Role of the World Health Organization In Reducing Health Inequities in Europe

1. Role of the World Health Organization In Reducing Health Inequities in Europe Dr. Piroska Östlin Special Adviser

2. Presentation outline Context and trends: the changing environment for health WHO’s role in tackling Europe’s health priorities and challenges Support to Member States: the way forward

3. WHO European Region 53 Member States, 886 Million people

4. Demographic shifts (1980–2010)changing distribution of population in WHO European Member States 25% Proportion aged 0–14 years Proportion aged 65 and over Source: WHO European Health For All database, 2010. 0% 1980 1990 2000 2010

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

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

7. Trends of life expectancy in the WHO European Region, 1980-2008 Source: WHO Health for All database, August 2010

8. Burden of disease in Million DALYs in European Region by disease group Source: WHO Global Burden of Disease, estimates for year 2004.

10. Premature mortality trends from trachea/ bronchus/ lung cancer in EU countries between 1970-2007 Country Male Female 70 Austria Denmark France Germany 60 Hungary Netherlands Poland 50 Sweden 40 30 20 10 0 1970 1975 1980 1985 1990 1995 2000 2005 1970 1975 1980 1985 1990 1995 2000 2005 Standardized death rate per 100.000 trachea/bronchus/lung cancer, 0-64 Source: WHO/Europe. European Health for All database, 2010

11. 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.

12. Absolute inequalities in rate of death by any cause, by education (men) Mackebach et al, 2008

13. Health and Social Problems are Worse in More Unequal Countries http://www.slideshare.net/equalitytrust/the-spirit-level-slides-from-the-equality-trust

14. Closing the Gap in a Generation Social injustice is killing on a grand scale! www.who.int/social_determinants

15. 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

16. Presentation outline Context and trends: the changing environment for health WHO’s role in tackling Europe’s health priorities and challenges Support to Member States: the way forward

17. 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

18. 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)

19. Strengthening of the health 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!

20. Presentation outline Context and trends: the changing environment for health WHO’s role in tackling Europe’s health priorities and challenges Support to Member States: the way forward

21. WHO European Region 53 Member States, 886 Million people 2006-7 6 2008-9 12 2010-11 23 Member States requesting technical assistance in the area of Social Determinants of Health

22. 2006 2008 2007 2005 1998 2003 1999 2010 2009 2000 1997 European policy dialogue forum: “Governance of population health and development” WHO/HBSC Forum: Socioeconomic determinants of healthy eating habits and physical activity levels among adolescents WHO Venice Office Official Opening 2004-2005: European Health Promotion Capacity Mapping Initiative FINLAND Multicountry event: Social determinants and health: the role of national action plans to reduce health inequities. Poverty and Health Technical Consultation WHO/HBSC Forum “Social Cohesion to Mental Wellbeing among Adolescents”

23. 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

24. 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

25. Collaborative Work - In-depth analysis of implementation

26. Cooperation sub-national level Slovenia United Kingdom Italy Czech Republic Veneto MURA Project Pomurje Liberec Scotland South Moravia Tuscany North West Region England South Bohemia Friuli Venezia Giulia

27. Lesson 1. Need to ‘modernize’ health sector 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! Source: Adapted from WHO, 2010; Kickbusch,2010

28. Lesson 2. A whole-of-government priority 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 Source: http://www.scotland.gov.uk

29. Lesson 3. A high performing governance 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.

30. Summary The 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.

31. Let us work together to tackle Europe’s health priorities Köszönöm kedves figyelmüket!