No one can build this bridge alone: JACARDI strengthens the science–policy interface


How can data and evidence generated by a project reach policymakers and influence real-world decisions? And what enables a successful pilot intervention to become part of health systems, rather than remaining an isolated “island of excellence”? Generating robust evidence is only one step. To achieve lasting public health impact, project results must be understood, communicated and translated into solutions that respond to policy priorities, engage the relevant stakeholders and can be integrated into existing systems.

JACARDI is addressing this challenge through a consortium-wide science-to-policy capacity-building programme: 46 consortium members have been trained as trainers, who are expected to train up to 412 participants in national training sessions across 18 European countries.

As part of this wider initiative, a two-day science-to-policy training took place on 14-15 July at the Italian National Institute of Health (ISS), involving 35 Italian pilot teams within the JACARDI consortium. The training was developed at consortium level under JACARDI’s work package on sustainability and aimed at strengthening participants’ capacity to transform the knowledge generated through their pilots into evidence that can inform policies, institutional decisions and future public health action.

Grounded in JRC’s Evidence for Policy Programme, driven by collaboration and trust

“I believe that science-to-policy is the responsibility to ensure that the best available evidence contributes to improving decisions, systems, and, ultimately, people’s lives.” said Benedetta Armocida, JACARDI’s Coordinator. “This requires expertise, of course. But above all, it requires courage, collaboration, and mutual trust. No one can build this bridge alone.”


The training was grounded in the approach of the European Commission’s Joint Research Centre (JRC) Evidence for Policy Programme, designed to enhance the capacity to bridge the gap between science and policymaking. Within JACARDI, this bridge is particularly important: the Joint Action is implementing a wide range of pilot interventions to improve the prevention and management of cardiovascular diseases and diabetes across Europe, but their long-term value will depend on whether effective approaches can be sustained, transferred and embedded within health policies and services.


Turning scientific results into policy-relevant messages


Participants worked on communicating evidence and project results to policymakers and institutional stakeholders in a clear, targeted and actionable way. Rather than simply presenting data, they learned how to identify the most policy-relevant findings, understand the needs and priorities of different audiences and formulate messages that can support concrete decisions.


The training therefore addressed a central challenge at the science–policy interface: the same evidence may need to be communicated differently depending on whether the audience includes technical experts, health authorities, institutional leaders, patient representatives or political decision-makers. Participants explored how to select the appropriate messages, formats, channels and moments for engaging each audience.


Beyond technical communication skills, the course also provided participants with a deeper understanding of policymaking processes and the interaction between scientists, stakeholders, policymakers, and politicians. Particular attention was given to the role of evidence in decision-making and to the factors that influence the uptake of scientific results in policy contexts. This involved looking beyond the production of scientific evidence to consider the broader environment in which decisions are made, including institutional priorities, available resources, stakeholder interests, political feasibility and opportunities for change.


An interactive training based on real pilot cases

In addition, the training supported the development of Sustainability Action Plans of pilot projects, including stakeholder consultation processes and consensus-building activities. These tailored plans will help each pilot team identify the actors to involve, the evidence to communicate and the actions needed to preserve, integrate or scale up the most valuable elements of their work beyond the end of JACARDI.


The training was delivered in person over two days through an interactive format combining brief lectures, practical exercises, skills-based sessions, simulations, and role-play activities based on real pilot cases. It was conducted by three pairs of trainers, who were previously trained by two experts from the JRC, following a train-the-trainers approach. This model does more than transfer knowledge: it builds capacity within the JACARDI consortium, enabling the methods and skills acquired to be shared, adapted and applied across countries and future initiatives.


The interactive sessions allowed participants to apply the concepts directly to their work, making the training strongly practice-oriented and closely connected to the implementation challenges faced by pilot teams. Participants did not work on abstract scenarios, but on the actual evidence, stakeholders and sustainability challenges emerging from their interventions.


Building capacity that lasts beyond the project


A pilot cannot be considered fully successful solely because it produces positive results during its implementation. Its added value also lies in its capacity to inform broader change: improving existing services, influencing institutional practices, guiding resource allocation or contributing to new policies.


This capacity-building activity is expected to generate value beyond the immediate scope of JACARDI. The skills, tools and methodologies acquired will not only support the implementation and sustainability of the current pilot activities, but will also be transferable to future initiatives. By strengthening participants’ ability to work at the science-policy interface, the training contributes to building lasting institutional expertise that can continue to support evidence-informed public health decisions after the conclusion of the Joint Action.


Through this initiative, JACARDI is investing not only in the results of individual pilots across Europe, but also in the people, relationships and institutional capacities needed to turn evidence into action. The ultimate objective is to ensure that effective interventions do not remain isolated experiences, but contribute to more sustainable, transferable and equitable health policies and practices at both national and European levels.

Related resources:

JACARDI as a proof-of-concept for Europe’s Safe Hearts Plan

A new commentary in the International Journal of Public Health explores how JACARDI supports the translation of Europe’s Safe Hearts Plan into practical implementation. Activities conducted across JACARDI’s portfolio of over 140 pilots are generating practical implementation evidence on how public health strategies can be translated into practical action to prevent cardiovascular disease and diabetes. The authors argue that coordinated, life course-based approaches, combining prevention, early detection and integrated care, are essential to reduce the burden of these conditions across Europe.

Cardiovascular disease remains the leading cause of premature mortality and disability in the European Union. The article, by lead author Benedetta Armocida and other contributors from the joint action, highlights that the main challenge is not the lack of strategies, but how to implement them effectively and equitably across different health systems.

The article presents JACARDI as a proof-of-concept for implementing the EU Safe Hearts Plan. A key message is that cardiovascular disease and diabetes should be addressed together using a life course approach, recognising that risk factors build up over time. Early actions, such as health literacy programmes for children and young people, can support long-term health outcomes.

Linking detection, care and everyday support

The authors highlight that screening is effective only when it is connected to follow-up care. JACARDI pilots test different approaches, including community-based screening, mobile units and digital tools linked to lifestyle support.

The commentary also emphasises integrated care and self-management. Pilot interventions like a co-designed mobile application to optimize secondary prevention in Madrid and care pathways co-developed with patients and caregivers in the Basque Country demonstrate that digital and telemedicine solutions can support continuity of care and help people manage their condition in everyday life.

Equity and data as key priorities

The article underlines the importance of strong data systems and a focus on equity. Shared data models enable better monitoring of health outcomes and differences between population groups. Inclusive, targeted approaches are needed to ensure that prevention and care reach everyone.

Overall, the commentary highlights that JACARDI provides a practical model for turning policy into action. The authors conclude that combining a life course approach, integrated care and equity-focused implementation can support long-term improvements in cardiovascular health across Europe.

Read more: Commentary on JACARDI and the Safe Hearts Plan

Publication: Closing the implementation gap: the Joint Action on Cardiovascular Diseases and Diabetes (JACARDI) as a proof-of-concept for Europe’s Safe Hearts Plan

Authors: Benedetta Armocida et al. (on behalf of the JACARDI Implementation Board)

Journal: International Journal of Public Health

Publication date: 15 June 2026

DOI: https://doi.org/10.3389/ijph.2026.1609906

Building a coherent European approach to NCD prevention: how three JACARDI deliverables support action

Cardiovascular diseases and diabetes remain among Europe’s most pressing public health challenges. Their prevention and management require more than isolated interventions: they call for evidence-based planning, structured and coordinated action across countries, health systems and EU-funded initiatives.

JACARDI brings together evidence, implementation guidance and European collaboration through three key outputs: the Context Analysis, the Methodological Framework, and the Action Plan on Synergies.

Together, they illustrate how evidence, methodology and collaboration can be combined into a coherent approach to sustainable public health action.

Context Analysis: from mapping gaps to guiding action in CVD and diabetes prevention

Without coordinated and effective action, cardiovascular disease and diabetes will continue to pose major public health challenges across Europe. To better understand the current landscape, the Context Analysis provides a comprehensive overview of how prevention and management are currently organised in European countries, highlighting key strengths, gaps, and opportunities across health systems.

Rather than a purely descriptive exercise, the analysis is designed to directly support action. It helps pilot teams tailor their interventions to country-specific needs, ensuring they are relevant, adaptable, and grounded in evidence. By strengthening the link between knowledge and implementation, it improves the potential impact and sustainability of pilot activities across Europe.


The analysis is the result of a collaborative process involving National Focal Points for Health from 32 European countries and technical experts from the JACARDI country representatives, ensuring broad coverage and comparability. It also integrates evidence from best practice sources and scientific literature to support the identification of effective and transferable approaches.

Overall, the Context Analysis provides a shared evidence base to guide more informed, equitable, and sustainable responses to cardiovascular diseases and diabetes across Europe.

Methodological Framework: guiding implementation across 143 pilots in 18 European countries

The Methodological Framework provides both a theoretical reference and a practical operational tool for JACARDI’s 143 pilot projects across Europe. It is designed to support a guided, systemic and monitored implementation approach, while allowing flexibility for pilot teams to adapt to national and local realities.

The JACARDI framework supports pilot teams throughout the entire implementation journey, from identifying challenges and designing context-sensitive interventions to monitoring progress, evaluating results, and planning for long-term sustainability. Rather than following a linear process, the framework promotes continuous learning, reflection, and adaptation, enabling interventions to evolve in response to emerging needs and evidence.

Two cross-cutting principles underpin all JACARDI activities: equity and sustainability. Through a dedicated equity approach, pilot teams are supported in addressing social determinants of health and reducing inequalities, ensuring that interventions respond to the needs of diverse populations and leave no one behind. This effort is reinforced through expert guidance and capacity-building activities designed to embed an equity perspective beyond the lifetime of the project. Sustainability is integrated from the outset, encouraging policy alignment, stakeholder engagement, and long-term planning to maximise impact beyond EU funding.

Another distinctive feature of the framework is its multidimensional assessment approach. All pilot projects assess their results across six outcome dimensions, including health outcomes, efficiency, and patient experience, providing a comprehensive understanding of their impact and potential for scale-up.

Action Plan on Synergies: strengthening impact through European collaboration

The Action Plan on Synergies broadens the perspective to the European level, highlighting the importance of synergies between EU-funded initiatives on non-communicable diseases (NCDs). The rationale is that isolated projects cannot fully address the complexity of NCDs, and that greater impact can be achieved by connecting initiatives, aligning efforts, and fostering collaboration across programmes. This is operationalised through a framework embedded in the EU4Health Programme, which aligns objectives, activities, and resources across JACARDI and nine Action Grants.

Collaboration is supported by governance mechanisms, joint meetings, and continuous dialogue. A structured mapping allowed partners to identify complementarities, avoid duplication, and design more coordinated actions to strengthen each project’s contribution. By sharing tools, methods, and experiences, participating projects improve their ability to address common challenges, fostering innovation and supporting the faster uptake of effective practices across countries, ultimately leading to shared learning, greater visibility, stronger sustainability, and more inclusive approaches.

Together, these three outputs show how JACARDI is turning evidence into implementation and collaboration into wider European impact. By combining contextual insights, practical guidance and structured synergies, they support public health action that is adaptable, transferable and sustainable over time.

Explore the full set of deliverables here.

Health literacy in action: JACARDI partners share lessons from 25 European pilots

The second JACARDI health literacy meeting brought together more than 50 professionals from public bodies, research institutes, and healthcare organisations across 13 European countries to exchange progress and lessons learnt from 25 pilot projects.

Over the two-day event coordinated by Biosistemak and held at the Euskalduna Conference Centre on 3–4 June in Bilbao, participants shared implementation experiences from different health literacy contexts, analysed common challenges, and discussed the evaluation of interventions, the inclusion of equity and diversity, and the sustainability and impact of JACARDI’s work beyond the project.

As a part of its integrated approach, JACARDI addresses the entire patient experience, making health literacy one of the fundamental pillars of health promotion and disease prevention. By focusing on enhancing how populations access, understand, evaluate and apply health information, JACARDI empowers individuals to make more informed decisions about their own health and well-being.

As a result, people are better prepared to adopt healthier lifestyle habits and become active agents in their own well-being and that of their communities, reinforcing health literacy as a cornerstone of a healthier and more equitable Europe.

Health Literacy for a Healthier Europe: 25 JACARDI pilots leading the way

During these two days, representatives from different countries including Croatia, Czech Republic, Finland, France, Iceland, Italy, Lithuania, Malta, Poland, Portugal, Romania, Spain, and Ukraine, they have addressed critical gaps in health literacy by developing and adapting tools, structures, and processes that empower individuals to better manage their health. 

The pilots target a wide range of population groups, from adults and people living with diabetes, to pregnant women, children and adolescents, and people in vulnerable situations such as migrants, ensuring that interventions are tailored to the specific needs and circumstances of each community.

At the heart of JACARDI’s approach is a commitment to equity, inclusion, and co-creation. Rather than applying one-size-fits-all solutions, the project places end-users, patients and the general population at the centre of the design process, co-creating tools and interventions directly with those who will use them. 

A key instrument in this effort is JACARDI’s Equity and Diversity Matrix guiding the pilots to ensure that health programmes reach the most vulnerable groups, including migrants and socio-economically disadvantaged populations, leaving no one behind. 

Within health literacy-related pilots the interventions are also focused on reducing social inequalities by enabling fair access to health information, services, and resources, with particular attention to culturally and ethnically diverse communities who are often the most underserved. During the two-day meeting, pilots shared their progress and experiences, highlighting the importance of meaningful stakeholder engagement through the involvement of local, regional, and national entities as a critical driver of sustainable impact.

A highlight of the meeting was a joint activity including a dedicated synergies session, bringing together complementary EU-funded initiatives to share preliminary results and foster cross-project collaboration. Three projects presented their work: JA PreventNCD, focused on strengthening health literacy to reduce inequalities in cancer and other NCDs; the Preventia Action Grant addressing the prevention of diabetes, obesity, and cardiovascular disease; and the DUSE Action Grant, which focuses on counteracting diabetes through interdisciplinary educative programmes. 

This collaborative exchange reflects JACARDI’s broader strategy of enhanced health promotion through shared learning,  promoting the systematic exchange of health literacy policies, tools, and capacity-building initiatives among member states, encouraging the adoption of WHO-recommended frameworks, and ensuring equity-driven health promotion across Europe.

Basque pilot supports youth to build health literacy for healthier daily habits

In the Basque Country region in Spain, Biosistemak Institute, together with Osakidetza, is leading a JACARDI pilot that aims to strengthen health literacy among adolescents and young people. Implemented under Work Package 6, which focuses on health literacy and awareness of cardiovascular diseases and diabetes, the pilot contributes to JACARDI’s wider goal of reducing the burden of non-communicable diseases through prevention, equity and stronger health systems.

The pilot responds to a central challenge in chronic disease prevention: young people need health information and resources that are understandable, relevant and usable in daily life. By supporting adolescents and young people to better access, understand and apply health information and services, the Basque pilot seeks to help them build healthier habits early, before cardiovascular disease and diabetes risks become established.

Making health information meaningful for young people

Health literacy is not only about providing information. It is about making sure that people can use that information and services in real situations: when making food choices, understanding physical activity recommendations, navigating health systems or recognising how everyday habits can influence long-term health.

As explained by Irati Erreguerena Redondo, Researcher and Project Manager at Biosistemak, the Basque pilot places young people at the centre of this process. Rather than applying a “one-size-fits-all” model, Biosistemak works within the JACARDI implementation methodology to adapt the pilot to the regional context, and integrate the needs of adolescents and young people as well as the realities of the Basque health system. This reflects the broader JACARDI approach, which promotes a co-designed health literacy programme based on local needs and situations, enhancing a participatory process with community stakeholders integrating the equity and sustainability perspective.

“By improving health literacy early in life, we can help adolescents and young people make informed choices that support their health now and in the future,” says Irati Erreguerena Redondo, Researcher and Project Manager at Biosistemak Institute for Health System Research.

From local action to European learning

The pilot also contributes to JACARDI’s wider commitment to equity. Young people do not all access, understand, use and appraise health information in the same way, and their opportunities to act on it can be shaped by social, economic, cultural and family circumstances. By focusing on understandable and relevant communication, the pilot aims to reduce barriers and make prevention more feasible for all. 

The results from the Basque Country pilot will contribute to JACARDI’s shared learning on how health literacy can support prevention from an early age. Insights from the pilot will feed into the project’s assessment and sustainability work, helping identify what can be maintained, scaled up or transferred to other settings after the project ends.

By helping adolescents and young people turn health information, resources and services into practical everyday choices, the Basque pilot shows how health literacy can become a foundation for healthier lives and more resilient health systems.

New RESIL-Card tool supports resilient and equitable cardiovascular care across Europe

A new online tool called RESIL-Card has been recently launched to help European healthcare professionals strengthen the resilience of cardiovascular care pathways and safeguard the continuity of lifesaving care during times of crisis.

The free resource was developed through the eponymous project, which is co-funded under the EU4Health Work Programme and led by the We CARE advocacy group. It provides a structured framework for assessing preparedness and identifying practical actions to ensure that essential cardiovascular services remain accessible when health systems are facing disruption.

Cardiovascular diseases remain the leading cause of death in Europe, making uninterrupted access to diagnosis, treatment and follow-up care a major public health priority. Following the COVID-19 pandemic and recent challenges, vulnerabilities in healthcare systems have been exposed, emphasising the importance of stronger preparedness planning. RESIL-Card was developed to help healthcare organisations move beyond crisis response and build resilience into routine service delivery.

Strengthening preparedness through collaboration and evidence

RESIL-Card is designed “by and for” hospital multidisciplinary teams involved in cardiovascular care. Through a structured, four-step self-assessment process, users can evaluate the preparedness of their care pathways, identify strengths and gaps, and define tailored actions to support and leverage improvement.

The tool was developed through an extensive co-creation process involving clinicians, public health experts, patient representatives, and policymakers from across Europe. By combining scientific evidence, existing preparedness frameworks and real-world experience, RESIL-Card translates resilience concepts into practical actions that can be implemented in diverse healthcare settings and geographies.

“The value of the RESIL-Card tool is that it gives our team a structured way to identify gaps we had intuitively recognised but never formally addressed,” says an early adopter of the tool.

Supporting JACARDI’s vision for stronger health systems

RESIL-Card’s objectives closely support JACARDI’s efforts to strengthen prevention, care pathways and health system sustainability across Europe. By helping healthcare organisations assess vulnerabilities, improve preparedness, and maintain the continuity of cardiovascular services during periods of disruption, the tool contributes to creating more sustainable and equitable health systems for people living with cardiovascular disease.

The initiative is also aligned with key European policy priorities, notably the EU Safe Hearts Plan and the health preparedness pillar of the EU Preparedness Union Strategy. RESIL-Card’s practical assessment framework helps translate these strategic objectives into concrete actions that healthcare providers can implement to strengthen preparedness, protect access to care and improve long-term system resilience.

By helping healthcare teams anticipate risks, improve coordination and strengthen service continuity, the tool supports a proactive approach to quality improvement and preparedness. It also encourages a patient-centred approach by prompting healthcare providers to identify and address vulnerabilities that could impact access to diagnosis, treatment and follow-up care. In doing so, RESIL-Card can help reduce inequalities in access to cardiovascular services and improve outcomes for people living with cardiovascular disease, particularly during periods of disruption.

“Cardiovascular care must remain uninterrupted regardless of the challenges health systems face. The RESIL-Card tool provides healthcare teams with a practical way to assess preparedness, identify improvement opportunities, and ultimately ensure that patients continue to receive lifesaving care when it matters most,” says Professor William Wijns, Research Professor in Interventional Cardiology at the University of Galway (Ireland) and coordinator of the RESIL-Card initiative.

By providing a common framework for assessing and strengthening preparedness, RESIL-Card contributes to ongoing European efforts to build more resilient health systems, promote the exchange of good practices across Member States, and support the implementation of strategies aimed at improving cardiovascular health, reducing inequalities and ensuring continuity of care during future crises.

RESIL-Card is already gaining traction across Europe, supported by national interventional cardiology working groups and hospitals that are helping drive its dissemination and implementation.

The tool is freely available through multiple dissemination channels to healthcare professionals, healthcare organisations, hospital groups, policymakers and other stakeholders who are committed to strengthening cardiovascular care resilience and protecting access to high-quality care for all, especially when it is needed most.

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Access the online RESIL-Card tool here
Learn more about the RESIL-Card initiative

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Relearning life after a heart attack: How patients are shaping their recovery

Through JACARDI´s AMIGA (Acute Myocardial Infarction Guidance and Adherence) pilot project, patients, clinicians, and researchers at Hospital 12 de Octubre in Madrid (Spain) and the Spanish National Centre for Cardiovascular Research (CNIC) are co-creating a mobile app to support life after a heart attack, turning uncertainty into guidance, and recovery into a shared journey. 

When María Eugenia left the hospital after her heart attack, she didn’t just carry a discharge report, she carried uncertainty. “This session felt timely and necessary for patients who leave the hospital feeling a bit lost or overwhelmed”, she says, speaking about one of the recent co-design sessions organised within the AMIGA pilot project at Hospital 12 de Octubre in Madrid (Spain). 

AMIGA is part of JACARDI’s Work Package on patients’ self-management. Led by Hospital 12 de Octubre and the Spanish National Centre for Cardiovascular Research (CNIC), it focuses on improving self-management after a heart attack through a co-designed mobile application. 

María Eugenia’s words capture a moment that many patients will recognize: the transition from hospital to home, when clinical care gives way to self-care and questions often outnumber answers. It is precisely in this vulnerable period where the project aims to make a difference.  

The initiative is led by Dr Héctor Bueno, cardiologist and scientific director of the Cardiovascular Research Area at the i+12 Research Institute, Hospital Universitario 12 de Octubre, in Madrid; leader of the JACARDI working group on data availability and quality; and leader of a research group at CNIC. 

A digital companion for life after a heart attack

The AMIGA pilot is developing a mobile application designed to support people recovering from a heart attack. Grounded in principles of positive psychology, the app aims to enhance therapeutic adherence and empower patients in their day-to-day self-care. 

Fifteen participants, most aged between 70 and 75, took part in individual sessions simulating the real patient journey: from recruitment into the program to hands-on interaction with the app. Among them, one participant stood out as a powerful reflection of the project’s ambition: a 95-year-old woman who became one of its key advisors. 

Behind this pilot lies a broader vision. Managing cardiovascular disease and diabetes depends not only on what happens inside hospitals, but largely on what patients are enabled to do in their everyday lives. 

JACARDI’s Work Package on patients’ self-management focuses precisely on strengthening that capacity. Its pilot projects explore how patients can be better supported to adopt healthier lifestyles, monitor their symptoms, follow treatments correctly, and communicate more effectively with healthcare professionals, especially nurses, who play a vital role in this project. Equally important, they address something less visible but not less critical: how people cope with the emotional and practical challenges of living with a chronic condition.

When patients are equipped and confident to manage their health, outcomes improve, not only in terms of quality of life, but also through reduced avoidable complications and lower pressure on health systems.  

Listening before building 

These sessions were not only about testing technology; they were about understanding people, how they think, what they need and where they struggle. As Dr Bueno explains, this approach is not just desirable, it is essential: 

“Many digital health solutions are developed without direct patient involvement, often resulting in low usage and adherence rates. In addition, given that the typical profile of these patients tends to be older, designing a digital tool that is accessible to individuals with potentially low digital literacy presents an additional challenge,” explains Dr Bueno. 

The AMIGA project places patients at the centre of the design process, shaping everything from language and tone to usability and content. 

Building together 

The sessions were enriched by the involvement of ASECOR, the Association of Cardiac Patients at Hospital 12 de Octubre, bringing lived experience and a strong sense of community into the process.

As Antonio Sánchez, President of ASECOR, highlights, “it’s important not only to give visibility to these diseases, but also to raise awareness through the experiences of the patients participating in the project.” That perspective is grounded in long-standing collaboration with the hospital, which Carlos Quijorna, Treasurer of ASECOR, describes as “contributing our grain of sand.”

Ultimately, the value of the initiative lies in something deeply human: reducing the sense of isolation many patients feel after discharge. As Luis Álvarez, Secretary of ASECOR, puts it, “this application helps patients who, until now, often felt alone. With this, they feel more supported and can consult about their own condition.”

Co-design as a path to impact 

These sessions are part of an ongoing process involving patients, caregivers, healthcare professionals, researchers, and technology experts. Each conversation, each piece of feedback, helps transform the app into something more than a digital tool, it becomes a reflection of real needs, real concerns, and real lives. 

For the JACARDI pilot, this approach maximizes the likelihood of real-world impact. For participants, it offers something equally valuable: the chance to shape a solution that could improve the lives of future patients.

And for people like María Eugenia, it turns a moment of uncertainty into one of purpose.

Equity Lens: Reframing NCD surveillance for equity-driven health systems

Small states in Europe, like Malta, provide an important opportunity to advance equity-focused surveillance, as smaller populations, centralised systems, and shorter distances make it easier to gain a comprehensive picture of population health. This data offers important signals for policymaking. As part of JACARDI’s Equity Lens series, this article explores what larger countries can learn from smaller ones, and how population-level surveys on non-communicable diseases could be developed to be more equity-driven, thereby helping to improve health systems so they are suitable for all.

Non-communicable diseases (NCDs) account for over 70% of deaths worldwide. Yet current health monitoring systems do not adequately capture who is affected and why.

Most surveillance relies on mortality data, hospital records, and self-reported surveys. While valuable, these sources primarily reflect late stages of disease and clinical outcomes. As a result, health systems often measure what is easiest, rather than what matters most for health equity. Prof. Sarah Cuschieri, a leading voice in chronic disease epidemiology and an associate professor  at the University of Malta, shared learnings in JACARDI Masterclass titled “Small States, Shared Equity Challenges: Reframing NCD Surveillance for Equity-Driven Health Systems”.

The missing middle of the disease pathway

According to Prof. Cuschieri, a major weakness of current surveillance is that it overlooks large parts of the disease pathway. Undiagnosed conditions, differences in awareness and access, patterns of risk clustering, and variations in treatment adherence and disease control often go unmeasured.

These are not minor gaps, they represent the earliest and most preventable stages of disease. When they remain invisible, disadvantage accumulates over time. This creates a “cascade of inequity,” where people with fewer resources face higher risks, delayed diagnoses, poorer treatment, and ultimately worse outcomes. By the time inequalities appear in morbidity statistics, they are already deeply entrenched and much harder to address.

Making inequities visible through Health Examination Surveys

Health Examination Surveys (HES) offer a more equitable approach to surveillance. Unlike routine data systems, HES are population-based, standardised, and biomarker-integrated. This allows them to identify both diagnosed and undiagnosed disease.

They also reveal how health varies across income, education, sex, age, and other demographic factors. When conducted regularly, HES should be seen not as one-off research projects, but as essential health system infrastructure.

Critically, they help identify who is being left behind, those unaware of their condition, inadequately treated, or unable to achieve disease control. In doing so, they make inequities visible and actionable signals for policy.

Small states as living laboratories for equity-oriented policy

Small states offer an ideal setting for building surveillance systems that support health equity. Their smaller populations and centralized structures allow near‑complete population coverage instead of fragmented data. This makes it easier to move from data to decisions quickly and to clearly see differences between population groups.

They also act as “living laboratories,” where policies can be tested and their effects seen sooner. The fast cycle from data to action means we can learn quickly what works, for whom, and under what conditions. As a result, small states can detect emerging trends early and provide valuable lessons for larger countries.

Towards fairer surveillance and policies

The lessons derived from small states are highly transferable and point toward a necessary reframing of surveillance in larger systems:

  • Surveillance must capture the full disease pathway, not just mortality
  • Indicators should be systematically disaggregated by socioeconomic factors
  • Data sources should be linked to track how inequities develop over the life course
  • Surveillance is inherently a political choice, measuring inequity creates accountability
  • Designing more effective systems requires sustained political commitment.

Read our interview with Sarah Cuschieri, a member of JACARDI’s advisory board here:

Sarah Cuschieri: Transforming small-state initiatives into the strength of Europe

Further readings:

Co-creating health literacy actions with migrant communities in Portugal for more equitable prevention

How can cardiovascular disease and diabetes prevention become more inclusive, accessible, and meaningful for populations experiencing vulnerabilities?

In Portugal, two pilots within JACARDI’s work package on Health Literacy are exploring how locally co-created health literacy actions can make cardiovascular disease and diabetes prevention more inclusive, accessible, and meaningful.

While each pilot addresses distinct population needs, both are guided by the Ophelia approach, Optimising Health Literacy and Access. This shared framework supports their commitment to equity-oriented prevention, locally tailored interventions, and participatory implementation.

One of the pilots, led by the NOVA National School of Public Health, focuses on migrant communities in the Lisbon Metropolitan Area. It aims to strengthen health literacy and support informed action to protect and promote health, with a particular focus on diabetes and cardiovascular disease. Special attention is given to people who may face additional barriers to health information, prevention, and care, including recent arrivals, women with caregiving responsibilities, and those less often reached by traditional health promotion initiatives.

Building and co-creating solutions with communities

The migrant-focused Portuguese pilot combines quantitative and qualitative methods with a participatory process, following key components of the Ophelia approach. During the first needs and resources assessment stage, the pilot involved more than 1,200 people, including over 1,100 migrants who completed a multilingual Health Literacy Questionnaire. Interviews and a photovoice study further explored lived experiences of health, prevention, and access to care, informing the development of 16 health literacy profiles and vignettes later used in idea-generation workshops with migrants and other stakeholders.

The workshops generated more than 70 action ideas, which were then refined through prioritisation workshops to select health literacy actions, strengthen the programme theory of change, and co-design the evaluation. 

Community engagement was built around co-creation from the outset, through a Community Board and a structured participatory process involving migrants, community organisations, health and social care professionals, researchers, decision-makers, and local stakeholders. The project placed particular emphasis on safe participatory spaces, supported by flexible scheduling, multilingual facilitation, child-friendly arrangements, and emotional support mechanisms. Migrant informal leaders were also trained as peer experts to co-facilitate sessions, helping to build trust and strengthen community capacity for sustained engagement beyond the project.

Testing culturally adapted health literacy actions

Following the co-design phase, the pilot moved into implementation across community organisations, with Health Links sessions adapted at the start of each group to reflect participants’ needs, priorities, and everyday contexts. To date, more than 100 migrant participants from 18 countries of origin have taken part in sessions covering communication with healthcare professionals, navigation of the Portuguese National Health System, understanding health information, healthy nutrition, physical activity, and cardiovascular disease and diabetes prevention.

The sessions combined practical learning, peer exchange, culturally adapted examples, and community participation to strengthen health literacy as a shared responsibility between individuals, communities, and services. Activities included role plays with health professionals, games on misinformation and reliable health information, tailored nutrition activities based on participants’ cultural food practices, and outdoor physical activity sessions in public parks.

The pilot evaluation used a mixed-methods approach, combining baseline and post-intervention data with qualitative feedback from participants, facilitators, and partner institutions. Preliminary results show strong participation, high acceptability, feasibility, perceived usefulness, and improvements in health literacy and behaviour change. Participants particularly valued the practical and culturally relevant content. 

From implementation to sustainability

Recently, the Portuguese teams welcomed colleagues from JACARDI’s Sustainability team for a joint working visit focused on long-term sustainability, transferability, and the integration of pilot activities into existing health and community systems. The visit included meetings with both pilot teams and visits to implementation settings, enabling direct exchange with participants, researchers, facilitators, community stakeholders, and participating institutions.

Discussions explored how co-creation practices, community ownership, and peer involvement can support continuity beyond project funding. The visit also highlighted reflective implementation practices already emerging within the pilots, including continuous adaptation based on participant feedback, collaboration with organisations and services, and multilingual and culturally sensitive facilitation strategies.

“The project has shown us that meaningful prevention cannot be designed far from people’s realities. Co-creation with migrant communities was not an accessory component, it became the foundation for building trust, relevance, and sustainability,” said Maria João Marques, researcher at NOVA and JACARDI Portugal scientific coordinator.

This focus on sustainability is also informing broader work at national level. Building on the lessons emerging from the Portuguese pilots, a national methodological roadmap is currently being developed in Portugal by the Directorate-General of Health (DGS), NOVA, and the Portuguese Diabetes Association (APDP), to support the implementation of health literacy actions across Local Health Units. The roadmap aims to facilitate the future adaptation, replication, and sustainability of community-based approaches.

In January 2026, interim findings from the JACARDI pilots in Portugal were presented during a national webinar on co-creation and health literacy. The event gathered more than 200 participants from health, policy, academic, and community sectors, strengthening dialogue around prevention, diabetes care, and culturally responsive health literacy interventions.

For those involved, the pilot has also created a different kind of experience. As Cadi Chengelam, one of the participants in the migrant-focused health literacy activities, reflected: “For the first time, I felt that people listened to our difficulties and adapted the sessions to our culture and daily life. It did not feel like receiving instructions, it felt like building solutions together.”

In the coming months, the teams will continue refining materials, analysing evaluation findings, and exploring opportunities for long-term integration within healthcare and community settings.

INCLIVA brings workplace health education to workers and employers across Spain

INCLIVA, the Health Research Institute of the Hospital Clínico Universitario de València, presented its work within JACARDI at Conecta INCLIVA, a public seminar held on 14 May in Valencia. Bringing together patients, researchers and clinicians, the event offered a space to connect ongoing European research with the people most affected by these conditions and shared the latest scientific advances in cardiovascular health and diabetes.

Cardiovascular diseases remain the leading cause of mortality in Europe, and diabetes already affects one in ten people over the age of 55 in Spain. These figures underline that public engagement with research is not just valuable, but necessary.

The event showcased four active European projects led or supported by INCLIVA‘s cardiovascular research team. The team consists of more than 200 researchers, has produced over 1,300 scientific publications, and currently has nearly 200 active projects and clinical studies. Among these, Dr. Clara Bonanad and Dr. Josep Redón presented JACARDI.

INCLIVA participates in JACARDI as an affiliated entity under FundeSalud, which serves as the Spanish competent authority in the Joint Action. INCLIVA plays an active role across five pilots covering data, screening, prevention, personalised care and health education.

Taking health education into the workplace

Within JACARDI’s health education projects, INCLIVA is developing an online training programme for workers and employers. The initiative aims to equip participants with practical self-care tools, raise awareness about cardiovascular risk, and support the workplace inclusion of people living with these conditions.

The programme consists of ten short five-minute videos, complemented by downloadable materials for all participants. To assess the learning impact, the course includes an evaluation of the knowledge acquired, measures how that knowledge is integrated into daily routines, and solicits participants’ feedback about their experience of the platform. The roll-out of the initiative is currently in progress. 

Citizens as partners in research

The event also highlighted citizen science, private philanthropic funding, and the importance of integrating patient perspectives, including a discussion on gender equity in cardiovascular research. One of the event’s special guests,  Ms. Maite San Saturnino, President of the Spanish Heart Foundation‘s patient association and an important JACARDI stakeholder, joined in a conversation that opened into a wider audience discussion on the active role citizens can play in scientific progress. 

Ms. Mariola Penadés Fons, Director General of Research and Innovation at the Valencian Regional Health Ministry brought the event to a close by highlighting that research only fulfils its purpose when it reaches the people it was always meant to serve. It is precisely this spirit that drives JACARDI’s work and INCLIVA’s commitment to bringing it into workplaces, communities and everyday life.

From a European project to a permanent resource for citizens: how Cantabria is building a sustainable and inclusive health education model

How can a health education initiative continue to generate impact once a European project comes to an end? This is one of the key questions guiding the work carried out in Cantabria by the Nursing Research Group at IDIVAL as part of JACARDI.

The pilot project titled MOOCs to Improve CVD & Diabetes Literacy implemented within JACARDI’s work package on Integrated Care Pathways, aims to improve health literacy and self-care among people living with diabetes and cardiovascular diseases by offering free online courses. Designed for and with patients, the courses help participants better understand their conditions and take an active role in managing their health.

Through this project, the team has developed a free online course aimed at people living with diabetes and cardiovascular disease, designed to improve health literacy and promote self-care. The programme has now reached its fifth edition, engaged more than 150 participants, and more than 90% of those who complete the training consider it highly useful.

By strengthening patients’ knowledge, confidence and self-management skills, the initiative contributes to improving patient pathways in Cantabria, promoting a more informed and active participation in healthcare and supporting long-term disease management.

Building a course with patients, professionals and communities

However, the goal extends beyond the development of a digital educational resource. The project has focused on building a collaborative model involving expert patients, healthcare professionals, researchers, patient associations and the Cantabrian School of Health, with the aim of creating content that is more accessible, relevant and useful for the people it is intended to serve.

“Sustainability is not only about keeping a course active; it is about creating a stable, updatable resource that can continue reaching citizens through different channels,” explains Paula Parás, IDIVAL researcher and coordinator of the pilot programme.

The programme’s continuity is being developed in close collaboration with the Cantabrian School of Health, where the materials created through JACARDI are progressively being integrated into its regular activities to ensure their availability beyond the project’s duration. At the same time, the team is exploring ways for the course to be recommended by physicians and nurses as a complement to routine clinical care.

The courses are freely available online and can be accessed through an online platform.

Equity is another cornerstone of the initiative. To make the training accessible to diverse population groups, IDIVAL collaborates with organisations such as COCEMFE Cantabria, UNATE, Movimiento por la Paz, Fundación Secretariado Gitano, Plataforma Romanés and several adult education centres across the region.

“Chronic diseases require continuous care, and education is essential for helping people better understand their condition and adopt a culture of self-care,” says Mariló Damalia Pineda, Managing Director of COCEMFE Cantabria.

This pilot is closely linked to other JACARDI activities implemented by IDIVAL in Cantabria. Alongside this pilot, the institution is also developing another pilot within JACARDI’s work package on Health Literacy and Awareness, based on online courses for the general population focused on cardiovascular disease prevention, and third pilot as a part of the work package on ‘Patients’ self-management’, aimed at strengthening face-to-face health education workshops through the integration of scientific evidence.

Embedding JACARDI results into Cantabria’s health system

Although these initiatives target different audiences and pursue different objectives, they share a common sustainability strategy through the Cantabrian School of Health, which is part of the Cantabrian Health Service. This collaboration helps ensure that the resources, knowledge and methodologies generated through JACARDI can continue benefiting citizens beyond the lifetime of the project.

This integrated approach has attracted the attention of JACARDI’s European sustainability leaders, who recently visited Cantabria to learn how research, the healthcare system and community organisations are working together to transform project outcomes into long-lasting benefits for citizens.

Making patient experience count: Finland’s JACARDI pilot brings patient voices into diabetes care

Led by the University of Eastern Finland (UEF), this pilot is coordinated by Professor Tomi Mäki-Opas, together with study coordinators Sonja Julkunen and Katja Soininen, and focuses on the digital collection of Patient Reported Outcome Measures (PROMs) in diabetes care.

How do people with diabetes actually feel in their everyday lives, beyond clinical indicators and laboratory results? 

That is the question behind one of JACARDI’s most forward-looking data pilots. Led by the University of Eastern Finland (UEF) within JACARDI’s Work Package on Data, the pilot explores how digital tools can be used to collect PROMs from people living with type 1 and type 2 diabetes receiving specialised care. 

The initiative focuses on the EQ-5D-5L questionnaire, an internationally recognised PROM tool that captures dimensions such as mobility, pain, anxiety and daily functioning. But the ambition goes far beyond digital surveys.

The pilot aims to understand how patient-reported outcomes can support value-based healthcare and help healthcare professionals see a more complete picture of diabetes management. 

“We now have the first real-world experience of integrating digital PROM collection into routine diabetes care,” explains study coordinator Sonja Julkunen.

Turning patient-reported outcomes into everyday care

The digital data collection officially started in February 2026 at the endocrinology outpatient clinic of the Wellbeing Services County of North Savo in Finland. Since then, the project team has already gathered important operational insights and encouraging early participation figures.

During the first 11 weeks, 545 patients were targeted for the baseline questionnaire. Among patients who received digital notifications, nearly half completed the questionnaire, and more than 70% of all responses were collected digitally.

Behind these numbers lies a carefully designed digital pathway. Patients receive text message reminders before their appointments and complete the questionnaire through the OmaSavo Plus platform using strong digital identification. The information is then transferred into a data lake and made accessible to healthcare professionals through a platform connected to electronic health records.

The experience has also highlighted the real-world challenges of digital innovation in healthcare.

Since the questionnaire follows strict digital representation guidelines, the team developed a custom-built form solution when existing systems could not adequately display the questionnaire format. Tight clinical schedules also make it difficult for doctors and nurses to systematically review responses during appointments.

Yet the pilot is already showing added value in patient interaction.

Healthcare professionals reported that the questionnaire can help initiate conversations, particularly with younger adults who may not spontaneously discuss wellbeing or mental health concerns during consultations. In some cases, nurses were able to identify issues in advance and alert physicians before appointments.

The project has also invested heavily in communication and patient engagement. Information campaigns were launched through social media, press releases, posters in clinics and collaboration with diabetes patient organisations — demonstrating that successful digital health innovation depends as much on communication as on technology.

From Finnish implementation to European learning

The pilot arrives at a particularly important moment for Finland’s healthcare system. The Finnish Ministry of Social Affairs and Health has designated the EQ-5D-5L questionnaire as the national generic PROM measure, with diabetes among the first target areas for implementation.

This means that the experience gathered through JACARDI’s pilot informed a broader national expansion of PROM data collection into primary healthcare and specialised diabetes services across Finland.

The pilot team will continue refining the system in the coming months, testing new approaches to improve response rates and strengthen value-based analysis.

Ultimately, digital healthcare transformation is not only about collecting more data, but about making patient experiences visible, actionable and impossible to ignore.

This is exactly where JACARDI’s Work Package on Data comes in: building the foundations for more accurate, comparable and patient-centred data on cardiovascular disease and diabetes across Europe. This pilot from the UEF is one step in that direction, turning patient-reported outcomes into real-world evidence that can help close gaps, highlight inequalities, and support better-informed healthcare decisions.