global health in germany really? yes,...
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Global Health
in Germany –
really?
Yes, really.
Dr Claudia Stein MD, PhD, FFPH
Director
Division of Information, Evidence, Research and Innovation WHO Regional Office for Europe
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“A state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity”
WHO definition of health (1948)
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Definition of public health at WHO
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„…shall be the attainment by all peoples of the highest possible level of health.“
Source: WHO‘s Consitution
WHO‘s Mission
WHO’s core mandate is:
• providing leadership on global health matters,
• shaping the health research agenda,
• setting norms and standards,
• articulating evidence-based policy options,
• providing technical support to countries, and
• monitoring and assessing health trends.
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Public health? Global health?
Source: BMJ, 1998
Medic
Engineer
Law
Social
science
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Researc
h
Pro
ble
ms
Poor WHO,
always standing
in the gap….
IEA World Congress of Epidemiology
Plenary Session
7 August 2011
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Public health practitioners at WHO
– Medical/paramedical professions
– Health economists
– Statisticians/mathematicians
– Epidemiologists
– Social scientists
– Natural scientists
– Anthropologists
– Medical humanities
– Political scientists
– Administrators and finance experts
– Lawyers
– Water & sanitation engineers
– Environmental scientists
– Journalists
– and many more…
Multi-disciplinary
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The breadth of public health –
it is everywhere
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The breadth of public health –
it is everywhere
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The breadth of public health –
it is everywhere
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The breadth of public health –
it is everywhere
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Heroes of multi-disciplinary public health
Rudolf Virchow, 1821-1902
Lord Ashley Shaftesbury
1801-1885
Founder of cellular pathology
Founder of anthropology
Discoverer of embolism
President of the
Royal Statistical Society
Who exactly are
these people….?
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Rudolf Virchow, 1821-1902Lord Ashley Shaftesbury
1801-1885
Founder of cellular pathology
Founder of anthropology
Discoverer of embolism
President of the
Royal Statistical Society
Benjamin Rush, 1746-1813Father of
American Psychiatry
Signatory to the US
Declaration of Independence
Father of Social Health
Insurance laws in
Bismarck’s Germany
Responsible for abolition
of child labour in 19th
century Britain
Public health is very political – it has to
be…..
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European Health 2020 policy
• Emphasis on health and well-being
• The right to health and access to care
• People at the centre
• Addressing the determinants of health
• Whole of society approach
• Whole of government approach
• Importance of partnerships
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The WHO European Region
53 Member States 900 million population
WHO Regional Office for Europe
Copenhagen, Denmark
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19 core and 18 additional
indicators for 6 targets
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Health 2020 monitoring framework –
targets and core indicators
Reduce premature
mortality
Premature CVD, cancer,
diabetes and chronic
respiratory mortality *
Increase life
expectancy
Tobacco use
Alcohol consumption
Overweight and obesity*
Vaccination coverage
External causes mortality*
Life
expectancy
at birth*
Reduce
inequalities
Infant
mortality*
LE at birth*
Primary
school
enrolment*
Unemployment
rate*
National
inequality
policies
GINI
Enhance
well-being
Life satisfaction*
Availability of
social support
UHC &
“right
to
health”
OOP as %
THE
Vaccination
coverage
THE %
GDP
National
targets
Process for
target setting
established
Evidence
documenting:
- National
polices aligned
with H2020
-Implementation
plan
- Accountability
mechanism
* Disaggregated by sex
Improved
sanitation facilities
GINI
Unemployment
rate*
Children not
enrolled in school*
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Targets must have realistic indicators
Measuring health and well-
being with realistic indicators
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• Highlights
Germany’s
achievements
in health and
health
systems;
• Calls for
leadership in
global health
by Germany;
• Outlines
Germany’s
role in global
health.
Quo vadis, Germany?
Public health in its
entirety Public health training &
professionalisation
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Thank you
Спасибо
Merci
Danke
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Thank you
Спасибо
Merci
Danke
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European Health Information Initiative (EHII)
• Provides
overarching
coordination &
guidance for health
information
activities WHO
Europe;
• Multi-partner
network;
• 8 Steering Group
meetings held to
date.
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EHII participants: 35 .. and growing
Austria
Belgium
Croatia
Czechia
Finland
Georgia
Germany
Greece
Italy
Kazakhstan
Kyrgyzstan
Latvia
Lithuania
Malta
Netherlands
Poland
Portugal
Republic of Moldova
Romania
Russian Federation
Slovenia
Sweden
Switzerland
fYR Macedonia
Turkey
United Kingdom
European Commission Wellcome Trust
European Public Health Association
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gateway.euro.who.int
Your work to
be included on
Gateway
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Published
to date:
Greece
Slovenia
Moldova
Georgia
To be launched:
Bulgaria
Malta
Russian Federation New wellbeing
modules More to follow in
2018
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Disseminating research & health information:
EURO public health journal
• Aimed at dissemination of good practices
and successful implementation of
evidence-informed policies;
• Bi-lingual (English/Russian);
• Quarterly publication;
• Theme-based;
• Peer reviewed.
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Since 2013
annually:
Turkey, Poland,
Russian Federation,
Romania, Georgia
Focus: Health 2020
monitoring (country case
studies, inequalities,
reporting, evidence for
policy)
Capacity building:
Autumn school of health information and
evidence for policy making
‘Advanced
course’
follows
annually
(June)
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Small Countries’ Health Information Network
• Initiative of the Minister of Health,
Malta; currently chaired by Malta;
• Third meeting held in Malta on 27th
June 2017;
• Agreement on reporting of ‘rolling
average’ of selected indicators;
• Developing joint indicator list for
reporting on HSPA and Health 2020.
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Health Information Networks: CARINFONET
Kazakhstan,
Kyrgyzstan,
Tajikistan,
Turkmenistan,
Uzbekistan
• Central Asian
Republics
Information
Network
• Provides platform
for joint reporting of
health statistics;
• Development of
joint indicator list
(29 core
indicators);
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European Burden of Disease Network
• Chaired by Public Health England (Prof John Newton);
co-chaired by The Netherlands;
• Two meetings held with 11 countries in London and Oslo.
• Hosted jointly with the Institute of Health Metrics & Evaluation (IHME);
• Editorial in European Journal of Public Health;
mapping of BoD studies
submitted to EJPH.
– National burden of
disease manual
in preparation;
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South-eastern Europe Health Network
(SEEHN) health information network
• Decision taken to establish
SEEHN health information
network;
• WHO now working with SEEHN
Secretariat to establish network,
ToRs and modalities.
Brand-new!
56
Purpose of a South-eastern European Health Information Network:
to promote coordination and collaboration among countries in the SEEHN,
in order to strengthen national health information systems, including data collection, processing,
analysis and dissemination.
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• Promotes systematic use of research evidence in
policy-making;
• Increases country capacity in developing sound
and effective health policies;
• Institutionalizes knowledge translation (KT)
through the establishment of KT country teams;
• 5th multi-country meeting held in Bratislava,
Slovakia.
EVIPNet Europe: growing rapidly
‘Live’ in 21 countries in the European Region
Concrete results
coming in
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National health information strategies
• Member States requested practical
support tool
• Tool developed by Working Group (17
countries), co-chaired by Netherlands
and Russian Federation
• Based on WHO HMN tools and
materials, adapted to European context
• Available in English & Russian
• Piloted in four countries and revision
under-way.
Should we develop something
similar or research, or use
existing materials from other
sources?
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European Advisory Committee on Health
Research (EACHR)
- Established special working
group on ‘implementation
research’.
Continues to meet annually and advises the Regional Director on
research matters:
- Reviews evidence for subjects to be presented at Regional
Committees;
- Advises on research use of existing information, including on
Big Data;
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Adoption of Action Plan and Resolution on evidence-
informed policy making
53 WHO Member States calling for enhanced
action to use evidence for policy:
Regional Committee 2016
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1. Strengthening health information systems, harmonizing health indicators and establishing an integrated health information system for the European Region;
2. Establishing and promoting health research systems to support the setting of public health priorities;
3. Increasing country capacities for the development of evidence-informed policies (knowledge translation);
4. Mainstreaming the use of evidence, information and research in the implementation of Health 2020 and other major regional policy frameworks.
Adopted by 53
Member States
through resolution
Concrete actions for
Member States and
WHO
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Member States
called on DG to
establish HII at
global level
Member States
called on DG to
develop global
action plan for EIP
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Thank you
Спасибо
Merci
Danke
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Extra slides – not for translation
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Where next with SDGs, Health 2020
culture & health, and well-being?
• Progress with cultural context of health and well-being;
• Develop joint monitoring systems for Member States;
• Further develop well-being indicators and new concepts of
Health 2020 through new expert group;
• Quantify more of the Health 2020 targets;
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H2020 and SDGs alone
Indicator-level: 13
Thematic: 15
No alignment: 9
10 indicators
overlap
thematically
across 3
frameworks
SDG NCD
H2020
Alignment of indicators across 3 frameworks
H2020 and NCD alone
Indicator-level: 8
Thematic: 4
No alignment: 25
H2020 and SDGs alone
Indicator-level: 6
Thematic: 8
No alignment: 11
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Consultation questions to Member States
1. Which of the five options do you prefer and why? Alternatively, is
there a sixth option that you could think of and which would be
preferable to you?
2. Do you foresee any challenges you may face when implementing
the preferred option? Which are those?
3. Will implementing the preferred option bring additional benefits to
you, in addition to reducing burden of reporting? What kind of
benefits?
4. How should WHO Regional Office for Europe assist you with the
implementation of the joint monitoring framework?
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#1
Streamlining
of indicators
Joint Set
of
Indicators
#2 Timing of
reporting
Jan Dec Jan Dec
#3 Pooling/
merging of data
collection
Jan Dec
SDGs NCDs
Health
2020
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#1
Streamlining
of indicators
Joint Set
of
Indicators
#2 Timing of
reporting
Jan Dec Jan Dec
#3 Pooling/
merging of data
collection
Jan Dec
SDGs NCDs
Health
2020
Option 4
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#1
Streamlining
of indicators
Joint Set
of
Indicators
#2 Timing of
reporting
Jan Dec Jan Dec
#3 Pooling/
merging of data
collection
Jan Dec
SDGs NCDs
Health
2020
Option 5
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#1
Streamlining
of indicators
#2 Timing of
reporting
#3 Pooling/
merging of data
collection
#1
Streamlining
of indicators
#2 Timing of
reporting
n = 3
Member States in support of JMF
Either
option 4
or 5
General
positive
support
n = 3 n = 3 n = 3
Option 4 Option 5
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European Health Information Initiative (EHII) – it all started with one Member State:
The Netherlands
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eHealth week 2017 in Malta –
WHO Europe as co-organizer
“What we need is a beautiful marriage
between public health and eHealth, and
before you get to a wedding there has
to be an engagement, a commitment.
Which brings me back to
WHO/Europe’s participation in eHealth
Week, as a celebration of our
commitment and dedication to reaping
the benefits of eHealth for all.”
(Dr Zsuzsanna Jakab,
WHO Regional Director for Europe)
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Health information strategies
• Member States requested practical
support tool
• Tool developed by Working Group (17
countries), co-chaired by Netherlands
and Russian Federation
• Based on WHO HMN tools and
materials, adapted to European context
• Available in English & Russian
• Piloted in three countries and revision
under-way.
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Current situation of
health reporting
in Europe
European
Health
Information
Initiative
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The future:
Integration of health
information
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EuropeanHealthReport2018
Where next with SDGs, Health 2020
culture & health, and well-being?
• Progress with cultural context of health and well-being;
• Develop indicators for joint monitoring systems for
Member States;
• Further develop well-being indicators and new concepts
of Health 2020 through this expert group;
• Quantify more of the Health 2020 targets.
• Redefine what ‘evidence
‘means in European Region:
quantitative and qualitative.
• Provide ‘Evidence for All’.
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The reporting challenge for countries:
6 targets
37 indicators
19 core
18 additional
17 goals
169 targets
300 indicators (26 indicators under SDG3)
9 targets
25 indicators
UNECE: even most developed countries
•Can only report on 50% of SDG indicators;
•Can only cover 76 out 169 targets.
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Alignment of H2020 and SDG indicators
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Adopted approach for Joint Monitoring Framework
Expert Group on Core Set of Indicators
Consultation with Member States on Draft Core Set of Indicators
Adoption of Core Set of Indicators
Process to arrive at the
common set of indicators
Q3-Q4/2017
Q1-Q2/2018
Q4/2018-
Q2/2019 Q3/2018
RC67
RC68
Strategic plan for
Big Data
First time joint indicator
framework established
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Cultural contexts of health & well-being
WHO Expert Group on Cultural
Contexts of Health and Well-being
• Explore different types of qualitative evidence
more fully;
• Commission further work in the area of culture and
health, including policy briefs and tool kit for
policy makers;
• Investigate cultural contexts of health more
systematically;
• Use a multisectoral and multidisciplinary
integrated research approach;
• Three meetings held to date, third one jointly with
UNESCO.
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• Morbidity
• Mortality
• Disability
• Loss of function
• Determinants (incl. risk factors)
of ill-health
How have we reported on health?