health 2020: a new european policy for health

WHO Regional Office for Europe

Montenegro

Zsuzsanna JakabWHO Regional Director for Europe

Health 2020: a new European policy

for health


Health – a precious global good

• Higher on the political and social agenda of countries and internationally

• Important global economic and security issue • Major investment sector for human, economic

and social development• Major economic sector in its own right• Matter of human rights and social justice


Why Health 2020?Significant improvements in health and well-being but … uneven and unequal progress

Europe’s changing health landscape: new demands, challenges and opportunities

Economic opportunities and threats: the need to champion public health values and approaches


CIS: Commonwealth of Independent StatesEU12: countries belonging to the European Union (EU) after May 2004EU15: countries belonging to the EU before May 2004

Source: European Health for All database. Copenhagen, WHO Regional Office for Europe, 2010.

Improved life expectancy but the European Region is scarred by inequalities


2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Life expectancy at birth, in years, male

60

65

70

75

80

Value

Life expectancy at birth, in years, male

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Life expectancy at birth, in years, female

60

65

70

75

80

Value

Life expectancy at birth, in years, female

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Life expectancy at age 65, in years, female

10

12

14

16

18

20

22

24

Value

Life expectancy at 65 years, in years, female

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Life expectancy at age 65, in years, male

10

12

14

16

18

20

22

24

Value

Life expectancy at 65 years, in years, male

Country NullAlbania

Country Montenegro European Region EU12

Life expectancy at birth and at 65 years in Montenegro and European regions, 2000–2011


2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Infant deaths per 1000 live births

0

2

4

6

8

10

12

14

16

18

20

22

24

26

28

30

Value

Infant deaths per 1000 live births

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Maternal deaths per 100000 live births

0

5

10

15

20

25

30

35

40

Value

Maternal deaths per 100000 live births


Infant and maternal mortality in Montenegro and European regions 2000–2011


Indicator

0 20 40 60 80 100 120 140 160 180 200 220 240 260 280 300 320 340 360 380 400 420 440 460

Premature diseases of circulatory

system

SDR, malignant neoplasms, 0-64, per

100000

SDR, external cause injury and poison,

0-64 per 100000

SDR, diseases of the digestive system,

0-64 per 100000

SDR, diseases of the respiratory

system, 0-64 per 100000

SDR, infectious and parasitic disease,

0-64 per 100000

SDR, 0-64 per 100000, by broad causes of death

Premature mortality from broad groups of causes of death in Montenegro and European regions, 2009–2010

Additional life expectancy gains are possible if efforts focus on the main risk factors, such astobacco, alcohol, obesity and high blood pressure.

SDR: standardized death rate.


2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

% of regular daily smokers in the population, age 15+

0

5

10

15

20

25

30

Value

Smoking prevalence

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

SDR, trachea/bronchus/lung cancer, 0-64 per 100000

0

2

4

6

8

10

12

14

16

18

20

22

24

26

28

30

Value

SDR, trachea/bronchus/lung cancer, 0-64 per 100000

1 2 3 4 5 6 7 8 9 10 11 12

Price of a 20 cigarrete pack in US$ in 2008

0

10

20

30

% regular daily smokers in the population, ages 15 +

PortugalKazakhstan

Israel

Denmark

Cyprus

Czech Republic

EstoniaFrance

GermanyGreeceHungary

IrelandItaly

Kyrgyzstan

Latvia

Luxembourg

MaltaNorway

Poland

Slovakia

Spain

Sweden

Turkey

Turkmenistan

% of regular daily smokers aged 15+ and price of a 20 cigarette pack

Country Montenegro EU12 European Region

Tobacco smoking and lung cancer in Montenegro and European regions, 2000–2011


2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Total government expenditure as % of GDP

0

10

20

30

40

50

Value

Total government expenditure as percentage of the gross domestic product

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Total health expenditure as % GDP, WHO estimates

0

2

4

6

8

Value

Total health expenditure as percentage of the gross domestic product

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Private sector expenditure on health as % of total healt..

0

10

20

30

Value

Private households out-of-pocket payment on health as percent of total health expenditure

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Public sector expenditure on health as % TGE, WHO e..

0

5

10

15

Value

Public sector expenditure on health as percentage of total government expenditure


Key health expenditures in Montenegro and European regions, 2000–2011


Working to improve health for all and reducing

the health divide

Improving leadership, and participatory governance

for health

Investing in health through a

life-course approach and empowering

people

Tackling Europe’s major health challenges:

noncommunicable diseases (NCDs)

and communicable diseases

Strengthening people-centred health systems,

public health capacities and

emergency preparedness,

surveillance and response

Creating resilient communities and

supportive environments

Health 2020: four common policy priorities for health

Health 2020: strategic objectives


Health systems’ responses to economic crisis in Europe


Health systems in times of global economic crisis: an update, 17–18 April, Oslo, Norway

Aligned health workforceAligned health workforce

Financial ProtectionObjectives• To review the impact of the economic crisis

on health and health systems in the Region• To draw policy lessons around three

themes: maintaining and reinforcing equity, solidarity and universal coverage; coping mechanisms, with a focus on improving efficiency

improving health system preparedness and resilience • To identify policy recommendations for

consideration by countries and possible future political commitments

http://www.euro.who.int/en/media-centre/events/events/2013/04/oslo-conference-on-health-systems-and-the-economic-crisis/about-the-conference


Some positive responses of countries in challenging circumstances

• Introduction of needed reforms

• Immediate efficiency gains – lower drug prices

• Other efficiency gains – identifying and prioritizing cost-effective services

• Efforts to protect people from financial hardship


But also negative implications for health systems’ performance

• Countries that reduced population coverage often targeted vulnerable people (poorer people, migrants)

• Over 25 countries increased user charges for essential services

• Some cuts had unintended consequences


Principles of universal health coverage

Ensure that people have equal access to high-quality health services and financial protection:

• coverage with health services (promotion, prevention, treatment and rehabilitation

• coverage with financial risk protectionPotential indicators, focusing on coverage and protection:1. increased coverage of essential services2. increased equity and financial protection3. strengthening health systems


The Tallinn Charter: health Systems for Health and Wealth and the Declaration of Alma-Ata: two key anniversaries

Tallinn: 2008 and 2013(governance)

Almaty: 1978 and 2013(primary health care)


The Tallinn meeting: basis of WHO’s work to strengthen health systems

Supporting Member States in keeping or moving towards universal health coverage (guided by the mission and vision of Health 2020)• Transforming financing arrangements to overcome sustainability

concerns • Positioning primary health care as the hub for other levels of care• Ensuring coordination across primary health care and public

health services• Revitalizing a flexible, multiskilled workforce with aligned task

profiles • Strategizing the use of modern technology and medicines for

maximum benefits


Transforming service delivery, addressing NCDs, investing in prevention


Using fiscal policy to improve health outcomes

TobaccoA 10% price increase in taxes could result in up to 1.8 million fewer premature deaths at a

cost of US$ 3–78 per DALY in eastern European and central

Asian countries

Alcohol In England, benefits close to

€600 million in reduced health and welfare costs and reduced labour and productivity losses, at an implementation cost of less than €0.10 per capita

Source: McDaid D, Sassi F, Merkur S, eds. The economic case for public health action. Maidenhead: Open University Press (in press).

DALY: disability-adjusted life-year.


Case for investing in public health: estimated expenditure on prevention and public health

NIS: newly independent statesSEE: south-eastern Europe

% o

f tot

al h

ealth

exp

endi

ture


WHO’s cost-effective public health interventions

• Reducing tobacco use• Taxes, tobacco-free environments, health warnings,

advertising bans

• Reducing harmful alcohol use• Taxes, health warnings, advertising bans

• Improving diet and physical activity • Reducing salt intake and salt content, reducing trans

fats, promoting public awareness


The cost of health inequities to health services, lost productivity and lost government revenue is so high that no society can afford inaction.

Tackling inequities in SDH brings other improvements in societal well-being, such as greater social cohesion, greater efforts for climate change mitigation and better education.

Reaching higher and broader – acting on the social determinants of health (SDH)


New governance for health

• Strategic role of the health ministry– Alignment of governance, regulatory capacity

and legal instruments– Organizational and management changes

• Involvement of stakeholders• Empowerment of people


The SEE 2020 strategy: improving health for inclusive growth

Inclusive growth pillar

Employment

Promote employment creation in SEE through regional

actions

Enhance labour- market governance for

employment

Stimulate social economy initiatives

Health Improve health and

well-being of all living in SEE

OB

JEC

TIVE

S O

BJE

CTI

VE

Pillar target: increase overall employment rate of the population aged 15+ years from 39.5% to 44.4%


WHO Regional Office for Europe gearing up for Health 2020 implementation


Health 2020 lays the foundation for a healthier European Region

“So many factors affect health, and health has an impact on so many areas of our lives that progress on public health can only come from whole-of-society and whole-of-government efforts.

That is why there is a role for everyone to play in implementing Health 2020, from prime ministers, to civil society, to citizens.”

– Zsuzsanna Jakab, WHO Regional Director for Europe


http://www.euro.who.int

THANK YOU

http://www.euro.who.int/en/what-we-do/health-topics/Health-systems



health 2020: a new european policy for health

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