Better health for Europe - equitable and sustainable
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Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the School of Public Health Management (Chisinau, Republic of Moldova, 24 November 2016)
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Better health for Europe - equitable and sustainable
- 1. Better health for Europe – equitable and sustainable Dr Zsuzsanna Jakab WHO Regional Director for Europe School of Public Health Management Chisinau, Republic of Moldova 24 November 2016
- 2. Facing the future • Health 2020 • Sustainable Development Goals (SDGs) • Health higher on the political agendaRepublic of Moldova: World Health Day 2016
- 3. Health 2020 • Health is a political choice • Public health approach • Two strategic objectives • Four priority areas
- 4. The new global framework: United Nations 2030 Agenda for Sustainable Development 4 Health in all policies = health in all SDGs
- 5. Life expectancy trends Life expectancy at birth (years), males Life expectancy at birth (years), females 60 65 70 75 80 1980 1990 2000 2010 1980 1990 2000 2010 European Region CIS Republic of Moldova CIS: Commonwealth of Independent States Source: European Health for All database. Copenhagen: WHO Regional Office for Europe; 2016
- 6. Standardized death rate, major NCDs* 30–69 years, males and females SDR, major noncommunicable diseases, 30-69 years, males SDR, major noncommunicable diseases, 30-69 years, females 400 800 1200 1600 1980 1990 2000 2010 1980 1990 2000 2010 European Region CIS Republic of Moldova Note: NCDs = noncommunicable diseases Source: European Health for All database. Copenhagen: WHO Regional Office for Europe; 2016
- 7. Age-standardized prevalence estimates for current smoking of any tobacco product among adults, 2012 Note: Country codes are International Organization for Standardization codes not WHO codes. Source:, Global status report on noncommunicable diseases. Geneva: World Health Organization; 2014
- 8. Alcohol consumption Pure alcohol consumption, litres per capita, age 15+ 0 5 10 15 1980 1990 2000 2010 European Region CIS Republic of Moldova Source: European Health for All database. Copenhagen: WHO Regional Office for Europe; 2016
- 9. Universal health coverage: key strategic focus Republic of Moldova: National Health Forum 2015 Tajikistan: Flagship course on strengthening health systems
- 10. AIDS incidence and tuberculosis mortality trends Incidence of AIDS per 100 000 SDR, tuberculosis, all ages, per 100 000 0 5 10 15 20 10 20 30 40 1980 1990 2000 2010 1980 1990 2000 2010 European Region CIS Republic of Moldova Source: European Health for All database. Copenhagen: WHO Regional Office for Europe; 2016
- 11. Eliminating mother-to-child transmission of HIV and syphilis 11 Armenia Republic of Moldova Belarus
- 12. Maternal and infant mortality Maternal deaths per 100 000, max of cod and clinical data Infant deaths per 1000 live births 0 40 80 120 10 20 30 40 50 1980 1990 2000 2010 1980 1990 2000 2010 European Region CIS Republic of Moldova Source: European Health for All database. Copenhagen: WHO Regional Office for Europe; 2016
- 13. Republic of Moldova: percentage of children vaccinated against measles, 2013 Source: European Health for All database. Copenhagen: WHO Regional Office for Europe; 2016
- 14. Celebrating the achievements – European Immunization Week 14 European Immunization Week 2016, Republic of Moldova
- 15. Source: European Centre for Disease Prevention and Control Source: WHO Regional Office for Europe European Antimicrobial Resistance Surveillance Network (EARS-Net) CAESAR (Central Asian and Eastern European Surveillance of Antimicrobial Resistance) network
- 16. Global Antibiotic Awareness Week, November 2016 16 Her Royal Highness Crown Princess Mary of Denmark World Antibiotic Awareness Week 2016, Republic of Moldova
- 17. The Health emergencies programme expands WHO’s role in emergencies Technical and normative Operational +
- 18. Preparedness and building International Health Regulations core capacities 18 Photo: WHO/Jan-Ole Rasmussen Hospital Safety Assessment, Republic of Moldova, June 2016
- 19. Better health for Europe More equitable and sustainable
Hinweis der Redaktion
- Your Royal Highness, excellences, dear Minister, health leaders in Moldova, colleagues, ladies and gentlemen, I am addressing you today, the present and future public health leaders in the Republic of Moldova.
- In the European region, we have been facing a growing number of challenges, such as, health inequalities, poverty, civil unrest, migration, terrorism, complex emergencies and climate change with extreme weather events. All had a profound impact on our work. But there have also been many opportunities for countries opened up by the European policy framework Health 2020 and the new 2030 agenda for sustainable development. Moldova has had a robust national development strategy, and health shall be high on the political agenda.
- The European Policy Framework Health 2020 pursue two strategic objectives: Improving health for all and reducing health inequalities; Improving leadership and participatory governance for health and focus on four priority areas: Investing in health through a life-course approach; Tackling communicable and non-communicable diseases (and this is important given Moldova’s double burden); Strengthening people-centered health systems, public health capacity and emergency preparedness, surveillance and response; and Creating resilient communities and supportive environments.
- Health and wellbeing is an outcome, a determinant and an enabler of the 17 Sustainable Development Goals and over 25 targets. The SDGs and Health 2020 give us the opportunity to tackle all health determinants. We therefore link the social, economic, cultural and environmental determinants, as well as gender and rights approaches, to reduce health inequities and leave no one behind. Whole-of-government and whole-of-society efforts are required to ensure health-in-all policies at country level through inter-sectorial work and shared responsibility. Moldova started the nationalization and localization of SDGs.
- Overall, there have been positive trends reported in the health status in the Region. Yet, not everybody benefited, and health inequities continue to scar the Region. Life expectancy has been growing in the Region, averaging above 77 years in 2013, but a gap exists with EU (above 80 years). In 2013, life expectancy reached 72 years in Moldova, which is within the CIS range. Besides, there is almost an 8-year gap in life expectancy between men and women.
- Non-communicable diseases are the main cause of the disease burden, yet some 80% of premature mortality is considered to be preventable. The chances of dying from heart disease or stroke before the age of 64 has been declining since 2000 in all parts of the Region. In Moldova there is a similar trend with a 24% decrease in premature mortality since 2000, but on average still the standard death rate owing to circulatory diseases is almost 3 times higher compared to EU countries. This inequality calls for action now.
- Among the WHO regions, Europe has the highest prevalence of tobacco smoking among adults (28%) and some of the highest prevalence of tobacco use by adolescents. The burden of smoking in Moldova is high, with more than one quarter of adult population smoking in 2014. The share of male smokers is 8-times higher than that of female smokers (43.6% men). Moldova passed a comprehensive tobacco control law in 2015. Moldova enacted legislation on banning smoking in public places effective May 2016. However, challenges remain with enforcing these regulations.
- Alcohol intake in the WHO European Region is the highest in the world. The harmful use of alcohol is related to premature death and avoidable disease. The recorded alcohol consumption per capita in Moldova was 6.3 liters per capita in 2011 – one quarter lower than the averages for the Region and the CIS. However, the combined recorded and unrecorded consumption of alcohol in Moldova is the highest in the world, tallying up to 16.1 liters per capita in 2012. Moldova has been working on updating the laws on alcohol control since 2014.
- We work closely with authorities and partners on health system strengthening. Moldova is one of leaders in organizing policy dialogues, conducting studies and drafting proposals for further improvements. To have measurable and tangible results, WHO will continue supporting the health authorities in Republic of Moldova in implementing a systematic approach to change the health services provision model towards more integration and people-centredness, building a quality improvement culture and practice, ensuring motivated health care workforce and team approach, financial protection, having stable health financing, and ensuring availability and affordability of safe medicines. Equity and removing health inequalities is the cornerstone of the Health 2020 policy framework.
- WHO European Region is the only one where the HIV epidemic is still growing. The HIV epidemic in Moldova is concentrated in key groups, like people who inject drugs, sex workers, men having sex with men, and their partners. Moldova is among the WHO European Region’s 18 high priority countries for tuberculosis and among the world’s 27 high multi-drug resistant TB burden countries. Major challenges persist in TB control, patient treatment follow-up and infection control. Drug-resistant TB accounts for almost one-quarter of all new patients and two-thirds of retreatment cases. New National HIV Control and National TB Control programs were developed and endorsed in 2016 aligned with the global health sector strategy for HIV and the End-TB Strategy.
- Five countries globally received validation of elimination of mother-to-child transmission of HIV and syphilis. I am proud to announce that three are in our Region; including the Republic of Moldova. Moldova also participated in the piloting of the three validation tools. Currently, Moldova is contemplating the possibility to apply for the validation of mother-to-child transmission of HIV in 2017.
- In child and adolescent health, the Region made substantial progress, but huge discrepancies still exist. Moldova has made significant progress in early childhood development and reached MDG 4 targets. The maternal mortality rate decreased in Moldova to 16 in 2013, within the European region’s average, however there is big discrepancy between lower and higher-income countries. Moldova endorsed a national Child and Adolescence Health Strategy in 2014. A new sexual and reproductive health action plan is under development.
- Vaccination rates in Europe are among some of the highest in the world, although there are downward-sloping trends reported as of lately. Moldova has had traditionally high vaccination coverage rates for most vaccines, in the range of 90’s and above. The country just adopted a new comprehensive National Immunization Program 2016-2020 and has a functional National Technical Advisory Group for immunization in Moldova. It also introduced some new vaccines (rotavirus vaccine, pneumococcal vaccine), and is about to introduce the human papillomavirus vaccine in 2017. Thirty-four countries in the Region interrupted the transmission of endemic measles and/or rubella by 2015, including Moldova.
- The use of vaccines as a major public health tool made these achievements possible. European Immunization Week 2016 once again saw all 53 Member States engage, with the launch of a new online Immunize Europe Forum. We are extremely grateful for the enormous support given by HRH Crown Princess Mary of Denmark to make the Week a success. Moldova has been actively participating in the European Immunization Week for a number of years now, including flash mobs, press club and media interventions to tackle vaccination hesitancy among health providers and parents alike.
- The United Nations General Assembly discussed antimicrobial resistance (AMR) in September 2016 at the High-level meeting, to ensure the highest political commitment to AMR. Moldova is currently a member of the Central Asian and Eastern European Surveillance of Antimicrobial Resistance (CAESAR) network. Moldova has a designated focal point for AMR and also established a cross-sector national working group for prudent use of antibiotics and AMR control, and is currently in the process of drafting a national AMR control strategy and action plan with WHO support.
- In November this year, the second World Antibiotic Awareness Week took place. Moldova has had a noticeable participation as well. I would like to express my gratitude to Her Royal Highness Crown Princess Mary of Denmark for raising awareness of AMR in the region and in Moldova.
- The WHE programme represents a fundamental change for WHO, complementing its traditional technical and normative capacities with new operational capabilities to enable it to work across the breadth of the emergency-management cycle in outbreaks and humanitarian emergencies.
- Preparedness and the building core capacities for the International Health Regulations (IHR) implementation has been a central part of the emergencies programme in Moldova, building the country’s preparedness and response activities following an all-hazard and multi-sectoral approach, including Public Health Emergency Management courses, surge capacity training, external assessment of core capacities and simulation exercises. These activities are being implemented in the context of broader on-goning Emergency Reform within WHO. In 2016 Moldova assessed all public hospitals in the country by using the WHO Hospital Safety Index tool.
- With political will and sustained technical and professional commitment, we shall continue to make progress towards, in essence, giving health and well-being their rightful places in human development. Thank you.