Day 2 of Life-course Conference: Minsk Declaration signed
The different life stages were discussed throughout the day's proceedings, starting with early childhood and adolescence – a time to optimize growth and development – through the middle years - with timely interventions to maintain peak health – and finally on the implications of the life-course approach for policy-making. The Conference ended with the signing of the Minsk Declaration.
Adverse childhood experience and the life-course
Professor Mark Bellis, WHO United Kingdom Focal Point for Violence and Injury Prevention, described the negative effects of adverse childhood experiences and their long reach later in life. The adverse experiences include both physical and sexual abuse, which have a cumulative effect when they persist. Professor Bellis said that, for example, physical abuse affects 18.6% of children up to the age of 18 in various countries in the European Region.
Children who suffer four types of adverse experience are three times more likely to be smokers, 10 times more likely to be problem drinkers and 49 times more likely to have attempted suicide. The repercussions can last a lifetime and can be transferred across generations. Poorly controlled alcohol use increases the effect of all adverse childhood experiences.
Yet, Professor Bellis explained, that there are interventions that can make a difference, such as parenting programmes, enrichment programmes to prepare children for school and screening programmes to identify those at risk for maltreatment. Research also indicates that some children are more resilient, because of certain factors, such as when a child has one or more stable, caring child–adult relationships. Professor Bellis concluded by saying that, by investing earlier, "Instead of mending broken adults, can we build stronger children."
Addressing developmental difficulties
Noting that one in six children experiences developmental difficulties, and the figures are rising, Ilgi Ertem, Professor of Paediatrics at Ankara Unversity, argued that strengthening paedatrics to identify children at risk and when, how and what can be done, as well as developing new standardized tools to identify developmental difficulties are two key ways to achieve progress on this issue.
Adolescence – Giving adolescents wings for life
Who are adolescents? Nina Ferencic, Senior Adviser in HIV/AIDS and Young People's Health Development and Protection at the UNICEF Regional Office for the countries of eastern Europe and the Commonwealth of Independent States, painted a vivid picture of adolescents today, the generation of 1.6 billion people around the world born around 2000. This generation is growing up in an information society, interconnected, with widely accessible knowledge and technology that support community and collaboration.
Dr Ferencic said that adolescence is a time when people are driven by emotions and impulses and influenced by peer pressure, when self-control is still developing. Adolescents are therefore at risk for unsafe activities, such as smoking and binge drinking. She commented that the policies, programmes and interventions developed to protect adolescents from these risks often do not work as they take an approach to control that is alienating and detrimental.
Instead, it is vital to create a circle of solidarity, to build resilience and hold adolescents to high expectations, according to Dr Ferencic. We must build the capacity of parents, teachers and health and social workers to talk to adolescents, recognizing their strengths. Ultimately, policies must create opportunities for adolescents to be "agents of change" in their own lives and as the next generation of parents.
Trends and adolescent prevention strategies in Estonia
Tiia Pertel, National institute for Health Development in Estonia, spoke on prevention strategies in the country to address tobacco, alcohol and drug use among adolescents. She recognized that local authorities have a strong influence on how young people spend their free time and underlined the vital role of people in direct contact with adolescents, including parents, youth workers, police and schools.
Ministers from Latvia, the Republic of Moldova and Tajikistan offered examples of how they are implementing the life-course approach in their countries.
Dying too young in the 21st century Europe
Beginning the day's second session, focusing on the middle years, from 40 to 60, Gauden Galea, Director of the Division of Noncommunicable Diseases and Promoting Health through the Life-course, analysed the implications of the changing rates of premature mortality across Europe during the past 10 years and their causes.
Dr Galea explained that premature mortality (among people up to 64 years of age) has been falling across Europe in recent years, but the gap between countries with the highest premature mortality rates, in eastern Europe and central Asia, and those with the lowest, primarily in western Europe, has not narrowed. Dr Galea said that the evidence indicated that interventions to address premature mortality should focus on men of working age in eastern Europe and central Asia, who die prematurely from cardiovascular diseases and injury primarily due to alcohol and tobacco use.
Germany's Prevention Act
Marcus Dräger, Federal Ministry of Health in Germany, described the key elements of Germany's new prevention act of that are relevant to people aged 40–60 years, including workplace health promotion, a new national prevention strategy and early detection examinations.
A focus on mental health through the life-course
Beginning her presentation, Dr Ann Hoskins, Deputy Director, Health and Well-being at Public Health England, explained that mental illness is an issue throughout the life-course and described interventions to promote mental health at different life stages in the United Kingdom.
The interventions include increasing the number of health visitors and training them to detect and intervene in cases of postnatal mental illness; promoting a culture and ethos of positive mental health in schools; promoting well-being in the workplace; and addressing social isolation and loneliness in old age through, for example, community transport schemes, working with Alzheimer societies and "making every contact count" in interactions between older people and the fire service.
Ministers from Georgia and Turkmenistan provided examples from their countries of interventions to sustain the peak of health and well-being in people aged 40–60 years.
Transforming the health and well-being of complex societies
In the third session of the day, Professor Sir Harry Burns, Professor of Global Public Health, University of Strathclyde, introduced his work in Scotland on promoting well-being through complex system changes. He described the low rise in life expectancy in Scotland, in comparison with the rest of Europe, which could not be explained by the common risk factors of smoking, alcohol use and poor diet. In fact, a cycle of alienation in young people, typically during the chaotic early years, including absenteeism from school, followed by unemployment and poverty, is leading to overuse of drugs and alcohol and increased violence and suicide. In order to break this cycle, small-scale interventions have been introduced with the overall aim of making Scotland the best place to grow up.
The Scottish approach involves generating ideas among large groups of practitioners, then testing them in the real world, collecting data and scaling up what works. One example was asking nursery-school children whether someone read them a bedtime story and charting the results. The simple fact of asking children this question, combined with informing parents at social events of the importance of reading, led to an increase from 20% to 82% of children who were read a story.
In his final comments, Professor Burns underlined that conventional "cause-and-effect" thinking will not succeed in changing a complex system; a whole-of-life approach to well-being requires new methods.
A life-course approach for communities
According to David Stuckler, Professor of Political Economy and Sociology at the University of Oxford, we should consider not only the life-course of individuals but also the life-course of communities.
Just like individuals, communities go through critical periods. The test for communities is how they manage these challenges. For example, for young people growing up in a community in decline, there is little incentive for having long-term life goals, investing in their own education and not smoking or drinking to excess. Citing the example of smokers who are much more successful in quitting when they see hope in the future, Professor Stuckler said that people must be given hope to be optimistic about a better future. That could create a long-term culture of promoting health.
Bridging the gap of health literacy
Kristine Sorensen, Assistant Professor at Maastricht University, listed the key drivers of health literacy as understanding, appraising and applying health information. Health literacy changes during the life-course (e.g. on becoming a parent or with an ill relative) and is affected by situational, social and environmental determinants. She called for more comprehensive action on health literacy to empower patients to be active agents in their own health, with health professionals as knowledge brokers.
Signing of the Minsk Declaration
Starting with Belarus, each Member State at the Conference read a section of the Declaration. It was then signed by Vasily Zarko, Minister of Health of Belarus, on behalf of all Member States in the WHO European Region, and Zsuzsanna Jakab, WHO Regional Director for Europe.
Zsuzsanna Jakab thanked the Government of Belarus and all participants and partners for their contributions to the Conference. In conclusion, she mentioned the opportunity provided by the sustainable development goals for stronger intersectoral collaboration. She said that the life-course approach is not only a guiding priority of Health 2020 but now also a strategy for WHO/Europe.
Biennial collaborative agreement (BCA) signed
In a bilateral meeting on 22 October 2015, the Ministry of Health and Medical Industry of Turkmenistan and WHO/Europe signed a BCA setting priorities for their joint work in 2016–2017.