Moving forward on the health equity agenda in

Europe

Dr Zsuzsanna JakabWHO Regional Director for Europe

Taking forward Health 2020: Small countries at the forefront of whole-of-government

approaches to health2– 3 July 2015

Soldeu, Andorra

Andorra, second high-level meeting of the small countries initiative

1. Small countries initiative: why it matters

2. Post-2015 agenda and global health priorities

3. Health 2020: progress made

4. More investment in the determinants of health

5. Getting to Vilnius

Big ideas from small places

Small countries have an acute understanding of the dynamics of globalization and excel in agility, social

cohesion, flexibility and public sector capacity.

A lesson learnt…(from small countries)

…you cannot bend the wind, so bend the sail…

The way to Andorra8/2012

AgreementWHO–San Marino

signed

9/2013 7/2014 9/2014 7/2015 10/2015 6/2016

Informal meeting during RC63

in Izmir

LaunchFirst high-level meeting of small countries

San Marino, 2-3 July 2014

Informal meeting during RC64

in Copenhagen

Second high-level meetingof small countries

Andorra, 2-3 July 2015

Capacity-buildingEuropean Public Health Conference

Milan 15-17 October 2015

Third high-level meetingof small countries

Monaco, June 2016

Key actions agreed in San Marino

1. Document how to align national health policies to Health 2020

2. Develop joint capacity-building events

3. Better engage media as implementation partners of Health 2020

4. Create a platform for sharing experience and mutual learning about Health 2020 implementation

Case study on San Marino national health and Health 2020 alignmentLaunched todayWorkshop during European Public Health conference, MilanOctober 2015Workshop for media during Andorra meetingRunning in parallel todayCommunity platform (yammer) to be launched during Andorra meetingeuro.who.int; dedicated tools

2015 is a special year

• The world will adopt the post-2015 development agenda.

• Both the global and the regional agenda are linked to this adoption.

Important global topics at the 68th World Health Assembly, May 2015

• Keynote speech by the German Chancellor giving high priority to global health (also at the G7, including health security, antimicrobial resistance, neglected tropical diseases)

• Many landmark decisions and resolutions

Landmark decisions and resolutions

• Preparing and responding to emergencies and the International Health Regulations (2005)

• PB for 2016-2017 adopted with 8% increase

• Global Action Plan on AMR: Europe has been leading the way

• Air pollution: again Europe is leading through the Environment and Health process

Malaria, polio, immunization

• Global malaria strategy adopted

• Polio

• Immunization

The framework for Health post-2015: Botswana report

Regional consultationInclusive sustainable development: perspectives from Europe and Central Asia on the post-2015 development agenda

Any goal for health should also address new challenges and maximize

healthy life expectancy, with universal health coverage as a key instrument. Taking a life-course approach – addressing the social, economic and environmental determinants of health – will be crucial. Health 2020 will prepare the ground for implementing this new vision in the Region.

Health goal 3 “Ensure healthy lives and promote well-being for all at all ages.”

Targets include:

the unfinished health MDGs

emerging global health priorities

universal health coverage and broader determinants of health

Several other goals also contain targets related to health.

Links to other sustainable development goals and targets

Progress in Health 2020 implementation in Europe

• Improve health and reduce inequities in health

• Promote upstream approaches by addressing the determinants of health

• Health is a political choice

Health 2020 implementation:European health report Main aims:

• To report on progress towards the Health 2020 targets (since 2010 baseline)

• To highlight new frontiers in health information and evidence, including subjective measures of well-being

Premature mortality

Although the European Region is on track to achieve the Health 2020 target to reduce premature mortality, much more can be done to reduce major risk factors.

Regional Health 2020 target: a 1.5% relative annual reduction in premature mortality from cardiovascular disease, cancer, diabetes and chronic respiratory diseases by 2020

Regional trends

Indicator: age-standardized death rate per 100 000 in people aged 30–69 for cardiovascular disease, cancer, diabetes mellitus and chronic respiratory disease combined

Country performance

0.0 100.0 200.0 300.0 400.0 500.0 600.0 700.0 800.0

BelarusRussian Federation

UkraineKazakhstanKyrgyzstan

Republic of MoldovaLatvia

BulgariaHungary

LithuaniaArmeniaRomania

SerbiaTFYR Macedonia

SlovakiaPolandEstonia

Bosnia and HerzegovinaRegional Average

CroatiaCzech Republic

GeorgiaTurkey

SloveniaBelgium

United KingdomDenmark

MaltaGermany

IrelandNetherlands

AustriaFinlandFrance

PortugalGreece

LuxembourgItaly

SpainNorwayCyprus

SwedenSwitzerland

Israel

Premature mortalityPremature mortality from four major NCDs: latest values for 2010–2012

Health inequity

The gaps between the highest and lowest values reported in the Region for the Health 2020 indicators linked to social determinants of health – infant mortality, life expectancy, primary school enrolment and unemployment – have decreased over time, but the absolute differences between countries remain large.

Regional Health 2020 target: Reduce the gaps in health status associated with social determinants within European populations.

Gaps have shrunk

Infant mortality

Life expectancy

Primary school enrolment

Absolute differences still large

Health 2020 indicator (source) Year Absolute difference between highest and lowest value reported in the Region (range)

Infant mortality (WHO HFA) 2010 20 infant deaths per 1000 live births (22.3–2.3)

Life expectancy at birth (WHO HFA) 2011 11.5 years (82.5–71.0)

Primary school-aged children not enrolled (UNESCO) 2012 10.5% (10.7% –0.2%)

Unemployment rate (WHO HFA) 2012 30.5% (31%–0.5%)

Absolute differences between the highest and lowest values reported in the Region for the Health 2020 core indicators linked to social determinants of health

WHO European Review of Social Determinants and the Health Divide• Avoidable health inequities exist

within and between countries.• These health inequities have social,

economic and environmental causes.• The wealth of a country is not the

only factor that determines the level of health.

• Government choices can make positive difference in countries at any level of gross domestic product.

Key areas for action to address health inequality

Average improvements in persistent health inequities reflecting associated with life circumstances and opportunities

Investing in health policy interventions

• Clear policy frameworks at government level and supporting strategies

• Strong political commitment at highest level

• Policy coherence between sectors and strong coordination across sectors

• Mayors, Prime Ministers, celebritiesHigh-level

commitment & champions

• Taxation, private sector • Co-ordination function needs resourcingDedicated resources

• Health promotion agencies; advisory task-forces; local government

• Do not discredit informal relationships & power of community

Institutional structures

• Quality of the “planning” can be more important than the “plan”Joint planning

• Trans-fat, setting up structures for health promotion Legislative tools

• Doesn’t matter who, but needs to be clear (shared or not, health or non-health)Accountability

• Targets focus action• Results are important for advocacy

Monitoring & reporting

Education All children in school, better learning

Healthy diets, active children, less family spending on

tobacco/alcohol

AgricultureImproved production,

environmental and financial sustainability

Increased consumption of fruit and vegetables (more available and affordable)

Industry Improved productivity, fewer staff absent

Healthier people (reducing premature disability and

death from NCDs)

Urban planningBeautiful cities, happier residents, more tourists,

more money

Safe spaces for physical activity and social

interaction, smoke-free environments

Finance More money for government budget

Higher taxes on tobacco and alcohol

Private sector Profit, brand reputationReformulating products to be

“healthier”, marketing healthy lifestyle

Gender equity

Less violence and poverty for women, better access to

health care and education for women

Reduced alcohol consumption, less

household spending on tobacco and alcohol

Police Less violence, crime and traffic accidents

Alcohol control

What do other sectors care about?

How can actions to promote health help?

Main focus on Health 2020 implementation to promote upstream approaches

Address all determinants of health: behavioural, economic and social, environmental, commercial, political, cultural.

Invest in public health functions like prevention and health literacy.

Governance aspects: health in all policies, whole-of-government, whole-of-society approaches

Life-course approach: Ministerial Conference in Minsk in October 2015

NCD prevention and control; Remaining communicable diseases and health security (IHR) Environment and health

Main strategic issues this year (RC65) Intersectoral action for health:

Health and foreign policy to link health to sustainable development

Health, education and social policy for early childhood development and social determinants

Health, environment and transport to reduce the impact of environmental pollution on health and promote physical activity

Meetings in Berlin, Paris and Haifa European Public Health Report: new frontiers in evidence;

reaching beyond targets

Main strategic issues this year(RC65)

Renewed action plan against multi-drug-resistant TB, 2016–2020

Physical activity strategy 2016–2025 (to support Food and Nutrition of last year);

Roadmap for tobacco control (FCTC) 2015–2025 Vision and priorities of modern health systems (primary health

care, coordinated integrated care, sustainable financing, reproductive health)

Renew work on emergency response (as part of a global process)

Discussions on maternal health.

Thank you!