EUR/00/5016447 ENGLISH ONLY UNEDITED E68404 REGIONAL OFFICE FOR EUROPE ____________________________ INVESTMENT FOR HEALTH IN ROMANIA Draft Report of an Expert Group from the WHO Regional Office for Europe and the European Committee for Health Promotion Development SCHERFIGSVEJ 8 DK-2100 COPENHAGEN Ø DENMARK TEL.: +45 39 17 17 17 TELEFAX: +45 39 17 18 18 TELEX: 12000 E-MAIL: [email protected] WEB SITE: HTTP://WWW.WHO.DK 2000 EUROPEAN HEALTH21 TARGETS 14,18,20,21 EUROPEAN HEALTH21 TARGET 14 MULTISECTORAL RESPONSIBILITY FOR HEALTH By the year 2020, all sectors should have recognized and accepted their responsibility for health EUROPEAN HEALTH21 TARGET 18 DEVELOPING HUMAN RESOURCES FOR HEALTH By the year 2010, all Member States should have ensured that health professionals and professionals in other sectors have acquired appropriate knowledge, attitudes and skills to protect and promote health EUROPEAN HEALTH21 TARGET 20 MOBILIZING PARTNERS FOR HEALTH By the year 2005, implementation of policies for health for all should engage individuals, groups and organizations throughout the public and private sectors, and civil society, in alliances and partnerships for health EUROPEAN HEALTH21 TARGET 21 POLICIES AND STRATEGIES FOR HEALTH FOR ALL By the year 2010, all Member States should have and be implementing policies for health for all at country, regional and local levels, supported by appropriate institutional infrastructures, managerial processes and innovative leadership (Adopted by the WHO Regional Committee for Europe at its forty-eighth session, Copenhagen, September 1998) ABSTRACT At the invitation of the President of the Romanian Senate and with the support of the Ministry of Health, an expert team of WHO staff and consultants carried out an assessment of Romania’s potential for investment for health with the purpose of considering the potential contribution of health – as distinct from health care services – as an essential resource for social and economic development. The Group concluded that a successful response would be possible but would require a significant advance in policy-making, policy coordination and policy implementation. This report describes the results of the appraisal and concludes with a number of recommendations for action. The work itself, and the report, are intended to be the first steps in a long-term partnership to create effective investment for health in Romania. Keywords HEALTH POLICY POLICY MAKING HEALTH PROMOTION HEALTH FOR ALL ROMANIA © World Health Organization – 1999 All rights in this document are reserved by the WHO Regional Office for Europe. The document may nevertheless be freely reviewed, abstracted, reproduced or translated into any other language (but not for sale or for use in conjunction with commercial purposes) provided that full acknowledgement is given to the source. For the use of the WHO emblem, permission must be sought from the WHO Regional Office. Any translation should include the words: The translator of this document is responsible for the accuracy of the translation. The Regional Office would appreciate receiving three copies of any translation. Any views expressed by named authors are solely the responsibility of those authors. This document was text processed in Health Documentation Services WHO Regional Office for Europe, Copenhagen CONTENTS Page Preface ...........................................................................................................................................................i Foreword......................................................................................................................................................iii 1 Summary ............................................................................................................................................... 1 2 The social, economic and health context .............................................................................................. 1 2.1 Land and people.......................................................................................................................... 1 2.2 Political context .......................................................................................................................... 2 2.3 Economic issues.......................................................................................................................... 2 2.4 Employment................................................................................................................................ 2 2.5 Social, educational and cultural issues........................................................................................ 3 2.6 Trends in life expectancy............................................................................................................ 3 2.7 Principal causes of illness and mortality..................................................................................... 3 2.8 Measures already taken to improve health.................................................................................. 4 2.9 Prospects for health..................................................................................................................... 4 3 The expert appraisal process ................................................................................................................. 5 3.1 Introduction................................................................................................................................. 5 3.2 The process in Romania.............................................................................................................. 7 3.3 The future of this draft report ..................................................................................................... 7 4 Assessment of the strengths, weaknesses, opportunities and threats with respect to promoting positive health in Romania........................................................................ 8 4.1 Key social and economic priorities............................................................................................. 8 4.2 Overall analysis of strengths, weaknesses, opportunities and threats......................................... 8 4.3 Sector by sector......................................................................................................................... 11 4.4 Structural, organizational and institutional issues .................................................................... 17 5 Recommendations............................................................................................................................... 19 6 Relationship with WHO/EURO.......................................................................................................... 23 Annex 1 The Ottawa Charter for Health Promotion................................................................................ 24 Annex 2 Terms of reference of the Expert Group................................................................................... 27 Annex 3 Membership of the Expert Group ............................................................................................. 29 Annex 4 Main documents consulted ....................................................................................................... 30 Annex 5 People interviewed in Romania, June 1999.............................................................................. 32 Acknowledgements The authors of this report would like to thank all the people who made themselves available for interviews and thus provided an essential source of information. Thanks also go to the local resource team that acted as a sounding board for the questions and ideas that arose during the process. This appraisal was made possible by a generous donation from the Swiss Federal Department of Foreign Affairs. EUR/00/5016447 page i Preface When we speak about health, we mainly understand health services. The other side of the “health” coin – prevention – is low on most of the agendas. Health itself is not valued unless it is lost and a disease occurs. We are confronted with a period of increase in the costs of medical services and of the burden of diseases overall for the whole population of our country. Although the slogan “it is cheaper to prevent than to treat” can be considered old-fashioned, we believe it is truer than ever. We need to make health education and promotion compatible with international, and especially European Union (EU), standards. Until 1990, health promotion and health education in Romania were not known under these names, being assimilated as sanitary education. There are only a few similarities between these two terms, which are still subject to annoying confusion. The beginning was made in 1948, when a sanitary education service was established in the Ministry of Health. The Sanitary Education Centre was created in 1951. Subsequently a network of 40 units specialized in planning, coordinating and control of sanitary activity was created, making Romania one of the first countries to have a state sanitary education system. The anti- epidemic action plan, the priorities for people’s sanitary education and local sanitary programmes were issued. The Scientific-Methodological Forum was set up as part of the Bucharest Institute of Hygiene in 1957. At the same time, in most non-communist countries people did not allow anyone to impose rules on them regarding their own health. In Romania, sanitary education became a working tool only for hygiene