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Better Health for Europe: More Equitable and Sustainable Better Health for Europe: more equitable and sustainable S SDG RK 13 F WO E O M 0 M H 202 RA LT G EA O H R P L A R E N E G Transformational Reflections 2010–2020 Better Health for Europe: more equitable and sustainable S SDG RK 13 F WO E O M 0 M H 202 RA LT G EA O H R P L A R E N E G Transformational Reflections 2010–2020 September 2019 Abstract Better Health for Europe: more equitable and sustainable, tells the story of how people working for WHO in the European Region have sought to make a reality of this goal over the last ten years. Zsuzsanna Jakab, WHO Regional Director for Europe from 2010 until 2020, narrates the story on behalf of all staff and describes the vision, strategic thinking and processes followed, as well as the impact achieved. Political leaders, public health managers and health practitioners and advocates from across the WHO European Region and beyond were invited to reflect upon the relevance and utility of the work of the Regional Office. Extracts from interviews with these ‘witnesses’ are presented throughout the book to enrich the narrative. This book is divided into three parts. Part I – Better Health for Europe: the seven strategic action priorities, presents the systematic process the Regional Office has followed in developing the policy frameworks, evidence base, capacities, relationships, partnerships, networks and skills needed to transform and enhance action for better, more equitable and sustainable health and well-being in Europe and beyond. Part II – Better Health for Europe: achievements, describes outcomes and the impacts of Regional Office work on the two objectives and four priority actions of the Health 2020 European policy framework. Part III – Better Health for Europe: conclusions and messages, summarizes reflections and looks at challenges beyond 2020. ISBN 9789289054225 Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office website (http://www.euro.who.int/pubrequest). © World Health Organization 2019 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo ). Under the terms of this licence, you may copy, redistribute and adapt the work for noncommercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Better Health for Europe: More Equitable and Sustainable. Copenhagen: WHO Regional Office for Europe; 2019. Copenhagen: WHO Regional Office for Europe. License: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. The witnesses alone are responsible for the view’s expressed in this publication and they do not necessarily represent the decisions or the policies of the World Health Organization. 2 WHO Regional Office for Europe 2010–2020 Contents Acknowledgements vii Acronyms and Abbreviations ix Foreword xiii Part I – Better Health for Europe: the seven strategic action priorities 2 Prologue – Voices from across the European Region and beyond 4 1. The vision and the context 9 Summary reflection 17 1.1 Global and Regional health context 18 1.1.1 Complex health challenges 18 1.1.2 The relative wealth and health of the WHO European Region 20 1.1.3 The persistence of health inequities 21 1.1.4 The rapid growth of knowledge and technologies 23 1.1.5 New sustainable development narrative 24 1.1.6 Twenty-first century public health challenges across the WHO European Region 25 Summary reflection 29 1.2 Historical WHO context 30 1.2.1 WHO constitution and global structures 30 1.2.2 The WHO Regional Office for Europe 1948–2010 33 Summary reflection 54 2. Health 2020 – developing the policy and its evidence base 57 2.1 Co-creation of the European health policy framework 57 2.2 The Review of social determinants and the health divide in the WHO European Region 70 2.2.1 Governance for health studies 74 2.2.2 Economic studies 76 2.2.3 Environmental determinants 79 2.3 The European Action Plan for Strengthening Public Health Capacities and Services 81 2.4 New tools and approaches to support Member States 85 2.4.1 Implementation package 85 2.4.2 Building intersectoral support 87 iii 2.5 Aligning national policies, strategies and implementation plans with Health 2020 89 2.6 Aligning Regional strategies with Health 2020 94 2.7 SDGs and Health 2020 103 2.8 The Thirteenth General Programme of Work (GPW13) 110 Summary reflection 111 3. Improved governance in the WHO European Region and in the Regional Office 113 Summary reflection 117 4. Strengthening collaboration with Member States 119 4.1 Collaborative agreements with countries and country offices 126 4.2 Geographically dispersed offices (GDOs) 134 Summary reflection 141 5. Strategic partnerships 143 5.1 The United Nations 143 5.2 Global health partnerships 148 5.3 The European Union 152 5.4 Non-State actors 157 5.5 Networks 159 5.6 ‘Hosted partnership’ 170 Summary reflection 172 6. Strengthening the European contribution to global health 173 6.1 Global Policy Group (GPG) 173 6.2 WHO Reform and Transformation 175 6.3 Health 2020, the United Nations 2030 Agenda for Sustainable Development and the SDG global narrative 176 6.4 Identifying and championing new initiatives and approaches 178 6.4.1 Case study: migration and health 179 Summary reflection 189 7. Reaching out through information and communication 191 7.1 Information 191 7.2 Communication 201 7.3 Emergency risk communication (ERC) 205 Summary reflection 207 iv WHO Regional Office for Europe 2010–2020 8. Creating a positive working environment 209 8.1 Positive working environment 209 8.2 Internalizing Health 2020 210 8.3 Sustainable financing 211 Summary reflection 213 Part II – Better Health for Europe: achievements 214 9. Health 2020 – Addressing objectives and priority health areas 217 9.1 Objective 1 – Improving health for all and reducing the health divide 217 9.2 Objective 2 – Strengthen leadership and participatory governance for health 221 9.2.1 Leadership 221 9.2.2 Governance 224 9.3 Technical work in the four action areas of Health 2020 227 9.3.1 Investing in health through a life-course approach and empowering people 227 9.3.1.1 Maternal and child health 228 9.3.1.2 Ageing 232 9.3.2 Tackling the European Region’s major health challenges– NCDs 234 9.3.2.1 Tobacco 239 9.3.2.2 Alcohol 243 9.3.2.3 Diet, overweight and obesity 245 9.3.2.4 Physical inactivity 246 9.3.2.5 Mental health 248 9.3.2.6 Injuries and violence 250 9.3.3 Tackling the European Region’s major health challenges – communicable diseases 251 9.3.3.1 Tuberculosis 251 9.3.3.2 The HIV epidemic 255 9.3.3.3 Viral hepatitis 256 9.3.3.4 Antimicrobial resistance (AMR) 257 9.3.3.5 Vaccine preventable diseases 259 9.3.3.6 Vaccine hesitancy 263 9.3.3.7 Polio,
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