Annual Report 2019

Developing high quality, multidisciplinary research

Our vision

The environmental, social and economic conditions in which individuals live, work and develop their daily activities influence a majority of the population's risk factors and health conditions – often representing "the causes of the causes" of disease. For example, a situation of poverty tends to limit the opportunities to adopt behaviours favouring good health (e.g. healthy diet, physical activity, etc.), to live in healthy environments (safety, healthiness, pollution), to access the means of self-realisation (education, social relationships), and to access quality health and long-term care services.

The mission of the cross-departmental Research Programme on 'Health and Health Systems' is to coordinate, develop and contribute to the health-related work carried out within and across any of the three departments of LISER. The work focuses on primarily quantitative, social, economic & environmental aspects of health, by harnessing the expertise and infrastructure throughout LISER. The Institute is uniquely placed to make a difference to research in this area, in light of its first-hand expertise in many non-health policy domains with massive indirect importance for health. Such domains include – but are not limited to – income inequality and poverty, labour markets, social protection, education, urbanisation, housing, and migration. The health-related work makes use of a broad range of methods, including applied econometrics, micro-simulation, experiments and evidence synthesis, tailored to the needs of the specific research question.

Marc Suhrcke
Programme Leader

The Research Programme fulfils its mission by developing high quality, multidisciplinary research, on a broad range of topics, with global reach and potential to impact on real life policy decisions:

  1. Socio-economic and spatial inequalities in the health of individuals and populations
  2. Socio-economic and environmental determinants of health
  3. The socio-economic consequences of health
  4. The economics of health behaviours
  5. The rigorous evaluation - in terms of effectiveness as well as (where feasible) 'value for money' - of policies that may directly or indirectly influence these determinants
  6. Health Services Research (e.g. assessing health system performance)

Exposure to heat and air pollution in Europe – cardiopulmonary impacts and benefits of mitigation and adaptation


Marc Suhrcke

This is an EU-H2020 Read also International recognition -funded research project with 14 partners from 10 countries from across Europe. The EXHAUSTION consortium is multidisciplinary, encompassing specialists in climate and air quality Read also Towards car use reduction with smart multimodal solutions modelling, cardiopulmonary medicine, epidemiology, health impact assessment, economics, and science communication. Professor Marc Suhrcke is a Co-Investigator on the project, leading one work package of the overall project.

Increasing temperatures and heat waves due to climate change, combined with air pollution, constitute major health risks, and could cause an increase in cardiovascular and respiratory diseases across Europe, as well as adverse socioeconomic consequences.

The EXHAUSTION project aims to quantify the changes in cardiopulmonary mortality and morbidity due to extreme heat and air pollution (including from wildfires) under selected climate scenarios. Extreme heat is identified as a key climate change risk in Europe in the near and long term, with major associated health harm. In particular, heat affects cardiovascular and respiratory diseases, which together constitute cardiopulmonary diseases. Increases in heat-related mortality are projected to outweigh reductions in cold-related mortality, and increasingly so with greater degrees of warming.

The health effects of extreme heat are interlinked with air pollution in several ways. Air pollution is currently the largest environmental killer in Europe, causing ~500,000 premature deaths annually. Previous studies indicate that there may be synergistic effects of extreme heat and air pollution on cardiopulmonary disease outcomes. Moreover, extreme heat may increase air pollution levels, which is linked to large-scale (synoptic) meteorological features.

The current cost of cardiovascular and respiratory diseases in total in EU is estimated at nearly €600 billion. This means that environmental stressors that adversely affect cardiopulmonary disease may bring ill health to a large number of Europeans and could have a substantial socio-economic impact.

The vulnerability to heat stress may differ widely among population groups due to complex causal pathways and differential vulnerability associated with contextual and individual factors. Excess mortality during extreme temperature events is largely preventable to the extent that adaptation measures can be tailored to alleviate contextual and individual vulnerability factors or otherwise mitigate the risks to vulnerable populations. To develop climate change adaptation policies, a detailed understanding of the predominant vulnerability factors in different communities and regions is needed.

EXHAUSTION will advance on key evidence gaps identified by the IPPC – as regards adaptation, interactive effects, and socio-economic costs – and quantify the changes in cardiopulmonary disease under selected climate scenarios while including a diverse set of adaptation mechanisms and measures, calculate the associated costs, and identify effective interventions for minimising adverse impacts Read also When psychological biases reduce workforce well-being .

Assessment of Primary Care Performance in Luxembourg


Valérie Moran

APPEAL is an FNR-CORE (Junior) funded project with Dr Valerie Moran as the PI of the project and Prof. Marc Suhrcke as the internal scientific advisor. The project is a collaboration between LISER and the Luxembourg Institute of Health (LIH).

Primary care Read also Fighting poverty: which objective and which policies? can ensure continuity and coordination of care, and contribute to health promotion and disease prevention. It has the potential to improve health outcomes Read also How we age in Luxembourg and in Europe? What are the living conditions of people in Luxembourg and in Europe? , health system efficiency and health equity. Systematic performance assessment of primary care across countries can help to achieve these objectives by identifying areas for improvement and informing policy solutions. Earlier studies have suggested that primary care in Luxembourg could be improved, compared to what some other European countries have achieved.

We undertake an in-depth assessment of the performance of primary care in Luxembourg in comparison with other European countries, bearing in mind the limitations of available data and the challenges of measuring performance Read also Societal impact . We move beyond current evidence and make a valuable contribution in two ways. First, we exploit rich and under-utilised data sources to investigate performance. Second, we apply state-of-the-art methodology to these data to produce high-quality evidence to inform improvements in performance. We start by investigating performance in terms of the technical efficiency (i.e. the ability to produce the maximum output from a given level of inputs) of primary care across European countries using country-level data. We estimate technical efficiency using parametric (Stochastic Frontier Analysis) and non-parametric (Data Envelopment Analysis) approaches. We then proceed to investigating various dimensions of performance, including access, coordination, efficiency and quality. We use individual- and country-level data to investigate variation in GP consultations and the utilisation of inpatient care for selected conditions for which timely and effective ambulatory care could prevent hospital admission. In a final step, we rigorously evaluate a concrete primary care policy in Luxembourg - the ‘Médecin Référent’ (Referring Doctor) programme, which has the potential to improve performance on the efficiency and quality of care.