This could not be a timelier conference, and I am both grateful and honoured to have to welcome you to the European Region and to have the chance to address you so early on in my time as Regional Director of the European Region of the World Health Organization. It could not be a timelier conference because even though only three years have passed since your last meeting in Vancouver, Canada, there are a number of changes which are happening for the first time in recorded history! They are changes that will have a huge impact on health. And they are changes which a strong, effective and credible health promotion strategy cannot ignore.
The first major global change I would like to draw your attention is climate change. All models of climate change indicate that we are irreversibly headed towards a period of increasing temperatures worldwide. The evidence has mounted since you last met in Vancouver. There is now no doubt that a major cause of this shift is due to human action. There is no doubt that developing countries will bear the brunt of many of ill-effects. There is no doubt that the words of adaptation and mitigation must become part of the vocabulary of health promoters worldwide.
Allow me to turn to the second major change that is happening right now. In 2008, the year after you met in Vancouver, the world's urban population exceeded the rural. We have become a planet of city-dwellers. Urbanization brings many benefits in the form of increased access to services and employment. Urbanization must be regarded, for the foreseeable future, as an irreversible trend. Yet it brings many problems: urban, landless, poverty; pollution; and increasingly inactive lifestyles, to name but a few. These issues have been systematically described in a recent WHO report released for the 2010 World Health Day “ 1000 Cities, 1000 Lives ” Health Promotion as a discipline gave birth to the settings approach and to the Healthy Cities movement. My Region, the European Region, has been at the forefront of this development. That movement is much needed now and you are challenged in this conference to explore how the lessons you have learned may be used to protect and produce health in cities through joint action with urban planners, local governments, civil society, and with the health sector itself.
Now the third major change. Before you meet again, at your next IUHPE World Conference, another extraordinary change will probably have been achieved. For the first time in human history, the global population aged over 65 will have exceeded that of children below 5 years. The phenomenon of ageing will stop becoming a future event but an increasingly tangible part of the present. As the boomer population surge into old age, and as health and social development helps more people achieve longer lifespan, the number of older persons in all societies will start to exceed the younger, the population pyramid will start to spin upside down. We are facing the last cohort of predominantly young people in many parts of the developing world. This cohort represents a rapidly closing window of opportunity to have a major impact on the health of a future aged population. Everything depends on the policy decisions we take now, the health promotion principles we concretely apply, the risks we manage to avert throughout this cohort's life course.
Even as gains are being made in the traditional health problems embodied in the Millennium Development Goals, this world still bears the scandal of unacceptable numbers of mothers and children dying in ways that would be deemed unacceptable in the industrialized world. In this slide you can see the summary of a recent study on maternal mortality. Many parts of Africa are seeing declines in maternal mortality that are as slow as the ones in Europe or North America, yet the African rates are much higher and the decline too slow. Yes, this too is a challenge for health promotion. The &quot;traditional&quot; problems of child survival, maternal mortality, tuberculosis and malaria should not be seen as technical concerns left to the specialists and &quot;basic scientists&quot;. The solutions to these problems lie in the domains of health promotion: in public policies that give access to services, in promoting health literacy, and in empowering communities, in addressing the so-called social determinanats of health .
While these traditional threats linger on scandalously, there is increasing recognition of the burden of noncommunicable diseases. You are familiar with the estimates of burden of disease so I will illustrate my point using another index, that of policy attention. In the last two years, the World Economic Forum has produced a report that assess a range of global risks: economic, geopolitical, environmental, societal and technological in nature. These include risks such as spikes in the price of oil, nuclear proliferation or mass migration. The epidemic of chronic diseases has, for both 2009 and 2010, been assessed in the top four risks in terms of likelihood of its taking place and in terms of severity to the global economy. It is not just the economists that are perking up. On May 13th, 2010, the United Nations adopted a Resolution on the prevention and control of noncommunicable diseases and has called for a high level meeting in 2011 comparable with the one held on AIDS in 2001. Where is health promotion standing on this issue? How will you all be involved?
I have spoken up to now about broad global trends as if all of these changes affect everyone equally. We know, of course, that this is far from the truth, whether we speak of epidemics or disasters. A United Nations report produced last year of a global assessment on disaster risk reduction confirms that poorer countries have disproportionately higher mortality and economic loss risks, given similar levels of hazard exposure. For example, globally, high-income countries account for 39% of the exposure to tropical cyclones but only 1% of the mortality risk . Low-income countries represent 13% of the exposure but no less than 81% of the mortality risk . For example, gross domestic product (GDP) per capita in Japan is US$ 31,267 compared to US$ 5,137 in the Philippines, and Japan has a human development index of 0.953 compared to 0.771 in the Philippines. Japan also has about 1.4 times as many people exposed to tropical cyclones than the Philippines. However, if affected by a cyclone of the same magnitude, mortality in the Philippines would be 17 times higher than that in Japan
The report on disaster risk reduction applies its findings in a general fashion and shows that the link between the impact of disasters and poverty is a much more structural problem. In the language of the conceptual model of the Commission on Social Determinants of Health, poor people face greater exposure to risk, are more vulnerable, have more adverse outcomes, and worse consequences than the rich.
The findings of the report on disasters are echoed by gradients across and within societies. A recent book, The Spirit Level, by Wilkinson and Pickett shows how income inequality in societies leads to adverse effects across a wide range of social outcomes. More unequal societies live shorter lives, do worse at maths, have more prisoners, have less trust, more teenage births, are more obese and have more mental ill-health. The Equality Trust suggests that the remedy is simple: ensure that people's income is more equal before tax or make it more equal after taxation and redistribution.
Underlying all these global trends is people's experience of injustice. Since you last met in Vancouver, the Commission on Social Determinants has also reported and its report quickly became one of the most downloaded publication on the whole of WHO's website. The report's cry that social injustice is killing people on a grand scale was echoed on media all over the world. It is very telling that a subject many thought would be too abstract should have defied all expectations and struck such a chord, in a publication on the theme of fairness and the right of people to have access to resources, to a fair income, and to a political voice. While on this subject, I would also like to highlight a more recent publication that emerged from the work of the Commission, the report of the knowledge network on priority public health conditions. This is a theme that I will return to later in this talk, the question of what is the role of health programmes themselves in addressing social determinants, after all, reorienting health services was one of the action areas of the Ottawa Charter.
As the oil spills uncontainably into the Bay of Louisiana and into our living rooms via the media, a symbol of the havoc that we have wreaked on the environment… As war is waged worldwide in the name of peace… As the financial world reels from the meltdown of 2008 and beyond… As the world grows older and moves to cities… As the chronic diseases overtake infections as the scourge of the poor… As all this happens, it is useful to ask if the assumptions of the past are any longer relevant to today's realities. In seeking solutions to again renew public health, should we be seeking new models to explain and guide us? Should we demand that economists be developing new ways of measuring production and prosperity? Should we demand that health services invest more heavily in defining and promoting the causes of health, the assets of individuals and communities, rather than continuing down the path of risk and disease, but not on their causes?
In finding remedies we must start from where we have greatest influence and control. There is a large unfinished agenda for health promotion in addressing the fifth action area of Ottawa. What is this agenda? There is a lot of &quot;health&quot; that is missing from the health sector's own policies . Many of the shortcomings and the failed achievements that I have mentioned are directly related to the health sector. No woman should die in childbirth; avoiding such deaths lies largely within the control of the health sector. Yet the health sector often fails to internalize the message of health promotion. Health promoters should see their success in reorienting health services as the testing ground for their ability to reorient other sectors. If we cannot achieve intra-sectoral promotion of health, how can we credibly aim to do it inter-sectorally?
Yet this must also be our ultimate aim. Most of the determinants of health lie outside the reach of the health sector and we have been trying, for the whole of the life of health promotion as a discipline, to find ways of acting across sectors, effectively and sustainably. Ottawa said we should build healthy public policies. Adelaide was a conference devoted to it. In April this year, Adelaide has revisited the theme of Health in All Policies, and produced a statement that calls for institutionalized processes that value cross-sector problem solving and address power imbalances. It suggests concrete solutions to enable intersectoral action: from integrated budgets and accounting to cross-cutting information systems; from joined-up workforce development to community consultations; from impact assessments to Health Lens analysis. Health promoters would do well to explore here how they can push forward this agenda in the coming three years leading up to the next Global Conference on Health Promotion in Helsinki, in 2013, itself having the theme of &quot;Health in All Policies&quot;.
RD can decide here to finish with one strong message of her leadership in Europe
Opening session presentation
OPENING PLENARY SESSION Inspiring insights into health and sustainable development Des avancées passionnantes sur la santé et le développement durable Reflexiones alentadoras en torno a la salud y el desarrollo sostenible
Co-chairs: Joachim Eder : President of the Executive Board, Health Promotion Switzerland, Switzerland Prof. Vivian Lin: La Trobe University, Chair, Global Scientific Committee Geneva 2010, International Union for Health Promotion and Education [IUHPE], Vice President for Scientific Affairs, Australia
Pascal Strupler : Director, Swiss Federal Office of Public Health [MoH], Switzerland Dr. David McQueen: President, International Union for Health Promotion and Education [IUHPE]: Associate Director for Global Health Promotion, US Centers for Disease Control and Prevention, USA WELCOME ADDRESS
Dr. Zsuzsanna Jakab: Regional Director, World Health Organization Regional Office for Europe [WHO Euro] INTRODUCTION TO THE CONFERENCE THEME
Zsuzsanna Jakab WHO Regional Director for Europe Health Promotion in a Fast-Changing World • Vancouver 2007 Geneva 2010•
A Changing Climate Source: Climate Change 2007: The Physical Science Basis http://www.ipcc.ch/pdf/assessment-report/ar4/wg1/ar4-wg1-chapter10.pdf
An Urban Planet Source: World Urbanisation Prospects | 2005 Revision http://www.un.org/esa/population/publications/WUP2005/2005wup.htm Rural Urban
And, by your next Conference… More People Aged 65+ than Under 5 1 Data Source: http://esa.un.org/unpd/wpp2008/peps_population-by-age-and-sex_5x1.htm UN, Department of Economic and Social Affairs - Population Division, World Population Prospects: The 2008 Revision, Estimates, 1950-2010. Low-fertility variant, 2010-2050
Traditional Burdens Remain Unacceptably High Source: Hogan et al. Maternal mortality for 181 countries, 1980–2008: a systematic analysis of progress towards Millennium Development Goal 5. Lancet 2010; 375: 1609–23 http://www.containerstoclinics.org/documents/Maternal_Mortality_for_181_Countries.pdf Yearly rate of decline in maternal mortality ratio, 1990–2008
And New Burdens Threaten Health and the Economy <ul><li>Of all global risks assessed in 2010, the epidemic of chronic diseases is deemed: </li></ul><ul><li>Third most likely to occur </li></ul><ul><li>Fourth most severe in economic impact </li></ul>Source: World Economic Forum http://www.weforum.org/pdf/globalrisk/globalrisks2010.pdf
Poor Populations are More Vulnerable Global assessment report on disaster risk reduction (2009) http://www.preventionweb.net/english/hyogo/gar/report/documents/GAR_Chapter_1_2009_eng.pdf
And Their Vulnerability is Structural United Nations International Strategy for Disaster Reduction Secretariat http://www.preventionweb.net/english/hyogo/gar/report/documents/GAR_Chapter_1_2009_eng.pdf
Health and Social Problems are Worse in More Unequal Countries http://www.slideshare.net/equalitytrust/the-spirit-level-slides-from-the-equality-trust
Social Injustice The Ultimate Cause of the Causes
And in Europe… <ul><li>European Health Policy… </li></ul><ul><li>Social Determinants Review… </li></ul><ul><li>Vulnerable population Groups…. </li></ul><ul><li>NCD` as priority…. </li></ul><ul><li>Revitalize public health and health promotion…. </li></ul><ul><li>Climate Change within Environment and Health ….. </li></ul><ul><li>Elderly…. </li></ul><ul><li>Health Sector Strengthening…. </li></ul><ul><li>Partnerships….. </li></ul><ul><li>BETTER HEALTH FOR EUROPE AND REDUCE HEALTH DIVIDE </li></ul>
Michael Hübel: Health and Consumer Affairs, European Commission [on behalf of Paola TestoriCoggi, Director General] INTRODUCTION TO THE CONFERENCE THEME
Moderator: Dr. David McQueen: International Union for Health Promotion and Education [IUHPE], USA Speakers: Dr. Zsuzsanna Jakab: WHO Euro Pascal Strupler: MoH, Switzerland Michael Hübel: DG Sanco, European Commission PANEL DISCUSSION
Prof. Vivian Lin: La Trobe University, Chair, Global Scientific Committee Geneva 2010, International Union for Health Promotion and Education [IUHPE], Vice President for Scientific Affairs, Australia INTRODUCTION TO KEYNOTE SPEECHES
Dr. Sarah Cook: Director, United Nations Research Institute for Social Development, UK KEYNOTE SPEECH I
Prof. Paul Hunt: University Essex, UN Special Rapporteur on the Right to Health (2002-2008), New Zealand KEYNOTE SPEECH II
Joachim Eder : President of the Executive Board, Health Promotion Switzerland, Switzerland THANK YOU