Presentaiton: Health and sustainable development in Europe – opportunities and challenges
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Presentation by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, delivered on 24 April 2018
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Presentaiton: Health and sustainable development in Europe – opportunities and challenges
- 1. (1) Health and sustainable development in Europe – opportunities and challenges Dr Zsuzsanna Jakab WHO Regional Director for Europe 24 April 2018, CDC Atlanta 1
- 2. (2) Health at the centre of development 2
- 3. (3) Health is a political choice 3
- 4. (4) “Leaving no-one behind” is our call for action 4
- 5. (5) Moving towards joint commitments 1. Focus on inequities 2. Achieve universal health coverage 3. Strengthen health systems 4. Work upstream: health promotion and disease prevention 5. Address all the determinants of health 6. Strengthen emergency preparedness and response 5
- 6. (6) Health 2020 Priorities Health systems Burden of disease Life- course approach Resilient commun- ities SDG3 Universal health coverage Emergency management (IHR) Halve death and injuries from road traffic accidents Reduce deaths and illness from environmental pollution Reduce maternal mortality End preventable deaths of children under 5 Strengthen prevention and treatment of substance abuse Universal access to sexual and reproductive health services End AIDS, TB, Malaria and other communicable diseases Reduce premature mortality from NCDs and promote mental health Research for vaccines and medicines Strengthen FCTC Health financing and health workforce Health 2020 is fully aligned with SDG goals 6
- 7. (7) 70 72 74 76 78 80 82 Overall Men Women Life expectancy is increasing in the WHO European Region Years 77.7 74.4 81.0 7
- 8. (8) 63 64 65 66 67 68 69 70 71 Overall Men Women Healthy years at birth reached to 68 years across the Region Years 68.3 65.6 70.5 8
- 9. (9) 2-3% annual average decline in premature mortality in most countries Aim is a decline of 40% by 2025 Decline in premature mortality 9
- 10. (10) Progress so far in the WHO European Region • Infant mortality: 6.7 per thousand live births • Children vaccinated against measles and rubella: 94% • Proportion of children not enrolled in school: boys 2.5%, girls 8.3% • Populations with improved sanitation facilities: 92.9% 10
- 11. (11) Discrepancies remain Life expectancy at birth ranges from 71.2 to 83.4 years Healthy years of life ranges from 59.8 years to 73.1 years 11
- 12. (12) Infant mortality ranges from 1.9 to 22.1 Rubella vaccinations ranges from 42% to 99% Discrepancies remain 12
- 13. (13) Health is more than SDG 3 only 13
- 14. (14) Promoting Intersectoral and Interagency Action for health and well-being in the WHO European Region France, December 2016 14
- 15. (15) National and local networks Catalysing action towards common goals 15
- 16. (16) South Eastern European Health Network (SEEHN) Subnational networks are key platforms for implementation 16
- 17. (17) Regions for Health Network Small Countries Initiative Healthy Cities Network 17
- 18. (18) *Rep Defined Health 2020 targets Health 2020 alignment 0 20 40 60 80 100 2010 2017 Health 2020 increasingly incorporated into national health policies 73% 88% 58% 93% *Reported countries 18
- 19. (19) 0 20 40 60 80 100 Implementation plans Accountability mechanisms Reducing health inequities 2010 2016 Most countries have policies addressing health inequalities *Reported countries 46% 86% 45% 89% 88% 98% 19
- 20. (20) Investing in public health pays back We need a new, invigorated public health movement since public health is a driver of equitable health improvement. 20
- 21. (21) Health systems Health 2020 Priorities Health systems Burden of disease Resilient communities 21
- 22. (22) Sales 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr “…all people and communities receive the quality services they need, including health promotion, disease prevention, treatment and rehabilitiation, without financial hardship.” Universal health coverage 22
- 23. (23) ”It is unacceptable that people become poor as a result of ill-health” The Tallinn Charter 23
- 24. (24) Catastrophic out-of-pocket payments affect the poorest 24
- 25. (25) Out-of-pocket payment share of total health spending high in many countries 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 Out-of-pocketpaymentas%oftotalhealthspending DANGER ZONE: > 30% WARNING SAFE: < 15% with pro-poor policies Source: WHO data for 2014 High and middle-income countries in the European Region 25
- 26. (26) 26
- 27. (27) Health systems respond to NCDs 27
- 28. (28) INCLUDE INVEST INNOVATE A vision for health systems in Europe: the future of the Tallinn Charter Celebrating the 10th Anniversary of the Tallinn Charter Tallinn, Estonia 13-14 June, 2018 28
- 30. (30) Making a sustainable health workforce in Europe 30
- 31. (31) Ensuring access to effective, high-quality medicines for all 31
- 32. (32) Tackling the main disease burdens 32
- 33. (33) NCD Outcomes – A success story (?) 33
- 34. (34) Major gains in measles and rubella elimination 34
- 35. (35) Measles cases, WHO European Region, 2016 Progress hampered by setbacks 35
- 36. (36) From malaria elimination to maintaining malaria-free status THE ASHGABAT STATEMENT 36
- 37. (37) 3.6 0 1 2 3 4 5 6 7 8 9 10 2000 2005 2010 2015 Rateper100000population –8.5% yearly between 2011 and 2015 36 0 10 20 30 40 50 60 70 80 2000 2005 2010 2015 Rateper100000population –4.3% yearly between 2011 and 2015 The Region has the fastest decline in TB incidence and mortality Estimated TB incidence rate Estimated TB mortality rate 37
- 38. (38) 0 0.5 1 1.5 2 2.5 3 3.5 4 2000 2005 2010 2015 Rateper100000population Estimated TB/HIV rate 6.2% annual increase between 2011 and 2015 TB/HIV co-infection on the rise 38
- 39. (39) 0 20000 40000 60000 80000 100000 120000 140000 160000 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 NumberofnewHIVdiagnoses East Centre West Increase 2006-2015: Region: 75% East: 109% HIV epidemic moving at an alarming rate New HIV diagnoses in the WHO European Region 2006-2015 39
- 40. (40) Comprehensive response guided by national strategies 40
- 41. (41) Mark the World Antibiotic Awareness Week in November 41
- 42. (42) Health emergencies, preparedness, surveillance and response 42
- 43. (43) Roles Responsibilities Accountabilities Timelines Partnerships WHO Emergency Programme is fully functional 43
- 44. (44) NUCLEAR DISASTER (SPECIALIZED MECHANISMS) CHEMICAL (SPECIALIZED MECHANISMS) INFECTIOUS OUTBREAKS (WHO LEAD ROLE) NATURAL DISASTER (IASC/OCHA LEAD) CONFLICT (IASC/OCHA LEAD) IMSandRESPONSE EVENTGRADING Rapid and efficient response 44
- 45. (45) Determinants of health Behavioral Environmental Social PoliticalEconomic Cultural Commercial 45
- 46. (46) Making good progress on tobacco control Tobacco plain packaging legislation now in: • France • Georgia • Hungary • Ireland • Norway • Slovenia • United Kingdom 46
- 47. (47) Alcohol consumption too slowly declining We are aiming for a ten percent decline until 2025 to achieve the 2030 global target 47
- 48. (48) 48
- 50. (50) Ostrava Declaration: European countries committed to national implementation by 2018 50
- 51. (51) 51
Hinweis der Redaktion
- Now with the Sustainable Development Goals and Universal Health Coverage, and with todays’ knowledge, we can achieve this dream. We must place health at the centre of development, focusing on the right to health, equity, fairness, universality, solidarity. We must see health as the smartest thing to invest in; as an investment that pays off. This is what we have been doing in the European region all these years. Above all we must secure strong political commitment to achieving these goals, and truly we must “leave no-one behind”.
- Health is indeed a political choice.
- The SDGs call for concerted actions to mobilize the necessary means and ensure implementation in a spirit of global solidarity.
- Our priorities are clear and we are moving forward with these joint commitments we made in the past years. We must focus on inequities, “leaving no-one behind”, embedding gender and human rights into all policies. We must achieve universal health coverage. We must strengthen health systems with a focus on primary health care. We must work upstream with an emphasis on health promotion and disease prevention with the life course approach. We must address all determinants of health; if we are to achieve health and well-being for all. And we must strengthen our emergency preparedness and response.
- As my talk proceeds the visual presentation will demonstrate this congruity between the SDGs and Health 2020.
- Our latest data indicates that life expectancy across the Region has now reached over 77 years.
- Healthy years at birth across the Region have now reached to 68 years.
- The decline in premature mortality started in 2000, and since 2003 almost all countries are showing an average decline of 2-3 percent annually. With a linear projection from 2000, we could expect this decline to reach 40% by 2025.
- Infant mortality is the lowest ever, 6.7 per thousand live births. The proportion of children vaccinated against measles and rubella now stands at 94%.
- Yet progress is uneven, there are substantial inequalities within and across countries. For example, life expectancy across the Region ranges from71 to 83 years, a difference of 12 years. Healthy years of life ranges between 60 and 73 years, a difference of over 13 years.
- Infant mortality has over a tenfold difference. For children vaccinated against rubella the difference is grave, from 42 to 99%. These are worrying differences that need to be addressed with determined actions.
- Ladies and gentlemen, we know that health in the SDGs means far more than SDG3only.
- The Conference on Promoting Intersectoral and Interagency Action held in Paris in December 2016, “Working together for better health and well-being” was an example of such critical engagement.
- Subnational levels also play a crucial role in implementation.
- The South Eastern European Health Ministerial Forum adopting the Chisinau pledge,
- the Regions for Health Network meeting outcome in Kaunas, the Small Countries initiative meeting decisions in Malta, as well as the European Healthy Cities Network Conference adopting the Pecs Declaration are key platforms for overseeing this role. We are committed for continued support.
- Mid-term review results show that Health 2020 has increasingly been incorporated into national health policies and this is generating action in countries. Almost all countries now have a national health policy aligned with Health 2020.
- They defined targets or indicators at the national and sub-national levels and a majority have a policy or strategy to address health inequalities. What is now needed is investment in health that many countries can afford. This is a political choice, rather than an economic constraint.
- Public health is a driver of equitable health improvement and we need a new and invigorated public health movement.
- Ladies and gentlemen, let me now turn to health systems which underpin Universal Health Coverage.
- Our definition is broad and covers access to health services, as well as health promotion, disease prevention, treatment and rehabilitation, without financial hardship. Universal Health Coverage is a unifying concept, a platform for integrated delivery of health services and public health, and one of the most powerful social equalizers.
- We in Europe are committed to Universal Health Coverage and a lot has been done. Its core message “no-one should become poor due to ill health” was at the heart of the Tallinn Charter as well as Health 2020.
- Most countries in Europe provide health coverage for the whole population, but this alone is no guarantee of financial protection. Out-of-pocket payments for health are still high in many countries of the European Region.
- High-performing health systems provide strong financial protection to keep out-of-pocket payments to a minimum: that is at or below 15% of total health expenditures. Many countries need to increase the share of public financing for health, together with stronger pro-poor policies.
- We are monitoring financial protection and producing estimates using a new approach for high- and middle-income countries in Europe. We are also gathering new evidence in half of the MSs.
- We are preparing for two high-level meetings on health systems in 2018. Firstly, just last week on health systems response to NCDs in Spain, providing a platform to review progress and inspire actions based on the country assessments we have conducted.
- Secondly in June the meeting on “Health systems for prosperity and solidarity – Leaving no one behind” in Tallinn will celebrate the tenth anniversary of the Tallinn Charter with the support of the European Observatory on Health Systems and Policies , Those will reconfirm the notion of value based health systems and outline our future vision in view of the 2030 agenda.
- In June 2017, I launched the WHO European Advisory Board to support the development of the new PHC Vision towards the 40th Anniversary of the Alma Ata Declaration in 2018. Please join us at this high level global event in Almaty together with Dr Tedros.
- Universal Health Coverage is not sustainable without a well-motivated, appropriately skilled and effectively managed workforce.
- Affordable access to effective, high-quality medicines is another major component of UHC and is of great concern for many Member States.
- Controlling and reducing the burden of Noncommunicable diseases is at the heart of SDGs and Health 2020.
- Europe can present a major success story in the area of the reduction of premature mortality from NCDs. Since the turn of the millennium, in both sexes, in the region as a whole, in all sub-regions of Europe, and in practically all countries where we have good data, we see premature NCD mortality declining rapidly. This rate of decline is so fast that, barring major disasters or crises, we will achieve Target 3.4 earlier than 2030. So WHY ARE WE HERE TODAY? Why not just to sit back and enjoy our successes for once? 1. At current rates, it will take 2 decades for countries with higher mortality to catch up with those with lower mortality; 2. There are pockets of avoidable high mortality among men under 70 with great implications for economic productivity and social implications for family structures; 3. Other gaps of inequality due to differential socio-economic means, environmental exposures, access to social policies and benefits; Millions of people in our region live with chronic conditions and report that their conditions are not managed in a person centred manner. And I could continue this list…. We know what to do! But we are not doing it all! Our status reports show, that cost effective NCD interventions are not always implemented and not in many member states, both at population level and as individual services. And this is why we are here. We are doing well but we could be doing much better. And until we do that, people die unavoidably and suffer from the consequences of their illness. In these coming two and half days, we will discuss extensively how we can respond much more effectively to NCDs through a stronger health system response.
- Since last Regional Committee, another five countries interrupted endemic measles and rubella transmission, bringing this total to 42 countries.
- However recent measles outbreaks in some countries with deaths and complications are an example of an unacceptable setback and are exposing shortcomings in immunization service delivery.
- Following the milestone of interrupting indigenous malaria transmission in the Region last year, we now focus on preventing the reintroduction.
- Thanks to intensive efforts, as well as our partners, particularly the Global Fund, our Region has the fastest decline of tuberculosis incidence and mortality rates among all WHO Regions during the past five years.
- Yet TB, and particularly drug resistant forms, remain a major public health concern with over 300,000 TB cases occurring every year. Moreover, TB/HIV co-infection is increasing by 6.2 % every year.
- With HIV, we need to act immediately as the epidemic in the eastern part of the Region is moving fast at an alarming rate. New HIV diagnoses increased by 75% in the Region as whole and more than doubled in eastern Europe and central Asia since 2006, mostly driven by two countries.
- We need to build on this positive momentum and take comprehensive actions for prevention, diagnosis and treatment, if we aim to eliminate viral hepatitis.
- The world will mark the third World Antibiotic Awareness Week in November 2017. Last year, 47 European countries joined the campaign and it is my sincere hope that ALL 53 countries will mark the week this year.
- Ladies and gentlemen, another priority of the Regional Office is preparedness and response to health emergencies.
- I am delighted to report that the new WHO Emergency Programme is now fully functional. New standard operating procedures are in place, and the updated Emergency Response Framework is already being implemented.
- The evidence is the rapid and efficient response to all recent health emergencies.
- Progress for health and wellbeing is not possible without addressing all determinants of health; political, economic, environmental, social, behavioural, cultural and commercial. Here the Regional Office has been a major advocate and gatherer of evidence, as well as a facilitator for implementation in your countries
- On tobacco control, we are making progress. Examples are the global movement for plain packaging of tobacco products. Thanks to the leadership of European Member States, seven of whom now have legislation to this effect
- and in Lithuania through the ground breaking legislative measures to control price, availability, and marketing – but more needs to be done.
- The increases in overweight among children and adolescents alone risks slowing or reversing the gains we are making in premature mortality in the Region. We must look for new solutions for faster and more effective preventive actions.
- We need concerted and integrated policy and governance responses across governments and society with a special focus on social protection. That should be a priority now for all governments.
- Through the Ostrava Declaration, Member States committed to attain relevant SDG targets, as well as to enhance national implementation by the end of 2018.
- The SDGs and Health 2020 lead the way. We need commitment, from politicians, policy and decision makers, professionals and from the people.