The health for all policy framework for the WHO European Region WHO Library Cataloguing in Publication Data Health21: the health for all policy framework for the WHO European Region (European Health for All Series ; No. 6) 1.Health for all 2.Health policy 3.Health priorities 4.Regional health planning 5.Europe I.Series ISBN 92 890 1349 4 (NLM Classification: WA 540 GA1) ISSN 1012-7356 The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this Organization, which was created in 1948, the health professions of over 190 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world of a level of health that will permit them to lead a socially and economically productive life. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 870 million people living in an area stretching from Greenland in the north and the Mediterranean in the south to the Pacific shores of the Russian Federation. The European programme of WHO therefore concentrates both on the problems associated with industrial and post-industrial society and on those faced by the emerging democracies of central and eastern Europe and the former USSR. In its strategy for attaining the goal of health for all the Regional Office is arranging its activities in three main areas: lifestyles conducive to health, a healthy environment, and appropriate services for preven- tion, treatment and care. The European Region is characterized by the large number of languages spoken by its peoples, and the resulting difficulties in disseminating information to all who may need it. Applications for rights of translation of Regional Office books are therefore most welcome. European Health for All Series No. 6 The health for all policy framework for the WHO European Region World Health Organization Regional Office for Europe Copenhagen ISBN 92 890 1349 4 ISSN 1012-7356 The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and enquiries should be addressed to the Office of Publications, WHO Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen Ø, Denmark, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © World Health Organization 1999 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. 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 the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The names of countries or areas used in this publication are those that obtained at the time the original language edition of the book was prepared. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization 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. PRINTED IN DENMARK WORLD HEALTH DECLARATION Adopted by the world health community at the Fifty-first World Health Assembly, May 1998 I We, the Member States of the World Health Organization (WHO), reaffirm our commitment to the principle enunciated in its Constitution that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being; in doing so, we affirm the dignity and worth of every person, and the equal rights, equal duties and shared responsibilities of all for health. II We recognize that the improvement of the health and well-being of people is the ultimate aim of social and economic development. We are committed to the ethical concepts of equity, solidarity and social justice and to the incorporation of a gender perspective into our strategies. We emphasize the importance of reducing social and economic inequities in improving the health of the whole population. Therefore, it is imperative to pay the greatest attention to those most in need, burdened by ill-health, receiving inadequate services for health or affected by poverty. We reaffirm our will to promote health by addressing the basic determinants and prerequisites for health. We acknowledge that changes in the world health situation require that we give effect to the “Health-for-All Policy for the twenty-first century” through relevant regional and national policies and strategies.1 III We recommit ourselves to strengthening, adapting and reforming, as appropriate, our health systems, including essential public health functions and services, in order to ensure universal access to health services that are based on scientific evidence, of good quality and within affordable limits, and that are sustainable for the future. We intend to ensure the availability of the essentials of primary health care as defined in the Declaration of Alma-Ata2 and developed in the new policy. We will continue to develop health systems to respond to the current and anticipated health conditions, socioeconomic circumstances and needs of the people, communities and countries concerned, through appropriately managed public and private actions and investments for health. 1 Text not highlighted in original. 2 Adopted at the International Conference on Primary Health Care, Alma-Ata, 6–12 September 1978, and endorsed by the Thirty-second World Health Assembly in resolution WHA32.30 (May 1979). v IV We recognize that in working towards health for all, all nations, communities, families and individuals are interdependent. As a community of nations, we will act together to meet common threats to health and to promote universal well-being. V We, the Member States of the World Health Organization, hereby resolve to promote and support the rights and principles, action and responsibilities enunciated in this Declaration through concerted action, full participation and partnership, calling on all peoples and institutions to share the vision of health for all in the twenty-first century, and to endeavour in common to realize it. vi ACKNOWLEDGEMENTS The new health for all policy framework for the WHO European Region is the result of a very extensive two-year process, during which drafts of this document were reviewed and input received from Member States, WHO networks and forums, United Nations agencies, inter- national and integrational organizations, nongovernmental organizations and individual public and private sector experts. I take this opportunity to thank all those who – in many different ways and in many different capacities – contributed to the process and to the final product. J.E. Asvall WHO Regional Director for Europe vii NOTE FOR THE READER Chapter 1 The HFA vision outlines the vision, aims and key values of the policy for health for all (HFA) and sets out the major orientation of the renewed policy. Chapter 2 Ensuring equity in health through solidarity in action focuses on fostering strong solidarity in health development between Member States and greater equity in health among groups within each country. Chapters 3 and 4 set out the desired health outcome for the peoples of the Region. Chapter 3 Better health for the 870 million people of the European Region focuses on how to enable people to attain a higher level of health sustained over life; and Chapter 4 Preventing and controlling disease and injury suggests strategies to reduce the incidence, prevalence and impact of specific diseases and other causes of ill health. Chapters 5 and 6 identify the range of strategies and actions to reach the overall goal of HFA. Chapter 5 Multisectoral strategies for creating sustainable health focuses on generating action from many sectors to ensure more health-promoting physical, economic, social and cultural environments for people; and Chapter 6 An outcome-oriented health sector on orienting the health sector to promote better health gain, equity and cost–effectiveness. Chapter 7 Policies and mechanisms for managing change proposes ways of mobilizing political, professional and public support for HFA at all levels. It aims to create a broad societal movement for health through innovative partnerships, unifying policies, and a health development process that is tailored to the new realities of the European Region. Chapter 8 HEALTH21 – a new opportunity for action contains the concluding comments and looks to the challenge ahead. viii CONTENTS Page World Health Declaration .............................................................................................................. v Acknowledgements ...................................................................................................................... vii Note for the reader ....................................................................................................................... viii Chapter 1 The HFA vision .........................................................................................................