand Social PolicyFoundation Alfried Krupp Kolleg GreifswaldProf. Dr. Bärbel Friedrich Scientific DirectorGreifswald University Women’s HospitalProf. Dr. Marek Zygmunt DirectorHerbert Quandt FoundationDr. Roland Löffler Head of Foundation118 Annex 3Institute for Political and Administrative Sciences University ofRostockProfessor Dr. Werz Chair of ComparativeNikolaus Government andPoliticsMartin Koschkar AdministrativeConsultantKiel Week Youth ForumMadara Muizniece RapporteurMaximilian Priebe RapporteurLife Science Nord Management GmbHDr. Hinrich Habeck ManagerLund UniversityPhD Björn Ekmann ResearcherMecklenburger FoundationDr. Wolf Schmidt ChairMinistry of Economy Mecklenburg-VorpommernHarry Glawe MinisterDr. Anja Gelzer AdvisorMinistry of Education Mecklenburg-VorpommernKatja Steinfeld AdvisorMinistries of Foreign AffairsErja Tikka Finland, Ambassadorfor Baltic Sea AffairsMichał Czyż Poland, Ambassadorfor CBSSRaul Mälk Estonia, Ambassadorfor CBSSGudmundur Stefánsson Iceland, AmbassadorArni for CBSSSergey Petrovich Deputy Director,RussiaAnnex 3 119Ministries for HealthRimanté Šalaševičiūtė Lithuania, Minister ofHealthAnnette Widmann-Mauz Germany,Parliamentary StateSecretary of theMinistry of HealthDmitry Kostennikov Russia, Vice Ministerof Health, StateSecretaryBo Könberg Former Minister ofHealth SwedenThomas Ifland Germany, SeniorAdvisor, Ministry ofHealthJurgita Kinderiené Lithuania, Advisor,Ministry of HealthEduard Salakhov Russia, Head ofDivision forInternationalCooperation in PublicHealthModeratorSusanne Kluge Moderator and TVPresenter120 Annex 3Robert Koch InstituteProf. Martin Mielke Head of Departmentof Infectious DiseasesRosa-Luxemburg-FoundationProf. Dr. Werner Pade ChairScanBaltPeter Frank General SecretaryJaanus Pikani Vice ChairState Chancellery Mecklenburg-VorpommernErwin Sellering Prime Minister ofMecklenburg-VorpommernAndrea Herrmannsen Head of DivisionUniversitair Medisch Centrum Groningen/NetherlandsProf. Dr. Rakhorst EmeritusGerhardUniversity of Applied Sciences WismarProf. Dr. Bodo Wiegand-Hoffmeister RectorUniversity RostockProf. Dr. Schareck RectorWolfgangWHO – World Health Organization, Regional Office for EuropeDr. Nedret Emiroglu Deputy DirectorWifOR – Wirtschaftsforschung – Economy ResearchDr. Dennis A. Ostwald Manager24Baltic Sea Parliamentary Conference Secretariatwww.bspc.netBSPC Secretariatc/o Lennéstraße 119053 SchwerinGermanyPhone (+49) 385 525 2777