Presentation: Launch of the Knowledge Hub on Health and Migration
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1. The WHO Regional Director for Europe launched the Knowledge Hub on Health and Migration, a multi-stakeholder platform for sharing knowledge and improving public policies around health needs of migrants. 2. An analysis of health indicators in Sicily found higher infant mortality, lower life expectancy, and social inequalities compared to other EU regions in Italy. 3. Reducing health inequities will require action on social, economic, and environmental determinants of health across the life course from early childhood through working years.
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Presentation: Launch of the Knowledge Hub on Health and Migration
- 1. Launch of the Knowledge Hub on Health and Migration Dr Zsuzsanna Jakab WHO Regional Director for Europe 15 November 2016, Palermo, Italy
- 2. Close collaboration between WHO/Europe, Italy and Sicily Region 2 Assessment missions Contingency planning Panorama case study 2011 2012 2014
- 3. Close collaboration between WHO/Europe, Italy and Sicily Region Workshop for toolkit consultation 3
- 4. 4 The Knowledge Hub on Health and Migration Migration and health multi-stakeholder knowledge sharing platform Scientific and capacity- building forum Aim: Improve public policies and interventions to address the health needs of migrants and the public health implications of migration in the WHO European Region
- 5. The Knowledge Hub 5 Collaboration and interaction between health and non-health sectors Gather good practices, experiences, evidence-based approaches Iimproving countries’ preparedness Promoting people- centred health systems Reducing health inequalities
- 6. Looking forward to a good collaboration with Sicily • Similar to the extensive and close collaboration with Italy 6
- 7. Extensive collaboration with Italy over decades • Member of WHO Governing Bodies • SCRC now • EB from 2017 • Pan-European conference in Rome in November 2015 on migration and health – migration/health strategy • 2018: Italy hosts the Regional Committee for Europe
- 8. Life expectancy trends in Italy Life expectancy at birth (years), males Life expectancy at birth (years), females 70 75 80 85 1980 1990 2000 2010 1980 1990 2000 2010 European Region EU15 Italy Source: WHO/Europe: European Health for All database 8
- 9. Proportion of population aged 65 and over and birth rate % of population aged 65+ years Live births per 1000 population 8 12 16 20 1980 1990 2000 2010 1980 1990 2000 2010 European Region EU15 Italy Source: WHO/Europe: European Health for All database 9
- 10. Mortality by broad cause, all ages SDR, Infectious and parasitic diseases, per 100000 SDR, Neoplasms, per 100000 SDR, Diseases of the circulatory system, per 100000 SDR, Diseases of the respiratory system, per 100000 SDR, Diseases of the digestive system, per 100000 SDR, External causes of injury and poisoning, per 100000 5 10 15 20 160 200 240 100 200 300 400 500 50 100 150 20 30 40 50 60 20 40 60 80 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 European Region EU15 Italy Source: WHO/Europe: Mortality indicator database 10
- 11. Premature mortality (064 years), by broad cause SDR(0-64), Infectious and parasitic diseases, per 100000 SDR(0-64), Neoplasms, per 100000 SDR(0-64), Diseases of the circulatory system, per 100000 SDR(0-64), Diseases of the respiratory system, per 100000 SDR(0-64), Diseases of the digestive system, per 100000 SDR(0-64), External causes of injury and poisoning, per 100000 5 10 15 60 80 100 50 100 10 20 30 10 20 30 25 50 75 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010 European Region EU15 Italy Source: WHO/Europe: Mortality indicator database 11
- 12. Health situation in Sicily – comparison with the European Region
- 13. Infant mortality, life expectancy and all-cause mortality in Sicily and comparison with EU regions, around year 2013 Indicator Sicily Comparison with EU regions (quintiles) (2010) Infant mortality rate (deaths per 1000 live births) 4.14 Life expectancy at birth – females (years) 83.4 Life expectancy at birth – males (years) 79.0 WHO/Europe: Equity in health project – interactive atlases, http://data.euro.who.int/equity
- 14. All-cause and amenable mortality in Sicily and comparison with EU regions, around year 2013 Indicator Sicily Comparison with EU regions (quintiles) Age standardized death rate (ASDR) per 100 000 population, all causes, all ages, females 705.2 ASDR per 100 000 population, all causes, all ages, males 1038.3 ASDR per 100 000 population, all causes, all ages, both sexes 967.8 ASDR per 100 000 population, amenable causes, 2064, both sexes 116.75 WHO/Europe: Equity in health project – interactive atlases, http://data.euro.who.int/equity
- 15. Causes of amenable death Standardized death rate by residence 2013 (all ages) GEO/SEX Malignant neoplasm of colon, rectosigmoid junction, rectum, anus and anal canal Malignant neoplasm of liver and intrahepatic bile ducts Malignant neoplasm of trachea, bronchus and lung Alzheimer disease Ischaemic heart diseases Acute myocardial infarction including subs. myocardial infarction Cerebrova scular diseases Asthma and status asthmaticus BPCO Malignant neoplasm of breast (Females) Malignant neoplasm of cervix uteri (Females) European Union (28 countries) 31.29 10.51 55.15 17.83 131.87 50.08 88.68 1.38 33.52 33.19 4.03 Italy 27.75 14.57 50.51 14.52 104.16 37.94 84.11 0.64 28.87 31.63 1.23 Sicily 29.06 13.59 46.56 15.19 103.83 38.20 115.42 0.60 6.77 29.91 1.27
- 16. Availability of hospital beds and human resources for health in Sicily and comparison with EU regions, around year 2013 Indicator Sicily Comparison with EU regions (quintiles) 2010 Hospital beds per 100 000 inhabitants 470.3 Physicians per 100 000 inhabitants* 705.5 WHO/Europe: Equity in health project – interactive atlases http://data.euro.who.int/equity
- 17. Social gradient in Italy – disposable household income and life expectancy, around 2010
- 18. Social gradient in Italy – disposable household income and amenable mortality, around 2010
- 19. Social gradient in Italy – long-term unemployment and amenable mortality, around 2010
- 20. Social gradient in Italy – long-term unemployment and premature mortality (064 years) from ischaemic heart disease among males, around 2010
- 21. Summary of findings • Infant mortality in Sicily is high, in the highest quintile of the EU regions. • Life expectancy in Sicily is close to the average of all EU regions and is the second lowest in Italy. • Inequalities in social determinants like disposable income and long- term unemployment are large between Italian regions. • In Italy, the difference between the regions with highest and lowest life expectancy is 2.5 years; • Sicily has one of the highest densities of physicians in the EU, but the availability of nurses and hospital beds is below average; • There is considerable inequality at regional level in Italy, and health outcomes like life expectancy and amenable mortality show strong correlation with social determinants.
- 22. Sicily: facts and figures on migration 22 Migrants arriving in Sicily through the Mediterranean Sea Foreign citizens living in Sicily and their origin
- 23. Maximum value Regional average Minimum value Situation in Europe: Inequalities in life expectancy: declining, but gap persists 23
- 24. Maximum value Regional average Minimum value Situation in Europe: Inequalities in life expectancy: declining, but gap persists 24
- 25. Health equity and determinants at the heart of Health 2020 Lifestyle, social, economic and environmental determinants of health Health equity Good governance
- 26. Towards a roadmap for implementation of the SDGs in the European Region
- 27. PARTNERSHIPS Agenda 2030: Health is central to development Health and well-being are an outcome, a determinant and an enabler of the 17 SDGs
- 28. PARTNERSHIPS Speaking one language HEALTH DISCOURSE DEVELOPMENT DISCOURSE Health equity Leave no one behind Social, economic and environmental determinants Social, economic and environmental dimensions Empowerment Empowered people Resilient communities Life course Rights- and gender-based Rights- and gender-based Whole-of-society Whole-of-government Health in all policies Health in all SDGs Good governance and peace-building Resilient nations
- 29. We are on track towards a healthier Europe Premature mortalityLife expectancy
- 31. The early years and childhood Health inequities have a strong association with material conditions and experiences Source: Life Gets Under Your Skin, International Centre for Life course Studies in Society and Health (ICLS), 2012 • Low birth weight • Not being breastfed • Maternal depression • Having a lone parent • Median family income <60% of average • Parental unemployment • Maternal qualifications • Damp housing • Social housing • Area deprivation
- 32. Gender inequity: longer life expectancy for women but more years in poor health Global Health Observatory (GHO) data [online database]. Geneva: World Health Organization; 2016 (http:// www.who.int/gho/en/, accessed 20 July 2016)
- 33. Geographic inequities Life expectancy at birth in EU NUTS 2 regions, 2007–2009
- 34. The working years • Long durations of involuntary unemployment (three or more years) in young men significantly predict heavy drinking and more frequent drinking at ages 2735 years. • Those who experienced long-term unemployment before the age of 33 are more likely to report risky health behaviours than those who had not experienced unemployment, including those from more advantaged backgrounds. • Poor mental health is more prevalent among workers with non-fixed temporary employment and those without contracts than among workers with permanent or fixed temporary employment contracts. • There is a 50% increased risk of fatal and non-fatal cardiovascular events in those experiencing work-related stressors and this follows a social gradient.
- 35. • There is a positive association between unemployment and hospitalization for all causes in the Belgian provinces. • There is a strong association between long-term unemployment and hospitalization for cerebrovascular disease in adult males. Unemployment as a risk for NCDs Belgian provinces with higher unemployment rates = higher illness rates Equity in health project – correlation map atlas, WHO/Europe 2012 35
- 36. Increasing European and international attention on reducing inequities Income inequalities Employment & educational inequalities Health inequities Good governance for equitable development
- 37. A joint monitoring framework for Health 2020, NCDs and SDGs Alcohol Educational attainment Health expenditure Household consumption Mortality Reducing income inequality Sanitation Smoking Social support TB treatment Unemployment Vaccination
- 38. Towards a roadmap for implementation of the 2030 Agenda Roadmap Consultations with experts Consultation with civil society Consultations with UN agencies Online review SCRC
- 39. PARTNERSHIPS Agenda 2030: Health is central to development Photo: Fotolia Leaving no one behind Health for all
- 40. Better health for Europe More equitable and sustainable
Hinweis der Redaktion
- Joint assessment missions WHO/Europe has been collaborating closely with Italian Ministry of Health and the Sicilian health authorities in the area of migration since the start of the Arab Spring in 2011. A first assessment mission took place in Lampedusa in March 2011. Since then, joint Ministry of Health and Regional Health Authority assessment missions were repeated in Sicily in 2012, 2013 and 2014 due to the changing scenario and flow of migrants and refugees with the aim to upgrade the regional health capacity to respond to the large arrivals of migrants and refugees. Contingency planning In the context of the large-scale arrivals of migrants to Sicily, one of the main recommendations that resulted from the several assessment missions was the need to develop a migration health contingency plan. Preparations for the development of the contingency plan started in April 2014 in collaboration with WHO/Europe. By that time over 6,000 migrants were arriving to Sicily in a week. The contingency plan was publicly launched in September 2014 in Sicily. Sicily became the pioneer and an example for other countries in the WHO European Region in the development of an operational health strategy to respond to these large-scale arrivals. Sicily’s contingency plan was adapted as a law by the Regional Parliament of Sicily on 23 September 2014. Panorama case study A case study was published on the first issue of the new WHO/Europe public health journal, Panorama. This case study described the process undertaken jointly with the Ministry of Health and regional health authorities in Sicily since the preparation of the first assessment missions to the development of the contingency plan and its adoption as law. Workshop for toolkit consultation The Toolkit to assess health-system capacity for large arrivals of refugees and migrants has been up to today tested in assessment missions conducted jointly with Ministries of Health and regional health authorities in 13 countries (Italy, Portugal, Malta, Spain, Greece, Cyprus, Croatia, Slovenia, Serbia, Hungary, FYROM, Bulgaria, Albania). As part of the consultation process for the finalization of this toolkit, a technical workshop was held in Palermo, Sicily, organized by WHO/Europe with the support of the Health Regional Councillor of the Sicily region and the Sicilian Medical Association. 15 technical experts gathered at the workshop from the ministries of health of Greece, Italy, Malta, Portugal, and WHO/Europe. The toolkit has been finalized in collaboration with IOM and UNHCR, and its launch is planned for 18 December 2016 on International Migrants Day.
- Workshop for toolkit consultation The Toolkit to assess health-system capacity for large arrivals of refugees and migrants has been up to today tested in assessment missions conducted jointly with Ministries of Health and regional health authorities in 13 countries (Italy, Portugal, Malta, Spain, Greece, Cyprus, Croatia, Slovenia, Serbia, Hungary, FYROM, Bulgaria, Albania). As part of the consultation process for the finalization of this toolkit, after a 1st consultation health in Rome and hosted by Ministry of Health of Italy a technical workshop was held in Palermo, Sicily, organized by WHO/Europe with the support of the Health Regional Councillor of the Sicily region and the Sicilian Medical Association. 15 technical experts gathered at the workshop from the ministries of health of Greece, Italy, Malta, Portugal, and WHO/Europe. The toolkit has been finalized in collaboration with IOM and UNHCR, and its launch is planned for 18 December 2016 on International Migrants Day. Tool Kit: The Italian and Sicily Region migration health experience was paramount in inspiring the development of a first world Toolkit for assessing health system capacity to manage large influxes of refugees, asylum-seekers and migrants. In recent years, the WHO European Region has seen a marked increase in arrivals of mixed flows of refugees, asylum-seekers and migrants. Their journey to Europe is often long and treacherous, with numerous health and safety risks along the way. It is imperative that the health needs of these vulnerable groups be addressed by transiting and receiving countries using human rights principles and with careful coordination across sectors. The Toolkit for assessing health system capacity to manage large influxes of refugees, asylum-seekers and migrants was developed by the WHO Public Health Aspects of Migration in Europe (PHAME) project, funded by Italian Ministry of Health because refugees, asylum-seekers and migrants arriving in large groups present a particular set of individual and public health needs, and assessment of preparedness and capacity requires a specialized approach. The aim of the present toolkit is to support national ministries of health in leading multisectoral collaboration to optimize the capacity of the health sector to manage large influxes of refugees, asylum-seekers and migrants, consequently improving their health and reducing health inequities.
- Knowledge Hub responds to the need of an educational institute devoted to international migration and public health in the WHO European Region. AIM: providing a scientific and capacity-building forum, supported by a multi-stakeholder platform, to develop and improve public policies and interventions to address the public health implications of migration in the WHO European Region by: Improving health and well-being of the refugee, migrant and resident population Reduce health inequalities Promote migrants health systems sensitivity Provide evidence based capacity-building Develop public health policies for health and migration across the WHO European Region
- The objectives of the Knowledge Hub are grounded on the WHO/Europe health policy framework, Health 2020, as well as the 2030 Agenda for Sustainable Development. Its work will contribute to the implementation of the Strategy and action plan for refugee and migrant health in the WHO European Region, adopted by the Regional Committee for Europe in September 2016. Objectives To increase knowledge and awareness of health and migration stakeholders regarding good practices and evidence-based approaches by: - Gathering and collating experiences, good practices, knowledge and evidence-based approaches from the whole WHO European Region and other relevant WHO regions. - Fostering knowledge transfer of good practices and evidence-based approaches on health and migration for effective implementation into policies and programmes. To recognise and recommend good practices and evidence-based approaches to improve health and health care of asylum-seekers, refugees and migrants. To promote collaboration and interaction among health and migration stakeholders by: - Supporting action-oriented research and policy analysis on health and migration; - Engaging governments, scientists, public health specialists, IGOs and NGOs, civil society and all key stakeholders from the health sector and non-health sector, in addressing the public health aspects of migration through a participatory approach. To contribute to improving countries’ preparedness and capacity, promoting people-centered health systems and reducing health inequalities within asylum-seekers, refugees and migrants.
- No doubt that if you should choose a country based on where you can live longer, then Italy would be the right place to be (the wonderful food and wine notwithstanding). In 2012, life expectancy for males was 79.8 years and 84.8 years for female. This is stable and much higher than the European average.
- However, Italy has an ageing population. In fact, Italy has the highest proportion of population aged 65+ in EU15 in year 2012 (21%).
- If we take a look at the mortality for all causes, Italy has one of lowest mortality rates in EU15, especially for age groups 30-44 (females), 45-59 (males and females), 60-74 (males and females); Additionally, Italy also has low mortality rates from diseases of respiratory and digestive system as well as external causes compared to EU15 average.
- Italy is also doing well in terms of premature mortality: mortality rates are below EU15 average for neoplasm, diseases of circulatory, respiratory and digestive system, injury and poisoning; Also in terms of Major noncommunicable diseases, mortality rates are below EU15 average for males and females.
- In Italy the infant mortality rate was 3.7/1000 during 2005, lower than the average IMR for the European Region 4.94/1000 ). Sicily is the Italian Region with the highest IMR, 4.5 per 1000 live births in year 2010. This value is among the highest in the regions of the EU. Life expectancy for males, females and both sexes is slightly above average than other regions in the European Union but lower than the Italian average ( male 79,8 and females 84,8 in 2012 ) .
- All cause mortality, and age standardized rates are somewhat below average of EU regions . Situation is similar also for amenable mortality, deaths that are considered to be avoidable through appropriate and timely health care interventions.
- Asma 0,60 BPCO 30,23 Demenze 38,01 Infarto miocardico acuto 38,20 Influenza 0,37 Malattia di Alzheimer 15,19 Malattie cerebrovascolari 115,42 Malattie ischemiche del cuore 103,83 Polmonite 6,77 Traumi e incidenti 31,63 Tumore maligno del colon-retto 29,06 Tumore maligno della cervice uterina 1,27 Tumore maligno della mammella 29,91 Tumore maligno della trachea, dei bronchi e del polmone 46,56 Tumore maligno primitivo del fegato e dei dotti biliari intraepatici 13,59 Totale complessivo 500,67
- The density of hospital beds is one of the lowest values in the European Union. However, the density of physicians is high, placing Sicily in the quintile of the European Regions with highest availability of physicians. Density of nurses and midwifes is 589.9 per 100 000 inhabitants, which is below average of European Regions. According to the national trend, Sicily is decreasing the hospital capacity and planning to shift partially the health care activities towards primary care settings. This is a European trend that we support. Italy provides one of the highest level of accessibility for irregular migrants to healthcare services at the European level. In 1998 a National law ensured to migrants the access to emergency care, hospital care and prevention services, cost free and anonymous. Primary care is not guaranteed by this law, but each region can choose if and how to guarantee it to undocumented migrants. With the increase of migratory flows, the health care activity increased and covered also the health care assistance during sea rescue and into migrants` hosting centers. In 2014 the Sicily Region approved a contingency plan, developed with the support of WHO, in order to strengthen the governance and the organization of the health system, facing increased migratory flows. In the same year, the Sicily Region guaranteed access to undocumented minors to primary care.
- In Italy, there is relatively strong association between disposable household income per inhabitant (x axis) and life expectancy (y axis). Sicily is the highlighted data point.
- In Italy, there is strong association between disposable household income per inhabitant (x axis) and amenable mortality (y axis). Sicily is the highlighted data point.
- In Italy, there is strong association between long term unemployment (x axis) and amenable mortality (y axis). Sicily is the highlighted data point.
- In Italy, there is strong association between long term unemployment (x axis) and premature mortality (0-64 years) from ischaemic heart disease among males. Sicily is the highlighted data point.
- Over 1 Million crossed the Mediterranean sea in 2015 with majority arriving to Greece; and with an estimated 3771 drowned or went missing along the way. Over 300,000 have risked their lives to reach Europe by sea so far in 2016. Data recorded in October 2016, 12% increase compared to the same period of 2014 and 2015. 20,500 unaccompanied children have arrived to Italy since the beginning of January 2016. No unaccompanied children have been relocated from Italy yet, but Italy will carry out first pilot transfer of unaccompanied children. UNHCR Data October 2016
- Let us see now what is the situation in Europe. In the last 30 years we made good progress n Europe in health outcomes and we gained 5 years in LE which is a tremendous success story. But inequities – although improving – still scar our region. Let us take life expectancy with this perspective in mind: Europeans are living longer and the differences between countries in health outcomes are shrinking: a clear sign that inequalities are declining.
- But the gap between the countries with the highest and lowest life expectancy is still 11 years. Only a few countries have the privilege to enjoy the higher figures and Italy is one of them.
- Health and health equity is at the heart of Health 2020 and is one of our 2 strategic objectives. To make progress, we have to address all determinants of health: economic, social, environmental, health behaviour – as well as we need intersectoral governance for health.
- Health 2020 is also a route towards the implementation of the 2030 Agenda for Sustainable Development in the European Region as the two are fully aligned.
- Today, more than one year after the UN General Assembly adopted the Agenda 2030 with the 17 Sustainable Development Goals, the centrality of health as outcome, determinant and enabler for sustainable development is widely acknowledged. And if we work smart and well coordinated on the implementation of Health 2020 and the Agenda 2030, partnering across all sectors and society, there clearly will be synergies and co-benefits for our investments in health and sustainable development.
- I would like to demonstrate this alignment to you. A quick look at the key conceptual terms used in the health discourse on the one hand and the development discourse on the other shows the close alignment. Just to highlight a few examples: The key strategic objectives of health equity and whole-of government and whole-of-society approaches in Health 2020 – and the overarching focus on ‘Leave no one behind’ and good governance of the Agenda 2030; and we see social, economic and env. actors as relevant determinants for health and well-being in H2020 and at the same time as key pillars for sustainable development. The concept of resilient communities and nations is featuring strongly in both frameworks, as does the concept of empowered people as a pre-condition for well-being and sustainable development. The rights- and gender based approach – is there in both frameworks. And the life course approach? Although the term does not exist explicitly in the Agenda 2030, many of the targets of the SDGs fully reflect the life course concept including intergenerational responsibilities, and by advancing the debate like we did through the Minsk Declaration on the life-course Approach in the Context of Health 2020 last year – act early, act appropriately and on time during the life’s transitions, act together – we underline our forward looking approach and strong focus of improving impact.
- In this regard we have reason to feel good about some of the progress we are making For example: Europeans continue to live longer and healthier lives than ever before. As this slide shows, the differences in life expectancy and premature mortality between countries across the region are diminishing.
- Yet, profound challenges remain: the absolute differences in health status between the countries remain substantial ( 12,5 years difference in life expectancy between the lowest and highest figure in Europe ) and within countries inequities also continue. These inequities in health are mainly linked to economic and social inequalities ( linked to globalization, economic processes ( such as liberalization and free trade - unless they are coupled with a social protection scheme. Opex markets require strong state and storng social protection, otherwise the result is what we have seen with the Brexit or what we see with the migration wave (economic migration). On this slide we can see how education, income and material conditions are linked to health inequalities in Europe. Interestingly material deprivation has the strongest effect . We know that these gaps are largely avoidable with good policy. We also know the policies and sectors that are important for increasing equity in health. The evidence is rich and convincing – as we all have been working hard in recent years to develop such evidence. Now we are discussing policy recommendations. This work requires that we reach out to the other sectors. Why?
- Health inequalities in early years have a strong association with adverse material conditions and experiences. Homelessness, abandonment, neglect, material deprivation, parental unemployment - these all increases the risks of low mental wellbeing, higher stress and anxiety levels, poorer schools attendance & grades and an increased risk of developing health problems in later life. These are also priorities for the education, labour and welfare sectors as well as for Health
- Women overall live longer than men with a 12,5 years difference in the region but this mortality advantage of women also hides years of mental and physical disability, like in Andorra where there is the highest life expectancy, they spend the last 12 years in ill health; these are also priorities for the social sector and for local authorities
- Lower development indicators such as GDP, employment, wages & earning often correlate with poorer health outcomes. The visible effects are geographic inequities within countries. For example in Hungary there is a 9,5 years gap in adult Life Expectancy between different micro-regions , reflecting higher rates of material deprivation and employment insecurity. And the same patterns exist in all our countries as we can see on the slide, including in Nordic and Baltic countries. In Hungary, the bad health status of the population and inequity in health – causes an economic loss of appr 12 % of the GDP. It clearly hinders economic growth. When we are focusing on action it is obvious that reducing geographic inequities is also a priority for the development and the labour sectors and for the sustainability of our town and cities.
- Not being in employment, education and training in youth and during working years is particularly associated with an increased risk for NCDs. As the figures on this slide show. This is particularly alarming as precarious employment and low-paid jobs have increased significantly in the last 7 years across the EU contributing to higher rates of unemployment and ‘in-work’ poverty. This is particularly affecting youth and migrants and those with fewer years in education.
- This slide shows an example from Belgium where we can see higher GP consultations for mental health problems and higher hospitalization rates for cerebrovascular diseases in the areas where there are higher rates of people in non-fixed temporary employment and those without contracts. These are priorities for the health, education, labour, welfare and finance sectors together. All of this data show us the necessity of cross sectoral action to increase equity in health BUT also how the benefits are shared by many sectors and deliver improvements for local people and for wider societal goals.
- We need to intensify our combined policy efforts making health and equity a whole of government goal. In this regard we are now at an interesting time in Europe and globally in our efforts to create the conditions for societies that are healthier, inclusive and sustainable. As this slide shows there is a convergence of interests across diverse communities of practice and from many disciplines including economics, health, labour, and environment and from the perspectives of rights & justice.
- As the WHO Regional Office for Europe, we have worked together with Member States to develop Health 2020 indicators and improve data collection, and developed a monitoring system with national targets that allows improved reporting, follow-up and review processes. The Agenda 2030 with its many targets and indicators, its international reporting requirements, and its still largely unresolved challenge how to disaggregate data to measure progress along various dimensions of inequality, constitutes additional challenges in our effort for better evidence of outcomes and impact. We, at the WHO Regional Office for Europe, have started the process of reviewing the further harmonization of indicators, reporting mechanisms and analysis across the Health 2020 and Agenda 2030 frameworks and will assist Member States, also through our Healthy Setting Networks, in this endeavour. It is, and will be again, an area in which much can be learnt from innovations on regional level, and we are looking forward to an even more intensified collaboration in this area with you.
- We now need to develop a regional roadmap to implement the SDGs. This will build on what we have already achieved. From an initial mapping carried out, it becomes apparent, that the implementation of the SDGs requires: A review and identification of regional priorities towards 2030. A stronger focus throughout on governance and inter-sectoral action for health as well as “no-one left behind” Alignments of national development and health policies and policy coherence across multiple goals A stronger focus on the means of implementation, is also required, to both advance Health 2020 and the SDGs. This will certainly include strengthened public health capacities, more partnership, increased financing for health, innovation, further research, and enhanced monitoring and accountability We are ready to work with all of you. We plan to consult with political and societal leaders, technical and professional experts, civil society, UN agencies, in various forums, including virtual forum, with all of you, and provide a regular update to the Standing Committee of the Regional Committee.
- Health 2020 and Agenda 2030: Whether through ‘health for all’ or ‘leaving no one behind’ – we will work for the well-being and sustainable development of current and future generations.
- Thank you for your attention.