WHO/Franz Henriksen

Only through broad international cooperation and bold strides in the way evidence is used in the 21st century will evidence fully inform health policy-making through intersectoral efforts, and by bringing data and information into the discussions with local communities.

by Zsuzsanna Jakab, WHO Regional Director for Europe

Shifting towards “evidence for all” to improve health and well-being in Europe

I am pleased to present the European health report 2018, the third in a series since Health 2020, the European policy framework for health and well-being, was adopted in the Region. Building on the last two editions of the report in 2012 and 2015, the 2018 report is closely linked to the values and requirements of the WHO Regional Office for Europe’s guiding overarching policy, Health 2020. Having crossed the half-way point of the implementation period of Health 2020, this report now reflects on the effect that it has had on the Region, and outlines aspects that may be unfinished by 2020 and beyond.

Just like its predecessors, the 2018 European health report is an essential resource for the 53 Member States to report on progress towards the Health 2020 targets. Trends for the Health 2020 indicators are presented as well as lessons learnt from the Region on how the Regional Office and the Member States have taken effective public health action to improve the health and well-being of their populations. The report also addresses the new public health challenges that have emerged in recent years. To respond effectively to these challenges, new forms of evidence are essential to measure health and well-being in cultural and subjective contexts, and therefore give a fuller picture of Health 2020  implementation. This is particularly important in the new context of the Agenda 2030 and the sustainable development goals whose health indicators overlap significantly with Health 2020.

Member States have taken active steps to align their policies with Health 2020. This has put the core ideals of “fairness, sustainability, quality, transparency, accountability, gender equality, dignity and the right to participate in decision-making” at the centre of public health policy-making in the WHO European Region. This report gives an overview of the ground-breaking work that is underway to develop a broader approach to monitoring and reporting precisely on those core values, both quantitatively and qualitatively as well as outlining reporting strategies.

The European health report is a flagship publication that is published once every three years. Its assessment of the available data across all six Health 2020 targets reveals positive developments as well as areas that need intensified public health action in our Region.

The 2015 report responded to the challenges that were identified in measuring and reporting on progress towards Health 2020, particularly in relation to measuring well-being, by outlining a two-pronged approach towards a vision for harmonized and integrated health information systems in Europe. It recognized the significance of smarter use of information from social sciences and medical humanities, making a case for new evidence for the needs of health and well-being policies in the 21st century. On the other hand, it outlined the importance of the WHO European Health Information Initiative for continued coordination of efforts in the area of health information by WHO, the Members States, international organizations and other stakeholders.

With the advent of the sustainable development goals, WHO increased its focus on new sources of qualitative evidence which can complement traditional health statistics to describe and monitor key Heath 2020 concepts: well-being, community resilience, community empowerment, life-course approach, and whole-of-society approach. I am pleased that this pioneering work by my office has made further progress and is taking practical steps to put into practice the vision of the European Member States for a fuller, more complete monitoring of the values-driven public health policy-making under Health 2020.

But population health monitoring is not only the analysis of data and indicators alongside qualitative and new sources of evidence; ensuring that health information is effectively used in the policy-making process is equally important. In the past three years, the European Region experienced a continued increase in the activities across the full spectrum of these two aspects of the work. The Member States defined a further strategic approach for a concerted regional action in health information, by adopting the European Action plan to improve the use of evidence, information and research in policy-making in the European Region, in 2016. This is the first of its kind, and it mandated WHO’s European Health Information Initiative as its implementing mechanism. This initiative has not only grown exponentially in membership in recent years but has also demonstrated that international coordination and alignment of health information stakeholders can achieve significant results despite the complexity  and number of projects, international and national efforts, and diverse policy goals and instruments.

Key opportunities and challenges for achieving effective interlinkage of these systems are identified in this report. Ultimately, public health policy relies on information and evidence from other sectors, and policy-makers are increasingly taking intersectoral action for health. In this context, such interlinked information systems for health focus on the use of information in decision-making for health, building on the foundation of solid and reliable health information systems while taking a broader approach that includes data from non-health sources and technology, such as promoting innovation and the use of affordable applications for eHealth, telemedicine, m-health and e-learning, and respond to the increased digitization of the individual’s personal life and work environments.

Primarily, the European health report 2018 aims to show progress at the regional level which has been achieved through the implementation of Health 2020. However, I am confident that this report will also prove to be a useful information source for policy-makers throughout the Region, helping them identify areas that need further assessment and policy action at the national level. I hope it will inspire Member States and other stakeholders to join and contribute to the work under the umbrella of the WHO European Health Information Initiative; a collaboration between the WHO Regional Office for Europe, European institutions and Member States, aimed at improving the information that underpins policy.

It is personally satisfying to see the transformative effect that Health 2020 has had on the health of the Region, the work of my office and on policy-making in the Region, having also in many ways been ahead of its time. This is also evident in Health 2020’s continued relevance and complementarity to the sustainable development goals, and I am confident that these aspects of Health 2020 especially will continue in the regional health policy-setting agenda beyond this policy framework’s end in 2020. For example, the Health 2020 targets and indicators have proven to be aligned with, and contribute significantly to the joint monitoring framework for reporting on indicators for the sustainable development goals, Health 2020 and the Global action plan for the prevention and control of noncommunicable diseases, that is currently in consultation in the Region and will be proposed for adoption at the upcoming Regional Committee in September 2018. The European Region’s Members States have in many ways been trailblazers in supporting and defining a vision for a truly forward-looking principle of information systems for health, thus making data, information, ensuring the availability of “evidence for all”.