This is the first year of the European Action Plan for the Implementation of the Regional Strategy for the Prevention and Control of Noncommunicable Diseases. It is also the year where the World Health Assembly has adopted the historic global goal of a 25% reduction in premature mortality from NCDs by 2025. In this context, it is fitting to note the success of some of the countries in this Region in providing leadership in the achievement of the global target already since a few years. I show here the trends circulatory mortality in three countries: the Russian Federation, Kazakhstan, and the Republic of Moldova, shown here compared to the average trend for the whole of the European Region.In each of these three countries, since 2005, we have seen a large and rapid fall, al most large enough to annihilate the rise seen in the early 1990s in the aftermath of independence an recession. The progress in these countries comes from a combination of increased prosperity, increased investment in health services, and to some extent from a change in risk behaviours as lifestyles shift more towards he European average. The success in these countries calls upon us to document these changes, to note that the global goal is indeed achievable, and to focus even more on country related deliverables in the coming years of the NCD Action Plan.
Health 2020: a new European policy framework for health and well-being, Conference “Creating Health for the Year 2020 Today”
Health 2020: a new European policyframework for health and well-beingZsuzsanna JakabWHO Regional Director for Europe
Health 2020: adopted by the WHO RegionalCommittee for Europe in September 2012 The European policy framework for supporting action across government and society for health and well-being
Dear President, Prime Minister, Minister, Mayor:Health is a prerequisite for social and economic development. Without health and well-being there is noeconomic growth and no development. Health and well-being contribute to the productivity of any societyand should therefore be considered as an investment and not as an expenditure. The present economic/financial crisis is affecting many countries in many ways, but it can also present an opportunity to do moreand better for people’s health. To improve health status, we have to address all determinantssimultaneously, and they are outside the health sector; they are everywhere where people live. All sectorsand levels of government and society therefore contribute to the creation of health.Your leadership for health and well-being can make a tremendous difference for the people of yourcountry or city and for Europe as a whole.Your support for Health 2020 is truly essential!
Health 2020 goal• To significantly improve the health and well-being of populations, to reduce health inequities and to ensure sustainable people-centred health systems.
Health 2020 documents• Health 2020 – A European policy framework supporting action across government and society for health and wellbeing• Health 2020 – European policy framework and strategy document
Health 2020 highlights • Health: a major societal resource and asset Policy framework • Strong value base: reaching the highest attainable standard of health • Strong social and economic case for improving health • Strategic objectives and common policy priorities • Working together: adding value through partnerships • Health 2020: a common purpose and a shared responsibility • Renewing the commitment to health and well-being: the context and drivers Strategy • Applying evidence-based strategies that work and the key stakeholders • Enhancing effective implementation, requirements, pathways and continuous learning
Why Health 2020?Significant improvements in health and well-beingbut … uneven and unequal
Overall health improvement (+ 5 years life expectancy) but with an important divide in the Region CIS: Commonwealth of Independent States EU12: countries belonging to the European Union (EU) after May 2004 EU15: countries belonging to the EU before May 2004
Why Health 2020?Europe’s changing health landscape:new demands, challenges and opportunities
Health landscape of European Region • Complexity and uncertainty • Multifaceted health challenges, requiring active involvement of all levels of government (international, national and local) People live longer Noncommunicable Control of infectious Health systems and have fewer diseases (NCDs) diseases (such as face rising costs children dominate the HIV, tuberculosis Primary health care disease burden (TB)) remains a systems are weak challenge People migrate and lack preventive within and between Depression and services countries; cities heart disease are Antibiotic-resistant Public health grow bigger leading causes to organisms are capacities are healthy life-years emerging outdated lost
Why Health 2020?Economic opportunities and threats:the need to champion public health values and approaches
Financial crisis of 2008: additional layer ofcomplexity from austerity• Evidence from previous Unemployment: crisis on relationship • associated with between doubling the risk of unemployment, social illness and reduced welfare and health likelihood of recovering• Active labour market from disease policies and well- • strong correlation with targeted social alcohol poisoning, liver protection can eliminate cirrhosis, ulcer, mental adverse effects disorders, suicide
Health 2020 development journey: two-yearparticipatory process with Member Statesand partners• Unprecedented evidence review• New evidence gathering• Solutions that work• Integrating and connecting• Stakeholder and peer reviewed
Health 2020: key studies• Governance for health in the 21st century• Supporting Health 2020: governance for health in the 21st century;• Intersectoral governance for health in all policies: structures, actions and experiences• Review of social determinants of health and the health divide in the WHO European Region• Review of the commitments of WHO European Member States and the WHO Regional Office for Europe between 1990 and 2010• The economic case for public health action
Building on public health history• WHO Constitution• Declaration of Alma-Ata• Health for All• Health21• Tallinn Charter: Health Systems for Health and WealthIntegrated policy frameworks canand have inspired health-generatingactions on all levels.
Health 2020 – a unifying policy framework tomeet these challenges• Recognizing that • Simultaneously countries have addressing all health different starting determinants, which points and seek mostly lie outside the different approaches health sector and are• Aim: to improve socially determined health outcomes, (including social reduce health divide determinants): root causes! • New type of governance
Health 2020 strategic objectives• Working to improve health for all and reduce the health divide• Improving leadership, and participatory governance for health
Health 2020: four common policypriorities for health• Investing in health through a life-course approach and empowering people• Tackling Europe’s major health challenges of NCDs and communicable diseases• Strengthening people-centred health systems and public health capacities, and emergency preparedness, surveillance and response• Creating resilient communities and supportive environments
Life expectancy and gross domestic product (GDP)per capita in European countries, around 2007 Source: European Health for All database. Copenhagen, WHO Regional Office for Europe, 2010.
Going upstream: reaching higher and wider • Address root causes such as social determinants • Invest in public health, health protection, health promotion and disease prevention • Make the case for whole-of-government and whole-of-society approaches • Offer a framework for integrated and coherent interventions
Review of social determinants of health and thehealth divide in the WHO European Region: keyfindings • Persisting inequities in health between and within countries, which are socially determined • Life-course approach to health equity • Addressing the processes of exclusion • Need to build on the resilience, capabilities and strengths of individuals and communities • Emphasis on intergenerational equity Do something; do more; do better! Study carried out by a consortium chaired by Professor Michael Marmot of the United Kingdom
Improving governance for healthSupporting whole-of-government and whole-of-society approachesLearning from a wealth ofexperience with inter-sectoral action and health-in-all-policies (HiAP) workin Europe and beyond Two studies on governance for health led by Professor Ilona Kickbusch of Switzerland (2011, 2012) Kickbusch, 2011 Source: McQueen D et al. Intersectoral governance for health in all policies. Structures, actions and experiences. Copenhagen, WHO Regional Office for Europe, 2012.
Major burden in the Region due to noncommunicable diseases SDR: standardized death rate
Premature mortality from leading causes of death forLithuania and European Regions Heart disease Cerebrovascular disease Lung cancer Breast cancer EU-12 EU-15 Cervical cancer Lithuania Suicide Traffic accidents Acute respiratory infections, pneumonia and influenza in children <5y 0 10 20 30 40 50 60 70 Standardized death rate per 100,000 population Source: European Health for All database. Copenhagen, WHO Regional Office for Europe, 2010.
Ischaemic heart disease Lithuania health situation andSource: European Health for All database. Copenhagen,WHO Regional Office for Europe, 2010. trends, 1970-2008
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 3% of their health hundreds of billions of promotion and 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 (EJHP Practice,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) .
Price of a 20-cigarette pack (US$) at official exchangerates, 2008 Ireland No rway UK France Germany Denmark Switzerland Netherlands Finland Italy B elgium Sweden A ustria Iceland M alta Israel P o rtugal Luxembo urg Spain Greece Slo venia Hungary Czech Republic Latvia Cro atia Esto nia Slo vakia Ro mania Turkmenistan B ulgaria Turkey P o land Lithuania A rmenia TFYR M acedo nia A lbania B o snia and Serbia A zerbaijan B elarus M o ntenegro Kazakhstan Kyrgyzstan Geo rgia Republic o f Russian Federatio n Uzbekistan Ukraine 0 5 10 Source: WHO report on the global tobacco epidemic. Geneva, World Health Organization, 2009.
Action Plan for Implementation of the European Strategy for thePrevention and Control of Noncommunicable Diseases 2012–2016Planning and Health in all Healthy Secondary oversight policies settings prevention Fiscal policies Cardio-metabolic Workplaces and risk assessment National plan schools and management Marketing Health Salt information system with Early detection Active mobility social of cancer determinants Trans fats disaggregation
Reduction of circulatory mortality European European European average average average
WHO European Action Planfor Strengthening PublicHealth Capacities andServices
Ten essential public health operations (EPHOs) VISION: sustainable health and well-being ENABLER EPHOs CORE EPHOs Governance INTELLIGENCE SERVICE DELIVERY EPHO 6 EPHO 1 + 2 Health promotion Public health Surveillance workforce EPHO 4 EPHO 7 Monitoring Funding EPHO 8 Informing Communication health assessments EPHO 9 EPHO 3 EPHO 5 and plans Research Disease EPHO 10 Health protection prevention
Supporting Member States in navigating thecrisis is central to our work • Strong economic case for health promotion and disease prevention, as economic cost of NCDs is extremely high • Prevention: one of most cost-effective ways to improve health outcomes • Use of fiscal policy, like increased taxes on tobacco and alcohol • Short-term benefits of “sin” taxes
Supporting Member States in navigating thecrisis is central to our work • Try to protect health budgets but, if cuts have to be made, avoid across-the-board cuts and focus public expenditures more tightly on poor and vulnerable people (avoid or reduce out-of- pocket payments, which lead to impoverishment) • Think long term: save in good times and spend in bad times!
Improving efficiency reduces adverse effectsof the crisis• Eliminate ineffective and inappropriate services• Improve rational drug use• Allocate more to primary health care 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
Health impact of spending on social welfareand growth of gross domestic product (GDP)• Each additional US$ 1 • Each increase in GDP per capita spent on of US$ 100 per capita social welfare is results in only 0.11% associated with 1.19% reduction in mortality reduction in mortality• Effect of social- • Than that of GDP welfare spending on growth mortality reduction is significantly greater …
Health 2020 framework• Health 2020 is an adaptable and practical policy framework• Health 2020 recognizes that countries engage from different starting points and have different contexts and capacities• Health 2020 recognizes that every country is unique and that countries will pursue common goals through different pathways and approaches, but be united in purpose