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Highlights of the work of WHO/Europe, Meeting of EU Chief Medical Officers
1. Highlights of the work of
WHO/Europe
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
Ms Zsuzsanna Jakab
WHO Regional Director for Europe
2. Agenda
• Tackling Europe’s health priorities
• Health 2020: A European policy framework
supporting action across government and
society for health and well-being
• Relations between the Regional Office and
the European Union
• WHO reforms for a healthy future: an
update
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
4. The changing environment for health
• Demographic (fertility, aging)
• Globalisation and migration (inc. of health workers)
• New technologies (inc. medical genetics)
• More informed and demanding citizens
• Recognition of importance of health to human development
During last 2 years work of Regional Office has been systematically and
gradually adapted to its changing environment. Partly through:
• “vision” approved by MS in Moscow at RC60 which set the agenda.
• WHO reform, globally and regionally
This work has been taken through RC61 and will be completed this year at
RC62 and next year at RC63
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
5. RC61: Tackling the most urgent health issues
Technical topics
European Action plans adopted:
• For the prevention and control of non-communicable diseases 2012–2016
• To reduce the harmful use of alcohol 2012–2020
• To combat antibiotic resistance
• To prevent and combat multidrug-and extensively drug-resistant tuberculosis
2011–2015
• For HIV/AIDS 2012–2015
All now in Implementation phases
Consulting for future
• Developing the new European policy for health – Health 2020
(a) Governance of health in the 21st century
(b) The health divide: European experiences in addressing the social
determinants of health
• Health systems strengthening in the WHO European Region
(a) Interim report on implementation of the Tallinn Charter and the way forward
(b) Strengthening public health capacities and services in Europe: a framework
for action
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
6. RC62: Laying the foundation
for the future
• This year (2012) in RC62 MAIN focus will be on the
European Health Policy Health 2020 (mandated in
Moscow) which has been developed over two years
through a truly participatory process. Two
documents:
1. Health 2020: policy framework for Europe
2. Health 2020: policy framework and strategy.
• Implementation arm of Health 2020: The European
Public Health Action Plan
• Healthy ageing
• Country strategy and GDO policy
• Communication Strategy
• WHO Reform.
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
7. Health 2020
A European policy framework
supporting action across government
and society for health and well-being
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
8. What is Health 2020?
Health 2020 is a value-based
action-oriented policy
framework, adaptable to
different realities in the countries
of the WHO European Region.
Health 2020 is addressed to
Ministries of Health but also
aims to engage ministers and
policy-makers across
government and stakeholders
throughout society who can
contribute to health and
well-being.
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
9. Health 2020 documents
The short Health 2020 policy The longer Health 2020
framework contains the key policy framework and
evidence, arguments and strategy document provides
areas for policy action to the contextual analysis and
address the public health the main strategies and
challenges, and opportunities interventions that work; and
for promoting health and describes necessary
well-being, in the capacities to implement the
European Region today. Health 2020 policy.
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
10. Health 2020 - a common purpose,
a shared responsibility
Health 2020 vision
A WHO European Region in which all people are enabled and supported in achieving their full health
potential and well-being and in which countries, individually and jointly, work towards reducing
inequities in health within the Region and beyond
Health 2020 goal
To significantly improve health and well-being of populations, to reduce health inequities and to
ensure sustainable people-centred health systems
Health 2020 strategic objectives: stronger equity and better governance
1. Working to improve health for all and reducing the health divide
2. Improving leadership, and participatory governance for health
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
11. Health 2020: Four common policy priorities
for health
The four priority areas are interlinked and are interdependent and mutually supportive
Addressing the four priorities will require a combination of governance approaches that
promote health, equity and well-being
Investing in health through a life course approach and empowering people
Tackling Europe’s major health challenges of non communicable diseases and
communicable diseases
Strengthening people-centred health systems and public health capacities, and
emergency preparedness
Creating supportive environments and resilient communities
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
12. Health as a major societal resource and asset
• Good health benefits all sectors and the whole of society –
making it a valuable resource
• What makes societies prosper and flourish also makes people
healthy – policies recognize this have more impact
• Health performance and
economic performance are
inter-linked – improving the
health sectors use of its
resources is essential
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
13. Why Health 2020?
Health in the WHO European Region has greatly improved in recent
decades – but not everywhere and equally for all; this is not
acceptable
Countries have different starting and entry points, but share common
goals and challenges, and use different pathways:
People live longer Noncommunicable Infectious diseases, Health systems
and have less diseases dominate such as HIV, face rising costs.
children. the disease burden. tuberculosis remain
Primary health care
a challenge to
systems are weak
control.
People migrate Depression and and lack preventive
within and between heart disease are services.
countries, cities leading causes to Antibiotic-resistant Public health
grow bigger. healthy life years organisms are capacities are
lost. emerging. outdated.
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
14. New opportunities and challenges
New concepts New drivers of health
Well-being as a measure of development Technologies and innovation
Anticipatory governance Health literacy: information, participation and
accountability
Collaborative leadership
Globalisation/ urbanisation
New evidence New demographics
The macroeconomics of health and Fertility levels dropping
well-being
Ageing
The social gradient and health equity
Migration
Genomics
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
15. Strategic objective 1: tackle the health divide
Life expectancy at birth, in years
80
Address the social
determinants of health
Emphasis on action across 75
the social gradient and on
vulnerable groups European Region
EU members before May 2004
EU members since May 2004
CIS
Ensure that continuous
reduction of health inequities 70
become a criteria assessing
health systems performance
65
1970 1980 1990 2000
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
16. Strategic Objective 2: improve leadership
and participatory governance for health
Smart governance for health and
Promote and adopt “health in all
policies”, whole-of-government and well-being
whole-of society approaches
Governing
through
collaboration Whole of society and whole of
government approaches to
Governing
through citizen
engagement
health and well-being
Joined-Up
Governing
through a mix of
Government for
Health in All
Policies
Good governance for
regulation and
persuasion
Improved
health and well-being
coordination,
Governing integration, and
through capacity centred
independent on shared goals Health is a
Health is a Health is a Health as
agencies and central
expert bodies Human Global Social
Power and component
responsibility for Right Public Good Justice
health and well
of well being
being diffused
Governing throughout
through adaptive government and
policies, resilient society
structures and
foresight
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
17. Policy priority 1 Invest in health through a life
course approach and empowering people
• Supporting good health throughout the lifespan leads to
increasing healthy life expectancy and a ’longevity dividend’
both of which can yield important economic, societal and
individual benefits
• Health promotion programmes
based on principles of
engagement and
empowerment offer real
benefits
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
18. Policy priority 2: Tackle Europe’s major health
challenges
Implement global and regional mandates
140
(NCDs, tobacco, diet and physical
activity, alcohol, HIV/AIDS, TB, IHR, antibiotic
Standardized death rate, 0-64 per 100,000
120
resistance, etc.) 100
80
Promote healthy choices Cause
60
Heart disease
Cancer
Injuries and violence
40
Infectious diseases
Strengthen health systems, including primary health Mental disorders
20
care, health information and surveillance
0
1980 1985 1990 1995 2000 2005
Year
100%
Reach and maintain recommended immunization 90%
coverage 80%
70%
60%
Deaths
50%
Develop healthy settings and environments 40%
30%
20%
10%
Attention to special needs and disadvantaged 0%
populations European Region EU-15
Country groups
EU-12 CIS
Circulatory system Malignant neoplasms External causes
Infectious disease Respiratory system Other causes
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
19. Policy priority 3: Strengthen people-centred health systems,
public health capacity and preparedness for emergencies
Strengthen public health functions and
capacities
Strengthen primary health care as a
hub for people-centred health systems
Ensure appropriate integration and
continuum of care
Foster continuous quality improvement
Improve access to essential medicines
and invest in technology assessment
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
20. Policy priority 3: Strengthen people-centred health
systems, public health capacity and preparedness for
emergencies
Ensure universal access
Make health systems financially
viable, fit for purpose, people centred
and evidence informed
Revitalize and reform education and
training of key professionals
Develop adaptive policies, resilient
structures, and foresight to deal with
emergencies
Foster continuous quality
improvement
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
21. Policy priority 4: Create healthy and supportive
environments
Assess the health impact of sectoral policies
Fully implement multilateral environmental
agreements
Implement health policies that contribute to
sustainable development
Make health services resilient to the
changing environment
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
22. Dear Prime Minister, Minister, Mayor:
Health is a prerequisite for social and economic development. The health of the population can be
seriously damaged by the financial crisis that is affecting many countries, in many ways. But it can also
present an opportunity to do more and better for people’s health. All sectors and levels of government
contribute to the creation of health.
Your leadership for health and wellbeing can make a tremendous difference for the people of your
country or city and for Europe as a whole.
Your support for Health 2020 is truly essential.
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
23. Relations between the Regional Office and
the European Union
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
24. Regional collaboration: An EC – WHO/Europe
shared vision for joint health action
Six flagship initiatives as part of Joint Declaration:
• One health security system to protect Europe
• One health information system to inform Europe
• Share and exploit good practice and innovations
• Exchange information and advocate for policies to tackle health
inequalities also for future generations
• Inform and facilitate efforts for investing in health to mitigate
effects of economic crisis
• Strengthen in-country cooperation through joint advocacy,
information exchange and health assessments
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
25. What has happened since
• DG delegated a global function to RD/EURO: to lead on WHO-
EU relations;
• Global Policy Group mandates WHO/Europe Regional Director
to establish and chair WHO Steering Committee on EU;
• Copenhagen Offices takes over high-level relations with the EU
and oversight of WHO Brussels Office (Roberto Bertollini Head);
• High-level and senior-official meeting with the European
Commission, March 2011 and 2012;
• Increased collaboration with EU Presidencies of Spanish,
Belgium, Hungary, Poland, Denmark, Cyprus;
• Renewed Memorandum of Understanding with the European
Center of Disease Control (ECDC);
• Strengthened relationship with European Parliament;
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
26. WHO reforms for a
healthy future: an update
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
27. Status as of March 2012:
1. Programmes and priority setting
Agreement in Member Status meeting on:
• GPW11 (2006-2015) only till 2013
• New GPW12 (2014-2019): 6 years
• 5 Criteria for priority setting:
– Current health situation (burden of disease at global, regional
and country levels)
– Individual country needs (as per CCSs)
– Internationally agreed instruments (agreements, resolutions and
decisions of WHO’s governing bodies)
– Existence of evidence-based, cost-effective interventions
– WHO’s comparative advantage.
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
28. Status as of March 2012:
1. Programmes and priority setting (cont’d)
Agreement on 5 programme categories (plus 1) for priority setting
• Communicable diseases
• Noncommunicable diseases
• Promoting health through the life course
• Health systems
• Preparedness, surveillance and response
Agreement on timeline for 12th GPW and PB 2014-2015:
• May 2012: draft outline of GPW12 2014-2019 to PBAC16 and WHA65
• Aug to Oct 2012: Draft GPW12 + Proposed PB 2014-2015 to RC62 together with
regional perspective + other RCs + web consultation
• Nov/Dec 2012: GPW12 & PB 2014-2015 reviewed by PBAC17
(if EB131 approve new timing)
• Jan/Feb 2013: EB132 reviews and comments on Draft GPW12 and PB 2014-2015
• May 2013: Approval by WHA66, through PBAC18 after incorporating
EB132 comments.
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
29. Status as of March 2012:
2. Governance
Revised proposals to EB131 (May 2012) through PBAC:
• Revised ToRs for PBAC;
• Increased linkages between RCs, EB and WHA;
• Harmonization of practices of RCs;
• Scheduling of sessions of governing bodies
• Roles and responsibilities at the 3 levels of the Organization.
For discussion during WHA65:
• Partnerships and engagement with other stakeholders;
• Oversight and harmonization of hosted partnerships;
• Principles governing WHO’s relations with NGOs.
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
30. Status as of March 2012:
3. Managerial reforms
Revised proposals to EB131 through PBAC:
• Detailed proposals for a new financing mechanism;
• Contingency fund for public health emergencies;
• Proposals for a consolidated resource mobilization strategy;
• Draft evaluation policy.
For discussion during WHA65:
• Independent evaluation of WHO: report of Stage I, carried out by
the external auditor;
• Road map for Stage II.
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
31. WHO Reform: implications for European Region
• Report to RC62 - “work in progress”: next main step WHA65;
• Significant implications likely in following areas:
o Apart from the 5 + 1 new categories EURO applied most of new
concepts in the operational planning (eg. results chain, KPOs), co-op
with HQ
o Programmes and priority setting: resource allocation ($, staff time) to
programmes likely to change in 2014-2015 and beyond;
o Planning processes hopefully simplified and less staff intensive;
o Governance: best practice in EURO (SCRC, RD election process)
likely to influence other regions;
o Policy of independent evaluations: involvement of SCRC ? (was
discussed by 18th SCRC in Andorra, November 2010)
o Managerial reforms: Probably the area with the most significant
implications ($, staffing and structures) but at this stage too early to tell.
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
32. Thank you
Chief Medical Officer’s Meeting
Copenhagen 12-13 April 2012
Notas del editor
There will be ministerial lunches and technical briefingsKeynote speakers: DG, Commissioner Dalli,, Princess Mary and the First Lady of Georgia .
The context for health improvement in Europe is very complex. Many of the challenges are common, but countries have different starting points, entry points and they use different pathways to achieve common goals. Overall health is improving, but with what we know and the technologies we have available, it should be improving faster and we could prevent more diseases.We all agree with dr Chan that “ money does not buy health – it is the right policies that do “
Our new governance for health will be based around the concepts of whole of society and whole of government responsibility and accountability. We focus on good governance and smart governance. There is a key role here for “health in all policies”. We must drive policies and actions for health across sectors, with a leading role for Ministers and Ministries of Health. Part of this responsibility must be the delivery of high quality and effective public health and health care services, delivering increased performance and satisfaction. We must establish structures for effective intersectoral problem solving and action, with wide stakeholder involvement, and work to empower people and patients. We must draw attention to health-damaging environments, life styles or products, as well as to gaps in the quality and provision of health care.
At the Regional committee in Moscow, a major step was forward was made in our relations with the European Commission.Since then we have been working steadily to improve our relation
Baseline for priority setting will remain the WHO Constitution, its preamble, and the functions set out in Article 2 of the Constitution- including the overriding mandate of the Organization “to act as the directing and coordinating authority on international health work.” In addition, the MS meeting agreed on the following 5 criteria to be applied in priority setting, within the framework of the Constitution: (list).
In addition to the 5 Criteria, the Meeting also reached agreement on 5 programme Categories which would represent priorities for the Organization..The meeting also agreed on a timeline for preparation of the 12th GPW and the next PB 2014-2015.
For several of the issues concerning Governance, there were some disappointment during the Board’s discussion in January that the Secretariat’s proposals did not go far enough: For example, on the issue of “Harmonization of practices of the RCs” important issues such as looking at best practice among the Regions, and maybe introducing oversight mechanisms like the SCRC also in other RC was not covered. Likewise, on scheduling of sessions of the governing bodies, the proposals could have been more creative, rather than just look at the interface between the EB and the PBAC. As we all know, Estonia, on behalf of the European Union made a more radical proposal in that regard, so we have to see how this will be carried forward.And then, there were some issues linked to Partnerships and relations with NGOs which will not go through the PBAC in May, but rather tabled as separate agenda items at the Assembly.
Most MS attending EB131 considered the DG’s proposals for a new financing mechanism a step in the right direction. Reservations were however also expressed, notably with the concept of an open, public pledging conference. So, we are now awaiting further details on how these concepts will be taken forward in the revised submittal to PBAC. The issue of establishing a contingency fund for public health emergencies - modelled on the CDC Outbreak Contingency Fund – was less controversial, but further details and a revised proposal was also requested in this instance.With regard to a new resource mobilization strategy, we are still waiting..And although there was broad agreement on the proposed evaluation policy, some further fune-tuning was requested, and a revised paper will also be submitted on this issue.
Reforms will continue to be major agenda item for RCs and a report on implications and impact of the Reforms for Europe will be presented to RC62. however, as you can see from what I have said so far this is “work in progress” and in a sense we are doing many things in parallel as the GB deadlines (eg for PB approval etc) don’t allow a stepwise approach! So we already start to draft the paper for RC62 but will finalise after WHA65 in May! So at this stage I can highlight the following as some of the issues for EURO and the synergies between the EURO initiatives and those of the Global Reforms.The 5 criteria and 5 (+1) categories of programmes : will lead to a gradual shift in $ and staff resources – between several of EURO’s programmes at both regional and country levels.A sharper focus in the GPW on WHO’s mandate, and elimination of the MTSP, will also hopefully lead to a simplification and streamlining of current planning and monitoring processes – something which is urgently required. In fact, the RD plans to initiate an independent assessment of strategic and operational planning in the Region, to be conducted over the next couple of months – in order to clarify what are the elements of current procedures which are imposed on us from global requirements, and what is – so to speak – self-inflicted.On Goverance and on the issue of harmonization between RCs: Likely that some of the work of the SCRC Working Group on Governance, linked to oversight functions of the SCRC and the evaluation mechanisms of candidates for RDs will be picked up by other Regions. (New RD for EMRO has already asked RD to share our experience and revised Rules of Procedure for the SCRC and the RC with him.)Regarding independent evaluations: Independent evaluations were in force in EURO during Dr Asvall’s days (through which Zsuzsanna’s own programme EUROHEALTH was also evaluated, if I remember right). At the time of presenting the first Oversight Report to the SCRC in Andorra, in November 2010, this issue was again discussed to see to what extent a sub-group of the SCRC could be mobilized for this purpose. Need to re-visit this issue again…And finally, on Managerial Reforms – whether in terms of HR reform, predictable financing mechanisms, or a more coherent resource mobilization strategy – there will be several implications. These continue to be developed guided by the GPG meetings (between the DG and the Regional Directors) – as well as the discussions in the PBAC and the Assembly – and should help clarify the impact on our structures, staff and resources.Thank you.