Zsuzsanna Jakab Health 2020: The New European Policy Framework for Health and Well-Being
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Zsuzsanna Jakab Health 2020: The New European Policy Framework for Health and Well-Being
- 1. Health 2020: The New European Policy Framework for Health and Well-Being Zsuzsanna Jakab WHO Regional Director for Europe EXPO Symposium, Izmir, Turkey 7 October 2013
- 2. My task today Is to show the synergy and alignment between: • The global Millennium Development Goals, • The WHO European Health Strategy: Health 2020 with • “Health for All” Before I start I would like to convey WHO’s deepest thanks to the BIE for our joint agreement to hold “smoke free” EXPOs. This is not only symbolic but is part of a worldwide movement! EXPO Symposium, Izmir, Turkey 7 October 2013
- 3. Where there is health there is hope Dr Margaret Chan Director General of WHO EXPO Symposium, Izmir, Turkey 7 October 2013
- 4. Health – a precious global good • Higher on the political and social agenda of countries and internationally • An important global economic and security issue • A major investment sector for human, economic and social development • A major economic sector in its own right • A matter of human rights and social justice The European Response to these challenges and opportunities: coherence in policies and programmes for health and well-being. EXPO Symposium, Izmir, Turkey 7 October 2013
- 5. A challenging, complex and uncertain environment • The global health architecture has become more extensive but very complex with many stakeholders • Health challenges require active involvement of all levels of government (international, national, and local) • In an interdependent world, the need to act together on health challenges and on the determinants of health becomes ever more important for all our security and economies. EXPO Symposium, Izmir, Turkey 7 October 2013
- 6. The role of health in the broader post-2015 development agenda • Health as both a contributor to and beneficiary of development in sectors other than health – Links with many other sectors need to be explicit – Emphasis on determinants of health • Health as a human right • Changes in global landscape – More diversity and complexity now than in 2000 – Post 2015 agenda is for all countries: universality EXPO Symposium, Izmir, Turkey 7 October 2013
- 7. Health in the post 2015 agenda: the story so far UNGA Resolution 66/288 “The Future we Want” recognized health “as a precondition for and an outcome and indicator of all three dimensions of sustainable development” The Rio Declaration on Social Determinants of Health and the UNGA resolution 67/81 on global health and foreign policy, recommended that consideration be given to including universal health coverage (UHC) in the discussion on the post2015 UN development agenda The Botswana meeting report called for new goals, which, building on the existing health-related Millennium Development Goals (MDGs) focus on sustainable health and well-being for all EXPO Symposium, Izmir, Turkey 7 October 2013
- 8. Health and development The suggested post-2015 framework DEVELOPMENT GOAL Sustainable wellbeing for all HEALTH GOAL Maximizing healthy lives Health Gender equity, wealth, education, nutrition, environment, security etc. Accelerate the MDG agenda Reduce the NCD burden Ensure Universal Health Coverage and Access Contributions of other sectors to health EXPO Symposium, Izmir, Turkey 7 October 2013
- 9. Life expectancy is improving, but the gains are unequal EXPO Symposium, Izmir, Turkey 7 October 2013
- 10. Burden of Noncommunicable Disease Burden of disease by broad cause group and region, 2004 NCD EXPO Symposium, Izmir, Turkey 7 October 2013
- 11. The economic case for health promotion and disease prevention The economic impact of non-communicable diseases amount to many hundreds of billions of euros every year Many costs are avoidable through investing in health promotion and disease prevention Today governments spend an average 3% of their health budgets on prevention EXPO Symposium, Izmir, Turkey 7 October 2013
- 12. The economic burden of chronic disease Cardiovascular disease Alcohol related harm Obesity related illness (including diabetes €169 billion annually in the EU; healthcare accounting for 62% of costs €125 billion annually in the EU, equivalent to 1.3% of GDP 1-3% of health expenditure in most countries and CVD) 9 million NCD could be saved in 20 years if obesity in Europe is reduced by 5% Cancer 6.5% of all health care expenditure in Europe Road traffic injuries Up to 2% of GDP in middle and high income countries Sources: Leal (2006), DG Sanco (2006), Stark (2006), Sassi (2010), WHO (2004) EXPO Symposium, Izmir, Turkey 7 October 2013
- 13. Why a European health policy framework? Significant improvements in health and well-being but …. uneven and unequal Europe’s changing health landscape: new demands, challenges and opportunities Economic opportunities and threats: the need to champion public health values and approaches EXPO Symposium, Izmir, Turkey 7 October 2013
- 14. Reaching higher and broader–acting on the social determinants of health • Going upstream to address root causes e,g. public health, promotion and prevention • Making the case for whole-of-government and whole-of-society approaches • Offering a framework for integrated and coherent interventions EXPO Symposium, Izmir, Turkey 7 October 2013
- 15. Improving governance for health and increasing participation Governing through: • collaboration • citizen engagement • a mix of regulation and persuasion • independent agencies and expert bodies • adaptive policies, resilient structures and foresight Source: Kickbusch, 2011 EXPO Symposium, Izmir, Turkey 7 October 2013
- 16. The complex problems in health policy call for learning and adapting • Complexity, uncertainty, high stakes, and conflicting value • Systems thinking used to analyse problems and devise solutions • Policies to be implemented as largescale experiments • A commitment to learning from practice • Monitoring and evaluation systems • Policies adapted based on experience EXPO Symposium, Izmir, Turkey 7 October 2013
- 17. Health 2020 2+4 Two strategic objectives and four common policy priorities for health 1. Working to improve health for all and reducing the health divide 2. Improving leadership, and participatory governance for health 1. Investing in health through a life course approach and empowering people 2. Tackling Europe’s major health challenges of non communicable diseases and communicable diseases 3. Strengthening people-centred health systems and public health capacities, and emergency preparedness, surveillance and response 4. Creating resilient communities and supportive environments EXPO Symposium, Izmir, Turkey 7 October 2013
- 18. The response of European Countries • Health 2020 was unanimously and enthusiastically approved by all 53 European Member States of WHO at the Regional Committee, Malta, September 2012. • Already 12 Member States have adapted or are adapting their Health Policies to Health 2020. • The Regional Office has put together an implementation plan to help all our Member States to do the same. EXPO Symposium, Izmir, Turkey 7 October 2013
Notes de l'éditeur
- Good Morning Ministers, honourable delegates, ladies and gentleman, it is a pleasure for me to be here once again in this beautiful part of the world where just 3 weeks ago the 53 Member States met for the annual WHO European Health Ministerial meeting.
- My task today is to present to you the new European Health Policy Health 2020 unanimously adopted by all the Ministers of Health of our 53 European MS in Malta last year. Also as you know globally all your Heads of Government have committed themselves to achieving the eight historic Millennium Development Goals – or MDGs - by 2015. Three of these goals are explicitly linked to health with a further four indirectly. Member States are also already discussing the post 2015 MDG agenda and finishing the unfinished business with a strong support for the goal of universal health coverage post 2015 which is strongly supported by our Director General Dr Chan. This goal of universal health coverage is also intrinsic to Health 2020 and indeed as you have heard from the Minister of Health of Turkey, universal health coverage also underpins the health reforms in Turkey and is fully reflected both in the title and the contents and sub-themes of EXPO 2020 “Health for All.” Indeed “health for all” is also all about universal health coverage and so EXPO 2020 interlinks with and is mutually supportive of the existing Millennium Development Goals (or MDGs) and also the post-MDG agenda.Other major smoke-free events are summer and winter Olympics, smoke-free FIFA and UEFA football cups. Together we are creating a movement that will protect our children and our children’s children. That is an objective worth the effort!
- As you probably know our DG unfortunately cannot be personally present neither today nor in Paris in November but she has sent a video message to emphasise that “Where there is health, there is hope”. Her key message is that it is not money alone that brings good health but “Good policies that tackle the root causes of ill-health through a whole of government and whole of society approach”.Like our DG Dr Margaret Chan and all my WHO colleagues, I am passionate about health. As this is the first EXPO ever with HEALTH as its main theme we were very happy to help with any technical support requested by Izmir for EXPO 2020 as we can see the huge potential benefit from an EXPO devoted to Health for improving the health of the whole world. It would show beyond doubt that health is truly a concern of all parts of society and all governments of the world! As you will later from my presentation this “whole of government and whole of society approach” is also the central pillar of the European Health Policy Framework Health 2020.
- For me personally, it is a great pleasure to be with you today, to discuss the challenges and solutions for global health. Today countries need more than ever to act together to ensure the health of their populations and to drive progress. These issues of managing interdependence are moving higher up the political and social policy agendas of policy-makers at all levels, locally, nationally and globally. Globally health has become an economic and security issue and is increasingly seen as a global public good for which collective action is needed. Health is now a major investment sector for human, economic and social development. It is a major economic sector in its own right. Vitally, health is also increasingly seen as a matter of human rights and social justice.In the WHO European Region there are many positive trends. We know much more about the range of determinants of disease, particularly the social determinants, and we have more evidence based information about what works and what does not. Also the technologies available to us have greatly improved, and will evolve even more in the future. To meet these challenges and opportunities the European Member States decided that collectively they needed to bring about a coherence in our policies and programs for improvement in health and wellbeing.
- As health has become such a global priority over the last years, the number of players has increased. There is a growing complexity in the institutional landscape for global level health, characterized by more partnerships, foundations, financial instruments, bilateral and multilateral agencies and civil society engagement. Although more people than ever before now have the chance to attain better health, no country can resolve these challenges to health and well-being on its own, nor can it harness the potentials of innovation and technology without extensive cooperation. It is also the case that reasonable solutions to the most complex problems require well-managed intergovernmental negotiations to reach a fair deal for all. Global health is about advancing common interests and reducing common risks, and taking mutual responsibility for health and well-being. WHO-negotiated common agreements, such as the International Health Regulations and the Framework Convention for Tobacco Control are examples of such collective action.
- Changes in global landscapePost 2015 agenda is for all countries: universality More diversity and complexity now than in 2000:Changes in development landscape: e.g. Busan, more actorsGreater role of civil society and private sectorMany more global agencies and partnerships Four key drivers of rapid changes in global health patterns: Demographic transition – increasing population size, substantial increase in the average age in most regions and falling death rates. Cause of death transition – fraction of deaths or years of life lost shifting from communicable, maternal, neonatal and nutritional to non-communicable diseases and injuries despite the HIV epidemic. Disability transition – steady shift to burden of disease from diseases that cause disability but not substantial mortality. Risk transition – shift from risks related to poverty to lifestyle risks. Health is both a contributor and beneficiary of development in sectors other than health: “Health is critical contributor to development in sectors other than health, a beneficiary from development, and a key indicator of what rights-based, sustainable and equitable development seeks to achieve”
- Even before the first consultations on post-2015 began, early discussions on the role of health emphasized the importance of sustaining, and indeed accelerating work on the current health MDGs, while recognizing that the health agenda is now broader and that there is a need to demonstrate clearly the links between health and other aspects of sustainable development.General Assembly Resolution 66/288 “The Future we Want” - … recognized health “as a precondition for and an outcome and indicator of all three dimensions of sustainable development” The Rio Declaration on Social Determinants of Health and the UNGA resolution 67/81 on global health and foreign policy - … consideration to be given to including universal health coverage (UHC) in the discussion on the post-2015 UN development agenda. The Global Health consultation and Botswana report - new goals, building on existing health-related Millennium Development Goals (MDGs) focusing on sustainable health and well-being for all.
- Health is human well-being in all its dimensions. It is central to sustainable social and economic development across all sectors, and is a key indicator of what people-centred, rights-based, inclusive and equitable development seeks to achieve. The Global Thematic Consultation on Health, one of a series of consultations convened by the United Nations to inform the new development agenda, called for new goals, which, building on the existing health-related Millennium Development Goals, set more ambitious targets and focus on sustainable health and well-being for all.Maximizing healthy lives could be the specific health goal, in which the health sector would play a larger but far from exclusive role. This goal should include: accelerating progress on the health MDG agenda; reducing the burden of NCDs; and ensuring universal health coverage and access. Achieving better health at all stages of life (including crucial phases such as adolescence) is a goal that is relevant for every country. Interventions from all sectors of society will be required.Ensuring universal health coverage and access is suggested as the key contribution by the health sector to achieving health goals and targets, but also as a goal in itself, even though the exact terminology and interpretation of coverage and access remains a subject of debate.Providing all people with access to affordable, comprehensive, and high-quality services that address basic health requirements and country health priorities is a means to achieve better health outcomes. It is also a desirable goal in its own right because people value the assurance of access to a health system that prevents and treats illness effectively and affordably within their homes and their communities, with referral to clinics and hospitals when required.
- Life expectancy has improved across the Region, but to different extent between countries. In general terms, the countries in the eastern part of the Region have seen less improvement than countries in thewestern part. Life expectancy: the average number of years of life expected by a hypothetical cohort of individuals who would be subject during all their lives to the mortality rates of a given period. It is expressed as years. On this slide, the differences between countries can be clearly seen, both in terms of both absolute life expectancy and the improvements seen between 1990 and 2009. As already mentioned by the Minister of Health, you can see that Turkey has had the most remarkable increase in its Life expectancy.
- Historically, communicable diseases were dominant and across the globe and non-communicable diseases were regarded as the disease of the richer (high income nations). Now, although CD remain important (especially in a globalised world) and can cause serious health, social and economic consequences (as AI and SARS has shown), today the predominant disease burden in nearly ALL parts of the world is from noncommunicable diseases. A complex interplay of genetic, developmental, social, economic, environmental and health system determinants affect prevalence and mortality at both the individual and population levels. Just as these determinants stretch across the whole of societies, so must the responses. Here again we see the importance of thinking in system terms, and conceptualizing and making whole of government and whole of society approaches work. We are learning more about how to do this, building on successful experience and examples across the European Region and the world.
- We know much better now the economic costs of these diseases. These costs are enormous, hundreds of billions of dollars a year, EVERY year. It is also clear that health promotion and disease preventions programs and activities could avoid many of these costs. Yet across the European Region we spend only a paltry 3% on average on such programs. This picture is the same across the world.
- Here are some examples of the present economic burden from non-communicable disease. Poor health places a considerable impact upon the economy, making the population less productive and creating additional health and social care costs.Cardiovascular disease costs €169 billion annually in the EU with healthcare accounting for 62% of costs.Alcohol related harm costs €125 billion annually in the EU, equivalent to 1.3% of GDP.Obesity costs between 1-3% of health expenditure in most countries already and is projected to increase. Furthermore 9 million NCD new cases could be saved till 2030 if obesity in Europe is reduced by 5%Certain determinants for health are especially worth targeting because of their high economic impact – for example road traffic injuries cost up to 2% of GDP in middle and high income countries.
- The new European Health Policy Framework, Health 2020, is a response to these significant challenges to health and wellbeing across the European Region, to the inequities that we see between and within countries, and to the financial and economicdifficultiesfacingmanycountrieswhichthreatensto reverse thesegains. Health 2020 wasadopted in Septemberlastyear at theEuropean Regional Committee in Malta. We embarked on this journey for three reasons. First, because the important and significant improvements in health status and well-being in the European Region over the last few decades were not experienced everywhere and equally by all. As we all agree we have to make the case for health as a resource and asset for societies as health performance and economic performance are interlinked and thus there is a strong political, social and economic case for improving health and reducing inequities . Second, because we believed that effectively addressing these health inequalities in the context of Europe’s changing landscape required a broad re-think of priorities, new focus on some key determinants, strengthened leadership and renewed approach to current governance mechanisms across all sectors and society as a whole. Health is complex: health outcomes are also the result of policies of other sectors ( like education, employment, social welfare ) and therefore our success depends very much on our ability to advocate and mobilize collaboration and high level political support. On the other hand improved health outcomes bring political, social, economic and financial benefits to all. And third, because we see huge opportunities in investing in health promotion and disease prevention which is not being adequately taken up and are concerned that the unfolding financial crisis poses an additional significant threat to public health. To this end we have developed Health 2020 as a platform for standing-up for public health values and approaches. Health 2020 aimstoaddressthesechallengesthatarisefromdemographicpolitical, social and economic currents of globalization, the powerful new technologiesthat are changing health and health care; as well as from the increasing and changing expectationsof citizens for information and closer involvement in decisions about their health and the services they access.Health 2020 encourages a broad re-think of current mechanisms, processes, relationships and institutional arrangements across all sectors and society as a whole. Crucially the policy framework is built on the values of health as a fundamental human right, and the importance of solidarity, fairness and sustainability. Its goal is: “To improve health and well-being of populations, to reduce health inequities and to ensure sustainable people-centred health systems with further strengthened public health capacities”. Health 2020 offers value and evidence based strategies and priorities, which are interconnected and which can contribute to improving health and reducing health inequalities. Money alone cannot buy health, but with both resources and the right policies we can achieve this goal.
- We know that health inequities remain substantial across the WHO European Region (even more so globally) and are worsening in many instances. These inequities are substantially socially determined and are unnecessary and unjust, arising from differences in life circumstances and inequities in opportunities to lead a full and meaningful life. Such inequities, and their social and economic costs, directly challenge solidarity and social cohesion. Responding requires broadly rethinking current mechanisms, processes, relationships and institutional arrangements across all sectors and society as a whole. National and local health policy-makers often lack the authority and instruments to lead a coherent, integrated approach to these key challenges, and current structures and processes are not adequate in this new environment and need revisiting.To address these issues, I commissioned the European review of social determinants of health and the health divide, led by Sir Professor Michael Marmot. This research shows that effective interventions require a policy environment that overcomes sectoral boundaries and enables integrated programmes. For example, evidence clearly indicates that integrated approaches to child well-being and early childhood development produce better and fairer outcomes in both health and education. Urban development that considers the determinants of health is crucial, and mayors and local authorities play an ever more important role in promoting health and well-being. Participation, accountability and sustainable funding mechanisms reinforce the effects of such local programmes.
- If Health 2020 is to achieve its goals, new forms of governance for health will be required, more coherent, inter-connected and participative. Because the determinants of non-communicable disease stretch across the whole of society and all its sectors, so must the response. We speak today of a whole of society and a whole of government responsibility and accountability for health. Health 2020 explores what this means in practical terms, and shows how this improved governance for health can actually be achieved. EXTRA NOTES (from Health 2020):Leadership from health ministers and public health agencies will remain vitally important to address the disease burden across the European Region. It needs to be strengthened. Health ministries and public health agencies are increasingly engaged in initiating intersectoral approaches for health and acting as health brokers and advocates. This includes highlighting both the economic, social and political benefits of good health and the adverse effects of ill health and inequalities on every sector, the whole of government and the whole of society. Exercising such a leadership role requires using diplomacy, evidence, argument and persuasion. The health sector also has a partnership role towards other sectors when strengthening health can contribute to achieving their goals.Governments at all levels are considering establishing formal structures and processes that support coherence and intersectoral problem-solving. This can strengthen coordination and address power imbalances between sectors. This approach advocates moving health up the policy agenda, strengthening policy dialogue on health and its determinants, and building accountability for health outcomes.
- The right health policy decisions and system thinking have to go together. “It is the right policies that make health” and therefore have to be fully integrated within the health systems.Countries need a health policy which is coherent and simultaneously addresses all determinants that improve health and reduce inequities. Health 2020 is therefore meant as an inspiration for this.But the complexity of these problems alsorequires a systems approach, which reflects their inherent complexity, uncertainty and conflicting values. We need a commitment to learning and adapting from practice, with policies implemented as experiments. Again Health 2020 discusses what this means in practice.
- Health 2020 recognizes that successful governments can achieve real improvements in health if they work across government to fulfil two linked strategic objectives: improving health for all and reducing health inequalities improving leadership and participatory governance for healthThe Health 2020 policy is based on four priority areas for policy action: investing in health through a life-course approach and empowering people; tackling the Region’s major health challenges of noncommunicable and communicable diseases; strengthening people-centred health systems, public health capacity and emergency preparedness, surveillance and response; and creating resilient communities and supportive environments. The four priority areas are interlinked, interdependent and mutually supportive. For example, action on the life course and empowerment of people will help contain the epidemic of noncommunicable diseases, as will stronger public health capacity. These, in turn, will also help to contain communicable disease outbreaks. Governments achieve higher health impact when they link up policies, investments and services and focus on reducing inequalities. The WHO Regional Office for Europe will step up its role as a resource for developing policy based on evidence and examples of integrated approaches. Regional headline targets will support the monitoring of Health 2020’s progress.Addressing the four priorities requires a combination of governance approaches that promote health, equity and wellbeing
- What Turkey is doing you have already heard from the earlier presentations BUT Turkey is not alone, 11 other countries from across our diverse region are doing the same. These are from western European countries such as Austria and Ireland to the new EU member States such as Latvia and Central Asian republics such as Kazakhstan.If EXPO2020 is to be on Health then we would welcome a WHO Pavilion to enable countries to share the experience of good solutions for health from across all the other WHO regions and Globally.