Regional Director's report on the work of the WHO Regional Office for Europe
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This document summarizes the work of the WHO Regional Office for Europe from 2010 to 2014. It outlines the office's strategic priorities, including improving health systems, addressing noncommunicable and communicable diseases, and strengthening emergency preparedness. Key achievements are highlighted, such as increased life expectancy in Europe, declines in premature mortality from noncommunicable diseases, and higher rates of treatment for HIV/AIDS and tuberculosis. Challenges remaining include health inequities and curbing the HIV epidemic. The report emphasizes multisectoral collaboration and a life-course approach to tackle challenges and promote healthier, more equitable and sustainable societies in Europe.
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Regional Director's report on the work of the WHO Regional Office for Europe
- 1. Report on the work of the WHO Regional Office for Europe Zsuzsanna Jakab WHO Regional Director for Europe
- 2. The 2010 vision and seven strategic priorities 1. European health policy 2. Improving governance 3. Strengthening collaboration 4. Strategic partnerships 5. Contributing to global health 6. Communication strategy 7. Positive working environment and sustainable funding
- 3. Building on the 2010 vision Life expectancy increased by five years but inequities persist Highest rate in WHO European Region Regional average Lowest rate in Region Source: European Health for All database (HFA-DB). Copenhagen: WHO Regional Office for Europe; 2014. 82 years 75 years 68 years
- 4. Facing the future Health higher on the political agenda Croatia: World Health Day
- 5. Responding to the challenges: renewed policy environment
- 6. Health 2020: overarching policy framework Two strategic objectives Four common policy priorities for health Investing in health through a life-course approach and empowering people Tackling the Region’s major health challenges of noncommunicable and communicable diseases Strengthening people-centred health systems, public health capacities and emergency preparedness, surveillance and response Creating resilient communities and supportive environments Working to improve health for all and reducing the health divide Improving leadership, and participatory governance for health
- 7. WHO working with Member States for Health 2020 July 2014: small countries’ meeting in San Marino for Health 2020 implementation May 2014: Health 2020 implementation in the former Yugoslav Republic of Macedonia December 2013: meeting on Health 2020 implementation in Turkey
- 8. Public health at the heart of Health 2020 implementation
- 9. Investing in public health interventions • Clear policy frameworks and supporting strategies • Strong public health infrastructure • Cohesion in health sector, and better coordination across sectors
- 10. Health 2020: counting on strong leadership Montenegro: Zsuzsanna Jakab with Milo Đukanović, Prime Minister of Montenegro San Marino: Zsuzsanna Jakab with the Captains Regent of San Marino Kyrgyzstan: Health 2020 launch with the Prime Minister of Kyrgyzstan and ministers
- 11. Better health for Europe: more equitable and sustainable Photo: © David Yu
- 12. Priority areas for action Photo: © David Yu
- 13. Investing in health through a life-course approach and empowering people
- 14. Action on early childhood development Integration of health and social welfare, multisectoral collaboration
- 15. From Millennium Development Goals to post-2015 development goals Any goal for health should aim also to address new challenges and maximize healthy life expectancy, with universal health coverage as a key instrument. Taking a life-course approach – addressing the social, economic and environmental determinants of health – will be crucial. Health 2020 will prepare the ground for implementing this new vision in the Region.
- 16. Child and adolescent health Estimates of under-5 mortality for the Caucasus and central Asia 49 per 1000 live births (2005) 36 per 1000 live births (2012)
- 17. Action plan on child maltreatment Report estimates that in the Region • 18 million children have been sexually abused • 44 million have been physically abused • 55 million have been mentally abused
- 18. Transforming maternal health Trends in maternal mortality ratio (estimates per 100 000 live births) 45 40 35 30 25 20 15 10 5 0 1990 1995 2000 2005 2010 2013 WHO European Region -
- 19. Tackling the Region’s major health challenges of non-communicable diseases (NCDs) Tackling the Region’s major health challenges: noncommunicable diseases (NCDs)
- 20. Tangible results from European action plan on NCDs
- 21. Decreasing premature mortality from NCDs 250 200 150 100 50 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Standardized death rate, 0–64 years, per 100 000 population Declining premature mortality from circulatory diseases, 2000–2011 European Region Eur-A Eur-B+C Eur-A: 27 countries with very low child and adult mortality Eur-B: 17 countries with low child and adult mortality Eur-C: 9 countries with low child but high adult mortality
- 22. Ashgabat Declaration on the Prevention and Control of Noncommunicable Diseases in the Context of Health 2020 Turkmenistan: Nurmuhammet Amannepesov, Minister of Health and Medical Industry, and Zsuzsanna Jakab with the signed Ashgabat Declaration
- 23. Investing in health promotion and disease prevention Investments bring returns in short and medium terms Turkey: health promotion event in Ankara with Dr Mehmet Müezzinoglu, Minister of Health
- 24. Decline in deaths from coronary heart disease: 50–75% attributable to prevention 0 20 40 60 80 100 England and Wales, 1981-2000 Poland, 1991-2005 Czech, 1985-2007 Sweden, 1986-2002 Finland, 1982-97 Iceland, 1981-2006 Treatments Risk factors Unexplained Source: Ford et al. N Engl J Med 2007; 356:2388-2398June 7, 2007 DOI: 10.1056/NEJMsa053935
- 27. Food and Nutrition Action Plan: follow-up to Vienna Declaration Austria: Federal Minister for Health of Austria and Zsuzsanna Jakab after signing the Vienna Declaration on Nutrition and Noncommunicable Diseases in the Context of Health 2020
- 28. Nutrition and physical activity Uzbekistan: International Conference “On the Most Important Reserves to Implement Food Programme in Uzbekistan”
- 29. Reducing tobacco use as a regional priority 28% of all adults in the Region smoke WHO Director-General Margaret Chan presents awards to Viktor Orbán, Prime Minister of Hungary, and Gurbanguly Berdimuhamedow, President of Turkmenistan
- 30. Reducing tobacco use – legal instruments Hungary: opening of the WHO Framework Convention on Tobacco Control (WHO FCTC) meeting in Budapest
- 31. Reducing tobacco use with the end game in mind Republic of Moldova: first smoke-free zones established for children's playgrounds, 1 June 2014 in Chisinau, with Deputy Speaker of the Parliament, deputy minister and WHO staff. Albania: activities related to an anti-tobacco campaign Turkmenistan: Ministerial Conference on the Prevention and Control of Noncommunicable Diseases in the Context of Health 2020, Ashgabat, Turkmenistan
- 32. Tackling the Region’s major health challenges: communicable diseases
- 33. Combatting tuberculosis (TB) Increasing treatment-enrolment rate 63% in 2012 96% in 2013
- 34. Eliminating TB in our lifetime Denmark: high-level meeting commemorating World TB Day 2014, at which WHO urged Member States to boost efforts to eliminate TB by 2050
- 35. More people receiving HIV/AIDS treatment 1600000 1400000 1200000 1000000 800000 600000 400000 200000 0 ART eastern Europe ART western and central Europe HIV cases 2009 2010 2011 2012 2013 People diagnosed with HIV and receiving antiretroviral therapy (ART) in Europe, 2009–2013
- 36. We have not yet managed to curb the epidemic! Key populations at higher risk • People who inject drugs and their sexual partners • Men who have sex with men • Transgender people • Sex workers • Prisoners • Migrants
- 37. Scale up evidence-based interventions • Deliver high-quality, integrated services • Use treatment as a strategic means, and for prevention • Implement evidence-based policies Russian Federation: Igor Ivanovich Shuvalov, First Deputy Prime Minister, Russian Federation; Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS); and Zsuzsanna Jakab addressing journalists at HIV conference in Moscow
- 38. Antimicrobial resistance (AMR): global health threat Belarus: staff of WHO, the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the National Institute for Public Health and the Environment (RIVM), Netherlands discuss laboratory procedures with hospital laboratory staff as part of a country assessment on AMR
- 39. European Antimicrobial Resistance Surveillance Network (EARS-Net) CAESAR (Central Asian and Eastern European Surveillance of Antimicrobial Resistance) network Source: European Centre for Disease Prevention and Control Source: WHO Regional Office for Europe
- 40. Working together towards a global action plan The Netherlands: Ministerial Conference on Antibiotic Resistance. Joining Forces for Future Health
- 41. European Vaccine Action Plan – now is the time to act Her Royal Highness Crown Princess Mary of Denmark, Patron of the WHO Regional Office for Europe
- 42. Commitment to eliminating measles and rubella Measles in 1993: 341 982 cases Rubella in 2000: 621 039 cases 35 088 27 132 31 685 9464 29 601 39 367
- 43. Last push for global poliomyelitis eradication
- 44. Malaria elimination: within reach 8 884 90 712 32 394 5 074 179 37 100000 90000 80000 70000 60000 50000 40000 30000 20000 10000 0 Cases due to local transmission Source: WHO centralized information system for infectious diseases (CISID). Copenhagen: WHO Regional Office for Europe; 2014.
- 45. Strengthening emergency preparedness, surveillance and response
- 46. Public health emergencies of international concern International spread of wild poliovirus Ebola outbreak in West Africa
- 47. Responding to humanitarian and natural crises Flooding in the Balkans Conflict in the Syrian Arab Republic
- 48. Responding to humanitarian and natural crises Humanitarian crisis in Ukraine
- 49. Responding to humanitarian and natural crises WHO Regional Office for the Eastern Mediterranean Typhoon Haiyan
- 50. Supporting preparedness for and responses to emergencies Azerbaijan: participants in a simulation exercise during training on public health and emergency management Denmark: Regional Office launching plans to implement the Pandemic Influenza Preparedness (PIP) Framework at a meeting in July 2014
- 51. International Health Regulations (IHR) Meeting of European IHR national focal points, February 2013
- 52. Strengthening people-centred health systems and public health capacity
- 53. The Tallinn Charter five years on Photo: Armo Vask Estonia: meeting on health systems for health and wealth in the context of Health 2020, October 2013
- 54. Coordinated, integrated health-service delivery towards people-centred care Denmark: memorandum of understanding between WHO and the European Forum of National Nursing and Midwifery Associations (EFNNMA), signed by Zsuzsanna Jakab and Valentina Sarkisova, Chairperson of the EFNNMA Steering Committee, in February 2014
- 55. Renewed vision for primary health care Kazakhstan: Zsuzsanna Jakab with Professor Turgeldy Sharmanov at the international conference marking the 35th anniversary of the Declaration of Alma-Ata on Primary Health Care
- 56. Articulating the consequences of economic crisis Norway: Oslo meeting on health systems and the economic crisis, April 2013
- 57. Universal health coverage: key strategic focus Republic of Moldova: National Health Forum, “Towards universal health coverage through joint efforts of the government and society” Tajikistan: flagship course on strengthening health systems
- 58. Flagship courses on health financing Photo: © Semmelweis University, Hungary Spain Hungary Estonia
- 59. Health care reforms: changing for the better Photo: Semmelweis University, Hungary Cyprus Malta Greece
- 60. Health information for action Kyrgyzstan: central Asian countries launch the new Central Asian Republics Health Information Network (CARINFONET)
- 61. European Advisory Committee on Health Research Denmark: meeting of the European Advisory Committee on Health Research (EACHR), May 2013
- 62. Creating resilient communities and supportive environments
- 63. Environment and health process: “Health 2020 in action” 1989 2014
- 64. Stronger governance for environment and health Italy: Fifth Ministerial Conference on Environment and Health, 2010 Serbia: joint meeting of the European Environment and Health Ministerial Board and Task Force
- 65. Environment and health a global challenge United Nations General Assembly
- 66. Implementation of WHO reform in the Region Implementation of WHO reform in the European Region
- 67. Improving health and policy coherence through partnerships
- 68. Improving health and policy coherence through partnerships
- 69. Improving health and policy coherence through partnerships Photo: European Respiratory Society
- 70. New partnerships strengthen public health
- 71. Strengthening collaboration with Member States
- 72. Strengthening collaboration with Member States
- 73. Strengthening collaboration with Member States
- 74. Strengthening collaboration with Member States
- 75. Reaching out through effective communication
- 76. Regional Office: a strong, evidence-based organization Stronger technical capacity Better use of existing resources and networks, including collaborating centres and national capacities
- 77. Increasing capacity: geographically dispersed offices Spain: WHO Barcelona Office for Health Systems Strengthening Germany: WHO European Centre for Environment and Health (ECEH) Italy: WHO European Office for Investment for Health and Development
- 78. Positive working environment and sustainable funding Regional Office on a more sustainable path than before
- 79. Better health for Europe: equitable and sustainable • Improve healthy life expectancy, extending the period of life lived in good health • Strive for equity in health • Link health more closely to sustainable development
Editor's Notes
- Mr President, Your Royal Highness Crown Princess Mary of Denmark, Madam Director-General, Mrs Evelin Ilves, First Lady of Estonia… Honorable ministers, dear partners, ladies and gentlemen, It is a real honor to address you once more at this sixty fourth session of the Regional Committee and I warmly welcome you to the Regional Office. The work of the Regional Office over the last five years has taken place in an environment with diverse and multi-faceted challenges.
- The health outcomes have significantly improved in the Region in the last decades, overall life expectancy increased by 5 years. Yet not everyone benefited and health inequities continue to scar the Region.
- Today’s main burden comes from non-communicable diseases, with its associated social, behavioural and environmental determinants. In addition the Region has seen profound economic recession and austerity over the past five years, resulting in reduced public health functions and poorer access to health services. Responding to these challenges requires new thinking. As we face the future, it cannot be “business as usual”. Health must be higher on the political agenda.
- That is why we initiated the process of developing Health 2020. Together with you, we also addressed a number of outstanding policies, strategies and action plans on priority areas during the last five years. Implementation started immediately. Now, the policy environment for the WHO European Region has been fully renewed.
- Now Health 2020 acts as our unifying policy framework. It sets the strategic directions and guiding values, of our combined efforts to improve health and reduce health inequities. It includes four policy priority areas for health. It recognizes the key role of the social determinants of health in influencing population health and the need to move beyond curative services to a whole-of-government and whole-of-society response.
- There is a an increasing momentum for implementing Health 2020 and many Member States are now taking up the challenge. We made every effort to assist countries, in the context of their own situation and priorities, making necessary arrangements for coordinated and integrated delivery. This work is closely aligned with the post-2015 development agenda and will also feed into the UNDAF development at the country level.
- Public health is at the heart of H2020 implementation. Inequalities in the burden of disease in our Region demonstrate that there is still a huge potential for health gains. This can be achieved through prevention, health promotion and appropriate management of diseases.
- We must invest in highly cost-effective public health interventions which are available, such as evidence-based fiscal policies, comprehensive prevention and health promotion packages, social determinants of health and new forms of governance. These investments must be made both within health systems to integrate the essential public health functions, as well as at population level through multisectoral approaches. This reorientation is the essence of Health 2020, which requires three main elements to be successful; right integrated policies (which we have); much stronger public health capacities and services; more cohesion within the health sector with much more sophisticated work across sectors including beyond governments.
- The conditions to change towards Health 2020, requires strong political commitment of governments and strong leadership from Health Ministries and public health agencies. Over the next five years, WHO is committed to support you in developing, implementing and aligning national health policies, working with other sectors, delivering high quality and effective health care services and strengthening public health capacities and services. Health 2020 targets and the monitoring framework will be the tool to measure progress and ensure accountability.
- The next five years will be about consolidation and full implementation at Regional, sub-regional and country levels. What we want to achieve is more equity in health and closer links between health and sustainable development. Our aim will be “Better Health for Europe: more equitable and sustainable.” I will present our Health 2020 implementation package tomorrow and therefore I keep this part of my speech short to allow more time now for the priority action areas.
- Improving health and health equity requires an effective life course approach. Actions to promote and protect health at all stages of life have been strengthened considerably in the last five years.
- Evidence demonstrates the need to focus on early childhood development and integration between health and social welfare. This requires multisectoral collaboration, especially with sectors like education, social policy and employment. A Ministerial Conference is envisaged in October 2015 and we will discuss this on Tuesday at the Ministerial lunch. Policy briefs are also being developed for collaboration with the other sectors. The one with the education sector will be made available tomorrow in the ministerial lunch as an example.
- Accelerating progress towards the health related MDG`s has been a key focus , but the work on the unfinished agenda will continue. Post-2015 Development Agenda will augment this work, and give it new energy in the years to come. We have been actively involved in the post 2015 process, engaging with all stakeholders. As outlined at the regional consultation in Turkey “Health 2020 will set the ground for implementing this new vision in the region”. We will have the opportunity to discuss this further during the Ministerial lunch today.
- In child and adolescent health, the Region made substantial progress, but huge discrepancies still exist. By implementing the European child and adolescent health strategy, Member States introduced comprehensive polices and improved the quality of care. Results are obvious, like decrease in under-five mortality to 36 per thousand live births in 2012 in Caucasus and central Asia. However despite the political commitment, lack of robust data and inconsistent financing are still the major barriers. The renewed child and adolescent health strategy is an excellent vehicle for identifying priority actions and it will be presented to you on Wednesday.
- The European report on preventing child maltreatment forms the basis for the European child maltreatment prevention action plan. The action plan provides examples on how to implement the child and adolescent health strategy and we will have the opportunity to discuss it on Wednesday.
- Again, we observe good progress in maternal health. Maternal mortality ratio decreased to 17 maternal deaths per 100 000 live births in 2013. Countries of Eastern and Central Europe benefited most from implementation of “Effective Perinatal Health” and “Beyond the Numbers” initiatives. Introduction of modern, effective contraception and promotion of sexuality education contributed to the reduction of unintended pregnancies. Sexual and reproductive health and rights will be an area where we will put more emphasis in the future.
- Non-communicable diseases are the main cause of disease burden, yet some 80% of premature mortality is considered preventable. It therefore vitally important to implement and renew action plans as they expire.
- Implementation of the European Action Plan for Noncommunicable Disease Prevention and Control focused on strengthening intersectoral policies and strategies in line with the Global NCD Action Plan and Health2020. It already started to show visible results. Number of Member States with national integrated noncommunicable diseases policies has grown substantially. Countries also strengthened monitoring systems by adapting the Global Monitoring Framework to their national context.
- Overall mortality from NCDs has a downward trend: premature mortality from cardiovascular diseases is generally decreasing across the whole of Europe — but there are huge disparities between countries that need to be addressed.
- In 2013, you endorsed the Ashgabat Declaration in Turkmenistan on the Prevention and Control of Noncommunicable Diseases. We will hear more during the session on Wednesday. Taking this opportunity, I would like to thank, through the Minister of Health, the President of Turkmenistan for hosting this important conference, and also to the First lady of Estonia for her invaluable contribution.
- There is now strong economic case for action to promote health and prevent disease. Evidence shows that investment into prevention brings a return in the short and medium-term and not only in the long-term, thus making this investment more attractive to policymakers.
- Looking for example at coronary heart disease, between 50-75% of the recent decline in deaths is attributable to prevention by addressing risk factors. And medical treatment contributes to approximately 25-50%. However governments spend, at best, only a small fraction of their health budgets on prevention.
- Equally, a high priority needs to be given to the management of noncommunicable diseases. Universal access to essential medicines for hypertension, diabetes, and cancer; the problem of the working age men with Noncommunicable Diseases; low or no utilisation of services; low rates of cardiovascular risk assessment; and inappropriate use of cancer screening are the needs identified from multi-disciplinary assessments. These are significant concerns that require concerted public health approaches in the next few years.
- Addressing risk factors remains a high priority. During the past years, we renewed strategies and action plans to reduce the harmful use of alcohol and mental health.
- The successful Conference in Vienna guided our work and as agreed, we developed the European Food and Nutrition Action Plan. It includes a set of priority actions to address major diet related problems and will be further discussed on Wednesday.
- The Conference in Uzbekistan earlier this year, promoted intersectoral discussions on diet and nutrition, food safety and security. It is worth to note that as a result of policy actions taken in several countries, important progress has been achieved, notably a significant reduction in salt consumption. Furthermore, we are working on the action plan for physical activity, as requested in Vienna Declaration, and we will present to the Regional Committee next year.
- While our Region has the highest number of Parties (50) to the WHO Framework Convention on Tobacco Control (FCTC), we are unfortunately also the Region with the highest rate of adult smoking. That is why, reducing tobacco use is among priorities, and many Member States are implementing exemplary initiatives. Tomorrow, together with the Director General, we will have a celebration, presenting the World No Tobacco Awards to some member states in our Region as a recognition of their leadership and commitment.
- New European Union Tobacco Products Directive is a major step forward in tobacco control and WHO is committed to support its implementation. Protocol to Eliminate Illicit Trade in Tobacco Products is an excellent vehicle to tackle cross-border illicit trade of tobacco products and I encourage you all to ratify the Protocol.
- I believe it is realistic to meet the global target of a 30 % reduction in tobacco use by 2025 in Europe. Moreover, I share your ambition of working towards a tobacco-free Region, as expressed by all of you in Ashgabat Declaration. I am committed to accelerate our support for action, and plan to bring the tobacco action plan in support of FCTC implementation to your attention next year.
- The Region reinforced its response to communicable diseases. However there remains unfinished business and new challenges emerge.
- There are still an estimated 350,000 new tuberculosis cases occurring every year in the Region, mainly in 18 high-priority countries. The Region also has the highest multi-drug resistant TB rates in the world. With your commitment and support of our partners, implementation of the European Action Plan is showing tangible results. Now more than half of estimated cases are detected. Treatment enrolment rate increased to 96 % in 2013, a major success within only one year. However treatment success rate is less satisfactory and varying widely, mostly due to health system challenges and lack of new effective medicines.
- We should aim to eliminate tuberculosis in our lifetime. To achieve this we need political and scientific commitment. Action is needed to address the social determinants of health, and to ensure equal access to quality care for all patients.
- Despite all the efforts, we did not yet succeed to curb the epidemic. . HIV cases continue to increase - by 7% since 2010 and AIDS cases and deaths are also increasing in the east And moreover, gains are unevenly distributed. Treatment is not keeping pace with the number of HIV infections. And epidemic remains concentrated in key populations, who are facing structural barriers to access services.
- We need to scale up targeted interventions and deliver high quality, integrated services. Access to treatment should be used as a strategic means. Evidence based policies, especially for key populations; including harm reduction for injecting drug users should be fully implemented in all countries. We had another excellent HIV/AIDS Conference in Moscow this year. I am pleased to inform you that we, together with the Minister of Health of Russia, agreed to establish a Joint Working Group. The Group will review the evidence on harm reduction strategies, which might lead to a change in strategic approaches. We will have the opportunity to discuss all these in detail on Thursday.
- Much progress has been made since the adoption of the European action plan, using a "One health" approach. Focus has been on supporting countries to build the capacity, to provide reliable diagnostics, perform national surveillance, run infection control programmes, implement policies for prudent use of antibiotics and establish multi sectorial coordination mechanisms.
- For the first time, we now have data on antimicrobial resistance and antibiotic consumption in a number of non-EU countries. We continue to collaborate with ECDC in expanding the European Antibiotic Awareness Day throughout the whole region. You will find details on the implementation of the European action plan on antibiotic resistance in the progress report, which is on the agenda on Thursday.
- Antimicrobial resistance is now recognized as a serious threat to public health and the role of European Member States in these efforts has been crucial. We will discuss how to proceed for development of a Global Action Plan on Thursday. Let me congratulate Netherlands for the successful meeting on “One Health” aspects of antimicrobial resistance in June, and appreciate Sweden and Norway who will be hosting similar meetings later this year.
- Great advances have been made in immunization. Traditionally well-functioning immunization programmes reaching high coverage and introduction of new vaccines saved many lives. However, we need to keep the pace at this pivotal point. We need to address the challenges, such as vaccine refusals and health care system restructuring. The Regional Office is committed to continue to support Member States to strengthen their immunization programs for equitable access to high-quality, safe, affordable vaccines and immunization services throughout the life course. As you requested, we now finalized the European Vaccine Action Plan which will be presented on Wednesday. I take this opportunity to thank Her Royal Highness Crown Princess Mary for advocating for maternal and child health and also for her continuous support to the European Immunization Week.
- Despite progress towards measles and rubella elimination goal by 2015, the region is seriously under threat due to outbreaks and continued transmission of both diseases. Now, more than ever, we need stronger political commitment to closely monitor and implement the “Package of Accelerated Action” while continue building strong partnerships with medical professional and civil societies.
- Meanwhile importation of wild poliovirus into the Region last year and the polio outbreak in neighbouring Syria continues to be another threat. Even though the risk of polio transmission remains low in the Region, we have to remain vigilant, ensuring high quality surveillance and high population immunity . I would like to applaud the intensive efforts of Israel and Turkey to tackle these threats. After declaration of polio as a “public health emergency of international concern”, we are ready to work with Member States and partners to support implementation of the temporary recommendations as advised by the IHR Emergency Committee. You will hear more about this and the polio end game strategies on Wednesday.
- Malaria elimination by 2015 in the Region is now within reach, with only 37 cases in 2013, reported from only two countries. A number of countries have now started implementing the framework on invasive mosquito species and re-emerging vector borne diseases after its endorsement by the Regional Committee.
- Let me now focus on another important area; health security. Through our Alert and Response Operations, we have been screening thousands of public health signals and notifications during the past year. And in collaboration with Member States and partners, we prepared for and responded to an increasing number of public health emergencies and disasters.
- This past year was marked by serious public health events with global significance; like H7N9 avian influenza outbreak in China, Middle East Respiratory Syndrome (MERS) coronavirus outbreak and imported cases into the Region. Director General declared two Public Health Emergencies of International Concern (PHEIC) under the provisions of IHR recently: the international spread of wild poliovirus in May, and the Ebola outbreak in West Africa in August. The Ebola outbreak is raising concerns as the number of cases is increasing. The Regional Office is supporting the global response efforts; so far we deployed three staff, including Dr Rodier, Director of Communicable Diseases, who has extensive experience in management of similar outbreaks. Another 23 staff member are preparing for future deployments. WHO issued a roadmap to guide and coordinate the international response to the outbreak and I call upon you all to support us. You will hear more about these on Thursday.
- In addition, several conflicts and resulting humanitarian crises and natural disasters happened during the past 12 months. These include the most severe flooding in history in the Balkans, especially affecting Bosnia and Herzegovina, Serbia and Croatia. The conflict in the Syrian Arab Republic continues to have direct spill-over effect to the Region, especially in Southern Turkey. I would like to thank the Government of Turkey for their outstanding support during the polio immunization campaigns in Syria, allowing to reach more than 1 million additional children. In addition, the support they provide to refugees from Syria is exemplary. We joined UN-interagency efforts providing cross-border assistance, a work closely coordinated with EMRO and HQ. We are now scaling up our presence in southern Turkey to increase the response capacity.
- We also contributed to other global crisis by deploying our staff to various emergency response operations; to the Philippines, to the Central African Republic, and to the Eastern Mediterranean Regional Office and the Emergency Support Team in Amman.
- All these events represent a significant challenge. We are committed to continue to support the preparedness and response efforts of Member States to all public health threats and emergencies, taking a multi hazard and multi sectorial approach.
- In this regard, IHR provides an excellent legal framework. The current public health emergencies show the importance of preparedness and development of IHR core capacity. In this respect, we conducted various trainings and assessments on health system capacity for crisis management. We soon will be launching Vulnerability Risk Assessment Mapping; a new preparedness tool for Member States using health, social and population data to map health system capacities during disasters, including disease outbreaks. This work will continue – in collaboration with Headquarters, particularly the Lyon Office, and partners such as the EC and ECDC. This summer marked an important benchmark in IHR, when the first two-year extension for building the core capacities came to a close in June 2014. As a follow-up to the WHA Resolution, we will seek your input to the proposed global coordination mechanism with regional representation, which will be discussed on Thursday.
- Now let me move to another area; health systems strengthening. Work with countries undertaken over the last five years was substantial and focused firmly on health outcomes and not just on system changes. These will form our commitment in health system work over the coming years, with growing support to Member States.
- Implementation of Tallinn Charter continued in full speed. Marking the 5th year anniversary of the Charter, a high level technical meeting was convened in Estonia last year. The meeting provided a unique platform to expand new frontiers to improve population health and to agree on future direction: weaving together the commitments of Charter, Health 2020 and moving towards Universal Health Coverage. You will hear more about the outcome of the meeting on Tuesday. We will present the final report of Tallinn Charter implementation at the Regional Committee next year, together with our proposals for overall health system strengthening, emphasizing public health and multi-sectorial approaches.
- Coordinated, integrated health service delivery towards people-centered care aims to optimize the provision of high quality health services. “People-Centered Health System Strengthening for Better Health Outcomes” showed tangible results on noncommunicable diseases, MXDR-TB, antimicrobial resistance and environmentally sustainable health systems. The approach aims to tighten the link between health gains and health system strengthening and it will guide our further work. We are committed to pursue a new European Framework through a consultative process, which we plan to present at the Regional Committee next year. This will include appropriate use of medicines, linked with the transformation of health professionals’ education and revitalization of nursing and midwifery. I would like to remind you about the technical briefing on “nursing and midwifery” which will be held on Wednesday.
- The 35th anniversary of the Alma Ata Declaration on Primary Health Care in Kazakhstan last year provided an excellent opportunity for renewing the vision. It is at the centre of our work providing coordinated and integrated services, with linkages to the hospitals and with social and long term people-centred care. This reinforces our operational approach; improved information technology and e-health measures; strengthening human resources for health in line with the WHO Global Code of Practice; assessing the rational use of medicines and their affordability, safeguarding quality of medicines, and improving medical product regulation.
- Another area we have been working intensively in supporting Member States was articulating the consequences of economic crisis on health. Guiding this work are 10 key policy lessons and recommendations which came out of the high-level meeting in Oslo. The 10 policy lessons offer a way forward to mitigate the impact of crisis on health outcomes, and have already proven to serve as a powerful tool for Ministers of Health in their dialogue with the Ministers of Finance and Prime Ministers
- Finally, a key strategic focus has been on universal health coverage (UHC), which guides our health systems strengthening work within the context of Health 2020 and will be the major focus in the years to come. UHC promotes equity of both access and outcomes, and contributes to a reduction in inequities in the Region. It is important to ensure long-term sustainability while providing reasonable levels of financial protection and comprehensive and accessible quality services according to health needs and socio-economic conditions. Let me mention that we are embarking on a project to strengthen evidence and support policy development. Through this project, financial protection in health systems will be monitored and a comparative report providing an overview in the Region will be prepared.
- We have been also responding to an increasing number of requests from Member States to support system wide health care reforms and transformation towards sustainable and resilient health systems. Focus was specifically on people centred service delivery models aligned with financial policies, improving efficiency within health systems, investing more in public health and moving towards universal health coverage.
- I would like to thank the European Advisory Committee on Health Research for the valuable scientific advice they provide in the formulation of policies and I warmly welcome Prof Dr Turmen, the Chair of the Committee and Professor Roza Adany, the Vice-Chair.
- Communities are one locus for governance for equitable health and wellbeing, and a key focus of Health 2020.
- For more than 25 years, the European Environment and Health Process has been “Health 2020 in action”. The process is an inspiring example of collaboration across different sectors globally and not only in the European Region. The Process provides a unique multisectoral platform for setting the agenda and implementation. It addresses key set of environmental determinants, which are still responsible for 20% of total mortality in our Region.
- While on Thursday you will have the opportunity to reflect on the progress made, let me highlight now that the renewed governance structure, established by Parma Ministerial Conference has now successfully taken off. Today, Environment and Health in Europe benefits from greater political leadership, and increased oversight and accountability for implementation of the Parma commitments. Thanks to the adoption of inter-sessional programmes of work by both the Environment and Health Ministerial Board and Task Force and a stronger link with the governance structures of WHO and of the UN Economic Commission for Europe. The upcoming high level mid-term review meeting of the Environment and Health Task Force will be an important milestone. The meeting will also mark the start of the process defining the new environment and health agenda for the sixth ministerial conference on environment and health in 2017.
- Environment and Health Process will retain its relevance in the years to come, in the face of the unfinished agenda posed by air pollution, chemical contamination and inadequate water and sanitation in parts of the Region, and of the new emerging challenges, like new technologies and climate change. While it will be up to the Member States to negotiate the new commitments, it is clear that the future environment and health agenda will need to be firmly anchored in and contributing to the major global developments at the core of the United Nations General Assembly debate on “Delivering on and implementing a transformative post-2015 Development Agenda”, which will be start next week in New York.
- Let me now move to the implementation of WHO reform in the Region. Since you will hear more about WHO reform today during the afternoon session, I would like to stress two points now. First is that, we have contributed substantially to all aspects of Reform including its full implementation across the European Region in the spirit of “one WHO”. The other aspect I would like to emphasize is the advanced work that we have done on governance in our region, among others to strengthen the role of our governing body, the Regional Committee, as well as governance structures in the Regional Office, which has been based upon, and contributed to the processes of global WHO reform.
- We have strengthened collaboration with partners and networks across the Region; engaging widely; helping to increase policy coherence; allowing more efficient support to Member States and supporting the development of new forms of networks. Working with the European Union has provided a strong foundation, significant opportunities and additional benefits. The Regional Office has fully implemented the Moscow Declaration with the European Commission, increased its collaboration with the European Parliament, and with the Presidencies of the European Union.
- Major progress has been achieved in collaboration with UN agencies in the region. In addition to intensive collaboration on MDGs, post 2015 and Roma, now we agreed on an interagency working group on noncommunicable diseases and social determinants of health led by WHO. Jointly with Ms Cihan Sultanoglu, Regional Director of UNDP, I will present this work during the partnership session on Wednesday afternoon, focussing on the collaboration with the UN agencies both at regional and country level.
- Working with civil society has also been strengthened and I am happy that once again many NGOs are present. Written statements submitted by NGOs are posted already on the website and the President will try to allocate time for the intervention during the sessions. I am honoured to receive the 2014 Annual European Lung Foundation Award on behalf of WHO. The range and depth of work with other partners has also increased, especially with the World Bank, OECD, the Global Fund, GAVI, the Council of Europe, development agencies and major nongovernmental organizations.
- Links with new and evolving types of partnerships for health provided important support to our joint work and will continue to play a crucial role. South-eastern Europe Health Network SEEHN); the Eurasian Economic Community; the Northern Dimension Partnership; the CIS Council; policy networks such as the European Healthy Cities Network and Regions for Health; and WHO’s health promotion networks, including healthy cities, schools, workplaces, hospitals and prisons can be listed among those.
- We developed a close working relationship with Member States and I visited many Member States. I was privileged to meet with many Presidents, Prime Ministers, Ministers of Health and other sectoral ministers. I advocated for putting health high on the government’s agenda, for Health 2020, jointly agreed priorities, and for the promotion of intersectoral work and mechanisms.
- Many Member States, ministers and delegations visited us at the Regional Office, where we provided them full briefing on the technical cooperation and assistance available. Discussions in the governing bodies on the country strategy and country presence have been very important and on Tuesday, there will be a technical briefing on this topic.
- We also embarked on development of Country Cooperation Strategies (CCSs) and have seen the completion of two CCSs, with a further three to be signed soon. A broader and more consistent roll out to other countries without country offices is planned for the next five years.
- Further strengthening country offices contributed to our work with, in and for the countries. In the future, we plan to further strengthen support to Member States by opening WHO Representative offices wherever necessary and appropriate, -subject to the availability of funds.
- We enhanced our communications to improve the availability and accessibility of information and messages. Governance process became more transparent to a wider audience through live webcast. We led many successful campaigns, using social media channels to reach new audiences and also placed more emphasis on communication at the country level, and responded to a growing demand from Member States. The Office will finalize the regional communication and web strategy, aligned to the global communications strategy. This will guide our work during the next five years.
- I committed that the Regional Office should be a leader in health; thus a strong evidence-based organization, relevant to the whole Region. A main priority was to improve the technical relevance of the work. With available resources, I streamlined and restructured the administrative support in the Regional Office to free up resources to strengthen much needed technical capacity. Strengthening technical capacity was reached not only by new recruitments, but also on better utilizing existing resources and networks, including collaborating centres and national capacities.
- Geographically Dispersed Offices generously supported by the governments of Germany, Spain and Italy have contributed substantially to our work. We have reviewed the GDO policy and achieved a consensus last year at the Regional Committee on the way forward. I am grateful to you for that. With the generous assistance of the governments concerned, we signed the Host Agreement for a new GDO on strengthening primary health care in Kazakhstan. During this Regional Committee, we are also signing an agreement with the Russian Federation to finance a project aimed at strengthening health systems for the prevention and control of noncommunicable diseases and to initiate the establishment of the new GDO in Moscow. Funds have already been made available for this purpose. We are also concluding the Host Agreement with Turkey on preparedness for humanitarian and health emergencies in Istanbul. I am grateful for the support provided by Member States to increase the capacity of the Regional Office. I also want to thank our partners in the European Observatory for Health System and Policies.
- For me an Office with a positive and secure working environment is paramount. This can only happen, if it is based on sound financial footing and prudent management. Significant efforts have been made to improve the overall funding situation and we continuously thrive for administrative efficiency, containing administrative costs. I am confident that today the Regional Office is on a more sustainable path than before. The aim now is to consolidate and further strengthen the internal management and administrative efficiency, while improving technical excellence through peer review and external evaluation, identifying means to further improve the quality of technical work.
- Honorable delegates, much has been done and learned since 2010… But our work is not finished yet. We face a host of new challenges, but also many opportunities. So there should be optimism, because health matters as never before. I am committed to work together with you, Member States and partners, to implement what we have jointly agreed on. While we work towards “Better health for Europe” for all our populations, we also aim to make our Continent more “equitable and sustainable”. Thank you for your attention.