Rede – Der Lebensverlaufansatz: von der Erkenntnis zur Handlung

Dr Zsuzsanna Jakab, WHO Regional Director for Europe

21 October 2015, Minsk, Belarus

Your Excellency, Vice Prime Minister, Ministers, Excellencies, Ladies and Gentlemen, welcome in Minsk at the occasion of the WHO European Ministerial Conference on the Life-course Approach in the Context of Health 2020. Special welcome to the representatives of our partner organizations, the UNICEF Regional Director and Deputy Director of the UNFPA Regional Office.

First of all I would like to thank Belarus for hosting this important Ministerial Conference in the wonderful city of Minsk.

A month ago during the 65th Regional Committee meeting in Vilnius it was confirmed that the strategic directions of Health 2020 remain central to improving health outcomes and reducing health inequalities.

This Ministerial Conference on Life-course Approach to Health is the first high level meeting linking Health 2020 with the newly adopted Sustainable Development Goals.

Achieving the Sustainable Development Goals by 2030 is critical to health and health equity taking into account that most of the 17 goals are in fact social, economic and environmental determinants of health. These goals set an ambitious agenda that addresses poverty, nutrition and food security, education, gender equality, water and sanitation, energy, sustainable economic growth, decent work, safe and resilient cities, climate change, and peaceful and inclusive societies. We cannot succeed in these ambitions unless we take a truly lifelong perspective on their solutions, the very theme of this Conference.

Health is a precondition and an indicator for sustainable development. Being specifically spelled out in Goal 3 "Good health and well-being for all at all ages", health is integrated to many adopted 153 targets. 

Actions to promote equity throughout the life-course

Reliance on policies that address specific groups of diseases or narrowly-defined stages of life will not be enough to reduce inequalities.

Health and inequalities accumulate over the life-course, and their benefits and deficits transfer across generations.

What a child experiences in early years has consequences later on: in learning capacity, educational achievement, in economic and social positioning, and health. Investment in the early stages of life has shown to yield high returns in economic, social, and health terms. This is particularly true for the less advantaged.

Act early

The earliest years of life set the tone for the whole of the lifespan.

Maternal nutritional status during foetal development and infancy influences growth and development of the child and later susceptibility to chronic disease. Exclusive breastfeeding helps protect mother and child throughout their lives from multiple forms of malnutrition and diseases.

Being born in a poor household can pose multiple risks that lead to disability or premature death. These risks include exposure to maltreatment, abuse, and family dysfunction. They include inadequate stimulation, parental ill-health and poor nutrition. They may lead to exposure to early infections and poor child health.

Already by the age of 7 the negative effects on cognitive performance are visible among children born to families experiencing the risk factors associated with poverty such as damp housing, low income and poor neighborhood conditions. Ministers of Health have a role in advocating for social policies that provide income protection, adequate benefits and progressive taxation to reduce child poverty.

Immunization is a core component of the human right to health. Protected against vaccine preventable diseases and their sequelae, children and adolescents have the opportunity to thrive and a better chance of realizing their full potential. Immunization also protects them throughout life against long-term consequences of infections, such as cancers and liver cirrhosis. 

Despite comparatively high vaccination coverage in the European Region, significant outbreaks were reported in 2013 and 2014. National immunization programmes are to adapt to the changing dynamic of outbreaks – addressing older populations with vaccines traditionally used to target children. New vaccines that have become available in the last decade and are introduced in many countries of the Region effectively control diseases not only in infants but are also beneficial for adults (for example, pneumococcal conjugate vaccine, vaccines against human papilloma virus, and influenza).

A healthy environment is the foundation of a healthy life-course. A child born in a family that lives near a toxic waste dump will receive damaging environmental insults at conception, during uterine life, at birth and will be more likely to continue a trajectory of hazardous life through all its stages and transitions. It is squarely a government and societal responsibility to take action in protecting future parents and their children from exposure to environmental hazards in the occupational and living environment.

Policies of universal access to good-quality early years of education are of high importance. Children who have access to education at early years have better outcomes at school and lead healthier lives in adulthood. The returns on education for disadvantaged children tend to be even greater.

Maltreatment and other adverse experiences in childhood cause toxic stress and affect brain development. This leads to cognitive impairment, health harming behaviours, which in turn over the life-course may lead to mental ill health, suicide, non-communicable diseases and may turn the victim of violence into a perpetrator. The health sector has a lead role to play along with welfare and education in supporting parents to foster nurturing relationships with their children.

Acting appropriately during life's transitions

Timely action to protect health during life's many transitions reaps dividends down the line.

A prerequisite for successful parenting is health literacy of future parents that starts in family and school and continues later in parenting programmes, through public information portals and other means.

School-aged children are vulnerable and can benefit hugely from health-promoting environments. School settings provide a unique opportunity to set children on a trajectory to good health. There is evidence on successful approaches to promoting healthy diets and physical activity in schools. We need to use this experience for the sake of our children and grandchildren.

Investing in safe schools programmes protects children from physical, emotional or cyber bullying, and leads to health gain and better educational outcomes and societal achievement. Childhood and adolescence are critical times to act and such interventions help to break the cycle of violence and injustice.

Health education including comprehensive sexuality education enhances human development, challenges damaging gender norms, and decreases the risks of sexual and reproductive ill-health.

Adolescence is a period of risk taking. Some of the effects of unsafe behaviour are visible in the short term but may have consequences for the rest of life. For eating habits and tobacco use the effects on health accumulate over time and can cause serious health problems after decades.

Stopping children from starting to smoke and being exposed to tobacco smoke is crucial from an early stage in their lives. Concentrated efforts of the educational environment and family setting have to play together and be mutually supportive. 

An effective approach requires:

1. high prices of tobacco that make tobacco products less affordable to children and youth
2. no smoking in ANY enclosed public place (schools ,space outside schools, and public transport) but also in some outdoor areas such as playgrounds and parks. Leading countries also ban smoking in private cars in the presence of children and youth under 18 years of age
3. banning of all tobacco related advertising, promotion and sponsorship 
4. large and strong pictorial warnings on tobacco products 
5. awareness about the health consequences of tobacco.

The effects of alcohol are devastating for the lives of many throughout Europe. There is evidence that alcohol use is slowly declining in Europe as a whole but the levels are still so high in many countries as to constitute a public health emergency. There is an unacceptably high level of alcohol use among young people. And there is close correlation between alcohol use and deaths during working age -- a double impact on the economy and on affected households. Only a concerted effort to control affordability, marketing, and selling of alcohol can rein in this problem.

The effects of being out of work can be long-lasting. Active labor market policies including those which include employment mentoring, apprenticeships program, training and opportunities for ongoing education and skills development are important to minimizing the health and exclusion consequences faced by people at risk of or already experiencing unemployment.

Mental wellbeing and mental disorders are associated with socio-economic and material determinants throughout life, so inter-sectoral interventions are required throughout the lifespan.

There are many opportunities for public-health actions across the life-course to foster healthy ageing. A person's intrinsic capacity has many determinants over their life span. Decline in intrinsic capacity, however, does not need to translate into a parallel decline of functional capacity and loss of independence, if adequate compensatory and supportive action is provided. In a life-course perspective there are many opportunities for intervening early, and at critical life events to prevent functional decline.

Health systems need further adaptations in order to remove barriers of access to good quality health and social care services, including an integrated system for long-term care. Healthy ageing requires strong reductions in health inequalities.

Acting together

No life is lived alone, and promoting health across the life course requires collective solutions, involving actions by the whole of society: all sectors of government, academia, civil society, the private sector, and the media.

Building an active environment requires close collaboration of the health sector with transport, urban planning and employment sectors to create environments more conducive to physical activity as part of everyday life for all.

Although many of the policies that have impact on the environment are determined by other sectors, such as industry, transport, energy, environment, housing, food and agriculture, the health sector has a key role to play and a responsibility to address environmental determinants within the public health context.

In our Region, the European Environment and Health Process already provides the institutional and policy framework for ministries of health to address the environmental determinants of health in partnership with the environment sector. Embracing the life-course approach implies redoubling the efforts already underway under this framework to address environmental hazards to health.

Importantly, the health sector can promote highly effective intersectoral action by supporting and advocating the ratification and implementation of relevant multilateral environmental agreements, whose provisions can be harnessed to address environmental along with other determinants of health throughout the life-course.

They are powerful policy tools for steering change and addressing inequalities in exposure to pollutants and can have important impacts on sectoral policies in the environment, transport and energy sectors, as well as in agriculture and industry.

Thirty million people in twenty countries of our Region live in 170 cities committed to age-friendly environment. What a great example! Should we not all live in environments that are age-friendly?

There are good examples of efficient networks in our Region. The life-course approach as one of the four priority areas for policy action has been on the agenda of the meetings of the Small-countries initiative and the South-eastern Europe Health Network and has resulted in well- defined calls for action.

Adopting a life-course approach calls on all health system functions, recognizing their inherently dynamic, and interdependent nature, to set the conditions 'below the surface' so to speak, as we transform health services delivery towards more integrated care. Ensuring the system is rooted to respond to an individual's needs, while also working to empower them to make decisions around their own health and well-being, are vital for the sustainability and long-term outcomes in strengthening health systems to be more people-centred. 

Getting there requires moving along the path towards universal health coverage, empowering people to make decisions around their own health and wellbeing, designing flexible models of care, organizing competent providers to increase coordination of services and continuously improving performance in the management of health and social services to achieve higher quality and safety for people. In this perspective, health systems constitute the natural platform for bringing knowledge and innovation to the service of early and joint actions embedded in a life-course approach.

Countries can monitor trends in health issues and measure impacts. For example, regular monitoring of child and adolescent obesity via surveys helps to identify signs of change over time, pinpoints critical transitions, and reinforces the case for sustained action.

We all agree that monitoring and evaluation of policies is key to their implementation. Such an approach is a measure of our commitment and accountability to the principles of life-course; but we need to ensure that monitoring is conducted in a harmonized way across the European Region. We should report using our regional platforms and web-portals and do so with regularity.

In this ministerial conference, we are challenged to start a new European process to systematically work through the determinants of health across the life-course and to identify those that have the greatest benefit further along in life -- both to the improvement of public health but also to the sustainable advancement of human development in Europe. Let us renew our commitment to the health of this generation and of those yet to come.