3rd Medical Faculty
Department of Preventive
Medicine
WHO Programs and Strategies of
Public Health
Alena Šteflová, M.D.,Ph.D.
2009/2010
WHO/ specialised UN agency
WHO established in 1948 - 7 April ( World health Day) – after
ratication of 23 countries
Target:
to promote technical cooperation for health among nations, to
carry out programmes to control and eradicate disease, and to
improve the quality of life.
World Health Organization
Specializovaná agentura OSN
„Its objective is the
attainment by all
people of the highest
possible level of
health“
Constitution, 1948
"Health is a state of
complete physical,
mental and social wellbeing and not merely the
absence of disease or
infirmity"
Definition of Health
Preambule of
Constitution
Structure of WHO
Headquarter (HQ): Geneve, general director Dr. Margaret Chan
( previous GD LeeJong-wook died 2006)
- WHA – World Health Assembly / the governing body of the
organization/ meeets annually / in 2009 62nd WHA in Geneva
- Executive Board consists from 32 experts, elected for 3years –
preparatory of strategies and resolutions
WHO includs 194 member states, divided into 6 geographical
regions
- AFRO Brazzaville/Congo - Africa
- EMR Cairo/Egypt – Middle-East
- AMR Washington/USA – South and North America
- SEAR New Delhi/India – South-East Asia
- WPR Manila/Philippines – West Pacific
Structure of WHO European region
EURO Copenhagen/Denmark – Europe
RD Zsuzsana Jakab since 1st Feb 2010 ( former Marc Danzon)
- Over 870mil inhabitens ( including all countries of former Soviet
Union)
- Diversities within the region: industrial societies, agriculture, new
democracies in East and Central Europe
- Regional Committee – once per year ( Standing Committee)
- Related strategies for the regions are adopted by member states
Country offices of WHO (Liaison Office) in 142 member states
- for the Czech Republic / Prague
- Participation of the Czech Republic since 1948 (figures separatly
since 1993)
The main tasks of the WHO
- Coordination and solution of the main acute health
problems with the impact on global health
- Preparedness of potential global pandemy ( SARS,
Avian Influenza, Swine Influenza); the struggle
with HIV/AIDS, Malaria, TB
- Humanitarien help and
crises management
(disasters, political conflicts)
- Health policy- support to member states/assistance,
consultancy
- Monitoring, assessment, HFA Database
- reports, campaigns, printing documents, etc.
Transnational strategies of Health
Policy
European Union – does not have united strategy of health
policy/health care mandatory implemented by member states
• Harmonization of legislation, support of preventive programs and
health promotion policy: Communitarian Program 2007-2013, 7th
framework program – medical research
WHO – creates frame for health policy as well as partial
technical recommendations, guidelines, strategies in three main
areas:
• Lifestyl conductive to health
• A healthy environment
• Appropriate services for prevention, treatment and care;
The Health for All Policy Framework for
the WHO European Region
The basic conceptional programmes for implementation in
respective countries accordingly to their conditions and
priorities:
Health for All to 2000
Health 21 – adopted at the 51st WHA ,
May 1998; supposed to be
implemented through relevant
regional ant national policies
Health 21 – the Health for All Policy
Framework for the WHO European Region
- The one constant goal is to achieve full health potential
for all
- Two main aimes for better health towards this goal –
promoting and protecting people’s health throughout the
course of their lives
- reducing the incidents of the main diseases and injuries
- Three basic values form the ethical foundation
- health as a fundamental human right
- equity and solidarity in health
- participation of individuals, groups and communities
Health 21 - Four Main Strategies
for Action
- Multisectorial strategies to tackle the determinants
- Health outcome driven programs and investments for
health
- Integrated family and community oriented primary health
care, supported by a flexible and responsive hospital
system
- Involvement of relevant partners for health at all levels –
home, school and worksite, local community and country
that promotes joint decision making and implementation
of action
Solidarity and Equity in Health
Closing the health gap between countries
- Target 1- Solidarity for health in the European
region
- Target 2 - Equity in health
Better Health for People
Strengthening health throughout life
- Target 3 - Healthy start in life
- Target 4 - Health of young people
- Target 5 - Healthy ageing
- Target 6 - Improving mental health
- Target 7 - Reducing communicable diseases
- Target 8 - Reducing non-communicable diseases
(CVD, cancers, DM, chronic respiratory and musculoskeletal
disorders, teeth caries)
- Target 9 accidents
Reducing injury from violence and
A Multisectoral Strategy for
Sustainable Health
To create sustainable health through more health-promoting
physical, economic, social and cultural environments for
people
- Target 10 - A healthy and safe physical environment
- Target 11 - Healthier living
- Target 12 - Reducing harm from alcohol, drugs and
tobacco
- Target 13 Settings for health (at home, school,
workplace and in the local community)
- Target 14 - Multisectorial responsibility for health
Changing the Focus: an OutcomeOriented Health Sector
To orient the health sector towards ensuring better
health gain, equity and cost-effectiveness
- Target 15 - An integrated health sector
- Target 16 – Managing for quality of care
- Target 17 – Funding health services and allocating
resources
- Target 18 - Developing human resources for health
Managing Change for Health
To create a broad societal movement for health
through innovative partnerships, unifying policies,
and management practices tailored to the new
realities
- Target 19 - Research and knowledge for health
- Target 20 - Mobilizing partners for health
- Target 21 - Policies and strategies for health for
all
National Health Programs of the
Czech Republic
HFA
- The National Program of Health Restoration and Promotion in the
Czech Republic – approved by the government in April 1992
- National program of health – long term strategy – approved by the
government in 1995
(successful community projects Healthy Cities, Health Promoting
Schools, Healthy Workplaces, Regions for Health); state budget for
the implementation of the national health program
H21
- The Czech version - A long-term Program for Improving the Health
of the Czech Republic – Health for All in the 21st Century
Approved by the Government of the CZH in 2002 –Resolution 1046
The global perspective
Non/ communicable diseases
Communicable disease
injuries
2001
75%
50%
25%
Zdroj: WHR 2002
AFR
AMR
EMR
EUR
SEAR
WPR
Major causes of death among
children under five years
Pneumonia
20%
Other
29%
Worldwide, about 10
million children died
per year
Deaths associated
with undernutrition
Diarrhoea
12%
54%
Malaria
8%
Perinatal
22%
Measles
HIV/AIDS
5%
4%
Sources:
For cause-specific mortality: EIP/WHO.
For undernutrition: Pelletier DL et al. American Journal of Public Health 1993, 83:1130–1133
WHO global priorities
EPIDEMY OF COMMUNICABLE DISEASES
• HIV/AIDS
• MALARIA
• TB
• Preparedness on potential global pandemy (SARS,ic
influenza
EPIDEMY NON – COMMUNICABLE DISEASES
• TABACCO
• ALCOHOL, DRUGS
• NUTRITION
• INJURIES
The WHO European Region
Child and adolescent health
– emerging issues
• HIV/AIDS
• Obesity
• Mental health
• Injuries
HIV infections newly diagnosed
in children, 1997–2002 – Europe
5000
Eastern Europe
4500
Cases
4000
3500
3000
2500
2000
1500
Western
Europe
1000
500
0
1997
1998
1999
2000
2001
Central
Europe
2002
Year of report
Source: EuroHIV
Prevalence of overweight children
in 31 countries grouped by region
Overweight Prevalence (%)
25
20
15
North America
(South) Western Europe
United Kingdom
(Southwest) Eastern Europe
Scandinavia
(Central) Western Europe
(Northwest) Eastern Europe
10
5
0
Source: HBSC
Increasing prevalence of
overweight
children in Europe
Prevalence %
30
25
20
15
10
5
0
1970
IOTF estimates.
1980
1990
2000
2010
Youth and depression
Four percent of 12–17 years old and
nine percent of 19 years old suffer from
depression, making it one of the most
prevalent disorders with wide-ranging
consequences.
Youth and depression
Depression is associated with youth
suicide and is the third leading cause
of death in young people.
Source: World Health Report 2001
Road Traffic Injuries: a huge global
public health problem
 1.2 million die a year
 Up to 50 million are
injured or disabled
 11th leading cause
of death
 3rd cause of death
and disability
in 2020
 account for 2.1%
of all deaths globally
RTIs: a huge European public health
problem
 127,000 die a year
 2.4 million more are injured or disabled
 One out of three deaths involve young people under
29 (about 43 800).
 Of these, nearly 80% are males (about 33 600)
 Over 2 million crashes happen every year
 65% crashes occur in towns (over 1.3 million)
 One out of three deaths involves a pedestrian or a
cyclist
 Costs (in the EU15):about 180 € billion/year
(equivalent to 2.0 % GDP)
Childhood (0-14) injury mortality is unequally distributed
across Europe: highest and lowest in the world (2002)
SDR(0-14), External causes of injury and poisoning, per 100000
<= 40
<= 32
<= 24
<= 16
Last
available
European Region
15.89
Source: WHO, Health for All database, June2004
<= 8
No data
Min = 0
People in lowmiddle income
countries are at
4 times the risk
of dying from
injuries than
people in high
income
countries (HIC).
Many costeffective
strategies exist
as in HIC,
which are
among the
safest in the
world.
Global/regional strategies
• Frame Convention of Tobacco Control (FCTC)
• European Action Plan against Alcohol
• Strategy of Environment and Health of Children /
Budapest Conference
• Declaration of mental health, Action plan /
Helsinky 2005
• Global strategy of healthy nutrition, physical
activities and health - Ministerial Conference in
Istanbul – 2006 European Charter on
Counteracting Obesity
• Ministerial Conference on Health Systems in
Tallin 2008
COMMISSION ON SOCIAL
DETERMINANTS OF HEALTH
Sir Michael Marmot
Chair of the Commission on Social
Determinants of Health
Professor of Epidemiology and
Public Health, Royal Free and
University College Medical School,
London
What are the social determinants of health?
"The poor health of the poor, the social gradient in
health within countries, and the marked health
inequities between countries are caused by the
unequal distribution of power, income, goods, and
services, globally and nationally, the consequent
unfairness in the immediate, visible circumstances
of peoples lives – their access to health care,
schools, and education, their conditions of work
and leisure, their homes, communities, towns, or
cities – and their chances of leading a flourishing
life. This unequal distribution of health-damaging
experiences is not in any sense a ‘natural’
phenomenon….Together, the structural
determinants and conditions of daily life constitute
the social determinants of health."
Why treat people…
then send them back
to the conditions that made them sick?
Life expectancy at birth (men)
Glasgow, Scotland (deprived suburb)
India
Philippines
54
61
65
Korea
Lithuania
Poland
Mexico
65
66
71
72
Cuba
US
UK
75
(WHO World Health Report 2006; Hanlon,P.,Walsh,D. & Whyte,B.,2006)
75
76
Inequalities: Between Countries
Life expectancy at birth (men and women): selected countries
Japan
Hong Kong
Iceland
Switzerland
Australia
82,3
81,9
81,5
81,3
80,9
China
Brazil
Russia Federation
India
Mozambique
Sierra Leone
Angola
Zimbabwe
Zambia
0
20
65
63,7
72,5
71,7
Glasgow Calton
54 (men)
42,8
41,8
41,7
40,9
40,5
40
60
Glasgow
Lenzie
82 (men)
80
National LE data HDP 2007/2008, Glasgow data: Hanlon et a l. 2006
100
Preston Curve in 2000
(Deaton, 2004)
Trends in life expectancy
(Human Development Report, 2005)
Under 5 mortality (per 1000 live births)
by wealth group
Poorest
Less poor
Middle
Less rich
Richest
350
300
250
200
150
100
50
0
Mali
(Houweling et al, 2007)
India
Morocco
Peru
Kyrgyz
Republic
All cause mortality (per 1000 person yrs)
Mortality over 25 years according to level in
the occupational hierarchy: Whitehall
Admin
Prof/Exec
Clerical
Other
80
70
60
50
40
30
20
10
0
40-64yrs
65-69yrs
70-89yrs
(Marmot & Shipley, BMJ, 1996)
Life expectancy of Indigenous Peoples
(Bramley et al, 2005)
Infant mortality in Brazil by race and mother's
education, 1990
(Pinto da Cunha, 1997)
Poverty is an issue
throughout the Region
Percent of children
living below national
poverty lines
Source: UNICEF Innocenti Research Centre,
Child poverty in rich countries
(Murphy et al, 2005)
(probability of living to 65 yrs when aged 20 yrs)
The widening trend in mortality by
education in Russia,1989-2001
What are the
social determinants of health?
Why emphasize social
determinants?
• Social determinants of health have a direct impact
on health
• Social determinants predict the greatest proportion
of health status variance (health inequity)
• Social determinants of health structure health
behaviours
• Social determinants of health interact with each
other to produce health
• Social justice
• Empowerment as a
means – material,
psychosocial, political
• Creating the conditions
for people to take
control of their lives
www.who.int/social_determinants
28 August 2008
World Health Assembly Resolution
May 2009
• All member states:
– Tackle health inequities through action on the
social determinants of health
– Impact of polices and programmes on health
inequities;
– Health equity in global development goals
"Public health can be grateful for backing from the
Commission on Social Determinants of Health. I
agree entirely with the findings. The great gaps in
health outcomes are not random. Much of the
blame for the essentially unfair way our world
works rests at the policy level."
Dr Margaret Chan, 62nd World Health Assembly,
May 2009
Photos:WHO/Cédric Vincensini
Framework for
action on
tackling social
determinants of
health inequities
1. Improve Daily Conditions
•
Improve the well-being of girls and women and the circumstances in which
their children are born
– Major emphasis on early child development and education for girls and boys
•
Manage urban development
– Greater availability of affordable housing
– Invest in urban slum upgrading especially water and sanitation, electricity, paved
streets
•
Ensure urban planning promotes healthy and safe behaviours equitably
– Active transport
– Retail planning to manage access to unhealthy foods
– Good environmental design and regulatory controls e.g. number of alcohol outlets
•
•
Ensure policy responses to climate change consider health equity
Full and fair employment made a shared objective of international institutions
and a central part of national policy agendas and development strategies
– Strengthened representation of workers in the creation of employment policy,
legislation, and programmes
1. Improve Daily Conditions
• International agencies should support countries to protect all workers
– Implement core labour standards for formal and informal workers
– Develop policies to ensure a balanced work–home life
– Reduce negative effects of insecurity among workers in precarious work
arrangements
• Progressively increase social protection systems
– Ensure systems include those in precarious work, including informal work
and household or care work
• Build quality health-care services with universal coverage, focusing on
Primary Health Care
– Strengthen public sector leadership in equitable health-care systems
financing, ensuring universal access to care regardless of ability to pay
– Redress health brain drain, focusing on investment in increased health
human resources and training and bilateral agreements to regulate gains
and losses.
2. Tackle the Inequitable Distribution of
Power, Money and Resources
• Place responsibility for action on health and health equity
at the highest level of government, and ensure its coherent
consideration across all policies
• Strengthen public finance for action on the social
determinants of health
• Increase global aid to the 0.7% of GNP commitment and
expand the Multilateral Debt Relief Initiative
• Institutionalize consideration of health and health equity
impact in national and international economic agreements
and policy-making
• Reinforce the primary state role for basic services essential
to health (such as water/sanitation) and regulation of goods
and services with a major impact on health (such as
tobacco, alcohol, and food)
2. Tackle the Inequitable Distribution of
Power, Money and Resources
• Create and enforce legislation that promotes gender equity
and makes discrimination on the basis of sex illegal
• Increase investment in sexual and reproductive health
services and programmes, building to universal coverage
and rights
• Strengthen political and legal systems
– Protect human rights
– Assure legal identity and support the needs and claims of
marginalized groups, particularly Indigenous Peoples
• Ensure fair representation and participation of individuals
and communities in health decision-making
• Enable civil society to organize and act to promote and
realize political and social rights affecting health equity
• Make health equity a global development goal
3. Measure and Understand the Problem
and Assess the Impact of Action
• Ensure routine monitoring systems for health equity locally, nationally,
and internationally
– Ensure all children registered at birth
– Establish national and global health equity surveillance systems
• Invest in generating and sharing new evidence on social determinants
and health equity and on effectiveness of measures
– Create dedicated budget for generation and global sharing of evidence
• Provide training on the social determinants of health to policy actors,
stakeholders, and practitioners and invest in raising public awareness
– Incorporate the social determinants of health into medical and health
training
– Train policy-makers and planners in health equity impact assessment
– Strengthen capacity within WHO to support action on social determinants
• Information about WHO
www.who.int.
www. who.dk
Country Office in the Czech Republic
www.who.cz