Zsuzsanna Jakab, WHO Regional Director for Europe, 29 November 2012, Vilnius, Lithuania

1. Health 2020: a new European policy
framework for health and well-being
Zsuzsanna Jakab
WHO Regional Director for Europe

2. Health 2020: adopted by the WHO Regional
Committee for Europe in September 2012
The European policy framework for supporting action
across government and society for health and well-being

3. Dear President, Prime Minister, Minister, Mayor:
Health is a prerequisite for social and economic development. Without health and well-being there is no
economic growth and no development. Health and well-being contribute to the productivity of any society
and should therefore be considered as an investment and not as an expenditure. The present economic/
financial crisis is affecting many countries in many ways, but it can also present an opportunity to do more
and better for people’s health. To improve health status, we have to address all determinants
simultaneously, and they are outside the health sector; they are everywhere where people live. All sectors
and levels of government and society therefore contribute to the creation of health.
Your leadership for health and well-being can make a tremendous difference for the people of your
country or city and for Europe as a whole.
Your support for Health 2020 is truly essential!

4. Health 2020 goal
• To significantly improve the health and well-being of
populations, to reduce health inequities and to ensure
sustainable people-centred health systems.

5. Health 2020 documents
• Health 2020 – A European policy framework supporting
action across government and society for health and
wellbeing
• Health 2020 – European policy framework and strategy
document

6. Health 2020 highlights
• Health: a major societal resource and asset
Policy framework
• Strong value base: reaching the highest attainable standard of health
• Strong social and economic case for improving health
• Strategic objectives and common policy priorities
• Working together: adding value through partnerships
• Health 2020: a common purpose and a shared responsibility
• Renewing the commitment to health and well-being: the context and
drivers
Strategy
• Applying evidence-based strategies that work and the key stakeholders
• Enhancing effective implementation, requirements, pathways and
continuous learning

7. Why Health 2020?
Significant improvements in health and well-being
but … uneven and unequal

8. Overall health improvement (+ 5 years life expectancy)
but with an important divide in the Region
CIS: Commonwealth
of Independent States
EU12: countries
belonging to the
European Union (EU)
after May 2004
EU15: countries
belonging to the EU
before May 2004

9. Why Health 2020?
Europe’s changing health landscape:
new demands, challenges and opportunities

10. Health landscape of European Region
• Complexity and uncertainty
• Multifaceted health challenges, requiring active involvement of all
levels of government (international, national and local)
People live longer Noncommunicable Control of infectious Health systems
and have fewer diseases (NCDs) diseases (such as face rising costs
children dominate the HIV, tuberculosis
Primary health care
disease burden (TB)) remains a
systems are weak
challenge
People migrate and lack preventive
within and between Depression and services
countries; cities heart disease are Antibiotic-resistant Public health
grow bigger leading causes to organisms are capacities are
healthy life-years emerging outdated
lost

11. Why Health 2020?
Economic opportunities and threats:
the need to champion public health values and approaches

12. Financial crisis of 2008: additional layer of
complexity from austerity
• Evidence from previous Unemployment:
crisis on relationship • associated with
between doubling the risk of
unemployment, social illness and reduced
welfare and health likelihood of recovering
• Active labour market from disease
policies and well- • strong correlation with
targeted social alcohol poisoning, liver
protection can eliminate cirrhosis, ulcer, mental
adverse effects disorders, suicide

13. Health 2020 development journey: two-year
participatory process with Member States
and partners
• Unprecedented evidence review
• New evidence gathering
• Solutions that work
• Integrating and connecting
• Stakeholder and peer reviewed

14. Health 2020: key studies
• Governance for health in the 21st century
• Supporting Health 2020: governance for health in
the 21st century;
• Intersectoral governance for health in all policies:
structures, actions and experiences
• Review of social determinants of health and the
health divide in the WHO European Region
• Review of the commitments of WHO European
Member States and the WHO Regional Office for
Europe between 1990 and 2010
• The economic case for public health action

15. Building on public health history
• WHO Constitution
• Declaration of Alma-Ata
• Health for All
• Health21
• Tallinn Charter: Health
Systems for Health and
Wealth
Integrated policy frameworks can
and have inspired health-generating
actions on all levels.

16. Health 2020 – a unifying policy framework to
meet these challenges
• Recognizing that • Simultaneously
countries have addressing all health
different starting determinants, which
points and seek mostly lie outside the
different approaches health sector and are
• Aim: to improve socially determined
health outcomes, (including social
reduce health divide determinants): root
causes!
• New type of governance

17. Health 2020 strategic objectives
• Working to improve health for all and reduce the
health divide
• Improving leadership, and participatory
governance for health

18. Health 2020: four common policy
priorities 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

19. Life expectancy and gross domestic product (GDP)
per capita in European countries, around 2007
Source: European Health for All database. Copenhagen,
WHO Regional Office for Europe, 2010.

20. Going upstream: reaching higher and wider
• Address root causes such as social determinants
• Invest in public health, health protection, health
promotion and disease prevention
• Make the case for whole-of-government and
whole-of-society approaches
• Offer a framework for integrated and coherent
interventions

21. Review of social determinants of health and the
health divide in the WHO European Region: key
findings
• Persisting inequities in health between and within
countries, which are socially determined
• Life-course approach to health equity
• Addressing the processes of exclusion
• Need to build on the resilience, capabilities and
strengths of individuals and communities
• Emphasis on intergenerational equity
Do something; do more; do better!
Study carried out by a consortium chaired by Professor Michael Marmot of the United Kingdom

22. Improving governance for health
Supporting whole-of-
government and whole-of-
society approaches
Learning from a wealth of
experience with inter-
sectoral action and health-
in-all-policies (HiAP) work
in Europe and beyond
Two studies on governance for health led by Professor Ilona Kickbusch of Switzerland (2011, 2012) Kickbusch, 2011
Source:
McQueen D et al. Intersectoral governance for health in all policies. Structures, actions and experiences. Copenhagen,
WHO Regional Office for Europe, 2012.

23. Major burden in the Region due to
noncommunicable diseases
SDR: standardized
death rate

24. Premature mortality from leading causes of death for
Lithuania and European Regions
Heart disease
Cerebrovascular
disease
Lung cancer
Breast cancer
EU-12
EU-15
Cervical cancer
Lithuania
Suicide
Traffic accidents
Acute respiratory
infections, pneumonia and
influenza in children <5y
0 10 20 30 40 50 60 70
Standardized death rate per 100,000 population
Source: European Health for All database. Copenhagen,
WHO Regional Office for Europe, 2010.

25. Ischaemic heart disease
Lithuania health situation and
Source: European Health for All database. Copenhagen,
WHO Regional Office for Europe, 2010. trends, 1970-2008

26. 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 3% of their health
hundreds of billions of
promotion and budgets on
euros every year
disease prevention prevention

27. 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) .

28. Price of a 20-cigarette pack (US$) at official exchange
rates, 2008
Ireland
No rway
UK
France
Germany
Denmark
Switzerland
Netherlands
Finland
Italy
B elgium
Sweden
A ustria
Iceland
M alta
Israel
P o rtugal
Luxembo urg
Spain
Greece
Slo venia
Hungary
Czech Republic
Latvia
Cro atia
Esto nia
Slo vakia
Ro mania
Turkmenistan
B ulgaria
Turkey
P o land
Lithuania
A rmenia
TFYR M acedo nia
A lbania
B o snia and
Serbia
A zerbaijan
B elarus
M o ntenegro
Kazakhstan
Kyrgyzstan
Geo rgia
Republic o f
Russian Federatio n
Uzbekistan
Ukraine
0 5 10
Source: WHO report on the global tobacco epidemic. Geneva, World Health Organization, 2009.

29. Action Plan for Implementation of the European Strategy for the
Prevention and Control of Noncommunicable Diseases 2012–2016
Planning and Health in all Healthy Secondary
oversight policies settings prevention
Fiscal policies
Cardio-metabolic
Workplaces and risk assessment
National plan
schools and
management
Marketing
Health Salt
information
system with Early detection
Active mobility
social of cancer
determinants
Trans fats
disaggregation

30. Reduction of circulatory mortality
European European European
average average average

31. WHO European Action Plan
for Strengthening Public
Health Capacities and
Services

32. Ten essential public health operations (EPHOs)
VISION: sustainable health and well-being
ENABLER EPHOs
CORE EPHOs Governance
INTELLIGENCE SERVICE DELIVERY EPHO 6
EPHO 1 + 2 Health promotion Public health
Surveillance workforce
EPHO 4 EPHO 7
Monitoring
Funding
EPHO 8
Informing
Communication
health
assessments EPHO 9
EPHO 3 EPHO 5
and plans Research
Disease EPHO 10
Health protection prevention

33. Supporting Member States in navigating the
crisis is central to our work
• Strong economic case for health promotion
and disease prevention, as economic cost of
NCDs is extremely high
• Prevention: one of most cost-effective ways to
improve health outcomes
• Use of fiscal policy, like increased taxes on
tobacco and alcohol
• Short-term benefits of “sin” taxes

34. Supporting Member States in navigating the
crisis is central to our work
• Try to protect health budgets but, if cuts have
to be made, avoid across-the-board cuts and
focus public expenditures more tightly on poor
and vulnerable people (avoid or reduce out-of-
pocket payments, which lead to
impoverishment)
• Think long term: save in good times and
spend in bad times!

35. Improving efficiency reduces adverse effects
of the crisis
• Eliminate ineffective and
inappropriate services
• Improve rational drug use
• Allocate more to primary health
care 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

36. Health impact of spending on social welfare
and growth of gross domestic product (GDP)
• Each additional US$ 1 • Each increase in GDP
per capita spent on of US$ 100 per capita
social welfare is results in only 0.11%
associated with 1.19% reduction in mortality
reduction in mortality
• Effect of social- • Than that of GDP
welfare spending on growth
mortality reduction is
significantly greater …

37. Health 2020 framework
• Health 2020 is an
adaptable and practical
policy framework
• Health 2020 recognizes that countries engage from
different starting points and have different contexts and
capacities
• Health 2020 recognizes that every country is unique and
that countries will pursue common goals through
different pathways and approaches, but be united in
purpose