Day 4 highlights: countries at the centre of health work

“It is now clearer than ever that we need to be bolder and reach further, to engage effectively with all those that have a stake in health,” said WHO Regional Director for Europe Dr Zsuzsanna Jakab on the final day of the 68th session of the WHO Regional Committee for Europe (RC68). Many non-State actors were accredited to attend future Regional Committee sessions, and Member States applauded the work of country offices.

Matters arising from resolutions and decisions of the World Health Assembly and the Executive Board

Dr Bekir Keskinkılıç from Turkey, Member of the Executive Board, opened the session by highlighting resolutions from the World Health Assembly that have particular relevance for the WHO European Region. These include resolutions related to: preparations for the upcoming United Nations high-level meeting on ending tuberculosis (TB); containment of poliomyelitis viruses; the Global action plan on physical activity; and improving access to assistive technology.

Delegates then discussed a series of specific matters, starting with the draft comprehensive global strategy on health, environment and climate change. The delegate from Austria, speaking on behalf of the European Union and other countries, underscored that addressing climate change presents a significant opportunity to improve health.

The delegate from Belgium noted the importance of the “One Health” approach, which links human health to environmental and animal health. She underscored that health cannot be the sole responsibility of the health sector.

Member States commenting on the draft roadmap on access to medicines and vaccines applauded the fact that WHO’s work covers the entire value chain of access to medicines. However, delegates of Austria and Switzerland emphasized the need for key deliverables and milestones, as well as more information about implementation. Statements from 2 nongovernmental organizations stressed the link between universal health coverage and access to medicines.

Dr Ranieri Guerra, WHO Assistant Director-General for Strategic Initiatives, was present to hear Member States’ comments on the collection of best practices and lessons learned regarding the health of migrants and refugees.

The Austrian and Swiss delegates expressed support for the United Nations’ cross-agency work in the face of increased migration, and highlighted the importance of continuing to take an intersectoral approach to migrant and refugee health.

Dr Guerra praised the Region as the place where much of the work in this area was initiated. He noted that comments from Member States on the collection of best practices include many good ideas and creative solutions to addressing the serious challenges in this area.

Accreditation of regional non-State actors

A resolution accrediting 19 regional non-State actors not in official relations with WHO to attend future Regional Committee sessions was unanimously adopted. This followed RC67’s adoption of a procedure of accreditation in line with the global Framework of engagement with non-State actors (FENSA), and was the first time the procedure was implemented. The 19 non-State actors thanked the Regional Committee and affirmed their commitment to continued collaboration with WHO.

International and European medical student representatives highlighted the importance of partnership and of the Regional Committee’s exemplary practice of involving youth. More than 100 representatives of non-State actors participated in RC68 – the largest number ever. Non-State actors not in official relations with WHO were invited to apply for accreditation.

Countries at the centre: the strategic role of country offices

This agenda item put the spotlight on WHO/Europe’s country offices and their strategic role in advancing the health agenda. “At WHO/Europe, impact has always been our objective and has, to date, been possible through close coordination between all 3 levels of the Organization by our country offices,” remarked Dr Lucianne Licari, Director of Country Support and Communications, in her introduction.

Dr Licari provided an overview of WHO’s work with, for and in countries. She drew attention to WHO’s 13th General Programme of Work (GPW13) and its focus on countries at the centre. She also alerted Member States to the inadequate levels of resources and staffing for the country offices, and described some of the creative and cost-effective solutions envisaged to ensure adequate support to Member States.

Dr Licari described the “trustful” relationship built between Member States and staff in the country offices, and the strong partnerships that contribute to the successful and positive outcomes in health reported throughout RC68.

The session also provided an opportunity to report on an initiative unique to the Region, which aims to give a subgroup of members of the Standing Committee of the Regional Committee (SCRC) and the Executive Board a better understanding of the work and functions of a country office. The initiative facilitated the subgroup’s visits to 4 country offices in the Region.

Dr Vesna Kerstin Petric, Chair of the SCRC subgroup, related her positive experience of the visits. She stressed the value of having the opportunity to witness first-hand the impact of the work of WHO and its partners, and to see how decisions taken during sessions of the Regional Committee are then translated into concrete action plans and implemented at the country level.

Many Member States commended the initiative and its value. Norway, on behalf of 8 Member States and echoed by the United Kingdom, expressed the wish to see this initiative expand to other WHO regions.

Dr Zsuzsanna Jakab closed the agenda item by highlighting the role played by geographically dispersed offices in providing support to Member States, particularly in light of the limited capacity of country offices. “I strongly believe in the strength of country presence for both WHO and Member States,” she concluded.

Resolution on the Action plan to improve public health preparedness and response in the WHO European Region

The Regional Committee endorsed the resolution on the Action plan to improve public health preparedness and response in the WHO European Region. The Action plan covers the full cycle of emergency management under the International Health Regulations (2005).

Regional Framework for Surveillance and Control of Invasive Mosquito Vectors and Re-emerging Vector-borne Diseases

The increased spread of vector-borne diseases was in focus during this agenda item. It indicated that climate change, globalization and people’s movement are contributors to the re-introduction and movement of vectors to larger and new areas.

Dr Ioannis Baskozos, Chair of the SCRC subgroup on vector control and Secretary General of Public Health at the Greek Ministry of Health, echoed WHO’s statements on the issue, noting the urgent need to accelerate the implementation of the Framework. “Now it is the time for the Framework to be activated and to proceed,” he said.

Clear interventions were identified to implement the Framework successfully, including political and financial commitment; surveillance, monitoring and evaluation; training of health-care workers; a multisectoral approach; community engagement; cross-border collaboration; and vector control supported by legislation. Dr Baskozos ended by saying, “We still do not know many things, but need to act urgently. We cannot continue with business as usual.”

Member States expressed their full support for the implementation of the Framework with a focus on research, multisectorality, the training of health professionals and vector control. WHO welcomed the request to expand the scope of the diseases covered to include tick-borne diseases and Crimean-Congo haemorrhagic fever, but acknowledged that more resources are needed for adequate country support.

Progress reports on action plans

Delegates and non-State actors welcomed the action plans on TB and on antimicrobial resistance (AMR), and applauded WHO’s efforts in fighting TB and in developing national health plans for AMR. They also noted that addressing AMR requires global multisectoral action.

Member States and non-State actors expressed support for the draft physical activity strategy for the Region through their interventions. Several mentioned the need to focus more on older people and to work intersectorally towards a global plan of action.

Although much has been achieved in the field of tobacco control, delegates raised concern about the tactics of the tobacco industry and the new products they are marketing. Member States voiced their strong commitment to scaling up implementation of the WHO Framework Convention on Tobacco Control (FCTC).

Delegates commended the progress made on implementing the Action plan for the prevention and control of noncommunicable diseases (NCDs), and congratulated WHO for actively supporting Member States in developing action plans specific to tobacco control, alcohol consumption and nutrition. They reiterated the need to focus on the ageing population.

The progress reports on child and adolescent health and on child maltreatment were well received. Access to palliative care for children and adolescents was raised as an additional area to include in the response to NCDs, and Sweden urged Member States to accelerate implementation of the Action plan.

Following the successful 6th Ministerial Conference on Environment and Health, held in June 2017 in Czechia, Member States are developing national portfolios of action to implement the Ostrava Declaration. A component has been developed in the European Health Information Gateway as an electronic platform for sharing data.

The International Organization for Migration commended the well established partnership with WHO in promoting the health of migrants and refugees, and expressed appreciation for WHO’s leadership in intersectoral action.

Delegates also contributed detailed comments throughout RC68 regarding the Action plan to strengthen the use of evidence, information and research for policy-making, demonstrating the key role of data monitoring in developing health policies.

Regarding compliance and accountability, Germany expressed a wish to know how WHO/Europe deals with harassment.

Dates and places of future Regional Committee sessions

  • RC69 will take place in Copenhagen, Denmark, on 16–19 September 2019.
  • RC70 will take place in Tel Aviv, Israel, on 14–17 September 2020.
  • RC71 will take place in Copenhagen, Denmark, on 13–16 September 2021.

Closure of RC68

On behalf of all Member States, the delegate of Hungary thanked the Italian Government and the Ministry of Health for hosting RC68, as well as the Regional Director for guiding the session “with patience and wisdom”.

The Regional Director also voiced her deep thanks to all delegates for the discussions and agreements that were reached at RC68, in a spirit of partnership and consensus. In her final comments, she emphasized that through bold action and broad engagement, “we will continue to make progress, reduce inequalities and deliver on our Health 2020, 2030 Agenda for Sustainable Development and GPW13 commitments”.

Technical briefing: the WHO European Health Equity Status Report initiative

Over 50% of poor health within countries in the Region can be explained by 6 factors: inequity in access to health care; lack of access to adequate food; higher levels of social isolation in more disadvantaged groups; income insecurity; poor housing; and unemployment.

The forthcoming European Health Equity Status Report, to be launched in January 2019, aims not only to examine the causes and sources of inequity, but also to provide decision-makers with tools to help them take action on addressing them.

Presenting at the final technical briefing of RC68, Ms Christine Brown, Head of the WHO European Office for Investment for Health and Development, explained that the Report will be produced every 4 years. It aims to:

  • improve accountability and the prioritization of health equity;
  • support countries in taking action for health equity; and
  • increase the attention paid to health equity as a goal and a measure of sustainability, inclusion, security and progress in Europe.

Ms Brown said the Report will act as a powerful tool to help ensure that discussions about national sustainable development plans include health equity. The Report will be accompanied by an interactive atlas, interactive policy guidance and a suite of tools to support action.

A panel discussion about health equity in Europe focused on experiences from Malta, Sweden and Wales (United Kingdom), and represented viewpoints from both government and politics. Panellists discussed the importance of working to secure high-level support for health equity while also creating a grassroots movement built on the refusal to allow vast inequalities to exist within countries. They also provided examples of intersectoral collaboration, and focused on the importance of incorporating health experts into non-health discussions – and vice versa.

First session of the Twenty-sixth SCRC

At the first session of the Twenty-sixth SCRC, members shared their reflections on RC68. They noted with appreciation the high-level political participation and the emphasis placed on the session being a healthy meeting. They also began considering the agenda for RC69. Dr Baskozos of Greece was elected Chair of the Twenty-sixth SCRC.

Breakfast briefing on the United Nations high-level meeting on universal health coverage in 2019

This meeting briefed Member States on the process leading up to the high-level meeting on universal health coverage in 2019 and sought their input, particularly on how the main outcomes of the regional health system events in 2018 (the conferences in Sitges, Spain; Tallinn, Estonia; and Astana, Kazakhstan) can feed into the 2019 meeting.

“We are keen to keep pushing health higher and higher on the agenda of governments, and these high-level meetings give us this opportunity. We are extremely committed to ensuring coherence of policy messages across these meetings,” said Dr Hans Kluge, Director of the Division of Health Systems and Public Health.

Looking ahead to forthcoming events, the 3rd United Nations high-level meeting on NCDs will take place in New York, United States of America, on 27 September 2018. “It is time to act now on NCDs,” said Dr Bente Mikkelsen, Director of the Division of Noncommunicable Diseases and Promoting Health through the Life-course. The Global Conference on Primary Health Care will take place in Astana, Kazakhstan, on 25–26 October 2018, 40 years after the groundbreaking Declaration of Alma-Ata was adopted.

Hungary will co-chair the United Nations high-level meeting on universal health coverage next year. “We will ensure that all the great technical work carried out this year, including the Sitges, Tallinn and Astana outcome statements, will feed into next year’s declaration,” said Ms Krisztina Biró, a delegate from Hungary.