Health 2020: A New European Policy Framework for Health and Well-Being Zsuzsanna Jakab WHO Regional Director for Europe Presented by: Dr Melita Vujnovic, WHO representative Kazakhstan VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 1 Health 2020 was adopted by the WHO Regional Committee in September 2012 53 Member States: The European policy framework for supporting action across government and society for health and well-being in Life expectancy at birth, in years <= 85 <= 81 <= 77 <= 73 Last available European Region 76.41 <= 69 No data Min = 65 VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 2 Health 2020 goal Significantly improve health and well-being of populations, reduce health inequities ensure sustainable people-centred health systems Why Health 2020? Europe’s changing health landscape: new demands, challenges and opportunities Zsuzsanna Jakab, Regional Director for Europe Kazakhstan country 4 visit Astana, Kazakhstan –15 November 2012 European Region landscape • We are dealing with complexity and uncertainty • Health challenges are multi-faceted and require active involvement of all levels of government (international, national, and local) People live longer and have less children. Noncommunicable diseases dominate the disease burden. People migrate within and between countries, cities grow bigger. Depression and heart disease are leading causes to healthy life years lost. Infectious diseases, such as HIV, tuberculosis remain a challenge to control. Antibiotic-resistant organisms are emerging. Health systems face rising costs. Primary health care systems are weak and lack preventive services. Public health capacities are outdated. VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 5 Overall health improvement (5 years life expectancy gained) but with an important divide Life expectancy at birth, in years 85 80 75 Kazakhstan European Region EU members before May 2004 EU members since 2004 or 2007 CIS CARK 70 65 60 1970 1980 1990 2000 2010 CIS: Commonweal th of Independent States EU12: countries belonging to the European Union (EU) before May 2004 EU15: countries belonging to the EU after May 2004 2020 VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 6 Health 2020 strategic objectives • Working to improve health for all and reducing the health divide ( address all health determinants simultaneously – mostly in other sectors) • Improving leadership, and participatory governance for health VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 7 Building on public health history • WHO Constitution • Alma Ata Declaration (35th anniversary: 1978 – 2013) • HFA • Health 21 • Tallinn Charter Integrated policy frameworks can and have inspired health generating actions on all levels. VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 8 Health 2020: Four common policy priorities for health • Investing in health through a life course approach and empowering people • Tackling major health challenges of non communicable diseases and communicable diseases • Strengthening people-centred health systems and public health capacities, and emergency preparedness, surveillance and response • Creating resilient communities and supportive environments VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 9 Why Health 2020? Economic opportunities and threats: the need to champion public health values and approaches VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 10 The economic case for health promotion and disease prevention The economic impact of non-communicable diseases amount to many hundreds of billions of euros every year Many costs are avoidable through investing in health promotion and disease prevention Today governments spend an average 3% of their health budgets on prevention VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 11 Health impact of social welfare spending and GDP growth • Each additional dollar • Each 100 dollar per capita increase in per capita spending on GDP results only in social welfare is associated with 1.19 0. 11 % reduction in % reduction in mortality; mortality; • There is a significantly greater effect of social welfare spending, than of GDP growth on mortality reduction. 12 Improving efficiency reduces adverse effects of the crisis: messages universal • Eliminate ineffective and inappropriate services • Improve rational drug use • Allocate more to primary and outpatient specialist care at the expense of hospitals • Invest in infrastructure that is less costly to run • cut the volume of least costeffective services VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 13 NCD action plan Planning and oversight Health in all policies Healthy settings Secondary prevention Workplaces and schools Cardio-metabolic risk assessment and management Active mobility (Ministry of Sports, Ministry of Education) Early detection of cancer Kazakhstan screening programmes Fiscal policies National plan Tobacco Control Marketing Health information system with social determinants disaggregation (Household survey, GATS) Salt Trans-fat VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 14 Support Member States to navigate the crisis is central to our work: messages universal • Strong economic case for health promotion and disease prevention as economic cost of NCD extremely high (only 3 % investment); • Prevention one of most cost-effective approaches to improve health outcomes; • Fiscal policy can be used like raising taxes of tobacco and alcohol: “Sin” taxes have immediate benefits. SDR, ischaemic heart disease, all ages per 100,000 population SDR, ischaemic heart disease, all ages per 100000 500 400 300 Kazakhstan European Region EU members before May 2004 EU members since 2004 or 2007 CIS CARK 200 100 0 1970 1980 1990 2000 2010 2020 VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 16 Kazakhstan – highest political commitment to health “Healthy lifestyle and the principle of shared responsibility for health this is what should be important both in the policy on public health, and in every day living” Nursultan Nazarbayev, President of the Republic of Kazakhstan Source: Address to the Nation, January 2012 VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 17 Kazakhstan: Health as a determinant and barometer of economic development “In the Global Competitive Index rating Kazakhstan holds 94 position due to its incidence of tuberculosis (index of 2007 was 130.0) and 121th position in terms of the influence of prevalence of tuberculosis on business” Source: The Global Competitiveness Report 2011–2012, (http://www3.weforum.org/docs/WEF_GCR_Report_2011-12.pdf) VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 18 Health 2020 documents & Kazakhstan strategies • Health 2020 - A European policy framework supporting action across government and society for health and wellbeing • Health 2020 – European policy framework and strategy document & • Kazakhstan 2030 & Health Code of Kazakhstan (2009) • ”Salamatti Kazakhstan”: Healthy Kazakhstan 2011–2015 • 20 steps to social modernization of Kazakhstan (2012) VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 19 Kazakhstan – Health 2020 VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 20 Kazakhstan: Health 2020 priorities Health 2020 Salamatti Kazakhstan • Investing in health through a life course approach and empowering people • Tackling Europe’s major health challenges of non communicable diseases and communicable diseases • TB, HIV, especially dangerous pathogens and smoking and alcohol related diseases; nutrition; CVD, cancer • Strengthening people-centred health systems and public health capacities, and emergency preparedness, surveillance and response • Transport medicine and emergency medicine; public health surveillance Creating resilient communities and supportive environments • Environment and health and occupational health • • Child & adolescent health: aging VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 21 Health 2020 in Kazahstan • Strengthen public health functions • Review all determinants of health incl. social and environmental determinants (intersectoral mechanism in place ) • Review link between health, employment and welfare/social policy • Improve health literacy and empower people through life course approach. Health 2020 in Kazahstan • Analyze the policy and strategy document • Analyze the evidence-based studies • Identify areas relevant for the Kazakhstan context and build them into Salamatti Kazakhstan • “ It is the right policy that produces health” which needs to be integrated with the health system strengthening for best results Health 2020: Towards a healthier Europe VI Astana Economic Forum, Kazakhstan Astana, 24 May 2013 24