Presentation delivered by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, at the 67th session of the WHO Regional Committee for Europe (Budapest, Hungary, 11–14 September 2017)

1. (1)
Report on the work of the
WHO Regional Office for Europe
Dr Zsuzsanna Jakab
WHO Regional Director for Europe

2. (2)Photo: Malin Bring

3. (3)
Health at the centre of development

4. (4)
Health at the centre of development

5. (5)Photo: Malin Bring
Leaving no-one behind

6. (6)
Health is a political choice

7. (7)
“Leaving no-one behind”
is our call for action

8. (8)
“Leaving no-one behind”
is our call for action

9. (9)
Moving towards joint commitments
1. Focus on inequities
2. Achieve universal health coverage
3. Strengthen health systems
4. Work upstream: health promotion and disease
prevention
5. Address all determinants of health
6. Strengthen emergency preparedness and response

10. (10)
Health 2020 is fully aligned with SDG goals

11. (11)
Health
2020
Priorities
Health
systems
Burden of
disease
Life-
course
approach
Resilient
communities SDG3
Universal
health
coverage Emergency
management
(International
Health
Regulations)
Halve death
and injuries
from road
traffic
accidents
Reduce deaths
and illness
from
environmental
pollution
Reduce
maternal
mortality
End
preventable
deaths of
children under
5 years
Strengthen
prevention and
treatment of
substance
abuse
Universal
access to
sexual and
reproductive
health services
End AIDS, TB,
malaria and
other
communicable
diseases
Reduce
premature
mortality from
NCDs and
promote
mental health
Research for
vaccines and
medicines
Strengthen WHO
Framework
Convention for
Tobacco Control
(FCTC)
Health
financing and
health
workforce
Health 2020 is fully aligned with SDG goals

12. (12)
Health
2020
Priorities
Health
systems
Burden of
disease
Life-course
approach
Resilient
communities
We are on track towards a healthier Europe

13. (13)
70
72
74
76
78
80
82
Overall Men Women
Life expectancy is increasing in the WHO European Region
Years
77.7
74.4
81.0

14. (14)
63
64
65
66
67
68
69
70
71
Overall Men Women
Healthy life years at birth reaches 68 years across the Region
Years
68.0
65.6
70.5

15. (15)
Noncommunicable disease (NCD) mortality trend
for those aged 30-69 declines

16. (16)
2-3% annual average decline in
premature mortality in most
countries
Aim is a decline of 40% by 2025
Decline in premature mortality

17. (17)
Progress to date in the WHO European Region
• Infant mortality: 6.7 per thousand live births
• Children vaccinated against measles and rubella:
94%

18. (18)
Discrepancies remain
Life expectancy at birth ranges from
70.0 to 83.4 years
Healthy life expectancy at birth
ranges from 59.8 years to 73.1 years
60.00
65.00
70.00
75.00
80.00
85.00
RussianFederation
Turkmenistan
Ukraine
RepublicofMoldova
Kyrgyzstan
Kazakhstan
Georgia
Belarus
Uzbekistan
Tajikistan
Azerbaijan
Lithuania
Latvia
Bulgaria
Armenia
Serbia
TheFormerYugoslavRepublicof…
Montenegro
Romania
Hungary
Slovakia
Estonia
Croatia
BosniaandHerzegovina
EuropeanRegion
Poland
CzechRepublic
Turkey
Albania
Portugal
Slovenia
Denmark
Ireland
UnitedKingdomofGreatBritainand…
Germany
Finland
Andorra
Belgium
Greece
SanMarino
Netherlands
Austria
Sweden
Malta
Norway
Italy
Cyprus
France
Iceland
Israel
Luxembourg
Switzerland
Spain
Life expectancy at birth

19. (19)
Infant mortality ranges from
1.9 to 22.1
Rubella vaccination ranges from 42%
to 99%
Discrepancies remain

20. (20)
Health is more than SDG 3 only

21. (21)

22. (22)
Improving health for
all and reducing
health inequalities
Improving leadership
and participatory
governance for health
STRATEGIC OBJECTIVES

23. (23)

24. (24)
Realizing policy
approaches:
• Whole of government
• Whole of society
• Health in all

25. (25)
Promoting intersectoral and interagency
action for health and well-being in the WHO
European Region
France, December 2016

26. (26)

27. (27)

28. (28)

29. (29)
Regional United Nations agencies
Issue-based Coalition on Health and Well-being

30. (30)
National and local networks
catalysing action towards common goals

31. (31)
South-eastern European Health Network
Subnational networks are key platforms for
implementation

32. (32)
Regions for Health Network
Small Countries Initiative
Healthy Cities Network

33. (33)
New WHO Collaborating Centre:
Centre Scientifique du Monaco
Collaborating centres: a valuable network

34. (34)
National health policies
driving better and more equitable health

35. (35)
th
0
ties
Health
systems
Health
financing and
health
workorce
Universal
health
coverage
Reduce deaths
and illnesses
from
environmental
pollution

36. (36)
*Rep
Defined Health 2020 targets
Health 2020 alignment
0 20 40 60 80 100
2010
2017
Health 2020 increasingly incorporated into
national health policies
73%
88%
58%
93%
*Reported countries

37. (37)
0 20 40 60 80 100
Implementation plans
Accountability mechanisms
Reducing health inequities
2010
2016
Most countries have policies addressing health inequalities
*Reported countries
46%
86%
45%
89%
88%
98%

38. (38)
Investing in public health
pays back
We need a new, invigorated
public health movement
since public health is a driver
of equitable health
improvement.

39. (39)
High returns for public health investments
• Reducing health inequality by 1% a year increases
annual rate of GDP growth by 0.15%
Health promotion and prevention works
• 10% reduction in cardiovascular diseases saves €20
billion annually in lower- and middle-income
countries

40. (40)
Investing in the positive effects of universal
social protection pays back
• Early years development investment estimated to
produce a 17-fold return
Cost of non-action is significant
• Direct and indirect cost of high disease burden in
countries can consume 15%–20% of GDP

41. (41)
Scope for increases in investments to public health
• An average of only 3% of national health budgets is spent
on public health in the WHO European Region.
Moving the public health agenda forward
• Review commissioned to look at the future of public
health and its contribution to achieving the SDGs and
Health 2020

42. (42)

43. (43)
SDGs
NCDs
Health
2020
Joint monitoring framework

44. (44)
Health systems
Health
2020
Priorities
Health
systems
Burden of disease
Resilient
communities

45. (45)
Universal health coverage

46. (46)
Sales
1st Qtr 2nd Qtr 3rd Qtr 4th Qtr
“… all people and communities receive the quality services
they need, including health promotion, disease prevention,
treatment and rehabilitiation, without financial hardship.”
Universal health coverage

47. (47)
“It is unacceptable that
people become poor as a
result of ill-health”
The Tallinn Charter

48. (48)
Catastrophic out-of-pocket payments affect the poorest

49. (49)
Out-of-pocket payment share of total health spending
high in many countries
0
5
10
15
20
25
30
35
40
45
50
55
60
65
70
75
Out-of-pocketpaymentas%oftotalhealthspending
DANGER ZONE: > 30%
WARNING
SAFE: < 15% with pro-poor policies
Source: WHO data for 2014
High- and middle-income countries in the European Region

50. (50)

51. (51)
Putting people at the
centre of health systems

52. (52)
Second meeting on health system
transformation at the policy level
United Kingdom
“How to” manage large-scale health systems transformation

53. (53)
Health systems respond to NCDs

54. (54)
INCLUDE INVEST INNOVATE
A vision for health systems in Europe: the future of the Tallinn Charter
Celebrating the 10th anniversary of
the Tallinn Charter
Tallinn, Estonia
13-14 June 2018

55. (55)
Primary health care at the
core of health systems

56. (56)
WHO European Centre for Primary Health Care
Kazakhstan

57. (57)
40th
anniversary of
Alma Ata
Declaration
2018

58. (58)
Courses on health systems strengthening
WHO Barcelona Office for
Health Systems Strengthening
Spain

59. (59)
A broad range of courses on health systems
PLACEHOLDER FOR REAL
PHOTO
WHO Barcelona Course on Health Systems Strengthening for
Improved TB Prevention and Care

60. (60)
WHO Barcelona Course on Health Financing for
Universal Health Coverage

61. (61)
Making a sustainable health workforce
in Europe

62. (62)
Number of jobs in
health and social
sectors in
countries of the
Organisation for
Economic
Co-operation and
Development
increases by 48%
between 2000
and 2014
Well-motivated, appropriately skilled and
effectively managed workforce

63. (63)

64. (64)
Ensuring access to effective, high-quality medicines for all

65. (65)
Increasingly, people cannot afford essential
or new medicines.
This hampers universal health coverage.

66. (66)

67. (67)

68. (68)
Equity
Resilience
Empowerment
Well-being
Qualitativeconcepts
Health information, evidence and research for policy and action

69. (69)
HEN reports serving as a source of evidence underpinning policy-
making

70. (70)
e-Health

71. (71)
e-Health Week conference
Malta
“A beautiful marriage between public health and e-Health”

72. (72)
Technical briefing: Big Data
Thursday, 14 September

73. (73)
Tackling the main disease burdens

74. (74)
SDG3
End AIDS, TB,
malaria and
other
Reduce
premature
mortality from
NCDs and
promote mental
health
Vaccines and
medicines
Reduce
premature
mortality from
NCDs and
promote mental
health

75. (75)
SDG 3.4 By 2030, reduce by one
third premature mortality
from non-communicable
diseases through
prevention and treatment
and promote mental
health and well-being.
Reduce
premature
mortality from
NCDs and
promote mental
health

76. (76)

77. (77)

78. (78)
WHO European Office for the Prevention and Control of NCDs

79. (79)
We can do better

80. (80)
We can do better

81. (81)Photo: Malin Bring

82. (82)

83. (83)
We could achieve further
reductions in disease
burden by fully
implementing the available
evidence on cost-effective
actions

84. (84)
Accelerating progress towards disease prevention and
elimination
Photo: Malin Bring

85. (85)
Major gains in measles and rubella elimination

86. (86)
Measles cases,
WHO European Region, 2016
Progress hampered by setbacks

87. (87)
Immunization: Leaving no-one behind

88. (88)
Equitable access to immunization remains a
priority for WHO/Europe

89. (89)
Equitable access to immunization remains a
priority for WHO/Europe

90. (90)
Her Royal Highness Crown Princess Mary of Denmark with mother
and son about to receive his vaccinations.

91. (91)
From malaria elimination to
maintaining malaria-free status
THE ASHGABAT
STATEMENT

92. (92)
From preventing malaria re-establishment
to tackling vector-borne diseases
• Vigilance
• Surveillance
• Intersectoral
collaboration
• Cross-border
cooperation

93. (93)
Regional vector control
plan, building upon the
regional framework for
vector-borne diseases
Building a regional plan for harmonized response

94. (94)
3.6
0
1
2
3
4
5
6
7
8
9
10
2000 2005 2010 2015
Rateper100000population
–8.5% yearly
between 2011 and 2015
36
0
10
20
30
40
50
60
70
80
2000 2005 2010 2015
Rateper100000population
–4.3% yearly
between 2011 and
2015
The Region has the fastest decline in
TB incidence and mortality rate
Estimated TB incidence rate Estimated TB mortality rate

95. (95)
0
0.5
1
1.5
2
2.5
3
3.5
4
2000 2005 2010 2015
Rateper100000population
Estimated TB/HIV rate
6.2% annual increase
between 2011 and 2015
TB/HIV co-infection on the rise

96. (96)
Rapid diagnostic tests
New medicines
Effective treatment regimen
Cross-border care
Addressing social determinants
SDG/UHC

97. (97)

98. (98)

99. (99)
0
20000
40000
60000
80000
100000
120000
140000
160000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
NumberofnewHIVdiagnoses
East
Centre
West
Increase
2006-2015:
Region: 75%
East: 109%
HIV epidemic growing at an alarming rate
New HIV diagnoses in the WHO European Region 2006-2015

100. (100)
1/3 of people living with HIV are
unaware of their status.
Life-saving antiretroviral therapy
coverage is as low as 25%.
Epidemic among key populations
not
adequately addressed.
Urgent action needed to curb
growing HIV epidemic

101. (101)

102. (102)
Building on the momentum to eliminate viral hepatitis

103. (103)
Comprehensive response guided by national strategies

104. (104)Photo: United Nations
Stronger partnerships across sectors and institutions to combat AMR

105. (105)

106. (106)

107. (107)
Mark the World Antibiotic Awareness Week in November

108. (108)
Her Royal Highness Crown Princess Mary of Denmark

109. (109)
Health emergencies, preparedness,
surveillance and response

110. (110)
Roles
Responsibilities
Accountabilities
Timelines
Partnerships
WHO Emergency Programme is fully functional

111. (111)
Essential Public Health Operations
10th anniversary of IHR
Health systems functions

112. (112)

113. (113)

114. (114)
Host agreement signed to establish WHO Office for Humanitarian and Health
Emergencies Preparedness in Istanbul, Turkey.

115. (115)
WHO/Europe is leading and coordinating the response
to two protracted emergencies.

116. (116)
Coordinating the international humanitarian health response in Ukraine

117. (117)
Coordinating the international humanitarian health response in Ukraine
• 18 tons of life-saving medical
supplies for 4700 surgeries and
1.2 million consultations
• Specialized supplies for neonatal
care
• Access to pyschosocial support for
11 000 people

118. (118)
Ensuring universal access to health services for Syrian refugees in Turkey

119. (119)
Ensuring universal access to health services for Syrian refugees in Turkey
Turkey hosting more than
3 million Syrian refugees

120. (120)
Syrian health professionals working in Turkey
1000 doctors
630 nurses
320 translators

121. (121)
Treating patients evacuated from
besieged towns
NGO mobile clinics accessing IDPs
in northern Syria
Responding to the Syrian crisis with the
whole-of-Syria approach
Photos: Health Cluster Partners

122. (122)
Cross border deliveries twice per month
and ad-hoc upon request
2,285,774 treatment courses provided
$3.7 million in value
2,000 people received mental health and
psychosocial support
Immunization campaigns in northern
Syria since 2016
2816 immunization team members
trained
Almost 2 million infants and children
vaccinated against poliomyelitis (polio)
and other diseases
Photos: Syria Immunization Group

123. (123)
The determinants of health

124. (124)

125. (125)

126. (126)

127. (127)
Determinants
of health
Behavioural
Environmental
Social
PoliticalEconomic
Cultural
Commercial

128. (128)
Focusing on behavioural determinants

129. (129)
Making good progress
on tobacco control
Tobacco plain packaging
legislation now in:
• France
• Georgia
• Hungary
• Ireland
• Norway
• Slovenia
• United Kingdom

130. (130)
Tobacco use among adults
decreasing in a number of
countries
but the decline is too slow in the
Region.

131. (131)
Countries support WHO tobacco control work

132. (132)

133. (133)
Alcohol consumption declining too slowly
Per capita alcohol consumption among people over 15 years
within a calendar year

134. (134)
Alcohol consumption declining too slowly
Objective: 10% decline
by 2025 to achieve 2030
global target

135. (135)
Obesity prevalence for over 18s: Men – 21.0%, Women – 23.9%
Photo: Malin Bring
Overweight and obesity alarmingly on the rise

136. (136)

137. (137)
Social determinants

138. (138)
Social determinants

139. (139)
WHO European Office for Investment for Health and Development
Venice, Italy

140. (140)
Environmental determinants

141. (141)
6th Ministerial Conference on
Environment and Health
Czech Republic, June 2017

142. (142)
United Nations Economic
Commission for Europe
United Nations
Environment Programme

143. (143)
Czech Republic
Moravian-Silesian Region
City of Ostrava

144. (144)
Ostrava Declaration: European countries
committed to national implementation by
2018

145. (145)
WHO European Centre for Environment and Health
Bonn, Germany

146. (146)
WHO European Centre for Environment and Health
Bonn, Germany
Providing comprehensive
technical support in the areas of:
• air quality
• safe drinking-water, sanitation
and hygiene
• effects of chemicals
• waste management and
contaminated sites
• climate change
•healthy cities
• environmental sustainability of
health systems

147. (147)
Leaving no-one behind across the life-course
Discussing the life-course
approach at RC66

148. (148)
Putting women, children and adolescents
at the core

149. (149)Photo: Hauranitai Shulika

150. (150)
International conference on sexuality education
Germany

151. (151)
Supporting those suffering from
disabilities, dementia or depression

152. (152)

153. (153)

154. (154)
Leading on public health aspects of migrants and refugees

155. (155)

156. (156)

157. (157)
First WHO European Knowledge Hub on Health and Migration
launched in November 2016

158. (158)
First WHO European Knowledge Hub on Health and Migration
launched in November 2016

159. (159)
Working for and with countries:
national health needs at the core

160. (160)

161. (161)

162. (162)

163. (163)

164. (164)
Working for and with countries

165. (165)

166. (166)

167. (167)

168. (168)

169. (169)

170. (170)

171. (171)
Strengthening partnerships for health
and policy coherence

172. (172)

173. (173)

174. (174)

175. (175)
A WHO “fit for purpose”

176. (176)
Zero tolerance for risks related to compliance

177. (177)
Categories and programme areas
WHA PB
2016–2017
Proposed
PB 2018–2019
% change
Categories 1–6, without
Health Emergencies Programme
219.47 222.50 1%
Subtotal base programmes, with
Health Emergencies Programme
235.40 258.60 10%
Outbreak and crisis response 3.0
Polio 7.40 5.90 -20%
Total PB 2018–2019 245.80 264.50 8%
Regional plan to implement Programme Budget (PB)
2018-2019 results from joint bottom-up planning

178. (178)
Approach to resource
mobilization
towards stronger partnership,
with particular focus at the
country level

179. (179)

180. (180)

181. (181)

182. (182)

183. (183)

184. (184)

185. (185)
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