Global Health

in Germany –

really?

Yes, really.

Dr Claudia Stein MD, PhD, FFPH

Director

Division of Information, Evidence, Research and Innovation WHO Regional Office for Europe

“A state of complete physical, mental and social well-being and

not merely the absence of disease or infirmity”

WHO definition of health (1948)

Definition of public health at WHO

„…shall be the attainment by all peoples of the highest possible level of health.“

Source: WHO‘s Consitution

WHO‘s Mission

WHO’s core mandate is:

• providing leadership on global health matters,

• shaping the health research agenda,

• setting norms and standards,

• articulating evidence-based policy options,

• providing technical support to countries, and

• monitoring and assessing health trends.

Public health? Global health?

Source: BMJ, 1998

Medic

Engineer

Law

Social

science

Researc

h

Pro

ble

ms

Poor WHO,

always standing

in the gap….

IEA World Congress of Epidemiology

Plenary Session

7 August 2011

Public health practitioners at WHO

– Medical/paramedical professions

– Health economists

– Statisticians/mathematicians

– Epidemiologists

– Social scientists

– Natural scientists

– Anthropologists

– Medical humanities

– Political scientists

– Administrators and finance experts

– Lawyers

– Water & sanitation engineers

– Environmental scientists

– Journalists

– and many more…

Multi-disciplinary

The breadth of public health –

it is everywhere

The breadth of public health –

it is everywhere

The breadth of public health –

it is everywhere

The breadth of public health –

it is everywhere

Heroes of multi-disciplinary public health

Rudolf Virchow, 1821-1902

Lord Ashley Shaftesbury

1801-1885

Founder of cellular pathology

Founder of anthropology

Discoverer of embolism

President of the

Royal Statistical Society

Who exactly are

these people….?

Rudolf Virchow, 1821-1902Lord Ashley Shaftesbury

1801-1885

Founder of cellular pathology

Founder of anthropology

Discoverer of embolism

President of the

Royal Statistical Society

Benjamin Rush, 1746-1813Father of

American Psychiatry

Signatory to the US

Declaration of Independence

Father of Social Health

Insurance laws in

Bismarck’s Germany

Responsible for abolition

of child labour in 19th

century Britain

Public health is very political – it has to

be…..

European Health 2020 policy

• Emphasis on health and well-being

• The right to health and access to care

• People at the centre

• Addressing the determinants of health

• Whole of society approach

• Whole of government approach

• Importance of partnerships

The WHO European Region

53 Member States 900 million population

WHO Regional Office for Europe

Copenhagen, Denmark

19 core and 18 additional

indicators for 6 targets

Health 2020 monitoring framework –

targets and core indicators

Reduce premature

mortality

Premature CVD, cancer,

diabetes and chronic

respiratory mortality *

Increase life

expectancy

Tobacco use

Alcohol consumption

Overweight and obesity*

Vaccination coverage

External causes mortality*

Life

expectancy

at birth*

Reduce

inequalities

Infant

mortality*

LE at birth*

Primary

school

enrolment*

Unemployment

rate*

National

inequality

policies

GINI

Enhance

well-being

Life satisfaction*

Availability of

social support

UHC &

“right

to

health”

OOP as %

THE

Vaccination

coverage

THE %

GDP

National

targets

Process for

target setting

established

Evidence

documenting:

- National

polices aligned

with H2020

-Implementation

plan

- Accountability

mechanism

* Disaggregated by sex

Improved

sanitation facilities

GINI

Unemployment

rate*

Children not

enrolled in school*

Targets must have realistic indicators

Measuring health and well-

being with realistic indicators

• Highlights

Germany’s

achievements

in health and

health

systems;

• Calls for

leadership in

global health

by Germany;

• Outlines

Germany’s

role in global

health.

Quo vadis, Germany?

Public health in its

entirety Public health training &

professionalisation

Thank you

Спасибо

Merci

Danke

Thank you

Спасибо

Merci

Danke

European Health Information Initiative (EHII)

• Provides

overarching

coordination &

guidance for health

information

activities WHO

Europe;

• Multi-partner

network;

• 8 Steering Group

meetings held to

date.

EHII participants: 35 .. and growing

Austria

Belgium

Croatia

Czechia

Finland

Georgia

Germany

Greece

Italy

Kazakhstan

Kyrgyzstan

Latvia

Lithuania

Malta

Netherlands

Poland

Portugal

Republic of Moldova

Romania

Russian Federation

Slovenia

Sweden

Switzerland

fYR Macedonia

Turkey

United Kingdom

European Commission Wellcome Trust

European Public Health Association

gateway.euro.who.int

Your work to

be included on

Gateway

Published

to date:

Greece

Slovenia

Moldova

Georgia

To be launched:

Bulgaria

Malta

Russian Federation New wellbeing

modules More to follow in

2018

Disseminating research & health information:

EURO public health journal

• Aimed at dissemination of good practices

and successful implementation of

evidence-informed policies;

• Bi-lingual (English/Russian);

• Quarterly publication;

• Theme-based;

• Peer reviewed.

Since 2013

annually:

Turkey, Poland,

Russian Federation,

Romania, Georgia

Focus: Health 2020

monitoring (country case

studies, inequalities,

reporting, evidence for

policy)

Capacity building:

Autumn school of health information and

evidence for policy making

‘Advanced

course’

follows

annually

(June)

Small Countries’ Health Information Network

• Initiative of the Minister of Health,

Malta; currently chaired by Malta;

• Third meeting held in Malta on 27th

June 2017;

• Agreement on reporting of ‘rolling

average’ of selected indicators;

• Developing joint indicator list for

reporting on HSPA and Health 2020.

Health Information Networks: CARINFONET

Kazakhstan,

Kyrgyzstan,

Tajikistan,

Turkmenistan,

Uzbekistan

• Central Asian

Republics

Information

Network

• Provides platform

for joint reporting of

health statistics;

• Development of

joint indicator list

(29 core

indicators);

European Burden of Disease Network

• Chaired by Public Health England (Prof John Newton);

co-chaired by The Netherlands;

• Two meetings held with 11 countries in London and Oslo.

• Hosted jointly with the Institute of Health Metrics & Evaluation (IHME);

• Editorial in European Journal of Public Health;

mapping of BoD studies

submitted to EJPH.

– National burden of

disease manual

in preparation;

South-eastern Europe Health Network

(SEEHN) health information network

• Decision taken to establish

SEEHN health information

network;

• WHO now working with SEEHN

Secretariat to establish network,

ToRs and modalities.

Brand-new!

56

Purpose of a South-eastern European Health Information Network:

to promote coordination and collaboration among countries in the SEEHN,

in order to strengthen national health information systems, including data collection, processing,

analysis and dissemination.

• Promotes systematic use of research evidence in

policy-making;

• Increases country capacity in developing sound

and effective health policies;

• Institutionalizes knowledge translation (KT)

through the establishment of KT country teams;

• 5th multi-country meeting held in Bratislava,

Slovakia.

EVIPNet Europe: growing rapidly

‘Live’ in 21 countries in the European Region

Concrete results

coming in

National health information strategies

• Member States requested practical

support tool

• Tool developed by Working Group (17

countries), co-chaired by Netherlands

and Russian Federation

• Based on WHO HMN tools and

materials, adapted to European context

• Available in English & Russian

• Piloted in four countries and revision

under-way.

Should we develop something

similar or research, or use

existing materials from other

sources?

European Advisory Committee on Health

Research (EACHR)

- Established special working

group on ‘implementation

research’.

Continues to meet annually and advises the Regional Director on

research matters:

- Reviews evidence for subjects to be presented at Regional

Committees;

- Advises on research use of existing information, including on

Big Data;

Adoption of Action Plan and Resolution on evidence-

informed policy making

53 WHO Member States calling for enhanced

action to use evidence for policy:

Regional Committee 2016

1. Strengthening health information systems, harmonizing health indicators and establishing an integrated health information system for the European Region;

2. Establishing and promoting health research systems to support the setting of public health priorities;

3. Increasing country capacities for the development of evidence-informed policies (knowledge translation);

4. Mainstreaming the use of evidence, information and research in the implementation of Health 2020 and other major regional policy frameworks.

Adopted by 53

Member States

through resolution

Concrete actions for

Member States and

WHO

Member States

called on DG to

establish HII at

global level

Member States

called on DG to

develop global

action plan for EIP

Thank you

Спасибо

Merci

Danke

Extra slides – not for translation

Where next with SDGs, Health 2020

culture & health, and well-being?

• Progress with cultural context of health and well-being;

• Develop joint monitoring systems for Member States;

• Further develop well-being indicators and new concepts of

Health 2020 through new expert group;

• Quantify more of the Health 2020 targets;

H2020 and SDGs alone

Indicator-level: 13

Thematic: 15

No alignment: 9

10 indicators

overlap

thematically

across 3

frameworks

SDG NCD

H2020

Alignment of indicators across 3 frameworks

H2020 and NCD alone

Indicator-level: 8

Thematic: 4

No alignment: 25

H2020 and SDGs alone

Indicator-level: 6

Thematic: 8

No alignment: 11

Consultation questions to Member States

1. Which of the five options do you prefer and why? Alternatively, is

there a sixth option that you could think of and which would be

preferable to you?

2. Do you foresee any challenges you may face when implementing

the preferred option? Which are those?

3. Will implementing the preferred option bring additional benefits to

you, in addition to reducing burden of reporting? What kind of

benefits?

4. How should WHO Regional Office for Europe assist you with the

implementation of the joint monitoring framework?

#1

Streamlining

of indicators

Joint Set

of

Indicators

#2 Timing of

reporting

Jan Dec Jan Dec

#3 Pooling/

merging of data

collection

Jan Dec

SDGs NCDs

Health

2020

#1

Streamlining

of indicators

Joint Set

of

Indicators

#2 Timing of

reporting

Jan Dec Jan Dec

#3 Pooling/

merging of data

collection

Jan Dec

SDGs NCDs

Health

2020

Option 4

#1

Streamlining

of indicators

Joint Set

of

Indicators

#2 Timing of

reporting

Jan Dec Jan Dec

#3 Pooling/

merging of data

collection

Jan Dec

SDGs NCDs

Health

2020

Option 5

#1

Streamlining

of indicators

#2 Timing of

reporting

#3 Pooling/

merging of data

collection

#1

Streamlining

of indicators

#2 Timing of

reporting

n = 3

Member States in support of JMF

Either

option 4

or 5

General

positive

support

n = 3 n = 3 n = 3

Option 4 Option 5

European Health Information Initiative (EHII) – it all started with one Member State:

The Netherlands

eHealth week 2017 in Malta –

WHO Europe as co-organizer

“What we need is a beautiful marriage

between public health and eHealth, and

before you get to a wedding there has

to be an engagement, a commitment.

Which brings me back to

WHO/Europe’s participation in eHealth

Week, as a celebration of our

commitment and dedication to reaping

the benefits of eHealth for all.”

(Dr Zsuzsanna Jakab,

WHO Regional Director for Europe)

Health information strategies

• Member States requested practical

support tool

• Tool developed by Working Group (17

countries), co-chaired by Netherlands

and Russian Federation

• Based on WHO HMN tools and

materials, adapted to European context

• Available in English & Russian

• Piloted in three countries and revision

under-way.

Current situation of

health reporting

in Europe

European

Health

Information

Initiative

The future:

Integration of health

information

EuropeanHealthReport2018

Where next with SDGs, Health 2020

culture & health, and well-being?

• Progress with cultural context of health and well-being;

• Develop indicators for joint monitoring systems for

Member States;

• Further develop well-being indicators and new concepts

of Health 2020 through this expert group;

• Quantify more of the Health 2020 targets.

• Redefine what ‘evidence

‘means in European Region:

quantitative and qualitative.

• Provide ‘Evidence for All’.

The reporting challenge for countries:

6 targets

37 indicators

19 core

18 additional

17 goals

169 targets

300 indicators (26 indicators under SDG3)

9 targets

25 indicators

UNECE: even most developed countries

•Can only report on 50% of SDG indicators;

•Can only cover 76 out 169 targets.

Alignment of H2020 and SDG indicators

Adopted approach for Joint Monitoring Framework

Expert Group on Core Set of Indicators

Consultation with Member States on Draft Core Set of Indicators

Adoption of Core Set of Indicators

Process to arrive at the

common set of indicators

Q3-Q4/2017

Q1-Q2/2018

Q4/2018-

Q2/2019 Q3/2018

RC67

RC68

Strategic plan for

Big Data

First time joint indicator

framework established

Cultural contexts of health & well-being

WHO Expert Group on Cultural

Contexts of Health and Well-being

• Explore different types of qualitative evidence

more fully;

• Commission further work in the area of culture and

health, including policy briefs and tool kit for

policy makers;

• Investigate cultural contexts of health more

systematically;

• Use a multisectoral and multidisciplinary

integrated research approach;

• Three meetings held to date, third one jointly with

UNESCO.

• Morbidity

• Mortality

• Disability

• Loss of function

• Determinants (incl. risk factors)

of ill-health

How have we reported on health?