(1)

Dr Zsuzsanna Jakab

WHO Regional Director for Europe

6 October 2017, Debrecen, Hungary

Presentation –

Health status of the Europeans

– challenges and main tasks

(2)Photo: Malin Bring

(3)

Health at the centre of development

(4)

Health at the centre of development

(5)

Health is a political choice

(6)

Moving towards joint commitments

1. Focus on inequities

2. Achieve universal health coverage

3. Strengthen health systems

4. Work upstream: health promotion and disease prevention

5. Address all the determinants of health

6. Strengthen emergency preparedness and response

(7)

Health 2020

Priorities

Health systems

Burden of disease

Life-course

approach

Resilient commun-

itiesSDG3

Universal health

coverage

Emergency management

(IHR)

Halve deaths and injuries from road

traffic accidents

Reduce deaths and illness

from environmental

pollution

Reduce maternal mortality

End preventable

deaths of children under

5

Strengthen prevention and

treatment of substance

abuse

Universal access to

sexual and reproductive

health services

End AIDS, TB, malaria and

other communicable

diseases

Reduce premature

mortality from NCDs and promote

mental health

Research for vaccines and

medicines

Strengthen FCTC

Health financing and

health workforce

Health 2020 is fully aligned with the SDGs

(8)

70

72

74

76

78

80

82

Overall Men Women

Life expectancy is increasing in the WHO European RegionYe

ars

77.7

74.4

81.0

(9)

63

64

65

66

67

68

69

70

71

Overall Men Women

Healthy years at birth has reached 68 years across the RegionYe

ars 68.3

65.6

70.5

(10)

The NCD mortality trend for those aged 30–69 is declining.

(11)

2–3% annual average decline in premature mortality in most countries

Aim is a decline of 40% by 2025

Decline in premature mortality

(12)

Progress so far in the Region

• Infant mortality: 6.7 per thousand live births

• Children vaccinated against measles and rubella: 94%

• Proportion of children not enrolled in school: boys 2.5%, girls 8.3%

• Populations with improved sanitation facilities: 92.9%

(13)

Discrepancies remain

Life expectancy at birth ranges from

71.2 to 83.4 years

Healthy years of life ranges from

59.8 to 73.1 years

(14)

Infant mortality ranges from1.9 to 22.1

Rubella vaccination ranges from 42% to 99%

Discrepancies remain

(15)

National and local networks –catalysing action towards common goals

(16)

*Rep

Defined Health 2020 targets

Health 2020 alignment

0 20 40 60 80 100

2010

2017

Health 2020 increasingly incorporated into

national health policies

73%

88%

58%

93%

*Reported countries

(17)

0 20 40 60 80 100

Implementation plans

Accountability mechanisms

Reducing health inequities

2010

2016

Most countries have policies addressing health inequalities

*Reported countries

46%

86%

45%

89%

88%

98%

(18)

Investing in public healthpays back.

We need a new, invigorated public health movement, since public health is a driver of equitable health improvement.

(19)

High returns for public health investments

• For every £1 invested in public health, £14 is returned to the wider health and economy.

• Reducing health inequality by 1% a year increases the annual rate of GDP growth by 0.15%.

Health promotion and preventions works

• A 10% reduction in heart disease saves €20 billion annually in lower- and middle-income countries.

(20)

Investing in the positive effects of universal social protection pays back.

• Early years development investment is estimated to produce a 17-fold return.

The cost of non-action is significant.

• The direct and indirect costs of high disease burden in countries can consume 15–20% of GDP.

(21)

There is scope for increased investments in public health.

• An average of only 3% of national health budgets is spent on public health in the Region.

Moving the public health agenda forward

• Review commissioned to look at the future of public health to contribute strongly to achieving the SDGs and Health 2020

(22)

Health systems

Health 2020

Priorities

Health systems

Burden of diseaseResilient

communities

(23)

Universal health coverage

(24)

Sales

1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

“…all people and communities receive the quality services

they need, including health promotion, disease prevention,

treatment and rehabilitiation, without financial hardship.”

Universal health coverage

(25)

“It is unacceptable that

people become poor as a

result of ill-health”

The Tallinn Charter

(26)

Out-of-pocket payment share of total health spending

high in many countries

0

5

10

15

20

25

30

35

40

45

50

55

60

65

70

75

Out-

of-

pocket paym

ent

as %

of

tota

l health s

pendin

g

DANGER ZONE: > 30%

WARNING

SAFE: < 15% with pro-poor policies

Source: WHO data for 2014

High and middle-income countries in the WHO European Region

(27)

Health systems respond to NCDs

(28)

INCLUDE INVEST INNOVATE

A vision for health systems in Europe: the future of the Tallinn Charter

Celebrating the 10th anniversary of the Tallinn Charter

Tallinn, Estonia13–14 June 2018

(29)

40th anniversary

Alma Ata Declaration

2018

(30)

Tackling the main disease burdens

(31)

SDG3

End AIDS, TB, malaria and

other communicable

Reduce premature

mortality from NCDs and

promote mental health

Vaccines and medicines

Reduce premature

mortality from NCDs and

promote mental health

(32)

We can do better

(33)

We can do better

(34)

We could achieve further reductions in disease burden by fully implementing the available evidence on cost-effective actions.

(35)

Accelerating progress towards disease prevention and

elimination

Photo: Malin Bring

(36)

Major gains in measles and rubella elimination

(37)

Measles cases,WHO European Region, 2016

Progress hampered by setbacks

(38)

Immunization: Leaving no one behind

(39)

From malaria elimination to

maintaining malaria-free status

THE ASHGABAT STATEMENT

(40)

3.6

0

1

2

3

4

5

6

7

8

9

10

2000 2005 2010 2015

Rat

e p

er 1

00

00

0 p

op

ula

tio

n

– 8.5% yearly

between 2011 and 2015

36

0

10

20

30

40

50

60

70

80

2000 2005 2010 2015

Rat

e p

er 1

00

00

0 p

op

ula

tio

n

– 4.3% yearly

between 2011 and 2015

The Region has the fastest decline in

TB incidence and mortality

Estimated TB incidence rate Estimated TB mortality rate

(41)

0

0.5

1

1.5

2

2.5

3

3.5

4

2000 2005 2010 2015

Rat

e p

er 1

00

00

0 p

op

ula

tio

n

Estimated TB/HIV rate

6.2% annual increase

between 2011 and 2015

TB/HIV coinfection on the rise

(42)

0

20000

40000

60000

80000

100000

120000

140000

160000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Nu

mb

er

of

ne

w H

IV d

iag

no

se

s

East

Centre

West

Increase

2006–2015

Region: 75%

East: 109%

HIV epidemic moving at an alarming rate

New HIV diagnoses in the WHO European Region 2006–2015

(43)

Building on the momentum to eliminate viral hepatitis

(44)

Comprehensive response guided by national strategies

(45)Photo: United Nations

Stronger partnerships across sectors and institutions to combat AMR

(46)

Health emergencies, preparedness,surveillance and response

(47)

Roles

Responsibilities

Accountabilities

Timelines

Partnerships

WHO Emergency Programme is fully functional

(48)

NUCLEAR DISASTER(SPECIALIZED MECHANISMS)

CHEMICAL(SPECIALIZED MECHANISMS)

INFECTIOUS OUTBREAKS(WHO LEAD ROLE)

NATURAL DISASTER(IASC/OCHA LEAD)

CONFLICT(IASC/OCHA LEAD)

IMS

and

RES

PO

NSE

EVEN

T G

RA

DIN

G

Rapid and efficient response

(49)Essential public health operations

10th anniversary of IHR

(50)

The determinants of health

(51)

(52)

(53)

Determinants of health

Behavioral

Environmental

Social

PoliticalEconomic

Cultural

Commercial

(54)

Focusing on behavioral determinants

(55)

Making good progress

on tobacco control

Tobacco plain packaging legislation now in:

• France• Georgia• Hungary• Ireland• Norway• Slovenia• United Kingdom

(56)

Tobacco taxation works

(57)

Alcohol consumption declining too slowly

Per capita alcohol consumption among people over 15 yearswithin a calendar year

(58)

Alcohol consumption declining too slowly

We are aiming for a 10% decline until 2025 to achieve the 2030 global target

(59)

Obesity prevalence for over 18s: men – 21.0%, women – 23.9%

Photo: Malin Bring

Overweight and obesity alarmingly on the rise

(60)

(61)

Social determinants

(62)

Social determinants

(63)

Environmental determinants

(64)

Ostrava Declaration: European countries

committed to national implementation by

2018

(65)

(66)

(67)

(68)

(69)

(70)www.euro.who.int

WHO Regional Office for Europe

UN City

Marmorvej 51

DK-2100 Copenhagen Ø

Denmark

Thank you