Day 1 highlights: RC69 opens

Health 2020, health equity and public health leadership were key themes on the first day of the 69th session of the WHO Regional Committee for Europe (RC69). The session opened with a charming series of international songs performed by the children’s choir of The Royal Danish Academy of Music.

Dr Armando Bartolazzi of Italy, President of RC68, outlined some of the highlights and decisions of last year’s session before introducing the election of officers and handing the chair to Mr Magnus Heunicke, Minister for Health and Senior Citizens, Denmark, and President of RC69.

Election of officers

  • Mr Magnus Heunicke, Minister for Health and Senior Citizens, Denmark, was elected President of RC69.
  • Mr Ioannis Baskozos of Greece was elected Executive President.
  • Mr Søren Brostrøm of Denmark was elected Deputy Executive President.
  • Dr Iva Pejnović Franelić of Croatia was elected Rapporteur.

Address by Her Royal Highness The Crown Princess of Denmark

Her Royal Highness The Crown Princess of Denmark, Patron of WHO/Europe, spoke of the need to strengthen health equity, invest in access to immunization, and deliver sexual and reproductive health services – three issues that are essential to delivering on the 2030 Agenda for Sustainable Development and its Sustainable Development Goals (SDGs).

“It is unacceptable that babies born in households and neighbourhoods with low levels of resources fail to thrive. It is intolerable that poverty, unsafe homes, social isolation, precarious work, and limited access to quality, affordable health services shorten people’s lives. It is a tragedy that exposure to such inequities can shorten a women’s life expectancy by up to 7 years, and a man’s by up to 15. Fifteen years – so much experience, opportunity, wisdom, laughter, love – cut short,” she said.

The Crown Princess described advocating for vaccination as a priority and a personal conviction. In the context of the current measles outbreak in the WHO European Region, she urged countries and partners “to work differently and do more to reach out to all parts of societies with fact-based information about vaccines and tailored services”.

In conclusion, The Crown Princess recognized Dr Zsuzsanna Jakab’s strong leadership in health in the Region over the past decade. “Thank you for your ceaseless energy, drive, commitment and care. Dear Zsuzsanna – you will be missed,” she said.

Address by Dr Tedros Adhanom Ghebreyesus, WHO Director-General

Opening his address, Dr Tedros recognized the contribution of Health 2020, the European health policy framework, to improving health outcomes and reducing health inequities in the Region. He noted key areas – including the health of refugees and migrants and addressing antimicrobial resistance – where the Region has been at the forefront of global health efforts.

Yet the Director-General was clear that the Region must do more. He cited tobacco use, alcohol consumption, overweight and obesity, out-of-pocket health spending, and variations in vaccination rates as “significant challenges” for the next Regional Director and European Member States.

“No country can afford simply to sit back and treat the effects of tobacco use, harmful alcohol consumption and unvaccinated children. We must be relentless in our efforts to promote health and prevent disease. This is the unfinished business of Health 2020, and you have to continue this work with determination,” he said.

Dr Tedros explained that the best asset we have for improving people’s health is people themselves. He called on Member States to empower people to be active participants in their own health by arming them with information to make healthy choices. In this regard, he described the European roadmap for implementation of health literacy initiatives through the life course, to be discussed on Thursday this week, as an “excellent first step”.

Health literacy was one of the 3 issues that the Director-General encouraged Member States to commit to next year, together with addressing the root causes of disease and prioritizing primary health care.

In his concluding remarks, he thanked and congratulated Dr Jakab on 10 years of serving the people of Europe. With reference to her next position as WHO Deputy Director-General, Dr Tedros said, “Europe’s loss is the world’s gain,” to widespread applause by delegates.

Address by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, on the work of WHO/Europe

Taking the floor at her final Regional Committee session as Regional Director, Dr Jakab reflected on progress in health and well-being over the past decade.

“Today it is wonderful, after 10 years, to be able to report that Health 2020 made a major contribution to and had a major impact on health across the Region as a whole, with the highest life expectancy now at 83.1 years,” she said.

She highlighted specific achievements, including:

  • a decrease in maternal mortality across the Region, from 13 deaths per 100 000 live births in 2010 to 11 in 2015;
  • a considerable drop in the infant mortality rate, from 7.3 infant deaths per 1000 live births in 2010 to 6.8 in 2015;
  • a fall in premature deaths from noncommunicable diseases among adults aged 30 to 69, from 421 per 100 000 in 2010 to 379 in 2014; and
  • an increase in treatment success for new cases of pulmonary tuberculosis, from 72% in 2012 to 75% in 2016.

Dr Jakab placed this progress in the context of our enhanced understanding of how health is created and what it is influenced by. The implementation of Health 2020 has taken account of the political, social, environmental, commercial and cultural determinants that, together with health systems, affect our health.

She explained that health is increasingly seen as a global public good, a human right, a matter of social justice and a necessity for development – all values embedded in Health 2020. Health 2020 thus anticipated the 2030 Agenda and WHO’s 13th General Programme of Work (GPW 13).

During her tenure as Regional Director, Dr Jakab placed an emphasis on working with Member States and partners by strengthening governance structures, providing technical and political support, building networks and partnerships, and enhancing the capacity of WHO’s country offices.

Yet, Dr Jakab cautioned that equity remains the biggest challenge in achieving health for all. “Our health has improved, yet not enough by far. I strongly believe that we have the knowledge, the policies and the means to do better, in absolute terms and also in terms of reducing the health inequities which scar our societies,” she concluded.

Plenary discussion

Many Member States took the floor to express their thanks for the work of WHO/Europe, and for the GPW 13 with its focus on achieving universal health coverage. Dr Zsuzsanna’s inclusive, visionary leadership of WHO/Europe was widely praised.

Speaking on behalf of the European Free Trade Association, the European Union and several other Member States, the delegate of Finland described Health 2020 as “ahead of its time, and ahead of the curve” with its emphasis on the broad determinants of health and the well-being of all. Noting that WHO/Europe has led many innovations in health governance, she thanked Dr Jakab and underlined that Europe is proud to lead by example.

Several common themes emerged in the interventions, including the following:

  • Health 2020 anticipated the 2030 Agenda and puts the Region in a good position to achieve the SDGs, particularly those related to noncommunicable diseases, and to make progress on the goals of the GPW 13.
  • The legacy of how Health 2020 has been implemented – by building effective relationships, forging partnerships, working across sectors and breaking silos – must continue beyond 2020.
  • WHO has a unique role in bringing different stakeholders together and promoting health as a global good.
  • Universal health coverage can only be achieved through a strong base of primary health care.
  • The high price of medicines affects access and remains a challenge for many Member States.
  • Guaranteeing access to health care for refugees and migrants is a priority for many countries.
  • Policy-making for health must be based on the effective collection of data and evidence.
  • Equity is a guiding value for many Member States.

Representatives from observer organizations including the Joint United Nations Programme on HIV/AIDS, the Northern Dimension Partnership in Public Health and Social Well-being, the United Nations Children’s Fund and the United Nations Population Fund also expressed their deep appreciation to Dr Jakab, emphasizing her dynamism and collaborative spirit during her tenure as Regional Director.

Keynote speech by Mr Ola Rosling: For a fact-based worldview

During his energetic keynote address, Mr Rosling of Gapminder Foundation revealed many of the misconceptions we have regarding progress on public health. “We have more data than ever before, but don’t have the culture or tools to make this data part of our decision-making,” he said.

Using the example of the global vaccination rate among children, he explained that most people in the European Region incorrectly assume that it is far lower than the actual rate of 88%. Because of this, many people – including those in the public health community – have a skewed and overly negative view of progress on public health and development. This is compounded by sensationalist media and our natural propensity to focus on the dramatic.

Mr Rosling underlined that the way to counteract this is to show people that their assumptions on many health issues are wrong, and to encourage an environment of curiosity and learning around data.

Report of the 26th Standing Committee of the Regional Committee (SCRC)

Mr Ioannis Baskozos, Chair of the 26th SCRC, briefly presented its work, including that of 3 subgroups on governance, leadership in public health and countries at the centre.

Promoting health equity in the WHO European Region

While countries have made great progress on health on average, successes have not been distributed equally, explained Ms Christine Brown, Head of the WHO European Office for Investment for Health and Development, as she introduced this agenda item.

Ms Brown explained that 5 key conditions are holding people back from good health and a decent life: inequity in access to quality health care, financial insecurity of the “working poor”, poor-quality housing and unsafe neighbourhoods, lack of trust and sense of belonging, and lack of decent work and poor working conditions.

A 50% reduction in gaps in life expectancy would provide monetized benefits to countries ranging from 0.3% to 4.3% of gross domestic product. Ms Brown concluded by affirming that reducing these inequities is achievable and has strong public support.

Panellists in the subsequent discussions made several points, including the following:

  • We must focus less on doing things “to” people and more on working “for” people.
  • The integration of social services in health care has proven successful.
  • Data must be at the base of decision-making.
  • We must not think of inequity as too complex to solve.
  • Universal health coverage prevents naming and shaming of different societal groups.
  • Nongovernmental organizations can function as the glue between various institutions and entities.
  • We should encourage collaboration and information sharing.

The panel discussions concluded by quoting Nelson Mandela’s famous words: “Overcoming poverty is not a gesture of charity. It is an act of justice. It is the protection of a fundamental human right, the right to dignity and a decent life.”

Ministerial lunch: Leadership in public health

The objective of this meeting was to share examples of effective and responsible leadership in translating the high-level, visionary aspirations of Health 2020 into practice. Dr Jakab shared her reflections on 5 qualities required to be a public health leader:

  • a vision and the ability to convince others (with compelling facts and evidence) that this is the right direction to take;
  • a commitment to public health based on values such as solidarity, equity and human rights;
  • a dedication to reaching out and engaging with all sectors;
  • the ability to pay attention to others, to listen and learn; and
  • a so-called political nose to engage and mobilize all partners for health.

Technical briefing: Digitization of health systems

A panel of speakers deliberated on success factors, pitfalls and ethical questions in digital health. Mr Clayton Hamilton from the Digital Health Initiative at WHO/Europe presented the structure and timeline of the regional roadmap on digital health currently in development. The roadmap draws upon discussions and presentations from the first WHO/Europe symposium on the future of digital health systems, held in February 2019.

A panellist from Sweden highlighted some of the country’s learnings, explaining that innovations and new models of delivering health care must be co-developed with patients, and that digital solutions must be adapted to people’s needs.

A delegate of Israel raised overarching questions about ownership of data, international standards and interoperability, and governance (regulation and supervision). A panellist from Estonia listed factors required for a successful digital health system, including regulation, the right principles for gathering data and interoperable architecture. The final panellist briefed the audience on recent international developments and broad questions in digital health.

Events before RC69

Briefing for non-state actors (NSAs)

Many NSA organizations were briefed on the RC69 agenda, social media coverage and the interactive exhibition wall, where they were invited to share examples of how NSAs collaborate with WHO.

5th session of the 26th SCRC

Members of the SCRC were briefed by the Regional Director, reviewed the programme and agenda for RC69, and agreed that several resolutions with proposed amendments could be put to the Regional Committee.

Highlights for Day 2

  • Private meeting for elections and nominations
  • Implementation of the programme budget for 2018–2019
  • Technical briefing on health diplomacy and migration
  • Launch of the World Patient Safety Day campaign