Tuesday, 13 September 2011

Health 2020. WHO EURO meeting, first day

I am in Baku, Azerbaijan, to attend the 61st regional commitee of the WHO European region as a representative of the Medicus Mundi International Network. This year two essential topics (amongst others) are debated by the member states. Firstly, the strategic development of Health 2020, an overall European health strategy to reduce health inequities within the region by 2020. Secondly, the European perspective on an upcoming WHO reform.

On the first day, a ministerial interactive panel was held to debate the Health 2020 strategy. The strategy is informed by several studies. One is the study Governance for health in the 21st century. A second study is the so called Marmot review, the Interim second report on social determinants of health and the health divide in the WHO European Region.

The panel was facilitated by Mihaly Kokeny, former minister of Health of Hungary and former chair of the WHO Executive board. Ilona Kickbush from the Geneva Graduate institute initiated the debate by explaining there are two aspects of governnance to be considered:
  1. Governance within the (global) health system; and
  2. Urgent needed governance for health that extends to other sectors and external actors (so called "whole-of- government" and "whole-of-society" approach).
Interestingly, but maybe not not surprisingly, countries like Sweden, Russia, Letvia and Poland explained the scope of their national health strategies, how to reach universal coverage, the impact of the economic crises, NCD's and demographic shifts (like the aging population).

They explained hence mainly the governance within the health system and not so much the relation with other sectors needed for policy coherence (Seeing health not only as addressing diseases but contributing to improved human wellbeing).

The Netherlands delegation reacted on the panel by announcing that Ministries of Health cannot be solely responsible for a whole-of-government approach. MoH should be responsible for accessible and affordable health services and programs, and work within their competencies.

They are cautious moving forward in intersectoral programs that are not evidence-based or cost efftective. With that statement they requested to amend the draft resolution on European health 2020 by canceling the resolution paragraphs on a whole-of-society and whole-of-governance approach (par 4), the report as an overall frame work (par 5-6) and all acts of paragraph 8 on health inequities. Instead it was proposed to further pursue consultations with member states, develop evidence based tools, and best practices. This amendment was supported by most Western-European and Scandinavian countries, except the UK. It demonstrates that these countries have cold feet engaging the health ministries with wider national socio-economic policies. There are worries that this wider public health approach, in contrast to a narrower health services approach, will require (financial) committents that most ministries are not yet willing to make.

The discussion on health inequities and social determinants of health as basis for healt 2020 will continue the second day. What remains in the air is the governance for health question. How should member states and WHO address health in wider context, recognising that most determinants of health (85%) have their origin outside the health sector? This is a crucial question in global health now inequalities in health within and between countries are on the increase. Food for further thoughts and debate.

Remco van de Pas, Wemos

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