Health 2020, Health Promotion and Health Education
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Presentation by Dr Zsuzsanna Jakab, Regional Director, WHO Regional Office for Europe, Bucharest, Romania, 24 February 2016
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Health 2020, Health Promotion and Health Education
- 1. Health 2020, Health Promotion and Health Education Dr Zsuzsanna Jakab Regional Director WHO Regional Office for Europe Bucharest, Romania, 24 February 2016
- 2. Health is a political choice
- 3. Long history of excellent collaboration between WHO and Romania
- 4. BETTER HEALTH FOR EUROPE: MORE EQUITABLE AND SUSTAINABLE
- 5. Maximum value Regional average Minimum value Inequalities in life expectancy: declining, but gap persists
- 6. Maximum value Regional average Minimum value Inequalities in life expectancy are declining, but gap persists
- 7. Region is on track to reducing premature mortality Maximum value Regional average Minimum value
- 8. litres of pure alcohol are drunk per person per year of the population is overweight or obese of the population uses tobacco
- 9. European countries are strengthening their policies all answers (31 for 2010 and 36 for 2013) No,butplanned forthefuture Yes,anotherstrategy Yes,comprehensivehealthpolicy NationalhealthpolicyisalignedwithH2020 Allanswers(n=31and36for2010and2013,respectively) 2013 2010 Yes, comprehensive health policy Yes, another strategy 0% 10% 20% 30% 40% 50% 60% 70% Noandnotplannedforthefuture No,butplanned forthefuture Yes,anotherstrategy 2013 2010 2013 2010
- 10. Strategic directions of Health 2020 remain relevant
- 11. Investing in health pays off Photos: Malin Bring
- 12. Photo: Malin Bring RETURN ON INVESTMENT Reproductive, maternal and child health US$ 20 per US$ 1 spent
- 13. Photo: Malin Bring RETURN ON INVESTMENT Reproductive, maternal and child health US$ 20 per US$ 1 spent
- 14. Health is an investment (not an expense): we need to invest more
- 15. Health is central to development
- 16. Transforming our world: the 2030 Agenda for Sustainable Development
- 17. Formulation of the health goal - fully aligned with Health 2020
- 18. Health Goal Goal 3: Ensure healthy lives and promote well- being for all at all ages 3.1 Reduce maternal mortality 3.2 End preventable diseases 3.3 End epidemics of AIDS, TB, etc. 3.4 Mortality from NCDs 3.5 Substance abuse 3.6 Road traffic accidents 3.7 Access to sexual and reproductive health 3.8 Universal health coverage 3.9 Hazardous chemicals and pollution Health as a target in other goals
- 19. Health targets will be met only by joining policy action with that for other SDGs Example: The health target to reduce premature mortality from NCDs should be reached in partnerships between health and sectors and policies responsible for education (SDG4) and economic growth and employment (SDG8).
- 20. RENEWED POLICY ENVIRONMENT FRAMED BY HEALTH 2020
- 21. Intersectoral action requires political commitment
- 23. European environment and health process
- 24. Social determinants of health: a strategic priority Second High-level Meeting of Small Countries, Andorra Promoting intersectoral and interagency action for health and well-being in the WHO European Region, France
- 25. Health situation in Romania
- 27. Health situation and trends in Romania: Maternal and infant mortality
- 28. Premature mortality (0–64 years), by broad cause
- 29. Trends in AIDS incidence and mortality from tuberculosis
- 30. Overweight and obesity (WHO estimates)
- 31. Alcohol consumption: total and spirits
- 32. Proportion of girls and boys of official primary school age not enrolled in school 0 5 10 15 20 25 1990 1995 2000 2005 2010 2015 2020 Romania European Region EU Proportion of children of official primary school age not enrolled, both sexesM mmm
- 35. Public sector and out-of-pocket health expenditure
- 36. A number to remember: keep out-of- pocket expenditure low
- 37. Financial protection in Romania: out-of-pocket expenditure at 19% Out-of-pocket expenditure as a % of total expenditure on health, by country groups from low to high income (high, upper-middle, lower-middle and low) Source: WHO Global Health Expenditure Database for 2011
- 38. Health situation and trends in Romania Findings, summary and main messages Romania has made substantial progress in selected areas of health, like tuberculosis and maternal mortality. Major challenges remain in other areas, like noncommunicable diseases and availability of health system resources. National policies have been aligned with Health 2020, which, with determination to continue health reforms, will accelerate health improvements and reduce health inequalities in future. Major global and European challenges, like the migrant crisis and global emergencies, must be taken into account in considering future developments.
- 39. Health situation and trends in Romania Findings, summary and main messages More effort is needed to tackle the determinants of population health by whole-of-society and whole-of-government approaches via Health 2020 strategic steps, as incorporated in the Romanian National Health Strategy 2014–2020. Overall governance for health should be improved and paths and approaches proposed for more equitable, sustainable, accountable health development in Romania. Improved health indicators and a better overall level of health and life satisfaction of the Romanian population can be attained by reaching above and beyond the health sector to achieve greater coherence among national sectors and a comprehensive response to inequalities.
- 40. Alma-Ata Declaration; Ljubljana Conference on Reforming Health Care 1978-96 Introduced core health system functions: governance; services delivery; financing; resource generation 2000 Tallinn Charter: health systems for health and wealth 2008 and 2013 Oslo conference: Impact of crisis 2009 and 2013 2012 Health 2020 priority area: strengthening people-centred health systems and public health Priorities in Romania in the coming years
- 41. New vision for health systems strengthening and work on health determinants reaches out to people
- 42. Mul umesc pentru aten ieț ț WHO High-level ConferenceWHO High-level Conference Working together for better health and well-beingWorking together for better health and well-being Paris, 11–12Paris, 11–12 July 2016July 2016
Editor's Notes
- Health is a political choice! It is only with leadership of Presidents, Prime Ministers and a whole-of-government and whole-of-society approach, that we can move forward with our quest for Better Health in Europe: More Equitable and More Sustainable.
- We have a historically good and close collaboration with Romania. Our WHO Country Office in Bucharest established in January 1991 contributed to this greatly. Now that our Head of Country Office is leaving to take up a new job and accepting a promotion, we have to make sure that our CO remains strong. Let me mention two of the many important joint work: The Romanian National Health Strategy 2014-2020 identifies improved health outcomes and equity as important objectives of the strategy in Romania. This is an important step towards the successful implementation of Health 2020. The Romanian Government approved this Strategy in November 2014. As a consequence of the high level visit in 2012 of the “then” EU Commissioner and myself, the Romanian Government strengthened the National Tuberculosis Control Programme and elaborated a new National Strategy. The Strategy has a particular focus on MDR TB. With rigorous implementation of this Strategy, Romania has the best chances by 2020 to achieve control of MDR TB and decrease significantly the incidence. We as WHO are continuing to support the implementation of the Strategy. In 2011 we also organized an important European Conference here on how to help children with intellectual disability which guides our work ever since. Romania also has close links to the WHO Governing Bodies: our RC was hosted in Bucharest some years ago; Romania is now the member of our SCRC. It is my pleasure to inform you that together with the Minister of Health just before this gathering in presence of the President of Romania HE Klaus Iohannis, we have signed the Biennial Collaborative Agreement stating the main direction for our cooperation during next two years.
- Better health for Europe: more equitable and sustainable – that is what we agreed to work for. We made very good progress in the last 3 decades and increased life expectancy by 5 years.
- Europeans are living longer and the differences between countries in health outcomes are shrinking: a clear sign that inequalities are declining and Health 2020 works.
- But the gap between the countries with the highest and lowest life expectancy is still 11 years.
- The Region is on track towards reducing premature mortality due to the decline in cardiovascular diseases (CVDs), and Europeans are reducing their health risk behaviours.
- But people in Europe still smoke and drink more than anywhere else in the world, and are among the most obese. And these risk behaviours are socially determined. Therefore the social determinants are important components of our work.
- More decision-makers are making coherent and interconnected government policies, with a strong intersectoral component, and using Health 2020 as the way forward. From 2010 to 2013, the proportion of countries with national health policies aligned with Health 2020 almost doubled: from 38% to 70%. I am proud of this.
- This progress demonstrates what we can do if we are committed and work together, but it also shows that we have many challenges ahead, confirming that the key strategic directions of Health 2020 remain more relevant than ever before.
- The economic case for investment in health is strong. Equally the economic case of investment in disease prevention and health promotion is also strong. Investing in health generates cost-effective health outcomes and economic, social and environmental benefits. The health sector’s call on government to invest in health will make this change happen. We need to give this message loudly.
- For example, current evidence suggests that investment in reproductive, maternal and child health has a potential return of more than US$ 20 for every dollar spent. The argument for investing in the best-buy interventions, in prevention and health promotion is equally clear for addressing noncommunicable diseases (NCDs) and its main determinants.
- We have all the evidence Mr President – developed together with the OECD.
- Health is an investment and not an expense. Current investments in health and public health are not sufficient. We need to invest more. Currently, for example, we spend only 3 % of our health expenditure on public health ( on prevention and health promotion ) in Europe and the rest to deal with the disease burden. We have to invest earlier on – to avoid this huge disease burden – and prevent NCD`s which is now appr 80% of the disease burden and death. This could save a lot of money. The very topic of this conference, which requires both governmental responsibility to create an environment where “Healthy Choice is the Easy Choice” and individual responsibility to reduce our risk taking behaviour.
- Development is impossible without better health. Health is a precondition for development: it is an outcome in its own right but it is also a contribution towards a sustainable society in other areas and an indicators of progress in development.
- 2015 was an exciting year! In September, world leaders gathered at the United Nations Summit and adopted the Agenda for Sustainable Development by 2030 and - leave no one behind. The Agenda has universal goals that applies to every nation – not just to developing countries. Health and well-being play a central role in the Sustainable Development Agenda.
- Goal 3 is the health goal which aims to “ensure healthy lives and promote well-being for all at all ages”. The formulation of the SDG health goal and the health targets in the other SDG’s which address the determinants of health - is fully aligned with Health 2020 which European Member States developed and adopted in 2012, exactly 3 years before SDGs. This shows the foresight of our MSs. We also have to “ marry them “ during the implementation.
- Focusing solely on the health goal would be a missed opportunity. All the SDGs influence health, because they address the determinants of health. The 2030 Agenda links different dimensions of development. This is the best support ever to our public health work: approved at the highest level, integrating the policy approaches and envisaging WOG/WOS approaches, just like we did in Health 2020.
- Individuals and families with higher and more secure income and more years in education are able to live healthier lives, experience fewer social and economic health risks such as long term, involuntary unemployment and have lower exposures to environmental and occupational health risks, all of which increase the risk of premature mortality of NCD. However interventions to reduce NCDs will also contribute to SDGs and targets agreed for Education and Employment. For example health and nutrition affect education by enhancing children’s physical ability to attend school and by increasing their cognitive ability to learn. A healthier workforce is more productive and more resilient due to better mental health, and there is less absenteeism. This highlights the relationship between health as an ‘input’ to promoting education and economic growth. In context of Romania: The synergy between the health and education sectors has a number of outcomes that would directly benefit Romania. The synergy would facilitate the creation of increased employment opportunities and improved social conditions; both of particular importance to Romania as it would help address the 2016 European Union Country Specific Recommendations, that specifically highlights the necessity for improved labour-market dynamics and social protection in Romania. Synergy between the health and education sectors culminates in improved education and social welfare, which in turn contributes to improved labour-market dynamics, and social protection. (EU Country Specific Recommendations Romania 2016: http://ec.europa.eu/europe2020/pdf/csr2015/cr2015_romania_en.pdf)
- Health 2020 is key in this renewed policy environment, and the expectations we formed in 2012 are becoming a reality. All Member States have shown incredible enthusiasm in embracing the guiding principles and priorities of Health 2020.
- Intersectoral action is key in this new policy environment but it requires political commitment. It should focus on key public health priorities and upstream interventions by addressing the determinants of health and health equity, and strive for maximum impact by creating win–win partnerships. This is what Health 2020 is about.
- Our Region has much experience with intersectoral action on, for example, the International Health Regulations, antimicrobial resistance and health-system financing and the impact of the financial crisis on health and health systems (working with ministries of finance), lifestyle issues.
- One concrete example is the European environment and health process. With its 26 years of experience in intersectoral work, it has proven to be a good model.
- Health 2020 prioritizes the social determinants of health and health literacy. Social policies – ranging from employment and education to housing – must be a strategic priority. On 11-12 July 2016 we are organizing a High-Level meeting in Paris on these topics, with the 3 key sectors in the upcoming period to move forward: health, education, social policy. Hope Romania will attend the Conference at a high level.
- Now let us briefly review where we are in Romania with regard to the health situation.
- Although there have been substantial improvements in life expectancy in recent years, with accelerated improvements since mid 1990ies, life expectancy in Romania remain one of the lowest of all new EU Member States. Recent rates of improvement are in line with EU13 average and the gap remains constant.
- No one knows the health situation and trends in Romania better than the Romanian health professionals. The added value of WHO is that we can provide you with the comparative health situation and trends analysis, in which we can compare your situation and data to other counties in the WHO European Region. Maternal mortality was historically very high in Romania but decreased rapidly in the early 1990ies. However, the levels remained very high compared to other EU13 countries until very recently. Although decreasing, most recent infant mortality rates are still highest of all new EU Member States and well above Regional and SEEHN averages.
- The mortality rate from infectious and parasitic diseases is reduced by half since year 2000, but the current rate is still among highest among the new EU Member States. Premature mortality from cancers is well above European average and is second highest among new EU Member States. Particularly worrying is the increasing trend of premature cancer mortality in Romania, while the rates are decreasing in most other European countries. On the positive note, premature mortality from diseases of the circulatory system is decreasing steadily and is approaching fast EU13 average. Premature mortality from diseases of the respiratory system is decreasing, but the levels are still highest of all new EU Member States and higher than the European average. Premature mortality from diseases of the digestive system is also high, well above averages and among highest of new EU Member States.
- AIDS incidence was decreasing since mid 1990ies until year 2000. However, an increase is observed since then, with rates that are between EU13 and Regional averages. Although mortality from tuberculosis has halved since year 2000, it still remains second highest of all new EU Members States and is above Regional average.
- An effective control of risk factors that are linked with NCDs is of outmost importance and reduction of the burden of NCDs is one of the major goals of Health 2020. In particular, intersectoral action for health and health promotion and education are effective means to combat NCDs and are therefore the key interventions for the implementation of Health 2020.
- Recorded alcohol consumption was 9.1 litres per capita in year 2011, which is in line with EU13 average but somewhat higher than the SEE HN average. However, WHO estimates that the unrecorded alcohol consumption is additional 4 years per capita.
- Education is known to have an effect on health. In the 21st century, education and health can no longer afford to work in separate silos. Robust evidence shows that children with environments that support their health demonstrate better education outcomes, and better-educated children become healthier adults.
- Life satisfaction is the subjective well-being indicator that Member States agreed to and on a scale from 0 to 10, it is 5 in Romania. This value places Romania in the lower third of countries in the WHO European Region.
- Total health expenditure in year 2013 was only 5.3% of GDP, which is the lowest value among all new EU Member States and 35% below the average of the European Region. Particularly worrying is the decreasing trend in the last 3 years.
- Approximately 80% of total health expenditure is funded from public sources, which is 12 – 13 percentage points higher than the average of the European Region. Therefore, private sector health expenditure and the out-of-pocket health expenditure are relatively low in Romania. The out-of-pocket health expenditure is around 19% of the total health expenditure, a value that is above the 15% threshold recommended for out-of-pocket expenditures by WHO.
- The key in reaching and maintaining population financial risk protection is to keep out-of-pocket payments below 15% of the total expenditure.
- Despite high levels of co-payments for pharmaceuticals and health services in Romania, patients’ direct out-of-pocket expenditure is higher than 15% of the total expenditure. Further work should be done in Romania on analysis of financial risk protection and possibility of the incidence of catastrophic level of health expenditure by households.
- Health system strengthening should continue to be a priority, an ageless priority one could say. But equally so, all the determinants of health ( lifestyles, social, environmental, commercial determinants - which can only be addressed through an intersectoral approach. In all this prevention and health promotion throughout the lifecourse should be at the forefront of our attention. This will bring dividents across the generations. The role and impact of the Presidents, with their leadership and advocacy are pivotal in achieving those objectives. And I am happy to see that HE Klaus Iohannis is particularly dedicated to this cause. I would also like to thank to the MOH for his leadership and to all the sectors for being present and working with us in the years to come.
- In all this work, we have to put the people at the centre – reach out to them and equally reach out to the civil society and local communities.
- While I congratulate his Excellency the President and MOH for this initiative, I am cordially inviting the President HE Klaus Iohannis, the Minister of Health Professor Patriciu-Andrei Achimaş-Cadariu, the Minister of Education as well as social sector Minister to attend and actively contribute to the forthcoming Paris High-level Conference – “Working together for better health and well-being”. The discussion at the Conference intends to strengthen and facilitate the intersectoral discussion and cooperation necessary to achieve policy coherence and utilize joint action to tackle health inequities for equal health and social outcomes. Good luck in your conference and see you soon as at the Paris High-level Conference - Working together for better health and well-being Thank you. (reads: Multsumesk pentru atentsie) Photo courtesy of Dr Cassandra Butu - cotton field