Regional Committee: Highlights of Day 2

WHO

Today the Regional Committee adopted 20 core indicators to measure Health 2020 targets, as well as reporting on national developments towards its implementation.

Implementing Health 2020

Zsuzsanna Jakab, WHO Regional Director for Europe, detailed the work undertaken over the past year by WHO/Europe to implement Health 2020, and some of the initiatives taken by countries to integrate the European policy into national work, since its adoption at the sixty-second session of the WHO Regional Committee for Europe.

In addition to introducing the policy at international fora, and making the policy the focus of work plans for 2014–2015, work is under way by WHO/Europe to develop a package of resources and services comprising nine components to assist countries in implementing it. Touching on developments at country level, Ms Jakab commended several countries.

  • Ireland applies a whole-of-government approach to policy-making.
  • Austria has set targets.
  • Latvia and Lithuania have national policies fully aligned with Health 2020 and have undertaken national consensus-building conferences.
  • Countries of the South-eastern Europe Health Network have a Health2020 growth strategy.
  • Ukraine has established a national centre for disease prevention and control.
  • Turkey is continuing to forge more intersectoral collaboration for health.

Describing Health 2020 as “our guiding star”, Zsuzsanna Jakab underlined how it and the goal of universal health coverage are closely aligned. In conclusion she cited Margaret Chan, WHO Director-General: “New approaches and perspectives are needed if universal health coverage is to be a reality for the countries of the WHO European Region: shifting the mindset of policy-makers, health providers and members of the public from one that sees health in terms of combatting illness to one that mainly focuses on promoting health and well-being.”

Launch of the report on social determinants of health and the health divide in the WHO European Region

Despite remarkable health gains achieved in the European Region, inequities persist between and within countries: the gap in life expectancy between countries is 17 years for men and 12 years for women.

The purpose of this review was to assemble new evidence that could be applied to the diversity of countries that make up the European Region: diversity in national income, social development, history, politics and culture. Thirteen task groups reviewed new evidence on what can be done, and the report launched today provides recommendations. In a nutshell, these recommendations are: do something, do more, do better.

  • If countries have very little in place in terms of policies on social determinants of health, any action matters.
  • Where some policies exist, this review shows how they can be improved to deal with large and persistent health inequities.
  • In the richest countries of Europe, there is still scope to do better in counteracting inequities.

Ministerial panel debate on implementing Health 2020

Facilitated by Professor Martin McKee, ministers and high-level officials from Austria, Latvia, Lithuania, Montenegro, Serbia, Turkey and Ukraine took part in the debate. The importance and challenge of achieving the highest level of political commitment to improve health and well-being, and implement beyond the health sector, were underlined by several participants. Panel members described how the ministry of health engaged other government sectors, either through the personal commitment of the head of state, establishing separate coordinative standing committees and bodies, or placing health on the cabinet agenda. Yet for some countries, moving beyond planning and engaging other sectors in implementation – who pays for what? – proved challenging.

The economic crisis has led several countries to adjust their health services, focus on efficiency and prioritize primary health care. Despite recognizing differences in country contexts, delegates saw benefits in working with neighbouring countries, and the creation of a cooperation and exchange platform of small countries to share know-how and policy capacity. There was also widespread agreement that ministries of health need a “language dictionary” for other sectors, particularly the finance sector, in order to explain the co-benefits of investing in health.
Health 2020 monitoring framework

To measure the success of Health 2020 and progress towards achieving its targets, Member States had agreed on the need to develop a series of indicators. Dr Claudia Stein from WHO/Europe explained how working groups of experts and a country consultation process identified and developed 20 core indicators, including for well-being. Dr Stein underlined that these indicators were based primarily on data routinely provided by countries, and were in line with the global framework for monitoring noncommunicable diseases, and that WHO/Europe would report regional averages of the data provided. She added that more work was needed to develop subjective indicators of well-being.

In plenary discussions, there was widespread support among delegations for the indicators, and praise for the inclusive process through which they were developed. The resolution on indicators for Health 2020 targets was adopted by the Regional Committee.

Technical briefing on preventing maltreatment and other adverse experiences in childhood

A new report, launched today by WHO/Europe, reveals that, as a conservative estimate, 18 million children under the age of 18 years suffer from maltreatment in the WHO European Region during the course of their childhood. According to the findings, 9.6% of children experience sexual abuse, 22.9% physical abuse, and 29.1% emotional abuse.

The report, discussed during a technical briefing, underlines the need to prevent all forms of abuse during childhood, and in so doing cut the link to risky behaviour later in life and long-term ill health. Targeted prevention initiatives for those most at risk such as nurse/family partnerships, positive parenting and multi-component pre-school programmes have proved effective.

Nutrition and noncommunicable diseases

When the WHO European Action Plan for Food and Nutrition Policy expired in 2012, the question was what should happen next. As Dr Gauden Galea of WHO/Europe explained, a WHO European Ministerial Conference on Nutrition and Noncommunicable Diseases in the Context of Health 2020 was held in July to address that question. With 15 out of 20 risk factors for noncommunicable diseases related to nutrition and physical activity, they clearly remain a concern. While many countries have adopted or strengthened nutrition-related policies, many are of the “softer” kind based on awareness-raising and information, and obesity continues to rise, particularly among children. The Vienna Declaration made at the close of the Conference had evolved through an extensive consultation process, which showed that countries wanted more. Member States backed this up at this session of the Regional Committee, by adopting a resolution endorsing the Vienna Declaration, including the development of a European action plan on food and nutrition and a physical activity strategy. Several delegates shared their experiences with national initiatives on nutrition, physical activity and diet that were failing to tackle obesity among children and adolescents, and welcomed the input of international action and guidance. Dr Galea welcomed “the resounding support for the Declaration and the resolution”, promising to do more “but carefully and within budget”.

Health in all policies

Taru Koivisto, from the Ministry of Social Affairs and Health, Finland, gave feedback on the 8th Global Conference on Health Promotion held in Helsinki in June 2013. Accepting the fundamental concept of the health-in-all-policies approach, the focus of the Conference was “how to” take health into account in all sectors, offering practical experiences as concrete guidance to countries. One day of the Conference, Europe Day, was dedicated to showcasing experiences from the European Region, reflecting its diversity and allowing comparison with other regions. It set health in all policies in the context of Health 2020 and health policy development. Sessions covered the life-course approach to health, better governance, noncommunicable diseases and their risk factors, the environment, tackling inequalities, and work and health. The Helsinki Statement on Health in All Policies called on governments to fulfil their obligations to their people as a political priority, whatever the conflicts of interest, and to recognize that although health is not always a top government priority it must always be taken into account. Delegates looked forward to continued discussion on the theme at the Executive Board and the World Health Assembly.

Health systems in times of global economic crisis

Dr Hans Kluge, from WHO/Europe, described the extensive support it has given to countries since the financial and economic crisis began in 2008, to help them offset its impact on population health and the health system. With inputs from a wide range of staff and other experts, WHO/Europe has gathered evidence on the nature of this impact, which will be published in two reports later in the year. A high-level meeting on health systems in times of global economic crisis, held in Oslo in April, developed 10 policy lessons and recommendations that were then further discussed, reviewed and revised through consultations with Member States and the Standing Committee of the Regional Committee. Given the multisectoral nature of the impacts, WHO/Europe is committed to facilitating the dialogue between health and finance sectors by continuing or developing collaboration with such partners as the Organisation for Economic Co-operation and Development, the International Monetary Fund as well as the European Observatory on Health Systems and Policies, and helping countries to improve the timeliness of their data collection and through the development of indicators.

Several delegates described their efforts to mitigate the health effects of the crisis on their populations, and how useful the 10 policy lessons and recommendations were in their discussions with other sectors, particularly the finance sector. The Regional Committee adopted the resolution on health systems in times of global crisis, endorsing the policy lessons and recommendations. As Dr Kluge summed up: “The interplay between health and fiscal policies shows that governments have a choice. This means that priorities matter, and they need to hear the evidence and the voice of the people.”

Progress update on the European environment and health process

The European environment and health process, active for 25 years, is the oldest and longest fully structured, multisectoral mechanism in the WHO European Region, and an example of WHO pioneering the health-in-all-policies and whole-of-government approaches that are at the core of Health 2020. A new governance mechanism has been in place since 2010, comprising the European Environment and Health Task Force and the European Environment and Health Ministerial Board.

This year, the Ministerial Board is reporting to the WHO Regional Committee and the United Nations Economic Commission for Europe (UNECE) Committee on Environmental Policy on the implementation of the Parma Declaration and the way forward.

During a panel discussion, delegates from Israel and Serbia, and representatives from the Federal Ministry for the Environment of Germany and the UNECE underlined that health and environmental equity are very closely linked. As the representative from the Federal Ministry in Germany commented: “You cannot succeed without us. The air people breathe, water they drink, food they eat, indeed all basic human needs are strongly affected by environmental pollution.” Addressing what are called “health inequalities” in one sector is the same as demanding “environmental justice” in the other.

There was broad support among delegations for the environment and health process, and the work of the Task Force and Ministerial Board, with emphasis placed on streamlining and focusing their work and commitments. The importance of remaining relevant to both sectors was underlined.

Highlights for Wednesday

  • Introduction to the regional framework for the surveillance and control of invasive mosquito vectors and re-emerging vector-borne diseases
  • European Mental Health Action Plan 2014–2020
  • Progress report on measles and rubella elimination
  • Governance of WHO/Europe
  • Partnerships for health
  • Geographically dispersed offices