Facing future challenges for global health, The Global Healthcare Summit 2012
Facing future challenges for global health Zsuzsanna Jakab WHO Regional Director for Europe
Health – a precious global good • High placement on the political and social agenda of countries and internationally • Important global economic and security issue • Major investment sector for human, economic and social development • Major economic sector in its own right • Matter of human rights and social justice
Life expectancy in European country groups, 1950–2045:population health improvement and ageing CIS countries 85 EU 12 countries EU 15 countries European Region 80 Other countries 75 Life expectancy at birth (years) 70 65 CIS: Commonwealth of Independent States EU12: countries belonging to the 60 European Union (EU) before May 2004 EU15: countries belonging to the EU after May 2004 55 1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 Year Source: World population prospects, 2008 revision. New York, United Nations Population Division, 2008.
Life expectancy is improving, but the gains are unequal
Burden of noncommunicable diseases (NCDs)Burden of disease by broad cause group and region, 2004 NCDs DALY: disability- adjusted life-year Source: The global burden of disease. Geneva, World Health Organization, 2008.
The economic case for health promotion anddisease prevention Many costs are Today governments The economic impact of avoidable through spend an average NCDs amounts to many investing in health of 3% of their hundreds of billions of promotion and health budgets on euros every year disease prevention prevention
Economic burden of chronic disease Cardiovascular €169 billion annually in the European Union diseases (CVD) (EU), health care accounting for 62% of costs Alcohol-related €125 billion annually in the EU, equivalent to harm 1.3% of gross domestic product (GDP) Obesity-related Over 1% GDP in the United States, 1–3% of illness (including health expenditure in most countries diabetes and CVD) Cancer 6.5% of all health care expenditure in Europe Road-traffic Up to 2% of GDP in middle- and high-income injuries countriesSources: data from Leal et al. (Eur Heart J, 2006, 27(13):1610–1619 (http://www.herc.ox.ac.uk/pubs/bibliography/Leal2006)),Alcohol-related harm in Europe – Key data (Brussels, European Commission Directorate-General for Health and Consumer Protection, 2006(http://ec.europa.eu/health/archive/ph_determinants/life_style/alcohol/documents/alcohol_factsheet_en.pdf)),Sassi (Obesity and the economics of prevention – Fit not fat. Paris, Organisation for Economic Co-operation and Development, 2010) and Stark (EJHPPractice, 2006, 12(2):53–56 (http://www.google.co.uk/url?q=http://www.eahp.eu/content/download/25013/162991/file/SpecialReport53-56.pdf&sa=U&ei=BNI4T-K7JoKL0QGXs6HFAg&ved=0CBwQFjAF&usg=AFQjCNHS922oF8d0RLN5C14ddpMVeRn8BA) .
Using fiscal policy: the short-term benefits of sin taxes Tobacco Alcohol A 10% price increase in taxes In England, benefits close to €600 could result in up to 1.8 million million in reduced health and welfare fewer premature deaths at a cost costs and reduced labor and of US$ 3–78 per DALY in eastern productivity losses, at an European and central Asian implementation cost of less than countries €0.10 per capita Source: McDaid, Sassi & Merkur. The economic case for public health action. Maidenhead, Open University Press (forthcoming).
Why Health 2020? Significant improvements in health and well-being but … uneven and unequal Europe’s changing health landscape: new demands, challenges and opportunities Economic opportunities and threats: the need to champion public health values and approaches
Reaching higher and wider– acting on thesocial determinants of health• Going upstream to address root causes, such as public health, health promotion and disease prevention• Making the case for whole-of-government and whole-of-society approaches• Offering a framework for integrated and coherent interventions (Photo: Marianna Bacci Tamburlini/VIPC2007)
Improving governance for health andincreasing participationGoverning through:• collaboration• citizen engagement• a mix of regulation and persuasion• independent agencies and expert bodies• adaptive policies, resilient structures and foresight
Health challenges:complex, multifaceted andmultilevel• Increasing health • Major disease inequities outbreaks• Demographic shifts • Financial pressures on health and welfare• Environmental threats systems• Obesity • Social and• Alcohol misuse technological• Narcotic drug use transformations • Geopolitical shifts
Complex problems in health policy call forlearning and adaptation• Complexity, uncertainty, high stakes and conflicting value• Systems thinking used to analyse problems and devise solutions• Policies to be implemented as large-scale experiments• Commitment to learning from practice• Monitoring and evaluation systems• Policies adapted based on experience
Health 2020, 2 + 4 Two strategic objectives and four common policy priorities for healthWorking to improve health for all and reducing the health divideImproving leadership, and participatory governance for healthInvesting in health through a life-course approach andempowering peopleTackling Europe’s major health challenges of NCDs andcommunicable diseasesStrengthening people-centred health systems and public healthcapacities, and emergency preparedness, surveillance andresponseCreating resilient communities and supportive environments
Primary care as a hub with coordination withhospital services NGOs: nongovernmental organization s Source: World health report 2008. Geneva, World Health Organization, 2008.
WHO European Action Plan for Strengthening Public HealthCapacities and Services 2012–2020 VISION: sustainable health and well-being CORE ESSENTIAL PUBLIC HEALTH OPERATIONS (EPHOs) ENABLER EPHOs INTELLIGENCE SERVICE DELIVERY Governance Surveillance Health promotion EPHO 6 EPHO 1 Public health EPHO 4 workforce Monitoring EPHO 7 EPHO 2 Funding EPHO 8 Communication Informing EPHO 3 EPHO 5 EPHO 9 health Research assessments Disease EPHO 10 and plans Health protection prevention
Summary of public health challenges and solutions for 2050 Environmental Social and Health determinants economic outcomes determinants Solutions CLIMATE NCDs CHANGE SUSTAINABLE AND LONGER PREVENTION DISASTERS AGEING LIFE AND EXPECTANCY PROMOTION • Heat-waves ECONOMIC • Fires DECLINE PRIMARY • Drought HEALTH • Floods INEQUALITIES Health system CARE • Mudslides implications• Chemical spills URBANIZATION PROTECTION INCREASED Emergency • Food security MIGRATION DEMAND preparedness • Changes in AND COSTSinfectious disease TECHNOLOGY INNOVATIVE habitat DECREASED WIN –WIN–WIN WORKFORCE APPROACHES Risks and projections RESEARCH IMPLICATIONS Innovative solutions
Promoting health in times of austerity • Countries in the European Region differ greatly • Across the Region, we see lower economic growth, higher unemployment • The crisis exacerbated existing challenges to health systems
Facts from present and past crises • Associated with a doubling of the risk of illness and 60% less likelihood of recovery from disease* • Strong correlation with increased alcohol poisoning, liver cirrhosis, ulcers, mental disorders** Unemployment • Increase of suicide incidence: 17% in Greece and Latvia, 13% in Ireland*** • Active labour market policies and well- targeted social protection expenditure can eliminate most of these adverse effects**** Sources: * Kaplan, G. (2012). Social Science & Medicine, 74: 643–646. ** Suhrcke M, Stuckler D (2012). Social Science & Medicine, 74:647–653. *** Stuckler D. et al. (2011). Lancet, 378:124–125. **** Stuckler D. et al. (2009) . Lancet, 374:315–323.
Health impact of social welfarespending and GDP growth Social • Each additional US$ 100 per capita spent on social welfare welfare (including health) is associated with a 1.19% reduction in mortality spending • Each additional US$ 100 per capita increase in GDP is GDP associated with only a 0.11% reduction in mortality Source: Stuckler D et al. BMJ, 2010;340:bmj.c3311.
Further reflections on navigating the crisis• Avoid across-the-board budgets cuts• Focus public expenditures more tightly on the poor and vulnerable• Protect access to services by focusing on supply-side efficiency gains, such as: – the wiser use of medicines and technologies – Rationalization of service delivery structures• Think long-term and implement counter-cyclical public spending (save in good times to spend in bad times)
Improving efficiency reduces adverse effects of thecrisis and helps secure support for more futurespending Eliminate ineffective and inappropriate services Improve rational drug use (including volume control) Allocate more to primary and outpatient specialist care at the expense of hospitals Invest in infrastructure that is less costly to run Cut the volume of least cost-effective services
Challenging, complex anduncertain environment• The global health architecture has become more extensive but very complex• Health challenges require active involvement of all levels of government (international, national and local)• In an interdependent world, the need for joint action on health challenges and health determinants becomes ever more important
WHO in the 21st century• WHO’s role in the global health architecture – reform process enhancing WHO’s role as a global health player• Forging partnerships for health and sustainable development a top priority• One WHO, regions working together• Closer to countries’ needs and realities• Increasing appreciation of health in foreign policy and international health diplomacy
Health 2020: the foundation for a healthierEuropean Region• Importance of shared governance for health at all levels, supporting whole-of-government and whole-of-society approaches• Partnership-based vision engaging governments, NGOs, civil society, the private sector, science and academe, health professionals, communities and every individual• Systematically strengthening partnerships: key goal of Health 2020
“We want to see better healthand well-being for all, as anequal human right. Money doesnot buy better health. Goodpolicies that promote equityhave a better chance. We musttackle the root causes [of illhealth and inequities] through asocial determinants approachthat engages the whole ofgovernment and the whole ofsociety” – Dr Margaret Chan WHO Director-General