Zsuzsanna Jakab, WHO Regional Director for Europe, 30 November 2012, London, United Kingdom

1. Facing future challenges
for global health
Zsuzsanna Jakab
WHO Regional Director for Europe

2. Health – a precious global good
• High placement on the political and social
agenda of countries and internationally
• Important global economic and security issue
• Major investment sector for human, economic
and social development
• Major economic sector in its own right
• Matter of human rights and social justice

3. Life expectancy in European country groups, 1950–2045:
population health improvement and ageing
CIS countries
85
EU 12 countries
EU 15 countries
European Region
80
Other countries
75
Life expectancy at birth (years)
70
65
CIS: Commonwealth of Independent
States
EU12: countries belonging to the
60 European Union (EU) before May 2004
EU15: countries belonging to the EU
after May 2004
55
1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050
Year
Source: World population prospects, 2008 revision. New York, United Nations
Population Division, 2008.

4. Life expectancy is improving, but the gains are unequal

5. DFLE: disability-free life
expectancy

6. Burden of noncommunicable diseases (NCDs)
Burden of disease by broad cause group and region, 2004
NCDs
DALY:
disability-
adjusted
life-year
Source: The global burden of disease. Geneva,
World Health Organization, 2008.

7. The economic case for health promotion and
disease prevention
Many costs are Today governments
The economic impact of
avoidable through spend an average
NCDs amounts to many
investing in health of 3% of their
hundreds of billions of
promotion and health budgets on
euros every year
disease prevention prevention

8. Economic burden of chronic disease
Cardiovascular €169 billion annually in the European Union
diseases (CVD) (EU), health care accounting for 62% of costs
Alcohol-related €125 billion annually in the EU, equivalent to
harm 1.3% of gross domestic product (GDP)
Obesity-related Over 1% GDP in the United States, 1–3% of
illness (including health expenditure in most countries
diabetes and CVD)
Cancer 6.5% of all health care expenditure in Europe
Road-traffic Up to 2% of GDP in middle- and high-income
injuries countries
Sources: data from Leal et al. (Eur Heart J, 2006, 27(13):1610–1619 (http://www.herc.ox.ac.uk/pubs/bibliography/Leal2006)),
Alcohol-related harm in Europe – Key data (Brussels, European Commission Directorate-General for Health and Consumer Protection, 2006
(http://ec.europa.eu/health/archive/ph_determinants/life_style/alcohol/documents/alcohol_factsheet_en.pdf)),
Sassi (Obesity and the economics of prevention – Fit not fat. Paris, Organisation for Economic Co-operation and Development, 2010) and Stark (EJHP
Practice, 2006, 12(2):53–56 (http://www.google.co.uk/url?q=http://www.eahp.eu/content/download/25013/162991/file/SpecialReport53-56.pdf&sa=U&ei=BNI4T-
K7JoKL0QGXs6HFAg&ved=0CBwQFjAF&usg=AFQjCNHS922oF8d0RLN5C14ddpMVeRn8BA) .

9. Using fiscal policy: the short-term benefits of sin taxes
Tobacco Alcohol
A 10% price increase in taxes In England, benefits close to €600
could result in up to 1.8 million million in reduced health and welfare
fewer premature deaths at a cost costs and reduced labor and
of US$ 3–78 per DALY in eastern productivity losses, at an
European and central Asian implementation cost of less than
countries €0.10 per capita
Source: McDaid, Sassi & Merkur. The economic case for public
health action. Maidenhead, Open University Press (forthcoming).

10. Why Health 2020?
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

11. Reaching higher and wider– acting on the
social determinants of health
• Going upstream to address root causes, such as
public health, health promotion and disease
prevention
• Making the case for whole-of-government and
whole-of-society approaches
• Offering a framework
for integrated and
coherent interventions
(Photo: Marianna Bacci Tamburlini/VIPC2007)

12. 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

13. Health challenges:
complex, multifaceted and
multilevel
• Increasing health • Major disease
inequities outbreaks
• Demographic shifts • Financial pressures
on health and welfare
• Environmental threats systems
• Obesity • Social and
• Alcohol misuse technological
• Narcotic drug use transformations
• Geopolitical shifts

14. Complex problems in health policy call for
learning and adaptation
• Complexity, uncertainty, high
stakes and conflicting value
• Systems thinking used to
analyse problems and devise
solutions
• Policies to be implemented as
large-scale experiments
• Commitment to learning from
practice
• Monitoring and evaluation
systems
• Policies adapted based on
experience

15. Connectedness

16. Health 2020, 2 + 4
Two strategic objectives
and four common policy priorities for health
Working to improve health for all and reducing the health divide
Improving leadership, and participatory governance for health
Investing in health through a life-course approach and
empowering people
Tackling Europe’s major health challenges of NCDs and
communicable diseases
Strengthening people-centred health systems and public health
capacities, and emergency preparedness, surveillance and
response
Creating resilient communities and supportive environments

17. Primary care as a hub with coordination with
hospital services
NGOs: nongovernmental
organization s
Source: World health report 2008. Geneva,
World Health Organization, 2008.

18. WHO European Action Plan for Strengthening Public Health
Capacities and Services 2012–2020
VISION: sustainable health and well-being
CORE ESSENTIAL PUBLIC HEALTH OPERATIONS (EPHOs) ENABLER EPHOs
INTELLIGENCE SERVICE DELIVERY
Governance
Surveillance Health promotion EPHO 6
EPHO 1 Public health
EPHO 4 workforce
Monitoring EPHO 7
EPHO 2 Funding
EPHO 8
Communication
Informing
EPHO 3 EPHO 5 EPHO 9
health
Research
assessments
Disease EPHO 10
and plans
Health protection prevention

19. Summary of public health challenges and solutions for 2050
Environmental Social and Health
determinants economic outcomes
determinants Solutions
CLIMATE NCDs
CHANGE SUSTAINABLE
AND LONGER PREVENTION
DISASTERS AGEING LIFE AND
EXPECTANCY PROMOTION
• Heat-waves ECONOMIC
• Fires DECLINE PRIMARY
• Drought HEALTH
• Floods INEQUALITIES Health system CARE
• Mudslides implications
• Chemical spills URBANIZATION PROTECTION
INCREASED Emergency
• Food security MIGRATION DEMAND preparedness
• Changes in AND COSTS
infectious disease TECHNOLOGY INNOVATIVE
habitat DECREASED WIN –WIN–WIN
WORKFORCE APPROACHES
Risks and projections RESEARCH IMPLICATIONS Innovative solutions

20. Promoting health in times of austerity
• Countries in the European Region differ greatly
• Across the Region, we see lower economic
growth, higher unemployment
• The crisis exacerbated existing challenges to
health systems

21. Facts from present and past crises
• Associated with a doubling of the risk of
illness and 60% less likelihood of recovery
from disease*
• Strong correlation with increased alcohol
poisoning, liver cirrhosis, ulcers, mental
disorders**
Unemployment
• Increase of suicide incidence: 17% in
Greece and Latvia, 13% in Ireland***
• Active labour market policies and well-
targeted social protection expenditure can
eliminate most of these adverse effects****
Sources: * Kaplan, G. (2012). Social Science & Medicine, 74: 643–646.
** Suhrcke M, Stuckler D (2012). Social Science & Medicine, 74:647–653.
*** Stuckler D. et al. (2011). Lancet, 378:124–125.
**** Stuckler D. et al. (2009) . Lancet, 374:315–323.

22. Health impact of social welfare
spending and GDP growth
Social • Each additional US$ 100 per
capita spent on social welfare
welfare (including health) is associated
with a 1.19% reduction in mortality
spending
• Each additional US$ 100 per
capita increase in GDP is
GDP associated with only a 0.11%
reduction in mortality
Source: Stuckler D et al. BMJ, 2010;340:bmj.c3311.

23. Further reflections on navigating the crisis
• Avoid across-the-board budgets cuts
• Focus public expenditures more tightly on the poor and
vulnerable
• Protect access to services by focusing on supply-side
efficiency gains, such as:
– the wiser use of medicines and technologies
– Rationalization of service delivery structures
• Think long-term and implement counter-cyclical public
spending (save in good times to spend in bad times)

24. Improving efficiency reduces adverse effects of the
crisis and helps secure support for more future
spending
Eliminate ineffective and inappropriate
services
Improve rational drug use
(including volume control)
Allocate more to primary and outpatient
specialist care at the expense of hospitals
Invest in infrastructure that is less costly to run
Cut the volume of least cost-effective services

25. Challenging, complex and
uncertain environment
• The global health architecture has become more
extensive but very complex
• Health challenges require active involvement of
all levels of government (international, national
and local)
• In an interdependent world, the need for joint
action on health challenges and health
determinants becomes ever more important

26. WHO in the 21st century
• WHO’s role in the global health architecture –
reform process enhancing WHO’s role as a
global health player
• Forging partnerships for health and sustainable
development a top priority
• One WHO, regions working together
• Closer to countries’ needs and realities
• Increasing appreciation of health in foreign
policy and international health diplomacy

27. Health 2020: the foundation for a healthier
European Region
• Importance of shared governance for health at
all levels, supporting whole-of-government and
whole-of-society approaches
• Partnership-based vision engaging
governments, NGOs, civil society, the private
sector, science and academe, health
professionals, communities and every individual
• Systematically strengthening partnerships: key
goal of Health 2020

28. “We want to see better health
and well-being for all, as an
equal human right. Money does
not buy better health. Good
policies that promote equity
have a better chance. We must
tackle the root causes [of ill
health and inequities] through a
social determinants approach
that engages the whole of
government and the whole of
society”
– Dr Margaret Chan
WHO Director-General