addressing health inequities through the new european policy framework for health and well-being...

Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020)

6 December 2013, Stockholm, Sweden

Addressing health inequities through the new European Policy Framework for Health

and Well-being (Health 2020)

Dr Piroska ÖstlinProgramme Manager



Presentation outline

1.• What is Health 2020 and why it is needed?

2.• Health 2020: Strategic objectives and

common policy priorities based on evidence

3.• Health 2020 policy implementation



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



Overall health improvement (+ 5 years life expectancy) but with an important divide in the Region

CIS: Commonwealth of Independent StatesEU12: countries belonging to the European Union (EU) after May 2004EU15: countries belonging to the EU before May 2004

Source: European Health for All database. Copenhagen, WHO Regional Office for Europe, 2010.

4



Significant improvements in health and well-being, but ….uneven and unequal

Life expectancy trends in Sweden 2000-2010, by education, men

Source: European Review of SDH, 2013Source: WHO HFA database, 2012



Significant improvements in and well-being, but ….uneven and unequal

Additional life expectancy at the age of 30 by educational attainment, women, 1986–2004, Hungary

Source: Hablicsek, 2007Source: WHO HFA database, 2012

Primary education not completedPrimary educationSecondary educationHigher educationAll education levels



Trends in probability of survival in men by education: Russian Federation

0.4

0.45

0.5

0.55

0.6

0.65

0.7

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

Calendar year

45 p

20

45 p20 = probability of living to 65 yrs when aged 20 yrs

University

Less than secondary

Source: Murphy et al 2006



Alarming and unacceptable health inequities for Roma in Europe – MDG 4 (child health)

© WHO/Djordje Novacovic

Under-five and infant mortality rate in Serbia

Source: MICS, Serbia 2012



Child (aged 0-6) vaccination rates in the countries of Central and Southeast Europe in 2011

BCG

IPV

DTaP

MMR

70 75 80 85 90 95 100

Non-RomaRoma

Source: http://europeandcis.undp.org/ourwork/roma/show/A40774B7-F203-1EE9-B5BE1384077AB8B5



Percentage of households unable to afford prescription medication in 2011

SKRS

RO MKMEMDHR

HCZBGBAAL

0 10 20 30 40 50 60 70 80

Non-RomaRoma

Source: http://europeandcis.undp.org/ourwork/roma/show/A40774B7-F203-1EE9-B5BE1384077AB8B5



What is Health 2020?

Health 2020 is a value-based action-oriented policy framework, adaptable to different realities in

the countries of the WHO European Region.

Health 2020 is addressed to ministries of health but also aims to engage ministers and policy-makers across government and stakeholders throughout society who can contribute to health and

well-being.



Building on public health history

• WHO Constitution• Declaration of Alma-Ata• Health for All • HEALTH21• Tallinn Charter

Integrated policy frameworks can and have inspired health-generating actions on all levels.



Reducing health inequities through actions on the social determinants of health is strongly emphasized in the new

European policy framework for health and well-being (Health 2020)

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



Increasing attention to inequity

For richer, for poorerGrowing inequality is one of the biggest social, economic and political challenges of our time. But it is not inevitable …

– The Economist, special edition, 13 October 2012(http://www.economist.com/node/21564414)

http://www.economist.com/node/21564414



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

Strengthening

people-centred health

systems

Creating resilient

communities and

supportive environmen

ts

Health 2020 strategic objectives and priorities for policy action



Health 2020: a policy informed by evidence

”Without knowledge

action is useless and knowledge

without action is futile.”

Abu Bakr (573-634)

“Don't invest in anything that

you don't understand. Do your research

first.”Paul

Clitheroe (1955 -)



New evidence informing Health 2020

• Report of social determinants of health and the health divide in the WHO European Region

• Governance for health in the 21st century

• Promoting health, preventing disease: the economic case

• Intersectoral governance for Health in All Policies: structures, actions and experiences

• Review of the commitments of WHO European Member States and the WHO Regional Office for Europe between 1990 and 2010



Evidence that will make a big difference

A strong human rights and social justice case

A strong economic case

Current economic difficulties are reasons for action and not inaction



The CSDH – Closing the gap in a generation

The Marmot Review – Fair Society, Healthy Lives

Social injustice is killing on a grand scale!



The root causes of health inequities

“Health inequities arise from the societal conditions in which people are born, grow, live, work and age, referred to as social determinants of health”.

(Rio Political Declaration on Social Determinants of Health, 2012)



What good does it do to treat people’s illnesses, and then

send them back to the conditions that made them sick?

Sir Prof. Michael Marmot



Aims of the European Review of the Social Determinants of Health and the Health Divide

To inform Health 2020 by:

• Assessing the magnitude and trends of health inequities in the WHO European Region

• Identifying the causes of current patterns of health inequities

• Providing recommendations for action that can be adapted to different country contexts



Main findings

a) Health inequities found in all European countries

b) Evidence of increased health divide

c) Presence of social gradient

d) Health inequities, among and within countries, explained by

the different conditions in which people are born, grow, live, work

and age



Four areas for action to address health inequalities – emphasizing priorities



Do something, do more, do better...

• If countries have very little in place in terms of policies on social determinants of health, “some” action matters

• Where policies do exist, they can be improved to deal with large and persistent health inequities

• There is scope to do better on inequities in the poorest and in the richest countries of Europe



Countries are taking up the Health 2020 challenge



Applying the Health 2020 lens to country

situation analysis

Integrated approaches to implementing the four priority policy areas of

Health 2020

Implementing whole-of-government and whole-of-

society approaches

Strengthening public health capacities and

services

Introducing Health 2020 to different stakeholders

across sectors

Addressing SDH, equity, gender and human rights

Strengthening monitoring and evaluation

Developing Health 2020-based national and subnational health

policies, strategies and plans

Operationalizing new concepts and evidence

Health 2020 implementation package



Health 2020 monitoring framework

1. Reduce premature mortality by 2020.

2. Increase life expectancy.

3. Reduce inequalities in health.

4. Enhance the well-being of the population.

5. Ensure universal coverage and the right to the highest attainable level of health.

6. Set national goals and targets related to health in Member States.



Follow up

• Major role in WHO/Europe assistance to Member States linked to Health 2020 implementation (e.g. BCA)

• Specific policy dialogue, situation analyses - both country and multicountry-based

• Mainstreaming of the social determinants of health in public health programmes and Action Plans

• Continued provision of medium and longer-term technical assistance



Political and social commitment

• Social policies can be judged by their likely impact on health equity

• The review provides evidence that makes this judgement possible, and recommendations for action

• What is now needed is the political and social commitment of governments, civil society, transnational bodies and academic institutions to translate this into reality



Health 2020 lays the foundation for a healthier European Region

“So many factors affect health, and health has an impact on so many areas of our lives that progress on public health can only come from whole-of-society and whole-of-government efforts.

That is why there is a role for everyone to play in implementing Health 2020, from prime ministers, to civil society, to citizens.”

– Zsuzsanna Jakab, WHO Regional Director for Europe

Dear prime minister, minister, mayor or member of parliament:

Good health underpins social and economic development and strengthens policies across all sectors. However, the economic and fiscal crisis facing many countries presents serious challenges and potentially risks undermining the positive progress that has been made. Nevertheless, it also presents an important opportunity to refocus and renew our efforts to improve the health of all people.

All sectors and levels of government and society contribute to health creation. Your leadership for health and well-being can make a tremendous difference for the people of your country, state, region or city and for European Region as a whole.

Your support for Health 2020 is truly essential.



Thank you!

addressing health inequities through the new european policy framework for health and well-being...

Documents

european health

wellbeing health

health landscape

unacceptable health

public health values

new european policy

policy implementation

new demands