Presentation - Together advancing health and well-being for all at all ages
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Presentation by Dr Zsuzsanna Jakab, WHO Regional Director for Europe, in Reykjavik, Iceland, 26 June 2018
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Presentation - Together advancing health and well-being for all at all ages
- 1. Together advancing health and well-being for all at all ages Dr Zsuzsanna Jakab WHO Regional Director for Europe Reykjavik, Iceland, 26 June 2018 1
- 2. The right to health is at the centre of development 2
- 3. Health in national reviews Issues mentioned in voluntary national reviews: • fight against epidemics • cancer prevention • noncommunicable disease reduction • mental health • child and adolescent health • workers’ health • women’s health Strategic directions proposed: • universal health coverage • engagement for equity • joint action on risk factors
- 4. Moving towards joint commitments: 5 strategic directions of the roadmap 1. Strengthen governance for health 2. Leave no one behind 3. Address all determinants of health and invest in prevention and health promotion 4. Engage communities, places and settings to strengthen health and well-being 5. Strengthen health systems and primary health care to achieve universal health coverage 4
- 5. Healthy life expectancy at age 60 0 5 10 15 20 25 Italy France Switzerland Israel Iceland Sweden Netherlands Malta Norway United… Ireland Spain Austria Greece Luxembourg Portugal Denmark Germany Belgium Finland Cyprus Slovenia Albania Chechia Croatia Estonia Poland Turkey Bosniaand… Montenegro Serbia Romania Slovak… Armenia Theformer… Hungary Latvia Bulgaria Georgia Uzbekistan Azerbeijan Tajikistan Kyrgyzstan Republicof… Lithuania Ukraine Belarus Russian… Kazakhstan Turkmenistan male, 2015 female, 2015 Large health improvements
- 7. Progress to reduce inequities between 2008 and 2015 was mixed. In many countries, the gap between the richest and poorest in society has not changed or has increased. In all countries, there are noticeable gaps in health and well-being. These follow a social gradient. Increasing equity in health must be central to all our actions for the prosperity of people and society.
- 8. Reaching Sustainable Development Goal (SDG) 3.4 in advance
- 9. Some risk factors on the rise
- 10. Luxembourg Iceland Malta Life satisfaction of our children
- 11. 25/06/2018 11 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1 Iceland Norway Finland Sweden Slovenia Ireland Germany France Denmark UnitedKingdom Latvia Bulgaria Switzerland Spain Lithuania Moldova Belgium Netherlands Portugal Estonia Poland Albania Israel Kazakhstan Croatia Austria Romania Luxembourg Ukraine Macedonia RussianFederation SlovakRepublic Italy Greece KyrgyzRepublic CzechRepublic Cyprus Malta Georgia Hungary Turkey Score (0= Inequality / 1= equality) Global gender gap for 41 Member States of the WHO European Region (2006 and 2017) score 2017 score 2006
- 12. 12 SDG 3 3.8. Universal health coverage 3.d. Emergency management (International Health Regulations) 3.6. Halve deaths and injuries from road traffic accidents 3.9. Reduce deaths and illness from environmental pollution 3.a. Strengthen WHO Framework Convention on Tobacco Control 3.b. Health financing and health workforce 3.c. Research for vaccines and medicines
- 13. 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 13
- 14. ”It is unacceptable that people become poor as a result of ill health.” The Tallinn Charter 14
- 15. 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 • Need Tallinn photo 15 INCLUDE INVEST INNOVATE
- 16. More public spending on health means lower burden on patients
- 17. <15% Have pro-poor coverage policies in place
- 18. Policy-relevant, action-oriented, pro-poor Regional report based on country-level analysis that goes beyond the numbers ALB | AUT | CRO | CYP | CZH | DEU | EST | FRA | GEO | GRE | HUN | IRE | KGZ LVA | LTU | NLD | POL | POR | MDA | SVK | SVN | SWE | TUR | UKR | UNK
- 20. 40th anniversary of the Declaration of Alma Ata: 2018 20
- 21. Source: Global Burden of Disease Study 2016 (GBD 2016) Health-related Sustainable Development Goals (SDG) Indicators 1990–2030. Seattle: Institute for Health Metrics and Evaluation; 2018 (http://ghdx.healthdata.org/record/global-burden-disease-study-2016-gbd-2016-health-related- sustainable-development-goals-sdg). Whole-of-society and government-wide effort needed
- 23. Water, sanitation and hygiene deserve a high level of attention • In 2015, more than 62 million lacked access to an adequate sanitation facility and 14 million did not use a basic drinking-water source. • Providing people with safe and sustainable water and sanitation services remains “unfinished business” in our Region. • The Protocol on Water and Health provides an intersectoral platform to translate aspirations of SDGs 3 and 6 into national targets and action. • The Iceland Statement (2005) reinforces our responsibility to address health and water in climate change adaptation and stimulates policy attention and action.
- 24. The why of the Small Countries Initiative - It offers an additional entry point for WHO policies. - Networks act as WHO’s ears for listening to what is happening on the ground. - It provides an incredible repository of practical knowledge and skill. - Platforms act as catalysers of change. - It strengthens capacity in core areas of Health 2020 and the SDGs. - It enables peer-to-peer learning. - It facilitates collaboration across countries and joint projects. - It provides ideal “laboratories” for policy implementations. - It boosts implementation in other countries by creating a virtuous cycle.
- 25. Better, more equitable health and well-being for all at all ages in Europe 25
Notas do Editor
- Dear Honorable Ministers, Dear colleagues, Dear Friends, it is a great pleasure for me to welcome you all on behalf of the World Health Organization to the 5th High-level meeting of the small countries “Working together for better health and well-being for all” here in Reykjavik. This meeting comes exactly one year after the successful high-level meeting we had last year in these very same dates in St Julian's, Malta.
- I am pleased to discuss progress in the implementation of the SDGs and highlight recent strategic direction taken by the WHO and its Member States. The 2030 agenda of sustainable development provides a great opportunity to rise action across all sectors in an integrated manner to improve health and well-being for all. This is a great momentum we must not waste. Above all we must secure strong political commitment to achieving the sustainable development goals, and truly we must “leave no-one behind”.
- Thirty-five European countries have already voluntarily reported to the United Nations High-level Political Forum, on the SDG implementation. This includes Montenegro, Cyprus, Luxemburg, Monaco in 2016 and 17; Andorra and Malta this year; and Iceland and San Marino are planned. I am pleased to see that health is increasingly recognized at the highest level of government and a call for action is provided for example to prevent cancer, reduce NCDs, improve mental health, workers health, child and adolescent health, fight against epidemics and aim for gender equity.
- In 2017, our Ministers of Health endorsed the roadmap to implement the SDGs, building on our European Health Policy, Health 2020. The roadmap aims to support European Member States in achieving health and well-being for all at all ages, through increasing governance for health focusing on “leaving no-one behind” strengthening our health systems to achieve universal health coverage. working 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. strengthening communities, places and settings to enable health for all. The question is, now, how far have we got in improving health and well-being?
- Europe is growing healthier: Life expectancy at birth increased by nearly 2 years on average in the European Region over the past decade, and has now reached close to 78 years. Your countries are between those with the highest life expectancy (exception Montenegro). But are our years of life healthy? The good news is, that the trend of a healthy life expectancy for women at age 60 continuos to be between 15 and 20 years; and the gap between men and women is diminuishing with an East to West gradient.
- But for those that are not healthy, "healthy" life years are lost through neoplasms, cardiovascular diseases, muscoloskeletal, mental and other conditions. Some of these conditions are associated with high levels of disability. The number of Years Lived with Disability (YLDs) associated with mainly chronic conditions has risen by more than 1 million – or 6.3% – between 2006 and 2016, globally. People with disability have unmet health-care needs across the health-care spectrum, in all countries.
- Life limiting poor health follows a social gradient: In the majority of countries in the chart on the left - the gap in limiting illness (self reported) between the richest and the poorest in our society has not changed or has increased between 2008 and 2015. If we look at the chart on the right for limiting self reported illness across socioeconomic groups in 2015 we can see a noticeable gap in every country and that the poorer people report less.
- The good news is that premature mortality from non communicable diseases in Europe and in your countries is on steady decline and we will be the only region that will reach the SDG target of 30 % reduction of NCD premature mortality by 2030 (even by 2025). A lot of this is from improved health care, early diagnosis and treatment. But challenges remain!
- One of this challenge is to reduce risk factors. We have not done enough: While alcohol consumption is reducing in some countries, it is increasing in others. Obesity levels, have remained stable high in the small countries and in many countries in the Region. To move forward, in every country we need a comprehensive health policy with emphasis on prevention, health promotion, health literacy over the life-course that addresses all determinants of health: lifestyles, social, environmental, commercial and cultural; involving all sectors.
- Our young people are our future: We have just finalized an update of the child and adolescents health status. Life satisfaction of our young people is good, but it reduces with age. Interesting to note that for Iceland boys and girls continue to be satisfied with life also at age 15. It would be interesting to understand what you are doing different?
- There are close interconnections between SDG 3 and 5 (gender equality and women empowerment) and in 2016 our Regional Committee adopted a strategy on women’s health that shows us clearly how these connections can be addressed through policy and other interventions. This year, the Regional Committee will consider a strategy on men’s health and well-being, which among other things provides direction on how male involvement in gender equality brings better health outcomes for men and for all. Europe has one of the highest levels of gender equality among WHO regions, but according to existing gender equality indexes no Member State has achieved full equality. Iceland is at the top of the list and we are keen to learn more from Iceland on the health impact of your gender equality policies, as well as on the Barbershop initiative that Iceland is spearheading within UN and other international contexts promoting male engagement on gender equality in different arenas, including health
- Ladies and gentlemen, let me now turn to health systems which underpin Universal Health Coverage.
- Our definition of Universal Health Coverage (UHC) 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.
- Recently, WHO’s GPW13 adopted at the WHA in May underlines the global importance of universal health coverage. As the Tallinn Charter puts it well and simply: “no-one should become poor due to ill health”. Health Systems have a major contribution to make, but they are complex and need to be better aligned to the current agendas. We therefore need to intensify our efforts to reaffirm the values of the Tallinn Charter, and strengthen health systems to achieve more equitable health gains, using the opportunities through pushing the SDG and UHC agendas.
- This was the subject of the tenth anniversary of the Tallinn Charter and the conference “Health systems for prosperity and solidarity – Leaving no one behind”, we organized thanks to the support of the Estonian government. We focused on three “I”s: Include, invest and innovate. Include: to move towards universal health coverage for a Europe free of impoverishing payments for health, specifying ways of improving coverage, access and financial protection for everyone. Invest: to offer options for health policy-makers to make the case for investing in health systems. Innovate: to acknowledge the need for health systems to strategically accelerate up take, roll out and scale up innovations to meet people’s needs, reconsidering governance mechanisms for harnessing future generations in Europe with technological and systems innovations, also with a view to promote resilience.
- One of the findings was, that more public spending on health means lower burden on patients. Increasing the share of government spending within total expenditure on health will provide stronger financial protection. Total health expenditure as proportion of GDP, has increased in most of the small country states.
- But out of pocket payment as proportion of total health expenditure is still high in some of your countries. In the European Region, we did set the benchmark of 15 percent of Out-of-pocket spending as a % of total health expenditure. 15% overall may be too high for some and not a burden for others. Distribution matters. In the Tallinn outcome statement we agreed that to include everybody, we need to extend coverage to the whole population; improve access to medicines; and carefully redesign policies on user charges towards protecting all households from financial hardship. Dr Hans Kluge, later today will explain more of the outcome of this conference.
- The results of “include”, are based on a country- analysis of 25 member states by the WHO Barcelona team in Hans’ Division that goes beyond the averages. It is based on a unique methodology applicable to medoum and high income countries and includes practical policy recommendations. I was very pleased to hear at the Tallinn meeting that several countries including Estonia and Lithuania already followed up on the findings. I am also very pleased to see that Cyprus participated to the assessment.
- In April, we organized 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 need comprehensive and aligned health system response to achieve universal health coverage and better NCD outcomes and to accelerate the rate of progress. We need to further prioritize and adequately resource the health system response to NCDs with a strong equity focus.
- Strengthening primary health care is an other cornerstone in achieving the SDGs. In October, the global conference on Primary Health Care: From Alma Ata towards UHC and SDGs will be the 40th Anniversary of the Alma Ata Declaration. We hope to reinvigorate action to strengthen PHC and see your governments at the highest level possible participating.
- Small countries rank high in the SDG health index - consisting of 37 health indicators. But scores are consistently not good for risk factors like alcohol and tobacco, obesity, injuries, violence and sexual abuse, mental health, and occupational health; and require improvement in some countries for air quality, UHC and others. We all know that these can only be achieved by working with the whole of society and the whole of government, by addressing the determinants of health.
- Last year, Malta hosted the 4th edition of the high-level small countries meetings. The event was organized under the Maltese Presidency of the European Union. The overarching theme was building RESILIENT and healthy communities. In Malta, the Ministers of the small countries of WHO Europe, endorsed a powerful Statement: “Ending childhood obesity: promoting healthy weight and well-being throughout the life-course”. Childhood obesity is an important public health challenge in the 21st century and one which could hinder the achievement of the Sustainable Development Goals. The action points suggested in the Statement are very concrete and we are going to hear how far the small countries have gone in their implementation in one of the sessions tomorrow. In the picture: group photo of the 4th High-level meeting of the small countries, 26-27 June 2017
- This year our attention will be on water, sanitation and hygiene – which requires special attention in all settings, including health-care settings and schools and requires close collaboration between the health and environmental sector. In 2015 more than 62 million lack access to an adequate sanitation facility and 14 million do not use a basic drinking-water source. Providing people with safe and sustainable water and sanitation services remains an “unfinished business” in our Region The Protocol on Water and Health provides an intersectoral platform to translate aspirations of SDGs 3 and 6 into national targets and action The Iceland statement, also builds on the Monaco statement on climate change, reinforcing our responsibility to address health and water in climate change adaptation.
- Dear Honorable Ministers, Dear colleagues, Dear Friends In conclusion. Our collaboration pays off – thanks also to the co-leadership of San Marino – in setting up this initiative, back in 2012. The new GPW13 gives paramount importance to the country focus and the impact that our policies make at country level. You are leading by example. You are an incredible repository of knowledge. Specifically, of practical know-how, which is in so high demand nowadays with the implementation of the SDGs. Just to mention one example: Here in Iceland, we are releasing a milestone publication on this front: ‘The life-course approach: from theory to practice. Case stories from two small countries in Europe’. This publication precisely aims at contributing to the wider dialogue on how to measure population impact of our policies. Therefore a very timely publication, fully in line with GPW13. In addition, throughout all these years our joint network has grown together and is A catalyser of change Strengthened capacity in core areas of Health 2020 / SDGs Enabled Peer-to-peer learning Provided collaboration across countries and joint projects And is an Ideal “laboratory” for policy implementations I am looking forword to even more stronger cooperation in the implementation of the SDGs.
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