Contemporary health policy context in Europe: some opportunities - - PowerPoint PPT Presentation

Contemporary health policy context in Europe: some

• pportunities and challenges

Dr Zsuzsanna Jakab WHO Regional Director for Europe

8 March 2017, Israel

What hat i is H Heal ealth h 2020? 2020? Heal ealth i h is a a pol political cal c choi hoice ce

• Concerted government action is needed to improve

health status and reduce inequalities.

• Action should be targeted through health determinants:

political, economic and social environments; lifestyle; environment; trade; and culture.

• These are part of other "key" ministries with wide and

different portfolios – addressing them requires a high level of commitment.

Heal ealth h 2020 and t 2020 and the he 2030 A 2030 Agenda genda

Loc Local alizat zation

• n of
• f the

he 2030 2030 Agenda genda

The he list of

• f maj

major

• r c

chal hallenge enges

Reducing existing differences in health status (leaving no one behind) Addressing the social determinants of health intersectorally Ensuring an adequate level of public funding for universal health coverage Strengthening the health system

The he list of

• f maj

major

• r c

chal hallenge enges

Reducing existing differences in health status (leaving no one behind) Addressing the social determinants of health intersectorally Ensuring an adequate level of public funding for universal health coverage Strengthening the health system

Prem emat atur ure e morta tality ity

The European Region is well on track to achieve health objectives set in Health 2020 of reducing premature mortality. The most important

• pportunities are in addressing social determinants

and risk factors and in strengthening health systems.

Health 2020 target: A 1.5% relative annual reduction in overall (four causes combined) premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases until 2020

200 400 600 800 1000 1200 2000 2005 2010 2015 2020

Deaths per 100 000 population aged 30–69 years

Minimum value European Region average Maximum value

Regi egional

• nal t

trends ends

Indicator: age-standardized mortality per 100 000 population aged 30–69 years for combined causes of death from cardiovascular disease, cancer, diabetes and chronic respiratory diseases

100 200 300 400 500 600 700 800

Switzerland Israel Sweden Norway Cyprus Luxembourg Iceland Spain France Finland Italy Malta Portugal Netherlands Austria Belgium Ireland United Kingdom Albania Germany Denmark Greece Slovenia San Marino Turkey Czech Republic Croatia Estonia European Region average Bosnia and Herzegovina Poland Slovakia Georgia Montenegro Romania Armenia Serbia Kazakhstan Lithuania MKD* Azerbaijan Latvia Hungary Bulgaria Tajikistan Uzbekistan Republic of Moldova Kyrgyzstan Belarus Ukraine Turkmenistan Russian Federation

Deaths per 100 000 population aged 30–69 years

The The lat ates est dat data f a from f four

• ur m

maj ajor

• r nonc

noncommuni nicab able di e diseas eases caus ausing g prema matu ture re m morta rtality ty

Tar arget 1.

• 1. Redu

educe pr prem emature mor

• rta

tality ty rate ate in n Eu Europe

EURO EURO EURO

EURO

Target get 2. Increas ease e life e expec pectanc ancy i in E Europe

• pe

EURO

Tar arget 3.

• 3. Redu

educe ineq equities in n Eur Europe

EURO EURO

Tar arget 4.

• 4. Enh

Enhance the the wel ell-bei being ng of the Europ

• pea

ean n popul pulat ation

• n

EURO

Ta Target 5. Un Univ ivers rsal l heal alth h cov

• verage and

and th the r right ght to hea to health

EURO EURO EURO EURO

Publ ublic heal c health h res espon ponses of ses of Israel ael

• Israel has many good public health and

intersectoral initiatives for health.

• These have been achieved through political

commitment and continuing collaboration with the public health community: a coherent approach to health as a contributor to overall development and well-being.

Reducing existing differences in health status (leaving no one behind) Addressing the social determinants of health intersectorally Ensuring an adequate level of public funding for universal health coverage Strengthening the health system

Fur urthe her ac action

• ns:

s: i in n cont

• ntinuum

nuum:

Impor mportant ant r rol

• le

e of

• f soci
• cial

al det eter ermina nants s of

• f heal

ealth

The 2020 health indicators related to social determinants of health are infant mortality, life expectancy, primary school enrolment and rate of unemployment. The distance between the highest and lowest regional values ​declined in recent years, but the absolute differences between countries are still significant.

Health 2020 objective: to reduce the gaps in health status and social determinants-related differences in European populations

The he gap has gap has been r been reduc educed ed

10 20 30 40 50 60 1990 1995 2000 2005 2010 2015 Infant deaths per 1000 live births Year

Infant mortality

Minimum value European Region Maximum value 60 65 70 75 80 85 1990 1995 2000 2005 2010 2015 Years Year

Life expectancy

Minimum value European Region Maximum value 5 10 15 20 25 1995 2000 2005 2010 2015 % Year

Primary school enrolment (non-enrolment rate)

Minimum value European Region Maximum value

Managing the social determinants of health can significantly improve the state of health

Konferencia a gyermekek egészséges környezethez való jogáról

• 2013. június 27.

In Estonia a man with a university degree aged over 25 years can live 13 years longer than less educated contemporaries.

In Italy there is a difference in life expectancy of 10 years for men between different social groups.

In Slovakia the newborn and adult mortality rate in disadvantaged regions is almost twice as higher as in developed regions. In the Netherlands the population morbidity and mortality of 25–50% could be reduced if levels of mortality and morbidity among poorly educated men were similar to those

• f graduates.

In Israel there is strong potential for leading on policy and governance for health and well-being towards managing the social determinants of health; this can significantly improve the state of health in the country.

Bui uildi ding on ng on adv advant antage ages i s in n Isr srael ael

• Strong political commitment

– Equity is enshrined in legislation – Health inequalities are high on the policy agenda

• Strong technical potential for:
• leading on policy and governance for health and well-being
• action on social determinants
• Policies and interventions have broad scope (e.g. reductions in cost-sharing, incentives

for professionals, development of service delivery)

The European Region is on track to implement the Health 2020 targets, but there are still many untapped opportunities to improve health status and reduce health inequalities.

Israel ael i is not not al alone

• ne

Reducing existing differences in health status (leaving no one behind) Addressing the social determinants of health intersectorally Ensuring an adequate level of public funding for universal health coverage Strengthening the health system

Fur urthe her ac action

• ns:

s: i in n cont

• ntinuum

nuum:

Uni niver versal al heal ealth h cover

• verage

age (UHC) C)

All people should get access to needed health services of sufficient quality to be effective (including prevention, promotion, treatment, medicine, rehabilitation and palliative care) without the risk of being exposed to financial hardship

Popul

• pulat

ation c

• n cover
• verage by

age by ins nsur uran ance does ce does not not mean mean hous househol eholds ar s are e pr prot

• tect

ected financ nancial ally

Households with catastrophic out-of- pocket payments in selected European countries where population coverage is 100%

Sources: Population coverage for selected countries in 2013 using Organisation for Economic Co-operation and Development (OECD) data; data on catastrophic

• ut-of-pocket payments for 2013 or closest year available using estimates prepared by the WHO Barcelona Office for Health Systems Strengthening

Our goal is a European Region free of an impov

• veri

erishing ng level of out-of-pocket payments

0%

Poor health High level

• f out-of-

pocket payments Poverty

Breaki eaking t ng the he vici cious c

• us cycl

ycle t e thr hrough bet

• ugh better

er heal health h financ nancing pol ng policies es

5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 Netherlands San Marino France Monaco United Kingdom Luxembourg Croatia Slovenia Germany Denmark Norway Sweden Czech Republic Andorra Austria Iceland Ireland Belgium Finland Estonia Italy Slovakia Poland Spain Hungary Switzerland Portugal Israel Malta Lithuania Greece Latvia Russian Federation Cyprus Turkey Romania Bosina & Herzegovina Belarus Turkmenistan Serbia TFYRM Republic of Moldova Kyrgyzstan Montenegro Uzbekistan Bulgaria Kazakhstan Ukraine Albania Armenia Georgia Tajikistan Azerbaijan OOPs as % of total spending on health

Out-of-pocket payments (OOPs) as a percentage of total spending on health are still very high in Israel

(high- and middle-income countries in the European Region)

* The Netherlands underestimates OOPs because it does not include the compulsory deductible paid by all adults

who use health services (a minimum of €375 per person per year) as OOP spending in national health accounts

SAFE: < 15% when the poor are protected WARNING

DANGER ZONE: > 30%

*

Source: WHO data for 2014

12.3% 10.2%

Source: WHO European Health for All database, 2013

10.2% 12.3%

Pub Public spe pending on he

• n health l

lags ags beh behind r rel elev evant Eur European compar parat ator

• r c

count untries es a and d aver erag ages es

Gi Giving ng pr prior

• rity to

to hea health in n pu public spe pending is is a a pol

• liti

tical choi hoice

Source: WHO data for 2013

The share of health spending within government budgets in the European Region (high-, upper-middle- and lower-middle-income countries)

5 10 15 20 25 Cyprus Russian Federation Latvia Hungary Israel Slovenia Poland Greece Estonia Lithuania Finland Croatia Portugal San Marino Malta Luxembourg Spain Italy Ireland Czech Republic Slovakia Sweden Belgium Iceland France Denmark United Kingdom Austria Norway Monaco Germany Netherlands Switzerland Andorra Azerbaijan Turkmenistan Montenegro Albania Turkey Kazakhstan Bulgaria Romania TFYRM Belarus Serbia Bosnia and Herzegovina Georgia Tajikistan Armenia Uzbekistan Ukraine Kyrgyzstan Republic of Moldova %

Minimum 12%

Reducing existing differences in health status (leaving no one behind) Addressing the social determinants of health intersectorally Ensuring an adequate level of public funding for universal health coverage Strengthening the health system

Fur urthe her ac action

• ns:

s: i in n cont

• ntinuum

nuum

Introduced core health system functions: governance; services delivery; financing; resource generation

2000 1978–1996

Alma-Ata Declaration; Ljubljana Conference on Reforming Health Care Tallinn Charter: health systems for health and wealth

2007 2008 2013

Strengthening people-centred health systems;

• perational approach to health system

strengthening

2020

Priority area: strengthening people-centred health systems and public health capacity

2009

WHO support to strengthening of health systems: from Alma-Ata to Health 2020

Building blocks: service delivery; health workforce; information; medical products; financing; leadership People at the centre of systems

Streng engtheni hening ng heal health h syst ystem em r res esponse ponses to

• nonc

noncomm

• mmuni

unicab cable di e disease eases ( s (NCDs CDs)

Israel ael: obes

• besity as

y as a a chal hallenge enge

Israel ael: obes

• besity as

y as an an ent entry poi y point nt…

• …for moving ahead in the WHO European Region

in intersectoral actions tackling major diseases:

– December 2011: National Programme to Promote Active, Healthy Lifestyle, an interministerial, intersectoral effort to address obesity and its contribution to the country’s burden of chronic disease – Based on evidence, initiated by professional community and supported by wide range of sectors: education, health, economy, local governments…

Huge uge potent ntial al of Israe ael for supp uppor

• rt of WHO wor
• rk with

h Mem ember Stat ates es

Leading on policy and governance for health and well-being Promoting healthy diet and regulating food safety (food labelling for health food)

iDigital health – regulation of data, innovative approaches, personally tailored medicine (genetics)

Health 2020 – social determinants of health qualitative indicators Universal health coverage and people- centred care Antimicrobial resistance in hospital care – benchmarking

Emergency

• perations

Addi ditional

• nal elemen

ents of collabor aborat ation

• n –

buildi ding ng furthe her on Israel el achi hiev evem ement ents

Health financing WHO norms, standards, guidelines and standard operating procedures Social determinants of health and intersectoral action Strengthening the use of strong information systems to tackle health inequalities

Implementation of the Health 2020 targets is on track, but there are many untapped opportunities to increase profits and reduce health inequalities. Health 2020 is a stepping stone towards the 2030 Agenda.

Without addressing social determinants it is not feasible to reduce health inequalities and to improve health and well-being. Israel could reduce the financial burden on patients through increased public spending on health for universal health coverage. Strengthening health systems ensures timely and adequate care. Further emphasis should be put on prevention, primary care and care coordination

Summary

Thank hank you! you!