Highlights of RC64 day 3 – Adoption of action plans on vaccines and prevention of child maltreatment

WHO/Franz Henriksen

Health systems for health and wealth in the context of Health 2020: follow-up to the 2008 Tallinn Charter

In the Tallinn Charter: Health Systems for Health and Wealth, Member States committed themselves to improving the performance of their health systems. WHO/Europe convened a second meeting in Estonia in 2013 to investigate new ways to improve population health, exchange inspiring examples of health-systems strengthening and agree on future directions, weaving together the commitments of the Tallinn Charter and Health 2020.

Dr Hans Kluge, Director of the Division of Health Systems and Public Health, identified four key themes emerging from the meeting; these were the needs:

  • to work towards people-centred, coordinated, integrated care;
  • to ensure that human resources for health are sufficient and fit for purpose;
  • to strengthen the role of public health in health service delivery, including in prisons; and
  • to harness the potential of e-health.

Further work was needed to develop a holistic, system-wide approach to health, and to ensure patients were agents in their own health, becoming front-line health workers. WHO/Europe worked to develop policy options to ensure that health systems remained sustainable, despite ageing populations and the pending pension crisis. WHO/Europe would publish the final report on implementation of the Tallinn Charter in 2015.

Member States expressed appreciation for WHO’s work in this area.

International Anniversary Conference marking 35 years of the Declaration of Alma-Ata on primary health care

Dr Hans Kluge, Director of the Division of Health Systems and Public Health, described the Declaration of Alma-Ata as a “timeless vision for primary health care, and far ahead of its time”, and outlined the priority actions agreed to revitalize primary health care (PHC):

  • provision of services throughout the life-course, based on individual needs, and noting the link between the health and social sectors;
  • integration of public health services, as well as secondary and tertiary services, into PHC;
  • increases in the prestige of the PHC workforce and inclusion of continuous training from the early stages of its education; and
  • provision of adequate financing, improved access to essential medicines and better use of information and communication technology

Dr Salidat Kairbekova, Minister of Health of Kazakhstan, underlined her country’s commitment to developing PHC, both in bringing health experts together to mark the anniversaries of the Declaration and in opening a WHO geographically dispersed office on PHC in Almaty. With support from WHO and partners including the United Nations Children’s Fund (UNICEF), Kazakhstan was improving training for PHC staff in remote areas and emphasizing joint responsibility for health with citizens.

Several countries expressed support for the reinforcement of the PHC concept, and their commitment to further developing it.

WHO European Ministerial Conference on the Prevention and Control of Noncommunicable Diseases in the Context of Health 2020

The Ashgabat Declaration was a major outcome of the Conference, held in Ashgabat, Turkmenistan in December 2013 and hosted by the Government of Turkmenistan. The Declaration identified three areas of commitment to addressing noncommunicable diseases (NCDs) that fully conformed with Health 2020 and the global action plan for the prevention and control of NCDs: acting across the whole of government, and accelerating both national action and action to protect present and future generations from the devastating consequences of tobacco.

Dr Gauden Galea, Director of the Division of Noncommunicable Diseases and Life-course, explained that, although 50 of the 53 European Member States had ratified the WHO Framework Convention on Tobacco Control, the European Region still had the highest proportion of adult smokers in the world. The Convention had a high level of support, but low implementation. The global goal was a 30% reduction in adult tobacco use by 2025; the European goal was to make the Region tobacco free for the generation of children born since 2000.

Dr Leyla Shamuradova, Deputy Minister of Health and Medical Industry of Turkmenistan, underlined that the Declaration was not just theoretical, but based on some of the actions already taken in her country. Thanking WHO for its continued support, and for Turkmenistan’s 2014 World No Tobacco Day award, the Deputy Minister noted that the country had a smoking rate of 8%, the lowest in the Region and the world, and aimed to become the first country to achieve an adult smoking rate below 5%.

The 64th session of the WHO Regional Committee for Europe (RC64) adopted the Ashgabat Declaration on the Prevention and Control of Noncommunicable Diseases in the Context of Health 2020.

European Vaccine Action Plan 2015–2020

RC64 adopted the Action Plan.

Dr Nedret Emiroglu, Deputy Director of the Division of Communicable Diseases, Health Security and Environment, explained that, because some groups remained underserved and vaccine hesitancy persisted, vaccine-preventable diseases still threatened the Region. WHO/Europe developed the European Vaccine Action Plan to enlist Member States, other stakeholders and partners in pursuing a long-term goal: “A European Region free of vaccine-preventable diseases, where all countries provide equitable access to high-quality, safe, affordable vaccines and immunization services throughout the life-course”.

The Action Plan had 6 goals:

  • sustain polio-free status;
  • eliminate measles and rubella;
  • control hepatitis B infection;
  • meet regional vaccination-coverage targets at all administrative levels throughout Europe;
  • make evidence-based decisions on the introduction of new vaccines; and
  • achieve financial sustainability of national immunization programmes.

It had been developed in direct and online consultations with many stakeholders and partners, including the European Centre for Disease Prevention and Control (ECDC), UNICEF, the GAVI Alliance and the European Commission (EC).

Describing immunization as the “backbone of any well-functioning health system, Professor Pierre Van Damme, Chair of the European Technical Advisory Group of Experts on Immunization (ETAGE), described the need to revitalize immunization, the importance of national technical advisory groups on immunization, and good governance. The Action Plan promoted “game-changing strategies” in the use of new technology, such as electronic registries and new methodologies.

Technical briefing on health information systems in Europe

The briefing addressed the status and future of health information systems, and the collection and appropriate use of data in Europe today.

Dr Claudia Stein, Director of the Division of Information, Evidence, Research and Innovation, described the progress made since the signing of the 2010 agreement between the EC and WHO/Europe on joint action, whose goals included the development of a common European health information system. A European Health Information Initiative was launched in 2012, which focused on action in five key areas to better connect scientific evidence to effective policy. In addition, WHO/Europe was launching a new web portal as a one-stop shop for data and other information useful for policy-making.

In addition to Dr Stein, representatives of the EC Directorate-General for Health and Consumers, the Organisation for Economic Co-operation and Development (OECD) and the Wellcome Trust described their work to improve health information in Europe. WHO/Europe, the EC and OECD were working towards a single European health information system.
The audience for the briefing included representatives of about 20 Member States, four international organizations and one nongovernmental organization (NGO). During the discussion, representatives expressed support for the activities initiated by the international organizations and interest in learning what their next steps would be towards building a European health information system. The Russian Federation offered to host the 2015 autumn school on health information and evidence for policy.

Technical briefing on nursing and midwifery

The briefing focused on how to strengthen nursing and midwifery to maximize their potential and enable their full contribution to implementation of Health 2020. The “European strategic direction for strengthening nursing and midwifery in support of Health 2020” and the “Compendium of good practices in nursing and midwifery” formed the basis for discussions.

Both provided technical guidance to Member States by identifying ways to improve workforce capacity, professional education and working conditions, and to strengthen health care services at the country, regional and institutional levels.

A panel including representatives of Finland, Israel, the United Kingdom, the International Council of Nurses and the EC discussed nursing and midwifery practices and developments in countries. The panel drew conclusions on, for example, the needs to increase the education level of nurses and midwives, to involve nursing and midwifery leadership at all levels in the health sector, to strengthen the professions and to include their perspective in activities to implement Health 2020. All that would ultimately strengthen health care services and optimize cost-savings.

Investing in children

RC64 discussed and approved the European child and adolescent health strategy and the European child maltreatment prevention action plan 2015–2020.

Dr Gauden Galea, Director of the Division of Noncommunicable Disease and Life-course, described the vision of the strategy: “We identified a vision where children are visible and attended to, free of poverty, bonded with caring parents, exclusively breastfed in first months, and schooled adequately to equip them as well-functioning members of society.”

The action plan for prevention of child maltreatment provided startling figures on abuse and neglect throughout the Region, with over 90% of cases going undetected. Solutions for this were difficult to find, but the action plan had objectives to counter the trend, including: making maltreatment more visible with reports and surveys, strengthening laws against corporal punishment, taking actions to reduce risks and increasing the skills of young parents through education.

In the discussion of the strategy and action plan, the representative of Italy, speaking on behalf of the European Union (EU) Member States, welcomed both, but asked whether the target of reducing the prevalence of child maltreatment and homicide by 20% by 2020 were a regional one. If so, the action plan should make that explicit.

Norway congratulated WHO for showing that investing in young people was also a business strategy for countries’ economies: “We cannot afford not to invest in the next generation.”
The representative of UNICEF called the strategy and action plan visionary and timely, but remained concerned that, while child mortality was decreasing, disparities across countries and populations persisted.

A spokesperson for multiple NGOs – including the European Public Health Alliance, Eurochild, National Roma Centrum and the International Planned Parenthood Federation – called for concrete steps to be taken, and for attention to be paid to the need for institutional care for children with migrant backgrounds or the particularly vulnerable, such as those with special needs. She expressed these NGOs’ overwhelming support for the strategy and action plan.
The representative of the International Federation of Medical Students’ Associations urged “Member States to engage young people when addressing the health of young people.”

European Food and Nutrition Action Plan 2015–2020

RC64 discussed the Action Plan.

Dr Gauden Galea, Director of the Division of Noncommunicable Diseases and Life-course, explained that all European countries exceeded the WHO recommendations on salt, and 48 exceed those on saturated fats: “Even with conservative aims, these figures fuel concerns for future problems.”

The Action Plan had a broad mission linked to Health 2020, emphasizing equitable access to healthy food. It aimed to go beyond nutrition policies to focus more attention on equity and rights-based approaches. “We must also find ways to guide action when evidence is still being formed and is uncertain,” added Dr Galea.

Key highlights of the Action Plan included:

  • promotion of breastfeeding
  • reduction in trans fats
  • restriction on marketing of foods to children
  • salt reduction
  • school nutrition
  • counselling in primary care
  • support for obesity management
  • improved monitoring and surveillance.

WHO/Europe was grateful to all Member States for their technical and political contributions to developing the Action Plan, particularly Austria for hosting the conference in Vienna in July 2013 that brought the Action Plan about.

The Champion of Health for Noncommunicable Diseases in the WHO European Region and First Lady of Estonia, Ms Evelin Ilves, praised the Plan for including all important aspects in supporting balanced nutrition. It was important to create a healthy food environment for children and establish healthy nutritional habits during childhood: “For that, we need to ensure that messages of healthy nutrition that children receive at home and at school are mutually supportive.” The Action Plan was right to call for reinforcement of health systems to promote healthy diets by providing evidence-based information on nutrition, examples of best practice and guidance.

SCRC member Professor Pamela Rendi‐Wagner of Austria said that governments needed to introduce or strengthen policies on nutrition and those in related areas such as agriculture, trade, education, finance and economic affairs.

In the debate, more than 10 countries endorsed the Food and Nutrition Action Plan. France urged that strategies ensure proportionality, so that the poor would benefit the most. Turkey appealed for more involvement in and support for the Action Plan from Member States.

Partnerships for health in the WHO European Region

RC64 concluded the day with a panel discussion on how United Nations agencies coordinated their support to countries. Ms Cihan Sultanoglu, Regional Director of the United Nations Development Programme (UNDP) and chair of the Regional United Nations Development Group, said that the United Nations focused on making a difference in countries, and WHO country offices were active members of United Nations country teams: “We are leveraging each other’s mandates to support governments better and improve people’s lives.”

A panel including representatives of Kazakhstan, Monaco, the Republic of Moldova and Turkmenistan, as well as Ms Sultanoglu and Ms Zsuzsanna Jakab, WHO Regional Director for Europe, shared examples of cooperation between United Nations agencies in countries.

Highlights for Thursday

  • Matters arising out of World Health Assembly resolutions and decisions
  • Progress reports on HIV/AIDS, alcohol, prevention of injuries, the European environment and health process, child and adolescent health and development, and antibiotic resistance