Opening address by Zsuzsanna Jakab, WHO Regional Director for Europe

15-09-2014

Mr President, Your Royal Highness Crown Princess Mary of Denmark, Madam Director-General, First lady of Estonia, excellencies, ministers, partners, ladies and gentlemen,

It is a real honour to welcome you and address you once more at this 64th session of the Regional Committee, and to welcome you to our new premises for the Regional Office.

As you may recall, my vision in 2010 was rooted in the WHO Constitution and the attainment of the highest standard of health as a fundamental human right. At the 2010 session of the Regional Committee, I committed for "better health for Europe".

I presented seven strategic priorities for action to achieve this, which form the basis of accountability for progress.

As we know, health outcomes in the European Region have significantly improved in the Region in the last decades. Overall life expectancy increased by 5 years. But not everybody benefited equally, and health inequities continue to scar the Region.

Today, noncommunicable diseases – with their associated social, behavioural and environmental determinants – account for the largest share of the burden of disease.

In addition, our Region has seen profound economic recession and austerity over the last five years, resulting in reduced public health functions and poorer access to health services.

Responding to these challenges requires new thinking. As we face the future, health must be higher on the political agenda.

That is why we initiated the process of developing Health 2020.

Together with you, the policy environment in the WHO European Region has been fully renewed in the last five years and implementation of your decisions is under way.

Now Health 2020 acts as our unifying policy framework. It sets the strategic directions and guiding values to improve health and to reduce health inequities. It includes four policy priority areas for action.

It recognizes the key role of the social determinants of health and the need to move beyond curative services to a whole-of-government and whole-of-society response.

There is a an increasing momentum to implement Health 2020 and many Member States are taking up the challenge. We made every effort to assist countries, in the context of their own situations and priorities, in making the necessary arrangements for coordinated and integrated delivery.

This work is closely aligned with the post-2015 development agenda and will also feed into the development of the United Nations development assistance frameworks at the country level.
Public health is at the heart of Health 2020 implementation. Inequalities in the burden of disease in our Region demonstrate that there is still a huge potential for health gains.

These can be achieved through prevention, health promotion and appropriate management of diseases.
We must invest in highly cost-effective public health interventions, such as evidence-based fiscal policies, comprehensive prevention and health promotion packages, action on the social determinants of health and new forms of governance. These investments must be made both within health systems, to integrate essential public health functions, as well as at population level, through multisectoral approaches.

This reorientation is the essence of Health 2020, which requires three main elements to be successful, as you can see on the slide.

The conditions for moving towards Health 2020 require strong political commitment from governments and strong leadership from health ministers and public health institutes.

Over the next five years, WHO is committed to supporting you in developing, implementing and aligning national health policies, working with other sectors, delivering high-quality and effective health care services and strengthening public health services and capacities.

The Health 2020 targets and the monitoring framework will be the tool to measure progress and ensure accountability.

The next five years will be about consolidation and full implementation of our commitments. What we want to achieve is more equity in health and closer links between health and sustainable development.
Our aim will be "better health for Europe: more equitable and sustainable".

I will present our Health 2020 implementation package tomorrow, so I have kept this part of my speech short, to allow more time now for the priority action areas.

I will now focus on our achievements in the priority areas and also elaborate on the way forward.

The details are in the biennial report for 2012–2013, as well as in the report on the main achievements of the last five years.

Ladies and gentlemen, improving health and health equity requires an effective life-course approach.

Actions to promote and protect health at all stages of life have been strengthened considerably in the last five years.

Evidence demonstrates the need to focus on early childhood development and the integration between health and social welfare. This requires multisectoral collaboration, especially with sectors such as education, social policy and employment, and we will discuss this at the ministerial lunch tomorrow.

Policy briefs are also being developed for collaboration with other sectors, and we will present an example from the education sector at the ministerial lunch. We also plan to organize a ministerial conference on the life-course in 2015.

Accelerating progress towards the health-related Millennium Development Goals (MDGs) has been a key focus of our work, and this work will continue on the unfinished agenda. The post-2015 development agenda will augment this work, and give it new energy in the years to come.

We have been actively involved in the process of setting this agenda, engaging with all stakeholders. As outlined in the regional consultation in Turkey, Health 2020 will set the ground for implementing this new vision in the Region. We will have the opportunity to discuss this further during the ministerial lunch today.

In child and adolescent health, the Region made substantial progress, but huge discrepancies still exist.

Member States introduced comprehensive polices and improved the quality of care. The results are obvious, such as the decrease in under-5 mortality to 36 per thousand live births in the Caucasus and central Asia in 2012.

The renewed strategy on child and adolescent health is an excellent vehicle for identifying priority actions and it will be presented to you on Wednesday.

The European report on preventing child maltreatment forms the basis for the action plan for prevention and we will have the opportunity to discuss it on Wednesday.

Another area where we observe good progress is maternal health. The maternal mortality ratio decreased to 17 maternal deaths per 100 000 live births in 2013. The countries of eastern and central Europe benefited most from the implementation of the Effective Perinatal Care and "Beyond the Numbers" initiatives.

The introduction of modern, effective contraception and the promotion of sexuality education contributed to the reduction of unintended pregnancies. Sexual and reproductive health and rights will be an area where we will put more emphasis in the future.
Noncommunicable diseases (NCDs) are the main cause of the disease burden, yet some 80% of premature mortality is considered to be preventable.
While implementing the European action plan on NCDs, we focused on strengthening intersectoral policies and strategies in line with the Global Action Plan and Health 2020.

These efforts have already started to show visible results. The number of Member States with national integrated NCD policies has grown substantially. Countries also strengthened their monitoring systems by adapting the global monitoring framework to their national context.

Overall mortality from NCDs shows a downward trend and premature mortality from cardiovascular diseases is generally decreasing across the Region.

As demonstrated in this slide, the chances of dying from heart disease or stroke before the age of 64 have been declining since 2000 in all parts of the Region: something to be proud of. But the huge disparities between countries need to be addressed.

In 2013, you endorsed the Ashgabat Declaration on the Prevention and Control of Noncommunicable Diseases, in Turkmenistan. We will hear more about this on Wednesday. Taking this opportunity, I would like to thank, through the Minister of Health, the President of Turkmenistan for hosting this important conference.

There is now a strong economic case for action to promote health and prevent disease.

Evidence shows that investment in prevention brings returns in the short and medium terms, not only the long term. This makes such investment more attractive to policy-makers.

Looking, for example, at coronary heart diseases, between 50–75% of the recent decline in deaths is attributable to prevention by addressing risk factors. And medical treatment contributes approximately 25–50%.

Nevertheless, governments spend, at best, only a small fraction of their health budgets on prevention.
Equally high priority needs to be given to the management of NCDs.

Multidisciplinary assessments identified the needs for: universal access to essential medicines for hypertension, diabetes and cancer; better utilization of services; higher rates of cardiovascular risk assessment; and appropriate use of cancer screening.
These are significant concerns that require concerted public health approaches in the next five years.

Addressing risk factors remains a priority. In recent years, we have renewed our strategies and action plans, as required.

The successful conference in Vienna guided our work and as agreed, we developed the European Food and Nutrition Action Plan. It includes a set of priority actions to address major diet-related problems and will be further discussed on Wednesday.

A conference in Uzbekistan earlier this year promoted intersectoral discussions on diet, nutrition, food safety and security.

It is worth noting that, as a result of policy actions taken by several countries, important progress has been achieved, notably a significant reduction in salt consumption.

Furthermore, we are working on an action plan for physical activity, as requested in the Vienna Declaration, which we will present to the Regional Committee next year.

While our Region has the highest number of Parties to the WHO Framework Convention on Tobacco Control (FCTC) (50 out of 53), unfortunately it also has the highest rate of adult smoking. That is why reducing tobacco use is among our priorities, and many Member States are implementing exemplary initiatives.

Tomorrow, with the Director-General, we will present WHO World No Tobacco Day awards to some Member States in our Region, as recognition of their leadership and commitment.

The new European Union Tobacco Products Directive is a major step forward in tobacco control and WHO is committed to supporting its implementation.

The Protocol to Eliminate Illicit Trade in Tobacco Products is an excellent vehicle to tackle cross-border illicit trade, and I encourage you all to ratify it.

I believe that the global target – a 30% reduction in tobacco use by 2025 in Europe – is realistic.

Moreover, I share your ambition to work towards a tobacco-free Region, as expressed in the Ashgabat Declaration.

I am committed to accelerating our support for action, and plan to bring an action plan on tobacco, in support of FCTC implementation, to your attention next year.

Ladies and gentlemen, now let me concentrate on communicable diseases. While the Region reinforced its response, unfinished business remains and new challenges are emerging.

With an estimated 350 000 new cases every year and the highest rates of multidrug-resistant tuberculosis in the world, combating tuberculosis remains a priority in the Region.

With your commitment and the support of our partners, implementation of the European Action Plan is showing tangible results. Now more than half of estimated cases are detected. And the treatment-enrolment rate increased to 96% in 2013, a major success just within a year.

However, the treatment-success rate is less satisfactory, mostly due to health-system challenges and lack of new effective medicines.

We should aim to eliminate tuberculosis in our lifetimes. To achieve this, we need political and scientific commitment.

Action is needed to address the social determinants of health and to ensure equal access to quality care for all patients.

In HIV/AIDS, joint efforts with our partners in implementing the European Action Plan are also leading to progress.

HIV testing and counselling services are now increasingly available. Good progress has been made towards eliminating mother-to-child transmission. Now more people in the Region are on antiretroviral treatment, which is also important for prevention.
Even though treatment coverage in the east increased significantly (by 52%), it is still low.

And despite all the efforts, we have not yet succeeded in curbing the epidemic. HIV cases have continued to increase by 7% since 2010. Treatment is not keeping pace with the number of HIV infections. And the epidemic remains concentrated in key populations, who are facing structural barriers to accessing services.

We need to scale up targeted interventions.

Evidence-based policies, especially for key populations, including harm reduction for injecting drug users, should be fully implemented in all countries.

We had another excellent HIV/AIDS conference in Moscow this year. I am pleased to inform you that we, with the Minister of Health of the Russian Federation, agreed to establish a joint working group. The group is reviewing the evidence on harm-reduction strategies, which might lead to a change in strategic approaches.

We will have the opportunity to discuss this in more detail on Thursday.

Much progress has been made against antimicrobial resistance since the adoption of the European action plan, using a "One Health" approach.

We have focused on supporting countries in building capacity, providing reliable diagnostics, performing national surveillance, running infection-control programmes, implementing policies for the prudent use of antibiotics and establishing multisectoral coordination mechanisms.

For the first time, we now have data on antimicrobial resistance and antibiotic consumption in a number of countries outside the European Union.

We continue to collaborate with the European Centre for Disease Prevention and Control (ECDC) in expanding the European Antibiotic Awareness Day throughout the whole Region.

You will find details on the implementation of the European strategic action plan on antibiotic resistance in the progress report, which is on the agenda on Thursday.

Antimicrobial resistance is now considered as a serious threat to global public health and European Member States played a crucial role in these efforts. We will discuss how to proceed in developing a global action plan on Thursday.

Let me congratulate the Netherlands for the successful meeting on "One Health" aspects of antimicrobial resistance in June, appreciate the leadership of Norway, Sweden and the United Kingdom, which will host similar events later this year, and the leadership of Denmark during its Presidency of the European Union.

Great advances have been made in immunization. Well functioning immunization programmes with high coverage and the introduction of new vaccines saved many lives. But we need to keep up the pace at this critical point. We need to address such challenges as vaccine refusal and reaching high-risk groups.
As requested, we developed the European Vaccine Action Plan, which will be presented to you on Wednesday.

I take this opportunity to thank Her Royal Highness Crown Princess Mary of Denmark for her advocacy for maternal and child health and for her continuous support for the European Immunization Week. I am looking forward to our trip to Tajikistan and I am honoured to accompany you.

Despite progress towards measles and rubella elimination goal by 2015, the region is seriously under threat due to outbreaks and continued transmission.
Now, more than ever, we need stronger political commitment to implement the "package of accelerated action", while continuing to build strong partnerships.

Even though the risk of poliomyelitis (polio) transmission remains low in the Region, we must remain vigilant, ensuring high-quality surveillance and high population immunity.

After declaring polio as a public health emergency of international concern, we are ready to work with Member States and partners to support implementation of the temporary recommendations. You will hear more about this and the Polio Endgame on Thursday.

Malaria elimination by 2015 in the Region is now within reach, with only 37 cases in 2013, reported from only two countries.

A number of countries have now started implementing the framework on vector-borne diseases, after its endorsement by the Regional Committee.

Ladies and gentlemen, let me now focus on another important area; health security.

The Director-General recently declared two public health emergencies of international concern: the international spread of wild poliovirus in May, and the Ebola outbreak in West Africa in August.

The Ebola outbreak is raising concerns, as the numbers of cases and deaths are increasing. The Regional Office is supporting global response efforts. So far we have deployed three staff, including the Director of our Division of Communicable Diseases, who has extensive experience in managing similar outbreaks. Another 23 staff are preparing for future deployment.

WHO issued a roadmap to guide and coordinate the international response to the outbreak, and I call upon you all to support us. You will hear more about these from the Director-General during her speech tomorrow and also on Thursday.

In addition, several natural disasters and conflicts resulting in humanitarian crises happened during the past 12 months.

These include the severe flooding in the Balkans, especially affecting Bosnia and Herzegovina, Croatia and Serbia.

The conflict in the Syrian Arab Republic continues to have direct spill-over effects on the Region, especially in southern Turkey.

I thank the Government of Turkey for its outstanding support during the polio immunization campaigns in Syrian Arab Republic, allowing more than 1 million additional children to be reached. In addition, the support they provide to refugees is exemplary.

We joined United Nations interagency efforts providing cross-border assistance, a work closely coordinated with the WHO Regional Office for the Eastern Mediterranean and headquarters. We are now scaling up our presence in southern Turkey to increase response capacity.

We scaled up our operations to respond to the humanitarian crisis in Ukraine, supporting the Ministry of Health and local administrations in filling the gaps in the health response to internally displaced persons and affected communities.

WHO provides leadership, coordination and support to the health sector's national and international partners. After the successful donor meeting in Geneva last week, we hope to be able to accelerate our support.

We also contributed to other global crisis by deploying our staff to various emergency response operations.
All these events represent a significant challenge.
We are committed to continuing to support Member States in preparing for and responding to all public health threats and emergencies, taking a multihazard and multisectoral approach.

In this regard, the International Health Regulations (IHR) provide an excellent legal framework.

This summer marked an important benchmark for the IHR, when the first two-year extension for building core capacities came to a close in June 2014. We will seek your input to the proposed global coordination mechanism with regional representation, which will be discussed on Thursday.

Ladies and gentlemen, now let me move to another equally significant area: strengthening health systems.

Work with countries undertaken over the last five years was substantial and focused firmly on health outcomes, and not just on system changes.
Implementation of Tallinn Charter continued at full speed.

Marking the fifth anniversary of the Charter, a high-level meeting was convened in Estonia last year.

It provided a unique platform to expand new frontiers, to improve population health and to agree on our future direction: weaving together the commitments of the Tallinn Charter, Health 2020 and moving towards universal health coverage. You will hear more about the outcome of the meeting on Tuesday.

We will present the final report on implementation of the Tallinn Charter to the Regional Committee next year, with our proposals for overall health-system strengthening, emphasizing public health approach and multisectoral approaches.

As part of the Tallinn process, we continue working on coordinated, integrated health-service delivery towards people-centred health care, along with the approach to tighten the link between health gains and health-system strengthening, which is already showing tangible results.

The 35th anniversary of the Declaration of Alma-Ata in Kazakhstan last year, provided an excellent opportunity for renewing the vision of primary health care. It is at the centre of our work providing coordinated and integrated services, with links to hospitals and with social and long-term people-centred care.

Another area which we have intensively supported Member States is articulating the consequences of the economic crisis on health.

Guiding this work are the 10 key policy lessons and recommendations that came out of the high-level meeting in Oslo.

These recommendations have already proved themselves a powerful tool for ministers of health in their dialogue with ministers of finance and prime ministers.

Finally, a key strategic focus is universal health coverage, which guides our work to strengthen health systems in the context of Health 2020.

Universal health coverage promotes equity of both access and outcomes, and helps to reduce inequities. It is important to ensuring long-term sustainability while providing financial protection, and this will be a major focus in the years to come.

In addition, annual flagship courses are increasingly recognized as a key support to Member States.
The courses address various important areas, combining a comprehensive approach to health systems and financing, supporting Member States moving towards universal health coverage.

We have also responded to an increasing number of requests from Member States to support system-wide health care reforms, and the transformation towards sustainable and resilient health systems.

The focus was specifically on people- centred service-delivery models aligned with financial policies, improved efficiency in health systems, greater investment in public health and movement towards universal health coverage.

We have continuously improved the Regional Office's information and analytical resources.

We have regularly updated our databases, published core health indicators annually and developed indicators of health and well-being for monitoring Health 2020.

Evidence for policy-making has also been the focus of our work and in this respect several important activities are ongoing; such as the autumn school for health information held in Turkey and the re-launching of the Central Asian Republics Health Information Network (CARINFONET). In addition, we are launching our health information web portal as a one-stop shop.

The technical briefing on Wednesday will provide detailed information and introduce a number of new tools.

Here let me acknowledge the valuable scientific advice provided by the European Advisory Committee on Health Research on policy formulation.

I warmly welcome Professor Tomris Turmen, Chair of the Committee, and Professor Roza Adany, the Vice-Chair, and members of the Committee.

Ladies and gentlemen, creating resilient communities and supportive environments is also a key focus of Health 2020.

For more than 25 years, the European environment and health process has been "Health 2020 in action".

The process is an inspiring example of collaboration among different sectors, and it provides a unique multisectoral platform for agenda setting and implementation. It addresses a key set of environmental determinants, which are still responsible for 20% of total mortality in the Region.

While on Thursday you will have the opportunity to reflect on the progress made, let me highlight now that the renewed governance structure that was established by the Parma Ministerial Conference has now successfully taken off.

The upcoming mid-term review meeting will be an important milestone, marking the start of work to define the agenda of the Sixth Ministerial Conference on Environment and Health.

The environment and health process will retain its relevance in the years to come, in the face of the unfinished agenda including air pollution, chemical contamination, inadequate water and sanitation in parts of the Region, and challenges such as new technology and climate change.

On the other hand, global developments will clearly influence the European agenda. The debate of the United Nations General Assembly, starting next week, will be an important milestone.

Let me now move to the implementation of WHO reform in the Region. Since you will hear more during this afternoon's session, I will just stress two points now.

First, we have contributed substantially to all aspects of reform, including its full implementation across the European Region, in the spirit of "one WHO".

Second is the advanced work that we have done on governance in our Region. Our work to strengthen the role of our governing body, the Regional Committee, and governance structures in the Regional Office has been based on and contributed to global WHO reform.

We have strengthened collaboration with partners and networks across the Region, engaging widely and helping to increase policy coherence. This enabled us to support Member States more efficiently.

Working with the European Union has provided a strong foundation, significant opportunities and additional benefits.

The Regional Office fully implemented the Moscow Declaration with the European Commission, and increased collaboration with the European Parliament and with the presidencies of the European Union.

We achieved major progress in collaboration with United Nations agencies.

In addition to intensive collaboration on the MDGs, post-2015 and Roma, we have now agreed on an interagency working group on NCDs and the social determinants of health, led by WHO.

We developed a guidance note to support United Nations country teams in taking this work forward, giving health a prominent focus in social development agenda, as well as in all other domains of cooperation. I am grateful to Ms Cihan Sultanoglu, Regional Director of the United Nations Development Programme (UNDP), for her support.

She and I will jointly present this work during the partnership session on Wednesday afternoon, focusing on collaboration with United Nations agencies at both the regional and country levels.

We also strengthened our work with civil society, and I am happy that once again many nongovernmental organizations (NGOs) are represented here. We have already posted written statements submitted by NGOs on our website and the President will try to allocate time to these interventions during the session. In addition, I am honoured to receive the 2014 Annual European Lung Foundation award on behalf of WHO.
Further, we increased the range and depth of our joint work with other partners, especially the World Bank, the Organisation for Economic Co-operation and Development (OECD), the Global Fund to Fight Aids, Tuberculosis and Malaria, the GAVI Alliance, the Council of Europe and development agencies.

Links with new and evolving types of partnerships for health provided important support to our work and will continue to play a critical role.

These include the South-eastern Europe Health Network (SEEHN), the Eurasian Economic Community; the Northern Dimension partnership, the CIS Council, policy networks (such as the European Healthy Cities and Regions for Health networks) and WHO's health promotion networks.

Meanwhile, we developed close working relationships with Member States.

I was privileged to visit many countries and meet with presidents, prime ministers, ministers of health and other sectoral ministers.

I advocated for putting health high on governments' agenda, for Health 2020, for jointly agreed priorities and for the promotion of intersectoral work and mechanisms.

Many ministers and delegations visited us at the Regional Office, where we briefed them fully on technical cooperation.

We also embarked on development of country cooperation strategies; we have completed three so far and two more will be signed soon. We plan a broader and more consistent roll-out to other countries without country offices in the next five years.

Further strengthening country offices contributed to our work with, in and for countries.

We plan to further strengthen our support to Member States by opening WHO representative offices wherever necessary and appropriate, subject to the availability of funds.

You can hear more about this during the technical briefing on Tuesday.

We enhanced our communications to improve the availability and accessibility of information and messages. Live webcasting made governance processes more transparent to a wider audience.

We led many successful campaigns using social media channels to reach new audiences, and gave greater emphasis to communication at the country level, in response to growing demand from Member States.
I committed that the Regional Office should be a leader in health: thus, a strong, evidence-based organization, relevant to the whole Region.

A main priority was to improve the technical relevance of our work. Within the available resources, I streamlined and restructured the administrative support in the Regional Office to free up resources to strengthen much-needed technical capacity.

Of course, the hard work and dedication of the staff contributed to achieving this public health excellence.
The technical capacity was strengthened not only through new recruitments but also by better utilizing existing resources and networks, including collaborating centres and national capacities.

Geographically dispersed offices (GDOs), generously supported by the governments of Germany, Italy and Spain, have contributed substantially to our work. I am grateful for Member States' support to increase the capacity of the Regional Office.

Two years ago, and also last year, the Regional Committee reviewed the GDO policy and achieved consensus on the way forward. I am grateful to you for that.

With the generous assistance of the Government of Kazakhstan, we signed the host agreement for a new GDO in that country for strengthening primary health care.

During this Regional Committee, we will sign an agreement with the Russian Federation to finance a project aimed at strengthening health systems for the prevention and control of NCDs, and to initiate the establishment of the new GDO in Moscow. Funds have already been made available for this purpose.

We are also concluding the host agreement with Turkey on the GDO for preparedness for humanitarian and health emergencies in Istanbul.

For me, a Regional Office with a positive working environment is paramount. This can only happen if the Office has a sound financial footing and prudent management.

We made significant efforts to improve the overall funding situation, and continuously strive for administrative efficiency, and to contain administrative costs. I am confident that today the Regional Office is on a more sustainable path than before.

The aim now is to consolidate and further strengthen internal management and administrative efficiency, while improving technical excellence through peer review and external evaluation, identifying means to further improve the quality of technical work.

Honourable delegates, much has been done and learned since 2010, but our work is not yet finished.
We face a host of new challenges, but also many opportunities. So there should be optimism, because health matters as never before.

I am committed to working with you, Member States and partners, to implement what we have jointly agreed on.

While we work towards "better health for Europe" for all our populations, we also aim to make the continent more "equitable and sustainable".

Thank you for your attention.