Health and sustainable development in Europe and Romania – opportunities and challenges
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Dr Zsuzsanna Jakab, WHO Regional Director for Europe, 31 May 2018, Romania
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Health and sustainable development in Europe and Romania – opportunities and challenges
- 1. (1) Health and sustainable development in Europe and Romania – opportunities and challenges Dr Zsuzsanna Jakab WHO Regional Director for Europe 31 May 2018, Romania 1
- 2. (2) Health at the centre of development 2
- 3. (3) Moving towards joint commitments 1. Strengthen governance for health 2. Leave no one behind 3. Strengthen health systems and primary health care to achieve universal health coverage 4. Address all determinants of health and invest in prevention and health promotion 5. Engage communities, places and settings to strengthen health and well-being 6. Strengthen emergency preparedness and response 3
- 4. (4) Discrepancies remain Life expectancy at birth ranges from 71.2 years to 83.4 years Healthy years of life ranges from 59.8 years to 73.1 years
- 5. (5) Most countries are experiencing a 2–3% annual average decline in premature mortality. The aim is a decline of 40% by 2025. Overall decline in premature mortality in Europe 5
- 6. (6) Premature mortality from major noncommunicable diseases, 30–69 years, declines in Romania *SDR is the age-standardized death rate calculated using the direct method. That is, it represents what the crude rate would have been if the population had the same age distribution as the standard European population. Source: European Health Information Gateway – Health for All explorer (gateway.euro.who.int/hfa-explorer)
- 8. (8) Age-standardized prevalence estimates for overweight and obesity, 2014; smoking, 2013; and trends in recorded alcohol consumption 58.6 23 29.2 57.6 21.7 30.5 60.1 24.3 30.8 56.8 21.2 33 0 20 40 60 80 % overweight % obese % smokers WHO/EURO Romania EU(13) SEEHN Source: European Health Information Gateway – Health for All explorer (gateway.euro.who.int/hfa-explorer)
- 9. (9) Increases in standardized mortality rates of cancer 9 Source: European Health Information Gateway – Health for All explorer (gateway.euro.who.int/hfa-explorer)
- 10. (10) Health systems respond to NCDs 10
- 11. (11)
- 12. (12) Selected progress in the WHO European Region and Romania • Neonatal mortality is 4.6 per 1000 live births in the Region. Romania is now aligned with this trend. 12
- 13. (13) Measles cases, WHO European Region, 2016 Progress hampered by setbacks
- 14. (14) 3.6 0 1 2 3 4 5 6 7 8 9 10 2000 2005 2010 2015 Rateper100000population –8.5% yearly between 2011 and 2015 36 0 10 20 30 40 50 60 70 80 2000 2005 2010 2015 Rateper100000population –4.3% yearly between 2011 and 2015 The Region has the fastest decline in tuberculosis (TB) incidence and mortality Estimated TB incidence rate Estimated TB mortality rate 14
- 15. (15) 15 SDG3 3.8. Universal health coverage 3.d. Emergency management (IHR) 3.6. an f traff gthen 3.b.Health financing and health workforce 3.c. Research for vaccines and medicines
- 16. (16) 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 16
- 17. (17) ”It is unacceptable that people become poor as a result of ill health.” – The Tallinn Charter 17
- 18. (18) Out-of-pocket payment share of total health spending is high in many countries 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 Out-of-pocketpaymentas%oftotalhealthspending DANGER ZONE: > 30% WARNING SAFE: < 15% with pro-poor policies Source: WHO data for 2014 High- and middle-income countries in the Region 18
- 19. (19) 19 Source: European Health Information Gateway – Health for All explorer (gateway.euro.who.int/hfa-explorer)
- 20. (20) 20
- 21. (21) Investing in public health pays back We need a new, invigorated public health movement, because public health is a driver of equitable health improvement. 21
- 22. (22) There are high returns on investments in health • Every £1 invested in public health yields a £14 return in the form of population health and economic growth. • Reducing health inequality by 1% a year increases the annual rate of GDP growth by 0.15%. • A 10% reduction in heart diseases saves €20 billion annually in lower- and middle-income countries. • Early-years development investments are estimated to produce a 17-fold return.
- 23. (23) 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, Estonia 13–14 June 2018 23
- 25. (25) Promote health, keep the world safe; and serve the vulnerable 25
- 26. (26) Better health for Europe more equitable and sustainable 26
Notas do Editor
- Now with the Sustainable Development Goals and Universal Health Coverage, and with todays’ knowledge, we can achieve this dream. We must place health at the centre of development, focusing on the right to health, equity, fairness, universality, solidarity. We must see health as the smartest thing to invest in; as an investment that pays off. This is what we have been doing in the European region all these years. Above all we must secure strong political commitment to achieving these goals, and truly we must “leave no-one behind”.
- Our priorities are clear and we are moving forward with these joint commitments we made in the past years. In 2017, our Ministers of Health endorsed the roadmap to implement the SDGs, building on our European Health Policy, Health 2020. We must increase governance for health We must focus on “leaving no-one behind” We must strengthen our health systems, and public health and primary health care to achieve universal health coverage. We must work upstream with an emphasis on health promotion and disease prevention within the life course approach and address all the determinants of health; if we are to achieve health and well-being for all. We must consider, to strengthen communities, places and settings to enable health for all. And we must strengthen our emergency preparedness and response.
- Our latest data indicates that life expectancy across the Region has now reached over 77 years. Healthy years at birth across the Region have now reached to 68 years. Yet progress is uneven, there are substantial inequalities within and across countries. For example, life expectancy across the Region ranges from 71 to 83 years, a difference of 12 years. Healthy years of life ranges between 60 and 73 years, a difference of over 13 years. Life expectancy in Romania for both genders is still below the EU13 and SEEHN average; but the good news is that it is increasing in line with trends in other countries of the WHO European Region
- The decline in premature mortality in European countries started in 2000, and since 2003 almost all countries are showing an average decline of 2-3 percent annually. With a linear projection from 2000, we could expect this decline to reach 40% by 2025.
- In Romania, premature mortality for non communicable diseases, is still above the WHO European Region average, for both genders. However, the good news is, that your policies have started to work, as of a visible decline. Notes: Males: The SDR (per 100 000) from major NCDs in Romania is 657 deaths (per 100 000) in 2014. The rate is above the European region, the EU13 and the SEEHN average. Overall, men have a higher SDR than females. Females: The SDR from major NCDs in Romania is 292 deaths (per 100 000) in 2014. The rate is in line with the SEEHN average, but below EU13 and clearly below the European Region average.
- The top 2 causes of ill-health, namely ischemic heart disease and cerebrovascular diseases are the same in Romania, Central & Eastern Europe and the WHO European Region. The burden of low back& neck pain are also high in Romania, the WHO European Region and Central & Eastern Europe. However, the burden of lung cancer and sense organ diseases is higher in Romania. Note: This slide shows Disability Adjusted Life Years (DALYs), a combined measure of health loss due to mortality and ill-health, for the Romania, WHO European Region and Central & Eastern Europe. Non communicable diseases dominate the list.
- Important risk factors contribute to this trend: Prevalence of overweight (57.6%) and obesity (21.7) is higher than the SEEHN averages, but below the European Region and EU13 averages. Alcohol consumption in Romania is 9.6 liters per capita (2014). This is above the WHO European region (8.6 liters per capita) and SEHHN average (7.9 liters per capita), but below the EU13 average (11.2 liters per capita). Burden of smoking in Romania is still high. According to the WHO estimates (not published yet), WHO projects that in 2025 around 23% of the population in Romania will be smokers. If Romania adopts the global voluntary NCD target of 30% relative reduction in tobacco prevalence from the 2010 baseline, the results indicate that, based on current smoking trends, Romania will not achieve the target by 2025.
- A worrying trend, observed is mortality due to malignant neoplasms, in Romania (2014) is 176 deaths (per 100 000). This is below the EU13 average (187 deaths per 100 000) but above the European region average (156 deaths per 100 000) and the SEEHN average (168 deaths per 100 000). Overall, mortality due to malignant neoplasms is stable or rising in Romania since 2000.
- Just a few weeks ago we had the meeting on health systems response to NCDs in Spain, providing a platform to review progress and inspire actions based on the country assessments we have conducted.
- We hope Romania, will join other countries in assessing their NCD outcomes…
- Neonatal mortality – which means deaths occurring in the first months after birth, - is the lowest ever, 4.6 per thousand live births in the Region. Romania has now reached this average. According to the National Institute of Public Health (Romania), since the beginning of the outbreak there were 13326 reported measles cases and 54 measles-related deaths (as of 24.05.2018). Particular challenges for you is to sustain the increased level of political commitment to stop the measles outbreak and making this commitment more operationalized, to fully immunize children against measles, mumps and rubella but also with all other antigens/vaccines in national immunization programme in underserved populations and regions.
- However recent measles outbreaks in some countries with deaths and complications are an example of an unacceptable setback and are exposing shortcomings in immunization service delivery. According to the National Institute of Public Health (Romania), since the beginning of the outbreak there were 13326 reported measles cases and 54 measles-related deaths (as of 24.05.2018). Particular challenges for you is to sustain the increased level of political commitment to stop the measles outbreak and making this commitment more operationalized, to fully immunize children against measles, mumps and rubella but also with all other antigens/vaccines in national immunization programme in underserved populations and regions.
- Thanks to intensive efforts, as well as our partners, particularly the Global Fund, our Region has the fastest decline of tuberculosis incidence and mortality rates among all WHO Regions during the past five years. 12 790 new TB cases were notified in 2017 in Romania. 85% among the new cases were treated successfully, however only 43% among MDR-TB cases, which is far below the 75% target. Romania is one of the 18 high-priority countries to fight tuberculosis (TB) in the WHO European Region. WHO acknowledges the huge efforts by the ministry and colleagues in managing the XDR-TB epidemic, and we look forward to see more good results.
- Ladies and gentlemen, let me now turn to health systems which underpin Universal Health Coverage.
- Our definition is broad and covers access to health services, as well as health promotion, disease prevention, treatment and rehabilitation, without financial hardship. Universal Health Coverage is a unifying concept, a platform for integrated delivery of health services and public health, and one of the most powerful social equalizers.
- We in Europe are committed to Universal Health Coverage and a lot has been done. Its core message “no-one should become poor due to ill health” was at the heart of the Tallinn Charter as well as Health 2020.
- Most countries in Europe provide health coverage for the whole population, but this alone is no guarantee of financial protection. Out-of-pocket payments for health are still high in many countries of the European Region. High-performing health systems provide strong financial protection to keep out-of-pocket payments to a minimum: that is at or below 15% of total health expenditures. Many countries need to increase the share of public financing for health, together with stronger pro-poor policies.
- In Romania, per capita health spending was EUR 814 in 2015 and this is the lowest in the EU, and under a third of the EU average. This equals 4.9 % of GDP – well below the EU average of 9.9 % and the Regional average. However, on a par with the EU average, 78 % of health spending is publicly funded, despite the share of out-of-pocket spending having increased. A recent analysis carried out by my team, highlighted the need to further increase public spending, to implement policies to strengthen financial protection of the population so to increase access to care and equity and limit catastrophic and impoverishing health care expenditures; improve the Health Insurance House payment mechanisms based on performance; and develop new payment mechanisms based on quality standards for primary care.
- We are monitoring financial protection and producing estimates using a new approach for high- and middle-income countries in Europe. We are also gathering new evidence in half of the Member States, which will be presented in Talin, in a few weeks.
- Public health is a driver of equitable health improvement and we need a new and invigorated public health movement.
- Let us not forget investing for health saves costs: For every £1 invested in public health policies at the national and subnational level, a £14 return is estimated to the wider health and economy. Reducing health inequality by 1% per year would increase a country’s annual rate of GDP growth by 0.15%. And health promotion and prevention works; 10% reduction in heart diseases can save 20 billion euro per year in lower and middle income countries. However this means we work with all sectors, throughout the whole of government and society.
- Secondly in June the meeting on “Health systems for prosperity and solidarity – Leaving no one behind” in Tallinn will celebrate the tenth anniversary of the Tallinn Charter with the support of the European Observatory on Health Systems and Policies , Those will reconfirm the notion of value based health systems and outline our future vision in view of the 2030 agenda.
- As anticipated earlier, primary Health Care is essential in achieving Universal Health Coverage. Therefore, in June 2017, I launched the WHO European Advisory Board to support the development of the new PHC Vision towards the 40th Anniversary of the Alma Ata Declaration in 2018. Please join us at this high level global event in Almaty together with Dr Tedros, in October, 2018.
- Delegates at World Health Assembly agree on new 5-year strategic plan: achieving universal health coverage; addressing health emergencies; and promoting healthier populations.
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