role of the world health organization in reducing health inequities in europe

Role of the World Health Role of the World Health Organization In Reducing Health Organization In Reducing Health

Inequities in EuropeInequities in Europe

Dr. Piroska Östlin Special Adviser

More Equal and Healthier Societies

30 November 2010, Budapest

Support to Member States:the way forward

WHO’s role in tackling Europe’s health prioritiesand challenges

Presentation outline

Context and trends: the changing environment for health



WHO European Region53 Member States, 886 Million people



Demographic shifts (1980–2010)changing distribution of population in WHO European

Member States

Proportion aged 0–14 years

Proportion aged 65 and over

25%

0%1980 20101990 2000

Source: WHO European Health For All database, 2010.



Life expectancy at birth for countries in the WHO European Region, 2008 or latest available year: males

606262

6565

6666

6768

696969

7070707070

7171717171

7373

7474

7576

767677

77777777787878787878787979797979

7980

80

55 60 65 70 75 80 85

Russian Federation (2006)Kazakhstan (2008)

Ukraine (2008)Kyrgyzstan (2008)

Belarus (2007)Republic of Moldova

Lithuania (2008)Latvia (2008)

Uzbekistan (2005)Estonia (2008)Georgia (2005)Turkey (2008)

Bulgaria (2008)Romania (2009)Hungary (2008)Slovakia (2005)Armenia (2008)

TFYR Macedonia (2003)Tajikistan (2005)

Azerbaijan (2007)Poland (2008)Serbia (2008)

Croatia (2008)Montenegro (2008)

Albania (2004)Czech Republic (2008)

Portugal (2004)Slovenia (2008)Belgium (2004)

Denmark (2006)Finland (2008)

Germany (2006)Malta (2008)

Luxembourg (2007)Andorra (2006)

San Marino (2006)United Kingdom (2007)

France (2007)Greece (2008)Austria (2008)Ireland (2008)Spain (2008)

Norway (2008)Netherlands (2008)

Cyprus (2008)Israel (2007)

Italy (2007)Sweden (2008)

Switzerland (2007)Iceland (2008)

Life expectancy at birth - males



Life expectancy at birth for countries in the WHO European Region, 2008 or latest available year: females

7373737373

7474

7676767677777777777878787878

79808080

8181

828282

8282828283838383

838383838383

848484858585

55 60 65 70 75 80 85

Kazakhstan (2008)Kyrgyzstan (2008)Uzbekistan (2005)

Russian Federation (2006)Republic of Moldova (2008)

Ukraine (2008)Turkey (2008)

TFYR Macedonia (2003)Azerbaijan (2007)

Belarus (2007)Tajikistan (2005)

Serbia (2008)Georgia (2005)Armenia (2008)Bulgaria (2008)Romania (2009)Lithuania (2008)

Latvia (2008)Montenegro (2008)

Slovakia (2005)Hungary (2008)Albania (2004)Estonia (2008)Croatia (2008)Poland (2008)

Czech Republic (2008)Denmark (2006)Portugal (2004)

United Kingdom (2007)Belgium (2004)

Luxembourg (2007)Germany (2006)

Malta (2008)Greece (2008)

Israel (2007)Netherlands (2008)

Ireland (2008)Slovenia (2008)

Iceland (2008)Norway (2008)Cyprus (2008)

Sweden (2008)Austria (2008)Finland (2008)

Andorra (2006)Italy (2007)

San Marino (2006)Switzerland (2007)

Spain (2008)France (2007)

Life expectancy at birth - females



Sour

ce: W

HO

Hea

lth fo

r All

data

base

, Aug

ust 2

010

Trends of life expectancy in the WHO European Region, 1980-2008

68

70

72

74

76

78

80

Life expectancy at birth, in years

1980 1985 1990 1995 2000 2005

European RegionEur-AEur-B+C



Burden of disease in Million DALYs in European Region by Burden of disease in Million DALYs in European Region by disease groupdisease group

0 5 10 15 20 25 30 35 40

Other neoplasmsSkin diseases

Maternal conditionsOral conditions

Endocrine disordersGenitourinary diseasesCongenital anomalies

Nutritional deficienciesDiabetes mellitus

Respiratory infectionsPerinatal conditions

Intentional injuriesMusculoskeletal diseases

Respiratory diseasesInfectious and parasitic diseases

Digestive diseasesSense organ diseasesUnintentional injuriesMalignant neoplasms

Neuropsychiatric conditionsCardiovascular diseases

Millions of DALYsSource: WHO Global Burden of Disease, estimates for year 2004.



Source: WHO/Europe. European Health for All database, 2010

Premature mortality trends from trachea/ bronchus/ lung cancer in EU countries between 1970-2007

Stan

dard

ized

dea

th ra

te p

er 1

00.0

00

trac

hea/

bron

chus

/lung

can

cer,

0-64

0

10

20

30

40

50

60

70

1970 1975 1980 1985 1990 1995 2000 2005 1970 1975 1980 1985 1990 1995 2000 2005

Female MaleCountryAustriaDenmarkFranceGermanyHungaryNetherlandsPolandSweden



Alcohol-attributable burden of disease as proportion of all DALYs, by sex and WHO region, 2004

Source: Rehm J et al. Lancet, 2009, 373:2223–2233.



Absolute inequalities in rate of death by any cause, by education (men)

Mackebach et al, 2008



Health and Social Problems are Worse in More Unequal CountriesHealth and Social Problems are Worse in More Unequal Countries

http://www.slideshare.net/equalitytrust/the-spirit-level-slides-from-the-equality-trust



www.who.int/social_determinants

Social injustice is killing on a grand scale!

Closing the Gap in a Generation



The statement ‘Inequality kills’ is clearly of a different nature than the statement ‘disease kills’. It should lead to a completely different sets of policy priorities, governance issues and key actors.

Source: Adapted from Kickbusch, 2010



Support to Member States:the way forward

WHO’s role in tacklingEurope’s health priorities and challenges

Presentation outlineContext and trends: the changing environment for health



New European health policy: Health 2020

• Will be developed through participatory process with Member States, sectors and partners

• Will be informed and underpinned by a European review on social determinants of health

• Will integrate policy areas and renew the commitment of the Regional Office to public health

• Will renew emphasis to further developing public health systems, capacities and functions and promoting public health as a key function in society

• Will clarify the linkages between public health, health care system, in particular primary health care (Tallinn Charter, 2008)

• Will position health as a critical development sector, and make linkages with the other sectors to promote health as a governmental responsibility under the ministry of health

• Will be an inspiration to Member States to develop, renew and update their national health policy and strategies

• Will be led by the Global Policy Council



WHO European Review on Social Determinants and the Health Divide

Provide evidence on the nature and magnitude of health inequities across the European region

Investigate gaps in capacity and knowledge

Synthesize evidence on the most promising policy options and interventions in diverse country context

Input into the new Health Policy for Europe (Health 2020)



Strengthening of the Strengthening of the health and public health systemshealth and public health systems

The Regional Office will continue implementing commitments made at the Tallinn Conference in 2008, bringing PH more centrally into the equation!



Support to Support to Member States:Member States:the way forwardthe way forward

Presentation outlineContext and trends: the changing environment for health

WHO’s role in tackling Europe’s health priorities and challenges



WHO European Region53 Member States, 886 Million people

Member States requesting technical assistance in the area of Social Determinants of Health

2006-7 6

2008-9 12

2010-11 23



199719992000200320102005

WHO Venice Office Official OpeningEuropean policy dialogue forum:

“Governance of population health and development”

2006

2004-2005: European Health Promotion Capacity Mapping Initiative

WHO/HBSC Forum: Socioeconomic determinants of healthy eating habits and physical activity levels among adolescents

20072008

WHO/HBSC Forum

“Social Cohesion to Mental Wellbeing among Adolescents” Poverty and Health Technical Consultation

2009

FINLAND Multicountry event: Social determinants and health:

the role of national action plans to reduce health inequities.

1998



Types of requests from countries• Assistance to build political support

• Support to develop human resources skills and governance mechanisms/ systems

• Strengthen monitoring & analysis of health inequities

• Technical assistance to strengthen health systems and pursue public health priorities

• Support to developing national and sub-national strategies to reduce health gaps, gradients and vulnerability



The role of the WHO Country Office in Hungary

• To help the translation of the WHO agenda in health policy context

• To support Hungarian policy makers and experts to integrate scientific knowledge into national health policy development, health strategies and projects

• To coordinate the work related to the Bilateral Cooperation Agreement between WHO and Hungary

• To engage health policymakers and experts in WHO capacity building projects

• To disseminate WHO publications, recommendations and international good practices

• To support WHO data collection and research



1. Collaborative Work - In-depth analysis of implementation



Cooperation sub-national level Slovenia Czech Republic United Kingdom

MURA Project Pomurje

Liberec

South Moravia

South Bohemia

North West Region England

Italy

Tuscany

Veneto

Friuli Venezia Giulia

Scotland



It will be very difficult, if not impossible, to tackle the magnitude and the causes of health inequities with the present vertical configuration of the health sector. Health inequities are intersectoral in nature and require intersectoral responses.

Health systems must be strengthen accordingly!

Lesson 1. Need to ‘modernize’ health sector

Source: Adapted from WHO, 2010; Kickbusch,2010



The issue of health inequities needs to be a whole-of-government priority to be addressed through a coherent set of policies and interventions on a scale appropriate to the trends and magnitude of the problem in the country

Lesson 2. A whole-of-government priority

Source: http://www.scotland.gov.uk



The issue of health inequities needs to be a whole-of-government priority at different levels of policy making. This is key to perform policy coherence through strong multi-level governance, locally, regionally, nationally.

Institutional capacity and civil society are crucial elements in the performance of such governance.

Lesson 3. A high performing governance



SummaryThe WHO Regional Office for Europe will:• develop a coherent European health policy;• promote a renewed political commitment to the

development of comprehensive national health policies, strategies and plans;

• maintain our commitment to strengthening health systems;

• promote public health capacity, functions and services; and

• ensure a commitment and investment in disease prevention and health promotion.



Let us work together to tackle Let us work together to tackle Europe’s health prioritiesEurope’s health priorities

Köszönöm kedves figyelmüket!

role of the world health organization in reducing health inequities in europe

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