Towards Health for All in England by William Waldegrave Health for All­ s the United Kingdom's Sec. retary of State for Health, I Abelieve there is no more impor­ theory and practice tant task facing me than developing a comprehensive strategy to improve by Justin Westhoff the nation's health. Thanks to our health reforms, creating and im­ Europe, summer 1991 . . . In hot situation in Berlin) mainly react posi­ plementing such a strategy is now a countries, the elderly are suffering tively when they are asked about reality. The time is right to do so. We badly from a heatwave. Because they WHO's slogan and its regional strategy can now focus attention on maximiz­ live in certain areas, more elderly to achieve "Health for All by the year ing health gains rather than on the people are dying prematurely than 2000" in Europe. Where criticism is day-to-day management issues of elsewhere. In view of climatic, genetic voiced, it is directed less at WHO and running our National Health Service. and other factors that cannot be more at the lack of practical work The overall aim of the strategy for altered, how meaningful is WHO's towards WHO's targets in the European England (Wales. Scotland and slogan 'Health for All'? Member States. Northern Ireland are developing their Turkey, spring 1991 ... Kurds, own, but similar, strategies) will be to maltreated for centuries, have fled More research needed improve the population's health, from civil war in Iraq to find safety and Ingrid Stahmer, Senator for Social making the best and most efficient compassion. In the refugee camps, Affairs in re-unified Berlin, was pre­ use of available resources. In doing children die every hour of the day from viously Senator for Health (a senator is so we seek to strike an effective malnutrition and diarrhoea! diseases the equivalent of a minister in one of balance between the three fun­ (which elsewhere would be easily con­ the German Ui.nder). For her, Health damental pillars of health: prevention. trolled), the elderly die of weakness for All means that problems of "social treatment and rehabilitation. and young men and women from their cooperation" and the conditions from Our consultative paper The Health wounds. The praiseworthy medical aid which disease arise must be linked of the Nation reflects the principles given by the international community together. Not enough research has laid down in Health for All. I was appears to be merely a drop in the been done on social and psychological delighted that Dr Jo Asvall. Regional ocean. Health for All? questions. Poor communication, stress Director of WHO (Europe) gave such France, or Germany, or the United at the workplace ... too little attention a warm endorsement to our Kingdom . . . A growing body of has been paid to these and other approach. "This is" , he said, "exactly research findings show that immigrants issues. Medicine often pays only lip what we would like every country to are subject to considerably more health service to mental health. do." hazards than the nationals of those She feels that WHO has taken the The Health of the Nation sets countries and have more obstructions right approach: tackling the different targets for improving health. Target to pass in order to gain access to the social causes of disease in appropriate setting is an essential discipline for all health care system. Equal health for ways with different "prescriptions", and those involved. Targets give us both all? not "steamrollering a uniform concept something to aim at and a set of Berlin . . . after unification of East across Europe". In this way, one benchmarks against which we can and West. People in the former Ger­ country can learn from another: Ger- measure progress. We will initially man Democratic Republic receive base the strategy around a small poorer medical care than those in the number of health priorities such as West, and in some cases the quality of coronary heart disease and smoking­ care has worsened since unification. related cancers. In time we will add One example: following efforts by the new areas. so building up a rolling health lobby to have health care process of health improvement. privatized as far as possible and to Better health is a job for everybody, close outpatient units and polyclinics, not just our health service. Individ ­ the number of diabetics suffering from uals, employers. voluntary organi­ diabetic coma has shot up in the zations. trade unions and others must eastern Ui.nder. Even for a rich all recognize their part in the strategy country in the heart of Europe, the and respond. Through a shared same questions must be asked: commitment to better health lies the Equality in health and life? Health for path to success. • All? Despite urgent questions like these, Mr William Wa/degrave is health care professionals and politi­ Secretary of State for Health cians in Germany (to judge by the of the United Kingdom, Department of Health, The big question that faces health Wellington House, 133- 155 policy-makers in Europe: how to reduce Waterloo Road, London SE1 inequalities in the struggle against sickness and death? 8UG, England.

4 WORLD HEALTH. November-December 1991 mans, for instance, can acknowledge national and local levels. @ the value of social cohesion within the The spokeswoman for a profes­ extended family in southern Europe, sional medical association voices her j while others may value the relatively thoughts forthrightly, almost with dis­ well-developed network of self-help approval. "I get annoyed every year," groups in Germany. Innovations need she says, "when the latest slogan for not inevitably entail higher costs. Mrs World Health Day is proclaimed. It Stahmer is particularly concerned yields just as few results as the claim to about a number of issues: the wide­ Health for All, so long as it remains just spread use of violence against children, something on paper!" a universal taboo in Europe; the lack of a lobby for the elderly; and inadequate Involving the nurses social harmony between people of Senior nurse Jutta Beikirch looks at different origins. "Existential fears", she matters in a different way. She is now insists, "make people ill". responsible for nursing personnel in Anette Schwarzenau is municipal the Berlin civil service. "WHO has councillor for health in Charlottenburg, helped us to get nurses more involved a large district of Berlin. She considers in health planning and reporting, even WHO's concept to be "inspiring". if they are not yet involved enough", Charlottenburg is to join the Healthy she says. Nurses and care personnel Cities network. WHO's targets are of are in much closer contact with great help to her in persuading people patients, and community nurses in who are conservative in health policy particular see the whole social and matters that health is more than economic situation and know what "bandages and pills". The slogan "primary prevention and care" means. Heath for all: "All it means is having the courage to dream that you will one Health for All has become a self­ This is often more important than day have the strength to act_" imposed obligation for urban districts scientifically oriented medical interven­ such as her own. tions. WHO was right to point this out, carefully monitored, she warns. There One of the leading experts in pre­ and nurses can often make practical are both opportunities and risks here. vention is Or Rolf Rosenbrock, a progress towards such targets more Health service workers can learn from sociologist and health researcher at the effectively than politicians or phy­ each other and offer mutual support in Berlin Science Centre. Both WHO's sicians. their demands for better training, but overall slogan and its regional strategy However, Mrs Beikirch would like this could also lead to a reduction to for Health for All in Europe contain a many of the Organization's arguments the "lowest common denominator". large number of "sensible thoughts", to be worded in "less abstract" terms Or Ellis Huber, chairman of the he says. He agrees that health pro­ since, she says, "my colleagues are Berlin Medical Association, considers motion should not be a matter of practical people and have not yet that Health for All is justified as a professional policy alone, that all activi­ learned much about dealing with "strategy for democratization". If you ties related to health must be coordi­ abstract concepts". Moves towards a want more health, you must get away nated with each other, that priorities frontier-free Europe in 1992 must be from "expertocracy". A far-sighted must be set, and that prevention and health policy has the task of creating cure must be seen as equally healthy living conditions and fighting important. against inequity. The home environ­ But what is the real situation today? INTRODUCTION·TO ment, working environment, reformed WHO has reported that in recent years THE WORLD HEALTH medical and social services, more inequalities with regard to disease and ORGANIZATION independence instead of dependence death have not been reduced, as had REGIONAL OFFICE for people, more "health autonomy"­ been recommended, but on the con­ such calls by WHO are far more trary have increased. Or Rosenbrock FOR EUROPE important than the introduction of blames this on the fact that little The World Health Organization's more highly specialized medical tech­ practical work towards WHO's targets Constitution took effect on 7 April nology. has been done in Germany. Politicians 1948. The Regional Office Jor "European thinking" must be like to give verbal support to WHO's Europe originated in January 1949 pushed forward in this direction, says formulations without really putting as the Special Office for Europe and Or Huber, and governments must be them into practice. In Germany, in was located in Geneva. In 1952 it reminded of their duty to bring about, particular, the health professions are became a Regional Office and was ultimately, "equity in health". If some­ transferred to Copenhagen in 1957. too resistant. "There is no powerful lt has some 270 permanent staff one says to him that WHO's slogan is health movement", he says, while members from 44 countries (com­ just a pious hope, he replies: "Only if acknowledging WHO's efforts to push plemented by tempmary consul­ you have the courage to dream do you forward the goal of Health for All by tants). who assist Member States have the strength to act". • means of top-level congresses and with expertise and technical support meetings, some of which have been In addition. more than 1000 held in Germany. But the Organization experts and scientists are involved Mr Justin Westhoff is a is not in a position to intervene in its each year in WHO meetings in freelance scientific and Europe. and many more are working Member States' social and political medical journalist; his address deliberations, and this is precisely why for WHO in the 375 collaborating centres and research institutes in the is Silingenweg 5, D - 1 000 a slogan is only as good as the Europepn Region. Berlin 19. Germany determination and vigour expressed at

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