Highlights of the work of WHO/Europe, Meeting of EU Chief Medical Officers
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Highlights of the work of WHO/Europe, Meeting of EU Chief Medical Officers
- 1. Highlights of the work of WHO/Europe Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012 Ms Zsuzsanna Jakab WHO Regional Director for Europe
- 2. Agenda • Tackling Europe’s health priorities • Health 2020: A European policy framework supporting action across government and society for health and well-being • Relations between the Regional Office and the European Union • WHO reforms for a healthy future: an update Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 3. Tackling Europe’s health priorities Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 4. The changing environment for health • Demographic (fertility, aging) • Globalisation and migration (inc. of health workers) • New technologies (inc. medical genetics) • More informed and demanding citizens • Recognition of importance of health to human development During last 2 years work of Regional Office has been systematically and gradually adapted to its changing environment. Partly through: • “vision” approved by MS in Moscow at RC60 which set the agenda. • WHO reform, globally and regionally This work has been taken through RC61 and will be completed this year at RC62 and next year at RC63 Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 5. RC61: Tackling the most urgent health issues Technical topics European Action plans adopted: • For the prevention and control of non-communicable diseases 2012–2016 • To reduce the harmful use of alcohol 2012–2020 • To combat antibiotic resistance • To prevent and combat multidrug-and extensively drug-resistant tuberculosis 2011–2015 • For HIV/AIDS 2012–2015 All now in Implementation phases Consulting for future • Developing the new European policy for health – Health 2020 (a) Governance of health in the 21st century (b) The health divide: European experiences in addressing the social determinants of health • Health systems strengthening in the WHO European Region (a) Interim report on implementation of the Tallinn Charter and the way forward (b) Strengthening public health capacities and services in Europe: a framework for action Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 6. RC62: Laying the foundation for the future • This year (2012) in RC62 MAIN focus will be on the European Health Policy Health 2020 (mandated in Moscow) which has been developed over two years through a truly participatory process. Two documents: 1. Health 2020: policy framework for Europe 2. Health 2020: policy framework and strategy. • Implementation arm of Health 2020: The European Public Health Action Plan • Healthy ageing • Country strategy and GDO policy • Communication Strategy • WHO Reform. Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 7. Health 2020 A European policy framework supporting action across government and society for health and well-being Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 8. What is Health 2020? Health 2020 is a value-based action-oriented policy framework, adaptable to different realities in the countries of the WHO European Region. Health 2020 is addressed to Ministries of Health but also aims to engage ministers and policy-makers across government and stakeholders throughout society who can contribute to health and well-being. Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 9. Health 2020 documents The short Health 2020 policy The longer Health 2020 framework contains the key policy framework and evidence, arguments and strategy document provides areas for policy action to the contextual analysis and address the public health the main strategies and challenges, and opportunities interventions that work; and for promoting health and describes necessary well-being, in the capacities to implement the European Region today. Health 2020 policy. Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 10. Health 2020 - a common purpose, a shared responsibility Health 2020 vision A WHO European Region in which all people are enabled and supported in achieving their full health potential and well-being and in which countries, individually and jointly, work towards reducing inequities in health within the Region and beyond Health 2020 goal To significantly improve health and well-being of populations, to reduce health inequities and to ensure sustainable people-centred health systems Health 2020 strategic objectives: stronger equity and better governance 1. Working to improve health for all and reducing the health divide 2. Improving leadership, and participatory governance for health Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 11. Health 2020: Four common policy priorities for health The four priority areas are interlinked and are interdependent and mutually supportive Addressing the four priorities will require a combination of governance approaches that promote health, equity and well-being Investing in health through a life course approach and empowering people Tackling Europe’s major health challenges of non communicable diseases and communicable diseases Strengthening people-centred health systems and public health capacities, and emergency preparedness Creating supportive environments and resilient communities Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 12. Health as a major societal resource and asset • Good health benefits all sectors and the whole of society – making it a valuable resource • What makes societies prosper and flourish also makes people healthy – policies recognize this have more impact • Health performance and economic performance are inter-linked – improving the health sectors use of its resources is essential Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 13. Why Health 2020? Health in the WHO European Region has greatly improved in recent decades – but not everywhere and equally for all; this is not acceptable Countries have different starting and entry points, but share common goals and challenges, and use different pathways: People live longer Noncommunicable Infectious diseases, Health systems and have less diseases dominate such as HIV, face rising costs. children. the disease burden. tuberculosis remain Primary health care a challenge to systems are weak control. People migrate Depression and and lack preventive within and between heart disease are services. countries, cities leading causes to Antibiotic-resistant Public health grow bigger. healthy life years organisms are capacities are lost. emerging. outdated. Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 14. New opportunities and challenges New concepts New drivers of health Well-being as a measure of development Technologies and innovation Anticipatory governance Health literacy: information, participation and accountability Collaborative leadership Globalisation/ urbanisation New evidence New demographics The macroeconomics of health and Fertility levels dropping well-being Ageing The social gradient and health equity Migration Genomics Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 15. Strategic objective 1: tackle the health divide Life expectancy at birth, in years 80 Address the social determinants of health Emphasis on action across 75 the social gradient and on vulnerable groups European Region EU members before May 2004 EU members since May 2004 CIS Ensure that continuous reduction of health inequities 70 become a criteria assessing health systems performance 65 1970 1980 1990 2000 Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 16. Strategic Objective 2: improve leadership and participatory governance for health Smart governance for health and Promote and adopt “health in all policies”, whole-of-government and well-being whole-of society approaches Governing through collaboration Whole of society and whole of government approaches to Governing through citizen engagement health and well-being Joined-Up Governing through a mix of Government for Health in All Policies Good governance for regulation and persuasion Improved health and well-being coordination, Governing integration, and through capacity centred independent on shared goals Health is a Health is a Health is a Health as agencies and central expert bodies Human Global Social Power and component responsibility for Right Public Good Justice health and well of well being being diffused Governing throughout through adaptive government and policies, resilient society structures and foresight Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 17. Policy priority 1 Invest in health through a life course approach and empowering people • Supporting good health throughout the lifespan leads to increasing healthy life expectancy and a ’longevity dividend’ both of which can yield important economic, societal and individual benefits • Health promotion programmes based on principles of engagement and empowerment offer real benefits Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 18. Policy priority 2: Tackle Europe’s major health challenges Implement global and regional mandates 140 (NCDs, tobacco, diet and physical activity, alcohol, HIV/AIDS, TB, IHR, antibiotic Standardized death rate, 0-64 per 100,000 120 resistance, etc.) 100 80 Promote healthy choices Cause 60 Heart disease Cancer Injuries and violence 40 Infectious diseases Strengthen health systems, including primary health Mental disorders 20 care, health information and surveillance 0 1980 1985 1990 1995 2000 2005 Year 100% Reach and maintain recommended immunization 90% coverage 80% 70% 60% Deaths 50% Develop healthy settings and environments 40% 30% 20% 10% Attention to special needs and disadvantaged 0% populations European Region EU-15 Country groups EU-12 CIS Circulatory system Malignant neoplasms External causes Infectious disease Respiratory system Other causes Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 19. Policy priority 3: Strengthen people-centred health systems, public health capacity and preparedness for emergencies Strengthen public health functions and capacities Strengthen primary health care as a hub for people-centred health systems Ensure appropriate integration and continuum of care Foster continuous quality improvement Improve access to essential medicines and invest in technology assessment Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 20. Policy priority 3: Strengthen people-centred health systems, public health capacity and preparedness for emergencies Ensure universal access Make health systems financially viable, fit for purpose, people centred and evidence informed Revitalize and reform education and training of key professionals Develop adaptive policies, resilient structures, and foresight to deal with emergencies Foster continuous quality improvement Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 21. Policy priority 4: Create healthy and supportive environments Assess the health impact of sectoral policies Fully implement multilateral environmental agreements Implement health policies that contribute to sustainable development Make health services resilient to the changing environment Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 22. Dear Prime Minister, Minister, Mayor: Health is a prerequisite for social and economic development. The health of the population can be seriously damaged by the financial crisis that is affecting many countries, in many ways. But it can also present an opportunity to do more and better for people’s health. All sectors and levels of government contribute to the creation of health. Your leadership for health and wellbeing can make a tremendous difference for the people of your country or city and for Europe as a whole. Your support for Health 2020 is truly essential. Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 23. Relations between the Regional Office and the European Union Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 24. Regional collaboration: An EC – WHO/Europe shared vision for joint health action Six flagship initiatives as part of Joint Declaration: • One health security system to protect Europe • One health information system to inform Europe • Share and exploit good practice and innovations • Exchange information and advocate for policies to tackle health inequalities also for future generations • Inform and facilitate efforts for investing in health to mitigate effects of economic crisis • Strengthen in-country cooperation through joint advocacy, information exchange and health assessments Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 25. What has happened since • DG delegated a global function to RD/EURO: to lead on WHO- EU relations; • Global Policy Group mandates WHO/Europe Regional Director to establish and chair WHO Steering Committee on EU; • Copenhagen Offices takes over high-level relations with the EU and oversight of WHO Brussels Office (Roberto Bertollini Head); • High-level and senior-official meeting with the European Commission, March 2011 and 2012; • Increased collaboration with EU Presidencies of Spanish, Belgium, Hungary, Poland, Denmark, Cyprus; • Renewed Memorandum of Understanding with the European Center of Disease Control (ECDC); • Strengthened relationship with European Parliament; Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 26. WHO reforms for a healthy future: an update Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 27. Status as of March 2012: 1. Programmes and priority setting Agreement in Member Status meeting on: • GPW11 (2006-2015) only till 2013 • New GPW12 (2014-2019): 6 years • 5 Criteria for priority setting: – Current health situation (burden of disease at global, regional and country levels) – Individual country needs (as per CCSs) – Internationally agreed instruments (agreements, resolutions and decisions of WHO’s governing bodies) – Existence of evidence-based, cost-effective interventions – WHO’s comparative advantage. Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 28. Status as of March 2012: 1. Programmes and priority setting (cont’d) Agreement on 5 programme categories (plus 1) for priority setting • Communicable diseases • Noncommunicable diseases • Promoting health through the life course • Health systems • Preparedness, surveillance and response Agreement on timeline for 12th GPW and PB 2014-2015: • May 2012: draft outline of GPW12 2014-2019 to PBAC16 and WHA65 • Aug to Oct 2012: Draft GPW12 + Proposed PB 2014-2015 to RC62 together with regional perspective + other RCs + web consultation • Nov/Dec 2012: GPW12 & PB 2014-2015 reviewed by PBAC17 (if EB131 approve new timing) • Jan/Feb 2013: EB132 reviews and comments on Draft GPW12 and PB 2014-2015 • May 2013: Approval by WHA66, through PBAC18 after incorporating EB132 comments. Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 29. Status as of March 2012: 2. Governance Revised proposals to EB131 (May 2012) through PBAC: • Revised ToRs for PBAC; • Increased linkages between RCs, EB and WHA; • Harmonization of practices of RCs; • Scheduling of sessions of governing bodies • Roles and responsibilities at the 3 levels of the Organization. For discussion during WHA65: • Partnerships and engagement with other stakeholders; • Oversight and harmonization of hosted partnerships; • Principles governing WHO’s relations with NGOs. Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 30. Status as of March 2012: 3. Managerial reforms Revised proposals to EB131 through PBAC: • Detailed proposals for a new financing mechanism; • Contingency fund for public health emergencies; • Proposals for a consolidated resource mobilization strategy; • Draft evaluation policy. For discussion during WHA65: • Independent evaluation of WHO: report of Stage I, carried out by the external auditor; • Road map for Stage II. Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 31. WHO Reform: implications for European Region • Report to RC62 - “work in progress”: next main step WHA65; • Significant implications likely in following areas: o Apart from the 5 + 1 new categories EURO applied most of new concepts in the operational planning (eg. results chain, KPOs), co-op with HQ o Programmes and priority setting: resource allocation ($, staff time) to programmes likely to change in 2014-2015 and beyond; o Planning processes hopefully simplified and less staff intensive; o Governance: best practice in EURO (SCRC, RD election process) likely to influence other regions; o Policy of independent evaluations: involvement of SCRC ? (was discussed by 18th SCRC in Andorra, November 2010) o Managerial reforms: Probably the area with the most significant implications ($, staffing and structures) but at this stage too early to tell. Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
- 32. Thank you Chief Medical Officer’s Meeting Copenhagen 12-13 April 2012
Hinweis der Redaktion
- There will be ministerial lunches and technical briefingsKeynote speakers: DG, Commissioner Dalli,, Princess Mary and the First Lady of Georgia .
- The context for health improvement in Europe is very complex. Many of the challenges are common, but countries have different starting points, entry points and they use different pathways to achieve common goals. Overall health is improving, but with what we know and the technologies we have available, it should be improving faster and we could prevent more diseases.We all agree with dr Chan that “ money does not buy health – it is the right policies that do “
- Our new governance for health will be based around the concepts of whole of society and whole of government responsibility and accountability. We focus on good governance and smart governance. There is a key role here for “health in all policies”. We must drive policies and actions for health across sectors, with a leading role for Ministers and Ministries of Health. Part of this responsibility must be the delivery of high quality and effective public health and health care services, delivering increased performance and satisfaction. We must establish structures for effective intersectoral problem solving and action, with wide stakeholder involvement, and work to empower people and patients. We must draw attention to health-damaging environments, life styles or products, as well as to gaps in the quality and provision of health care.
- At the Regional committee in Moscow, a major step was forward was made in our relations with the European Commission.Since then we have been working steadily to improve our relation
- Baseline for priority setting will remain the WHO Constitution, its preamble, and the functions set out in Article 2 of the Constitution- including the overriding mandate of the Organization “to act as the directing and coordinating authority on international health work.” In addition, the MS meeting agreed on the following 5 criteria to be applied in priority setting, within the framework of the Constitution: (list).
- In addition to the 5 Criteria, the Meeting also reached agreement on 5 programme Categories which would represent priorities for the Organization..The meeting also agreed on a timeline for preparation of the 12th GPW and the next PB 2014-2015.
- For several of the issues concerning Governance, there were some disappointment during the Board’s discussion in January that the Secretariat’s proposals did not go far enough: For example, on the issue of “Harmonization of practices of the RCs” important issues such as looking at best practice among the Regions, and maybe introducing oversight mechanisms like the SCRC also in other RC was not covered. Likewise, on scheduling of sessions of the governing bodies, the proposals could have been more creative, rather than just look at the interface between the EB and the PBAC. As we all know, Estonia, on behalf of the European Union made a more radical proposal in that regard, so we have to see how this will be carried forward.And then, there were some issues linked to Partnerships and relations with NGOs which will not go through the PBAC in May, but rather tabled as separate agenda items at the Assembly.
- Most MS attending EB131 considered the DG’s proposals for a new financing mechanism a step in the right direction. Reservations were however also expressed, notably with the concept of an open, public pledging conference. So, we are now awaiting further details on how these concepts will be taken forward in the revised submittal to PBAC. The issue of establishing a contingency fund for public health emergencies - modelled on the CDC Outbreak Contingency Fund – was less controversial, but further details and a revised proposal was also requested in this instance.With regard to a new resource mobilization strategy, we are still waiting..And although there was broad agreement on the proposed evaluation policy, some further fune-tuning was requested, and a revised paper will also be submitted on this issue.
- Reforms will continue to be major agenda item for RCs and a report on implications and impact of the Reforms for Europe will be presented to RC62. however, as you can see from what I have said so far this is “work in progress” and in a sense we are doing many things in parallel as the GB deadlines (eg for PB approval etc) don’t allow a stepwise approach! So we already start to draft the paper for RC62 but will finalise after WHA65 in May! So at this stage I can highlight the following as some of the issues for EURO and the synergies between the EURO initiatives and those of the Global Reforms.The 5 criteria and 5 (+1) categories of programmes : will lead to a gradual shift in $ and staff resources – between several of EURO’s programmes at both regional and country levels.A sharper focus in the GPW on WHO’s mandate, and elimination of the MTSP, will also hopefully lead to a simplification and streamlining of current planning and monitoring processes – something which is urgently required. In fact, the RD plans to initiate an independent assessment of strategic and operational planning in the Region, to be conducted over the next couple of months – in order to clarify what are the elements of current procedures which are imposed on us from global requirements, and what is – so to speak – self-inflicted.On Goverance and on the issue of harmonization between RCs: Likely that some of the work of the SCRC Working Group on Governance, linked to oversight functions of the SCRC and the evaluation mechanisms of candidates for RDs will be picked up by other Regions. (New RD for EMRO has already asked RD to share our experience and revised Rules of Procedure for the SCRC and the RC with him.)Regarding independent evaluations: Independent evaluations were in force in EURO during Dr Asvall’s days (through which Zsuzsanna’s own programme EUROHEALTH was also evaluated, if I remember right). At the time of presenting the first Oversight Report to the SCRC in Andorra, in November 2010, this issue was again discussed to see to what extent a sub-group of the SCRC could be mobilized for this purpose. Need to re-visit this issue again…And finally, on Managerial Reforms – whether in terms of HR reform, predictable financing mechanisms, or a more coherent resource mobilization strategy – there will be several implications. These continue to be developed guided by the GPG meetings (between the DG and the Regional Directors) – as well as the discussions in the PBAC and the Assembly – and should help clarify the impact on our structures, staff and resources.Thank you.