Address by the Regional Director

Regional Committee for Europe, Sixty-second session 

10 September 2012

Mr President, Your Royal Highness, Madam Director-General, Mr Commissioner, Mr Deputy Secretary-General, honourable ministers, dear partners, ladies and gentlemen,

It is a real honour to address you at the sixty-second session of the Regional Committee and provide highlights of the work of the WHO Regional Office for Europe. I will briefly describe our collective achievements and plans, along with some of the key challenges and opportunities for addressing them.

I took office in 2010 and shared my vision of better health for Europe with you Member States at the sixtieth session of the Regional Committee in Moscow that same year.

We agreed on a roadmap with specific milestones, to enable the Regional Office to respond adequately to the changing European environment and to further strengthen it as an evidence-based centre of health policy and public health excellence that could better support the 53 Member States in our diverse WHO European Region.

I committed to making progress on seven strategic priority areas. Now we are half-way through the five-year period covered by the vision, and, as a result of the work of all of us in this room, Work has either been completed or is at an advanced stage of development in all these areas.

The changes and challenges we have faced in health status and outcomes in Europe, particularly inequities in health, have been the driving force.

We observe improved life expectancy, with five years gained during the last two decades, but not achieved by all countries at the same pace. There are huge gaps in health and health-system development within and between countries. Inequalities are growing, and this is the most worrisome trend for European health policy-makers: these differences mean a gap in life expectancy of around 12 years in the Region.

The population is ageing at a fast pace in all countries in the Region, and people aged over 65 years will represent 25% of the European population by 2050. This puts additional pressure on both the social and health systems, as well their financing.

The largest share of the disease burden in the Region comes from noncommunicable diseases (NCDs), which account for about 86% of total deaths. Nevertheless, we should not forget the remaining serious challenges from communicable diseases.

We have been tackling all these and other priorities during the past three years. We focused on NCDs, and the 2011 Regional Committee adopted action plans to prevent and control NCDs and reduce the harmful use of alcohol.

We also addressed communicable diseases such as poliomyelitis (polio), measles and rubella at the 2010 Regional Committee and the 2011 session endorsed action plans on multidrug-resistant tuberculosis (MDR-TB), HIV/AIDS and antibacterial resistance. All these are now being fully implemented!

We made use of all of our training programmes – such the global one on developing national health policy and strategy and the flagship courses on financing – and started new training in health diplomacy for Member States' representatives and our own staff.

We will continue to address remaining health challenges (such as violence and injuries, and mental ill health) with continuing attention to health systems, particularly to universal coverage and the effects of the financial crisis, and report the results to you at the next two Regional Committee sessions.

Recognizing the need for a coherent policy framework that addresses all the challenges to better health in the Region, we developed a new European health policy, Health 2020, building on the good traditions of our Region, as requested by you in 2010.

We did this through an intensive participatory process to which all of you contributed, and that was informed by a number of studies and an unprecedented review of existing evidence in the Region.

The process of developing Health 2020 and other areas of our work have been fully aligned with the ongoing WHO reform, and reflects the agreed values, approaches and priorities that underpin WHO's work, while also capturing the specific circumstances and needs of our Region and Member States. This is a good example of how global and regional (and ultimately national) developments can mutually support and reinforce one another.

We believe this value-based and action-oriented Health 2020 policy will inspire development and support action across governments and societies for health and well-being, and will guide us for years to come. We will spend more time tomorrow reviewing the policy and related studies.

Health 2020 strongly supports action to reduce health inequalities and therefore tackles root causes of ill health through an "equity lens". The Director-General emphasized the need for such action in a speech to the Executive Board this year.

Unfortunately, significant inequities in health and their social determinants exist across and within countries in the Region, as confirmed by the European review we made. As indicated in the Rio Political Declaration on Social Determinants of Health, improving these determinants requires focused political commitment and a new approach to governance. The Regional Office has led in this area for many years, through the work of our Venice Office, and we will continue to do so. Thanks to the Italian Government for hosting and generously funding our Venice Office!

We cannot achieve equity in health without reducing existing gender inequities and making the right to health a reality. Evidence shows that marginalized populations in the European Region – such as Roma, other ethnic minorities and migrants – experience growing health inequities. I have now established a programme on vulnerability and health, to support the promotion and protection of these groups' right to health and the satisfaction of their needs.

Thanks to the support of the Italian and the Belgian governments, the Regional Office developed a project on the public health aspects of migration in Europe. The Regional Office also actively supports efforts to build countries' capacities to monitor and deliver on the European Union (EU) framework for national Roma integration strategies and action plans for the Decade of Roma Inclusion. There is an exhibition on Roma and migrant health in the lobby that I encourage you to visit.

Along the same lines, I would like to share with you the news that we are leading two United Nations interagency working groups coordinating action to achieve the Millennium Development Goals (MDGs): one on the health of Roma women and children, and the other on tackling inequities. In addition, we published a biennial report on progress towards the health-related MDGs in 2011.

As the MDGs have been a priority for me, I am delighted to see the importance Member States have given them. I would like particularly to thank the Russian Federation and Uzbekistan for organizing two high-level and very successful international MDG fora and allowing us to contribute.

Discussions have already begun on the goals and targets that could build on and succeed the MDGs after 2015. We plan to take an active role in the global process, fully supporting the Director-General, by developing a strategic coalition of partners and European Member States, to ensure Europe's voices are heard and health plays an important role in the post-2015 development agenda.

Let me now focus on some key technical areas in our work.

Health challenges, as well as the pressures exerted by the financial crisis, highlight the need for comprehensive system responses, working towards universal coverage with evidence-informed policies.

We give special emphasis to public health as an essential component of health systems. You will hear later this week about the proposed action plan for strengthening public health capacities and services, requested by the Regional Committee last year. I was honoured to receive the Andrija Štampar Medal from the Association of Schools of Public Health in the European Region (ASPHER), in recognition of the Regional Office's contribution to public health in 2011. This of course includes the work of all Member States, including the example of our host country, Malta.

Universal coverage is the key policy direction in our work to strengthen health systems. Many countries have achieved substantial progress in providing their populations with financial protection and access to health care. Nevertheless, 19 million people in the Region experience out-of-pocket health expenditures that place a catastrophic burden on their households. This issue will therefore remain a priority for us for years to come. In addition, we accelerated our work on integrated health service delivery based on people-centred primary health care, with kind support from Belgium and the Netherlands.

In October 2013, we will meet again with Member States in Estonia to mark the fifth anniversary of the adoption of the Tallinn Charter: Health Systems for Health and Wealth, and to review the progress made towards the commitments embedded in it. Thanks to Estonia for this initiative. We plan to submit the final report on the Charter's implementation, together with a way forward, to the Regional Committee in 2015.

The financial crisis and its impact on public finances have tested Member States' commitment to health. Nevertheless, the crisis can be seen as an opportunity to consider changes in policy directions to protect health budgets: specifically, strengthening financial protection, improving efficiency within health systems, investing more in public health and using health financing policy to strengthen universal coverage. This is the focus of our work.

With partners, we have supported countries' efforts to minimize the harmful effects of the financial crisis. For example, our joint work with the Organisation for Economic Co-operation and Development (OECD) on financial sustainability was a success, and I think we should explore further collaboration with OECD and the EU in this field.

We have started to prepare a high-level meeting to follow up the 2009 meeting in Oslo, Norway, which will also be hosted by the Norwegian Government, to review experience since the onset of the financial crisis and discuss the way forward.

We successfully completed the second course on health financing, held in Barcelona, Spain and focusing on improving health-system performance through better financing policies, with universal coverage as the special focus. In addition to the participants in Barcelona, the course attracted more than 500 viewers globally through webcasting. We now plan to organize another course specifically for EU countries and include financing as a topic for discussion at a meeting with members of the European Parliament. I will continue to fully support our Barcelona Office in continuing its excellent work, and thank Spain for hosting and funding the Office, which now plays a crucial role in shaping policies on health financing in Europe.

The Regional Office intensified its support to Member States on health-workforce policies. In line with the WHO Global Code of Practice on the International Recruitment of Health Personnel, we provided evidence on and policy options for the planning, retention and performance of the health workforce. We have revived our programme on nursing and midwifery, and I assure you that human resources for health will continue to be a priority for the Regional Office.

I would like to take the opportunity to congratulate Norway on receiving the Health Worker Migration Policy Council Innovation Award, which was accepted by Dr Bjørn Inge Larsen, Director-General of the Norwegian Directorate of Health.

Providing evidence and information for policy-makers is an important part of the Regional Office's work. We completed a review of all our databases, including the Health for All database, the most comprehensive source of health information. I would like to remind all of you to submit data regularly to it.

To harmonize health information and platforms across Europe, we continued to work with the European Commission (EC) and OECD to develop an integrated health information system for Europe.

We also started to work on new tools that will permit analyses of data on an integrated database platform. We plan to launch a European evidence-informed policy network soon, to support Member States in translating knowledge into policies. These efforts are part of a new information strategy that will be submitted to the Regional Committee next year.

We have started implementation of the European Action Plan to Implement the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016, and the Political Declaration of the General Assembly of the United Nations. Both were adopted in September 2011.

As we celebrate the adoption of a global target to reduce premature mortality from NCDs, success stories from our Region are worth mentioning. I specifically highlight the decreasing trends in circulatory mortality in three countries: Kazakhstan, the Republic of Moldova and the Russian Federation. This progress comes from a combination of factors: increased prosperity, investment in health services and changes in risk behaviour. These countries' success requires us to document the changes made, to note that the global target is indeed achievable and to focus even more on implementing the European Action Plan, particularly at country level in the coming years.

The Regional Office supported country-based activities to tackle NCDs in line with the European Action Plan, and this work is already showing results at country level. Let me give three examples.

Ukraine is one the countries developing NCD action plans. We worked intensely with the country to integrate "best buys" into the draft plan. We would like more countries developing national plans to adopt such a process.

Turkey became the first country in the world to attain the highest implementation score for all of WHO's MPOWER measures, the demand-reduction interventions contained in the WHO Framework Convention on Tobacco Control (FCTC).

The Russian Federation is supporting a project to develop outcome-oriented NCD interventions in a small number of high-burden countries in Europe. In addition, the Norwegian Government, as a contribution to global consultations, kindly hosted consultations on the global monitoring framework for NCDs and on mental health. I would like to thank both countries for this support.

With the International Atomic Energy Agency (IAEA), the Regional Office organized a workshop in the Republic of Moldova on comprehensive cancer control, as well as a series of joint missions to strengthen national programmes.

Collaboration with OECD and the Danish Ministry for Interior and Health resulted in conferences on diabetes and on patient empowerment, respectively.

As you requested, we developed indicators and a checklist for policy-makers of action to reduce the harmful use of alcohol. A number of Member States are updating their alcohol policies. For instance, the Republic of Moldova adopted a national alcohol plan and the Russian Federation recently introduced a ban on alcohol advertising.

Working closely with the EC on monitoring alcohol use, we published a popular new publication in March 2012: Alcohol in the European Union. Consumption, harm and policy approaches.

Thanks to the Polish Government for hosting a meeting at which national counterparts on alcohol policy could exchange best practices and review new developments.

Much progress has been achieved in our Region in implementing the FCTC. Now that the Czech Republic and Uzbekistan have become Parties to the FCTC, the European Region has the highest number of Parties of any WHO region.

We welcomed a number of country initiatives, such as Bulgaria, Hungary and Ukraine's becoming smoke free; Uzbekistan's strengthening of smoke-free legislation; France and the Russian Federation's use of pictorial health warnings on tobacco packaging; Ukraine's ban on advertising of tobacco products; and the Republic of Moldova's adoption of a strong five-year national action plan on tobacco control.

For World No Tobacco Day 2012, the WHO Director-General gave awards to the Prime Minister of Kazakhstan and the Minister of Health of the Republic of Moldova, recognizing their strong commitment and whole-of-government approach to tobacco control.

Overweight, particularly in lower socioeconomic groups, is an increasing problem in all countries. Most Member States are acting on the European Charter on Counteracting Obesity and the European Action Plan for Food and Nutrition Policy 2007–2012, to promote healthy eating and physical activity and to prevent obesity, but there is still much to be done. Therefore a high-level conference is planned to be held in Austria next year to take stock of progress in implementing the Action Plan and agree on further actions.

The European Childhood Obesity Surveillance Initiative (COSI), covering 200 000 children, has been established as a standardized European surveillance system. It is already one of the most powerful obesity surveillance mechanisms in the world.

The Region has made good progress in maternal health and observed a major decrease in the number of maternal deaths. Yet there are striking inequities between and within countries; the highest rates are estimated to be 30–40 times the lowest.

The Region has also made good progress in child health, but again countries differ substantially. The highest rate of infant mortality is 25 times the lowest.

Preventing unintended pregnancies remains a challenge in the European Region. Such pregnancies should be rare and we will find ways together to make abortions accessible and safe, when needed. WHO will continue to support countries in revising their policies and improving the quality of services. In line with this, we organized a regional meeting to improve access to reproductive health services, including safe abortion, in 2012. Thanks to Latvia for hosting it!

In Europe and internationally, 2012 is the year of active and healthy ageing. With the motto "Active ageing: good health adds life to years" and the understanding that healthy ageing starts at birth, the Regional Office, and its partners and Member States organized World Health Day events throughout the Region. We launched them with the Danish Presidency of the EU.

The Regional Office drafted a strategy and action plan on healthy ageing in Europe that you will consider later this week.

In close collaboration with Member States and partners, we continued to work on unfinished business with communicable diseases.

Full implementation of three action plans, on tuberculosis, HIV/AIDS and antimicrobial resistance, all calling for urgent action on areas placing a significant burden on public health in the European Region, began after their endorsement last year by the Regional Committee.

With the EC and the Global Fund to Fight AIDS, Tuberculosis and Malaria, we officially launched the Consolidated Action Plan to Prevent and Combat Multidrug- and Extensively Drug-resistant Tuberculosis in the WHO European Region 2011–2015, in Moscow last year. Working closely with the Global Fund, EC and the European Centre for Disease Prevention and Control (ECDC), we assisted countries in adopting national strategies and conducted a number of country reviews. I plan to visit Romania soon with European Commissioner John Dalli. We have already started to see the results of these joint efforts: for example, the increase in access to treatment from 70% to 96% within only a year. I am planning to establish a regional interagency coordination committee, with involvement of key stakeholders and civil society, to oversee progress.

In response to the rising number of people living with HIV, the European Action Plan for HIV/AIDS is being implemented at full speed, offering a framework for urgent action and accelerating effective responses through an approach focused on strengthening health systems.

Thanks to continuous efforts to scale up treatment, the numbers of people receiving antiretroviral therapy are steadily increasing, and continuous progress has been made towards eliminating mother-to-child transmission of HIV.

The regional strategic action plan on antibacterial resistance is also being implemented, in partnership with Member States and a broad coalition of partners. Thanks to Denmark for holding a conference on antimicrobial resistance during its Presidency of the Council of the European Union in March 2012; Her Royal Highness Crown Princess Mary of Denmark, Patron of the Regional Office, and WHO Director-General Margaret Chan addressed the participants. And I would like to remind you to mark the date of European Antibiotic Awareness Day – 16 November 2012 – a very successful ECDC initiative that we are expanding to Member States outside the EU.

The Region has made remarkable progress towards eliminating malaria by 2015. Only five countries now report malaria cases, and numbers of cases have dropped significantly. Armenia, Kazakhstan and Turkmenistan were certified malaria free, and Georgia is expected to proceed with certification before the end of 2012.

Nevertheless, the incidence of some vector-borne and parasitic diseases, such as dengue and chikungunya, has been on the rise. We started working with Italy and the Netherlands to address this and, with increased support from our Member States, we will work towards starting the process for developing a regional action plan.

This year we celebrated the tenth anniversary of a polio-free Europe. While recognizing and applauding the successes in the Region during the last 10 years, we cannot afford to become complacent. Unfortunately, the Region faced a huge polio outbreak in 2010. Even though the European Regional Certification Commission for Poliomyelitis Eradication announced that the Region remains free of polio, it highlighted the continued risk, especially due to gaps in population immunity in many countries. Member States need to ensure uniformly high immunization coverage and improve their surveillance.

The 2012 World Health Assembly called the eradication of polio a "programmatic emergency" for global health. Failure to capitalize on this moment would see more and deadlier outbreaks in polio-free regions. That is why I pledge to you all to maintain the momentum.

Let me also share my deep appreciation of the Russian Federation and Turkey for their financial and technical support in reaching both these elimination goals, as well as for the good collaboration we established with the WHO Eastern Mediterranean Region.

Unfortunately, the Region's goal of eliminating measles and rubella by 2015 is at risk. Measles and rubella continue to spread in the Region, causing large outbreaks in a number of countries. In 2011, the vast majority of cases occurred among adolescents and younger adults in the western part of the Region, and EU Member States reported 80% of cases. Worse, Europe exports the viruses to other countries and regions.

Accelerated action to reach susceptible populations, strong political support and sustained funding for immunization programmes are required if we collectively are to eliminate these diseases. We at the Regional Office are committed to supporting you Member States on this front.

Immunization is the most effective instrument to confront these diseases. The seventh European Immunization Week, in April this year, was celebrated for the first time in the context of World Immunization Week, and with the remarkable participation of all 53 European Member States. I would like to thank Her Royal Highness Crown Princess Mary of Denmark for supporting European Immunization Week since it began, and we look forward to continued work with her.

In line with our role as a leader in humanitarian and public health emergencies, the Regional Office has worked to help countries cope with emergencies and heath crises, in close collaboration with WHO headquarters, the EC and its institutions, such as ECDC and the European Food Safety Authority (EFSA). We have a well-established system for vigorous monitoring of events that may pose a potential threat to public health.

Implementation of the International Health Regulations (IHR) remains a priority, especially in view of the need for countries to meet the core-capacity deadline of June 2012. We provided intensified support to Member States in strengthening their capacities for preparedness and response. In particular, we assessed health systems' preparedness and helped countries strengthen it by, for example, offering guidance on hospital resilience and safety, and providing training and capacity building. We will continue to do so.

The new global WHO Emergency Response Framework, endorsed by the World Health Assembly, foresees a greater role for regional and country offices. Thus, we have substantially revised our regional emergency procedures, and tested them in exercises. The Regional Office now has a fully operational emergency operations centre.

With large mass gatherings taking place in the Region, we worked with national authorities to anticipate and prepare for the associated health needs. Jointly with governments and ECDC and in collaboration with headquarters, we established an enhanced monitoring system in this new area during the European football championship hosted by Poland and Ukraine and the Olympic Games hosted by the United Kingdom. Key health messages were produced and widely disseminated.

During the biennium, the Regional Office responded to several major public health emergencies, disasters and crises through various missions and investigations.

Speaking of emergencies, I want to acknowledge the efforts of the Government of Malta, our host, and of other European Member States (particularly Greece, Italy and Turkey) for dealing so commendably with the recent influx of migrants and refugees from North Africa. WHO appreciates the excellent work that Malta and other countries have done in past years. I would also like to thank Turkey for its continuous support to this technical area, as well as its efforts to accommodate refugees from the Syrian Arab Republic.

The Regional Office scaled up its technical work on environment and health to achieve the commitments in the Parma Declaration. The new agreement with the German Government, signed in February this year, enabled us to consolidate our environment and health programmes. With a strong policy function in Copenhagen, the Bonn Office represents a centre of excellence in the Region and globally. Our thanks to the German Government!

With a stronger mandate for intersectoral governance, the European Environment and Health Ministerial Board has successfully led the European environment and health process. At its third meeting in Azerbaijan in November this year, it will start setting priorities for the future. These will be informed by the Parma commitments, Health 2020 and the sustainable-development agenda of Rio+20 (the United Nations Conference on Sustainable Development). Next year, we will ask the Regional Committee to endorse these priorities, which will pave the way to the next ministerial conference.

Everything you have heard so far, everything we have done, we have done it together, as one WHO and with Member States and partners.

This is the concept of one WHO in line with WHO reform. I am personally committed to WHO reform, supporting the Director-General in all her endeavours. I am grateful for the guidance provided by the Regional Committee and the Standing Committee of the Regional Committee (SCRC) with its improved oversight function. With a stronger role played by the Regional Committee, we were able to reach consensus on manz difficult issues.

Through increased representation (by increasing SCRC membership from 9 to 12 countries and opening its meetings to all Member States) and coordination meetings with European delegations during Executive Board sessions and World Health Assemblies, we ensured full participation of all Member States, leading to greater transparency.

The European Health Policy Forum of High-level Government Officials played a crucial role in strategic discussions to facilitate consultation on Health 2020 and other important public health areas. Our thanks go to the Member States who hosted and generously supported the meetings financially: Andorra, Belgium and Israel. We will present the results of the evaluation of the Forum this week, to seek your guidance on its further work.

In addition, I am happy to report that we were able to ensure full accountability of the Regional Office to its governing bodies by reporting regularly on the implementation of our work. At Member States' request, we decided to present the current financial situation of the Regional Office in depth on Tuesday and Wednesday, so I will not go into details on our finances now. I would like to point out, however, that we managed to raise around US$ 240 million in the last biennium, a figure comparable to the income in previous biennia. Further, implementation of available funds was very high: over 90%.

While the high implementation rate was good news, it also meant that we had to start 2012–2013 with a significantly reduced carry-forward. This represents a challenge for the current biennium, which goes hand in hand with others with which you are familiar: resource mobilization, which is particularly relevant for our Region as we raise a large portion of our resources from voluntary contributions, and the distribution of resources. I warmly welcome the Director-General's initiative to set up a global task force to address these two areas, and I am more than honoured to co-chair it with a deputy director-general.

We have continued to improve relations and foster cooperation with a wide range of partners. For example, we work closely with United Nations agencies, the EU and its institutions, and subregional networks such as the Eurasian Economic Community, with which we are ready to sign a memorandum of understanding. We also strengthened our collaboration with global health partnerships, particularly the Global Fund and GAVI Alliance, as well as civil-society organizations.

I warmly welcome Commissioner Dalli, and report that we made major progress in implementing the joint roadmaps agreed with the EC in 2010. We also continued to work closely with ECDC, with which we have joint annual workplans and common guiding principles of collaboration. Meanwhile, we have intensified our collaboration with EFSA, the European Environment Agency (EEA), the European Medicines Agency (EMA) and the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA).

Our collaboration with the countries holding the EU Presidency (particularly Cyprus and Denmark) has been extremely valuable, and we look forward to continuing it with upcoming holders of the Presidency. In addition, we reach out to work with other regions.

I am delighted to welcome Mr Yves Leterme, the Deputy Secretary-General of OECD, to this Regional Committee session. He and I will be signing a joint action plan today as a sign of strengthened collaboration.

The interim strategy on work with countries that we will present on Thursday is aligned with WHO reform. A final strategy will be presented to you as soon as the reform process is complete. Meanwhile, to serve all 53 Member States and address their needs adequately, we have reinforced the structure of the Regional Office and its country presence.

I am happy to report that I and my staff have observed intensified collaboration with Member States on various visits to countries, and have welcomed at least 17 official ministerial visits to the Regional Office since September 2011. We have also started developing country cooperation strategies. We thank Switzerland for being the first Member State to participate. It is setting an excellent example, to be followed, we hope, by the Russian Federation and Turkey. We want these strategies to capture two dimensions, as discussed with the Director-General:

1. bilateral collaboration of the country with WHO at all levels;
2. the contribution of the country to global, regional and subregional health development.

Finally, ladies and gentlemen, to publicize our work and raise awareness of public health issues, we use both traditional and new, innovative communication methods, including social media. We issue a range of press materials and have an active presence on Facebook, Twitter and other platforms.

To facilitate our work and to promote a positive working environment, we are developing a comprehensive internal communications strategy, optimizing the use of the intranet as a key platform and increasing information sharing and interaction between all WHO offices in the Region.

While the discussion of our communication strategy was postponed until the next Regional Committee, we continue showcasing the work that we, Member States and other partners all do together, building on our networks and reaching out to broader audiences.

Thank you very much for your attention and support.