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Health 2020
and Improving Roma Health in
          Europe

                     Zsuzsanna Jakab
       WHO Regional Director for Europe

 Conference on “Scaling up action for Roma health in Serbia and beyond”
                Belgrade, Serbia, 28–29 February 2012
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




                      Š WHO/WHO Country Office, Serbia



                                                         Health 2020 and Improving Roma Health
                                                                                     in Europe

                                                                             29 February 2012, Belgrade
Health 2020: taking action
 Health 2020 goal
 To improve health and well-being of populations, to reduce health inequities and to ensure sustainable
 people-centred health systems


Health 2020 strategic objectives                                Six areas for policy action

1. Working together: adding value through                     Tackle the health divide
partnership
                                                              Invest in making people healthier, empower citizens
                                                                   and create resilient communities
2. Setting common priorities
                                                              Tackle Europe’s major disease burdens

                                                              Create healthy and supportive environments for
3. Improving governance for health and increasing
                                                                   health and well-being
participation                                                 Strengthen people-centred health systems, public
                                                                   health capacities and preparedness for
                                                                   emergencies
4. Accelerating the uptake of new knowledge and
innovation through leadership                                 Promote and adopt health-in-all-policies, whole-of-
                                                                  government and whole-of-society approaches



                                                                            Health 2020 and Improving Roma Health
                                                                                                        in Europe

                                                                                                  29 February 2012, Belgrade
Policy action 1. Tackle the health divide




Source: Towards equity in health: comparative study of national health surveys in the Roma population and the general population in Spain. 2006.


                                                                                                            Health 2020 and Improving Roma Health
                                                                                                                                        in Europe

                                                                                                                                      29 February 2012, Belgrade
Policy action 2. Invest in making people healthier,
empower citizens and create resilient communities
Health promotion, empowerment and resilience through the life-course




                                               Health 2020 and Improving Roma Health
                                                                           in Europe

                                                                   29 February 2012, Belgrade
Policy action 3. Tackle Europe’s major disease
burdens
  • Data suggests that Roma men smoke more
    than men in the general population (54.9%
    versus 31.6%), but fewer Roma women
    smoke than women in the general population
    (14.7% versus 21.5%).


  • The nutritional status of Roma children can be
    worse than that of children of the general
    population or non-Roma children.
    Sources: Health and the Roma Community, analysis of the situation in Europe (Madrid, FundaciĂłn Secretariado Gitano, 2011) and United Nations Development
    Programme regional survey of Roma in central and south-eastern Europe.




                                                                                                          Health 2020 and Improving Roma Health
                                                                                                                                      in Europe

                                                                                                                                          29 February 2012, Belgrade
Percentage of obesity: women over 18 years of age




Source: Towards equity in health: comparative study of national health surveys in the Roma population and the general
population in Spain. 2006



                                                                                Health 2020 and Improving Roma Health
                                                                                                            in Europe

                                                                                                      29 February 2012, Belgrade
Policy action 3. Tackle Europe’s major disease
burdens
• Factors contributing to      Rest of European Region

  immunity gaps and recent     United Kingdom

  outbreaks include:
   – social exclusion of
     marginalized groups;
   – low perception of risk;
   – lack of confidence in
     vaccine safety and
     quality; and
   – perceived inconvenience
     of or challenges in
     accessing services.




                                        Health 2020 and Improving Roma Health
                                                                    in Europe

                                                            29 February 2012, Belgrade
Policy action 4. Create healthy and supportive
environments




                                    Environmental health inequalities in Europe.
                                    Assessment report. Copenhagen, WHO
                                    Regional Office for Europe, 2012.




                                   Health 2020 and Improving Roma Health
                                                               in Europe

                                                              29 February 2012, Belgrade
Policy action 5. Strengthen people-centred health
   systems, public health capacity and preparedness
   for emergencies
                                       EXAMPLES OF ACTIONS FOR ROMA HEALTH EQUITY

                                         Ensure that equity is a cross-cutting principle for assessing
Primary health care as a hub for             health system performance, and that actions for
people-centred health systems                improving Roma health are integrated across all
                                             system functions
                                         Conduct outreach with Roma communities regarding their
                                             rights, entitlements and obligations for accessing
Empowering patients                          health services; increase health literacy and uptake of
                                             prevention services
                                         Improve effective coverage for marginalized Roma, from
Ensure appropriate continuum of care         early detection all the way through referral, treatment
                                             compliance and follow-up services; make available
                                             integrated services
                                         Guarantee financial protection for Roma, working to
Improve access to affordable                 overcome barriers presented by the cost of seeking
medicines                                    care and of purchasing medicines, and working across
                                             sectors to get Roma the documentation required for
                                             health insurance
Foster continuous quality                Ensure non-discrimination in service provision; build the
improvement                                  capacity of health professionals to provide culturally
                                             competent services; reorient priority public health
                                             programmes to better address equity and
                                             determinants

                                                                    Health 2020 and Improving Roma Health
                                                                                                in Europe

                                                                                           29 February 2012, Belgrade
WHO’
   s




       Health 2020 and Improving Roma Health
                                   in Europe

                           29 February 2012, Belgrade
Policy action 6. Promote and adopt health-in-all-
policies, whole-of-government and -society
approaches
                SWIFT (Sustainable Waste Management Initiative for a Healthier Tomorrow) I –
                             Responsible implementers/overall management – WHO

                            Deputy Prime Minister’s poverty-reduction strategy paper

                                      Ministries of health and environment

           HEALTH                           INCOME GENERATION                     SOCIAL MOBILIZATION
                                            United Nations Office for Project        International Organization
                                                     Services (UNOPS)                       for Migration (IOM)
       Ministry of Health                     Belgrade Municipality                 Belgrade Municipality
     Belgrade Municipality                                                        Ministry of Internal Affairs
      Ministry of Labour
          & Social Affairs                                                             Ministry of Labour
                                            Ministry of Economy and
                                                                                           & Social Affairs
  Institute of Health Insurance                Regional Development
                                             Ministry of Environment                Ministry of Minorities
   Institute of Public Health
                                             Chamber of Commerce                    Ministry of Education
    Institute of Occupational
                 Health
                                      COMMUNITIES AND CIVIL SOCIETY

                         UNOPS – Administrative Agent – administration and finance


                                                                                Health 2020 and Improving Roma Health
                                                                                                            in Europe

                                                                                                           29 February 2012, Belgrade
First Roma health and nutrition survey in
Belgrade settlements
  Children aged 6–59 months fully vaccinated against:
  • diphtheria, pertussis and tetanus (DPT) – 16.7%
  • poliomyelitis (oral polio vaccine – OPV) – 16.0%
  • measles, mumps and rubella (MMR) – 14.3%


  The strongest determinant for vaccination:
   citizenship


                                      Health 2020 and Improving Roma Health
                                                                  in Europe

                                                          29 February 2012, Belgrade
New law in Serbia:
“Roma people who have no permanent
residence … are entitled to full health-care
services coverage and without co-
payment”



                             Health 2020 and Improving Roma Health
                                                         in Europe

                                                 29 February 2012, Belgrade
Š WHO/WHO Country Office, Serbia




THANK YOU

                                    Health 2020 and Improving Roma Health
                                                                in Europe

                                                        29 February 2012, Belgrade

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Health 2020 and Improving Roma Health in Europe

  • 1. Health 2020 and Improving Roma Health in Europe Zsuzsanna Jakab WHO Regional Director for Europe Conference on “Scaling up action for Roma health in Serbia and beyond” Belgrade, Serbia, 28–29 February 2012
  • 2. 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 Š WHO/WHO Country Office, Serbia Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 3. Health 2020: taking action Health 2020 goal To improve health and well-being of populations, to reduce health inequities and to ensure sustainable people-centred health systems Health 2020 strategic objectives Six areas for policy action 1. Working together: adding value through Tackle the health divide partnership Invest in making people healthier, empower citizens and create resilient communities 2. Setting common priorities Tackle Europe’s major disease burdens Create healthy and supportive environments for 3. Improving governance for health and increasing health and well-being participation Strengthen people-centred health systems, public health capacities and preparedness for emergencies 4. Accelerating the uptake of new knowledge and innovation through leadership Promote and adopt health-in-all-policies, whole-of- government and whole-of-society approaches Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 4. Policy action 1. Tackle the health divide Source: Towards equity in health: comparative study of national health surveys in the Roma population and the general population in Spain. 2006. Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 5. Policy action 2. Invest in making people healthier, empower citizens and create resilient communities Health promotion, empowerment and resilience through the life-course Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 6. Policy action 3. Tackle Europe’s major disease burdens • Data suggests that Roma men smoke more than men in the general population (54.9% versus 31.6%), but fewer Roma women smoke than women in the general population (14.7% versus 21.5%). • The nutritional status of Roma children can be worse than that of children of the general population or non-Roma children. Sources: Health and the Roma Community, analysis of the situation in Europe (Madrid, FundaciĂłn Secretariado Gitano, 2011) and United Nations Development Programme regional survey of Roma in central and south-eastern Europe. Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 7. Percentage of obesity: women over 18 years of age Source: Towards equity in health: comparative study of national health surveys in the Roma population and the general population in Spain. 2006 Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 8. Policy action 3. Tackle Europe’s major disease burdens • Factors contributing to Rest of European Region immunity gaps and recent United Kingdom outbreaks include: – social exclusion of marginalized groups; – low perception of risk; – lack of confidence in vaccine safety and quality; and – perceived inconvenience of or challenges in accessing services. Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 9. Policy action 4. Create healthy and supportive environments Environmental health inequalities in Europe. Assessment report. Copenhagen, WHO Regional Office for Europe, 2012. Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 10. Policy action 5. Strengthen people-centred health systems, public health capacity and preparedness for emergencies EXAMPLES OF ACTIONS FOR ROMA HEALTH EQUITY Ensure that equity is a cross-cutting principle for assessing Primary health care as a hub for health system performance, and that actions for people-centred health systems improving Roma health are integrated across all system functions Conduct outreach with Roma communities regarding their rights, entitlements and obligations for accessing Empowering patients health services; increase health literacy and uptake of prevention services Improve effective coverage for marginalized Roma, from Ensure appropriate continuum of care early detection all the way through referral, treatment compliance and follow-up services; make available integrated services Guarantee financial protection for Roma, working to Improve access to affordable overcome barriers presented by the cost of seeking medicines care and of purchasing medicines, and working across sectors to get Roma the documentation required for health insurance Foster continuous quality Ensure non-discrimination in service provision; build the improvement capacity of health professionals to provide culturally competent services; reorient priority public health programmes to better address equity and determinants Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 11. WHO’ s Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 12. Policy action 6. Promote and adopt health-in-all- policies, whole-of-government and -society approaches SWIFT (Sustainable Waste Management Initiative for a Healthier Tomorrow) I – Responsible implementers/overall management – WHO Deputy Prime Minister’s poverty-reduction strategy paper Ministries of health and environment HEALTH INCOME GENERATION SOCIAL MOBILIZATION United Nations Office for Project International Organization Services (UNOPS) for Migration (IOM) Ministry of Health Belgrade Municipality Belgrade Municipality Belgrade Municipality Ministry of Internal Affairs Ministry of Labour & Social Affairs Ministry of Labour Ministry of Economy and & Social Affairs Institute of Health Insurance Regional Development Ministry of Environment Ministry of Minorities Institute of Public Health Chamber of Commerce Ministry of Education Institute of Occupational Health COMMUNITIES AND CIVIL SOCIETY UNOPS – Administrative Agent – administration and finance Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 13. First Roma health and nutrition survey in Belgrade settlements Children aged 6–59 months fully vaccinated against: • diphtheria, pertussis and tetanus (DPT) – 16.7% • poliomyelitis (oral polio vaccine – OPV) – 16.0% • measles, mumps and rubella (MMR) – 14.3% The strongest determinant for vaccination: citizenship Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 14. New law in Serbia: “Roma people who have no permanent residence … are entitled to full health-care services coverage and without co- payment” Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade
  • 15. Š WHO/WHO Country Office, Serbia THANK YOU Health 2020 and Improving Roma Health in Europe 29 February 2012, Belgrade