Day 1 highlights: RC68 opens

The 68th session of the WHO Regional Committee for Europe (RC68) opened with a rousing recital of Italian musical pieces by the Giuseppe Verdi di Roma Choir conducted by Maestro Giovanni Cernicchiaro.

The day unfolded with a review of the work of WHO/Europe and of the health status of the WHO European Region by Dr Zsuzsanna Jakab, WHO Regional Director for Europe. Dr Tedros Adhanom Ghebreyesus, WHO Director-General, called on countries to work across sectors to deliver on the goals of WHO’s ambitious 13th General Programme of Work (GPW13).

Delegates will discuss issues requiring stronger focus across the Region in the coming days, including universal health coverage (UHC) and financial protection, immunization, men’s health, and the implementation of the 2030 Agenda for Sustainable Development.

They pledged to make the session a healthy one, with active breaks, healthy snacks and initiatives to reduce waste integrated into the programme.

Welcome by His Excellency Prime Minister Conte of Italy

Expressing his pride in hosting RC68, the Prime Minister welcomed delegates to Rome. This year, Italy also celebrates the 40th anniversary of its National Health Service. Prime Minister Conte explained that the right to health is rooted in Italy’s constitution. Indeed, as the recently launched “European health report 2018” indicates, Italy sets an example for the rest of the world – the country enjoys the second-longest average life expectancy in the Region.

The Prime Minister also underlined his Government’s commitment to maintaining UHC for future generations, addressing inequalities, and fighting poverty and social marginalization.

Opening comments by Dr Giulia Grillo, Minister of Health of Italy

Minister Grillo described Italy’s National Health Service as a “reference point for the world”. She explained that it is working to address 3 current health challenges in Italy that require long-term focus: the lack of health-care professionals, high out-of-pocket payments and long waiting lists for specialized care.

The Minister thanked WHO for its work, particularly regarding emergency preparedness and response, and underlined the importance of working together at the international level to improve health.

Election of officers

• Dr Armando Bartolazzi, State Secretary of Health of Italy, was elected President of RC68.
• Professor Amiran Gamkrelidze, of Georgia, was elected Executive President.
• Mr Ioannis Baskozos, of Greece, was elected Deputy Executive President.
• Ms Outi Kuivasniemi, of Finland, was elected Rapporteur.

Address by Her Royal Highness The Crown Princess of Denmark

Her Royal Highness Crown Princess Mary of Denmark, Patron of WHO/Europe, spoke of the need for stronger action in 3 areas during her opening address: improving vaccination coverage; adopting a “One Health” approach to antimicrobial resistance; and supporting men as caregivers and in their own health.

Referring to the high numbers of measles cases seen across the Region this year, Crown Princess Mary called on health authorities to analyse the varied and complex reasons behind low vaccination rates and to take context-specific measures to address them. She described the current situation as, “intolerable, when we learn that 37 people have now lost their lives as a consequence of a disease that can be avoided with just 2 shots of an available vaccine”.

A highlight on the RC68 agenda is the proposed strategy on the health and well-being of men, which identifies transitions in life as opportunities to improve health. “Think about one such transition – into fatherhood – that joyous, poignant moment many of us look back on tenderly when we become a parent,” said Crown Princess Mary. “This time could present a golden opportunity to boost their child’s, their partner’s and their own physical and mental health.”

Address by Dr Zsuzsanna Jakab, WHO Regional Director for Europe

“Health is positioned at the centre of development,” began Dr Jakab in her opening address reviewing progress in and challenges to health across the Region. She noted that the Sustainable Development Goals (SDGs), the European policy framework Health 2020 and the GPW13 are truly coherent and aligned, and provided an update on 3 indicators for health and well-being in the Region that contribute to these overarching agendas:

• life expectancy at birth rose to 77.9 years in 2015;
• the maternal mortality rate decreased to 11 deaths per 100 000 live births in 2015; and
• the reduction of premature mortality from cardiovascular diseases, cancer, diabetes and chronic respiratory diseases is on track at 1.5% annually.

Yet Dr Jakab also cautioned that health inequalities remain between and within countries. Major challenges include:

• addressing the more than 10-year gap in life expectancy at birth between countries in the Region;
• accelerating the reduction in tobacco use;
• lowering alcohol consumption, for which the Region has the highest rate globally;
• curbing the upward trend in overweight and obesity;
• tackling persistent immunity gaps that enable measles transmission and thus outbreaks; and
• cutting HIV co-infections and putting agreed targets back on track.

In order to make sustainable progress on health and well-being, the Regional Director encouraged Member States to work in transformative ways. This, she explained, means ensuring policy coherence across different sectors and at different levels, and using inclusive and transparent governance mechanisms. Partnerships, networks and platforms are key.

One key area of focus is working with industry to address the commercial determinants of health. “It is clear that today’s rise in noncommunicable diseases reflects a system that prioritizes economic and financial growth and advantage over better health … I believe we should do our best to convince the food and soft drink industries to follow WHO standards and norms,” Dr Jakab said.

Turning to WHO’s own reform process, the Regional Director underlined that WHO/Europe is implementing a comprehensive transformation to enhance impact in countries and deliver on the GPW13’s “triple billion” goal.

In conclusion, Dr Jakab reminded delegates of their collective vision and the steps needed to achieve it. “We share a vision: to build a world where everyone realizes their right to a healthy and prosperous life. To reach this vision, all of us – politicians, decision-makers, professionals and people in all walks of life – need to pledge their commitment.”

Plenary discussion

Responding to the Regional Director’s report and plenary address, many Member States took the floor to express their thanks for the work of WHO/Europe and the Regional Director’s continued and dedicated leadership.

The delegate of Austria, which currently holds the Presidency of the Council of the European Union, spoke on behalf of the European Union and its Member States. He welcomed WHO’s work on strengthening health systems, describing the high-level regional meeting held in June in Tallinn, Estonia, as “a milestone in promoting our joint basic values of solidarity, equity and participation”. The delegate also mentioned the upcoming Global Conference on Primary Health Care in Astana, Kazakhstan, as an opportunity for a “big leap forward” in achieving UHC.

Several common themes emerged in the following interventions, including:

• a commitment to moving towards UHC and to reinvigorating primary health care in this context;
• the growing momentum of country-level work on the 2030 Agenda;
• the need for solidarity in addressing migrant health issues;
• the importance of a stronger focus on digital health;
• the need to maintain regional financing levels to address health challenges including HIV, multidrug-resistant tuberculosis and measles;
• the promotion of treatment of hepatitis C;
• the adoption of a life-course approach to address health risk factors, including tobacco use;
• appreciation for WHO’s enhanced role in emergency preparedness and response, and its joint external evaluations to assess countries’ implementation of the International Health Regulations (2005); and
• recognition of the strong technical work undertaken by the Region’s 5 geographically dispersed offices and the invaluable work of country offices.

Address by Dr Tedros Adhanom Ghebreyesus, WHO Director-General

The compelling case for investing in health was a recurring theme in the Director-General’s address at RC68. Dr Tedros detailed key elements of the RC68 agenda, including new evidence on financial protection, renewed drive to advance the European Vaccine Action Plan 2015–2020, and the draft strategy on men’s health and well-being.

He noted, “All the measures you are considering this week require investments. Nothing comes for free. But it’s critical that countries see them as investments, and not as costs. They are investments in a healthier Europe. They are investments in a fairer Europe. And they are investments in a safer Europe.”

The Director-General reminded Member States of the 3 goals of the GPW13:

• 1 billion more people benefitting from UHC;
• 1 billion more people better protected from health emergencies; and
• 1 billion more people enjoying better health and well-being.

In conclusion, Dr Tedros urged Member States to take up 3 challenges: to work across government to protect and promote health; to fight declining vaccination rates; and to deliver UHC. “Take ownership for ensuring that the people of this Region are set free from catastrophic health spending. Celebrate your successes, learn from your mistakes, and share those lessons with the Region and the world. Europe is the home of UHC. It should continue to lead from the front,” he said.

Impact of WHO reform on work in the European Region

Dr Bernhard Schwartländer, WHO Chef de Cabinet, outlined the WHO transformation process, which seeks to enhance the quality of the Organization’s normative and standard-setting role in global health and to ensure this work translates into real impact at the country level.

This transformation is needed to adapt to the changing global environment in which WHO works, making it fit to promote the implementation of SDG 3 and the health-related SDGs. “The GPW13 clearly articulates who we are, what we will do and how we will do it,” he said. He also reassured delegates that WHO’s transformation is fully aligned with United Nations reform.

Speaking of the reform process at the regional level, Dr Nedret Emiroglu, Director of WHO/Europe’s Division of Health Emergencies and Communicable Diseases and  Director of Programme Management, explained that WHO/Europe has been implementing transformations since 2010. She underlined that this is fully integrated into the global transformation architecture.

Several Member States requested further information on strengthening WHO’s presence at the country level, and called for consistency across WHO regarding the United Nations Resident Coordinator mechanism and collaboration with other United Nations organizations.

Noting that WHO’s greatest resource is its staff, the delegate of Germany proposed that WHO consider modern working methods such as teleworking and flexible working hours.

Press briefing on men’s health and well-being

Ahead of its official presentation to RC68 delegates on Wednesday, a press briefing was held to inform journalists about the newly released report on men’s health and well-being in the Region. WHO experts shared key points from the report with members of the media, highlighting the high burden of noncommunicable diseases and injuries among men and discussing how health systems and primary health care can help ensure that men receive the services they need.

Experts emphasized that the report does not blame men for poor health outcomes, but aims to understand what men need in order to seek healthier behaviours.

Ministerial lunch: migration and health, and emergency medical teams

The ministerial lunch provided an opportunity to reflect on recent developments in the Region regarding migrant health. Participants underlined the importance of government commitment to developing policies based on the Strategy and action plan for refugee and migrant health in the WHO European Region.

The report “Communication barriers for migrants’ and refugees’ access to, and utilization of, health-care services in the WHO European Region” was also launched, along with a short overview of the “European refugee and migrant health report”, which presents evidence on the health of refugees and migrants.

Experts outlined developments and areas of future focus at the global level, making reference to the Strategic Initiative on Health and Migration of WHO headquarters and the forthcoming global action plan on the health of refugees and migrants.

At a short ceremony, representatives of 10 emergency medical teams from across the Region received congratulations on being certified as WHO Emergency Medical Teams. The Director-General thanked them for their willingness to be deployed to improve the health and well-being of populations affected by emergencies.

Technical briefing: measuring health literacy in the European Region

Growing evidence suggests that health literacy – people’s knowledge, motivation and ability to understand and apply health information to make informed decisions on health – over the life-course leads to better health and fewer chronic diseases. Yet the results of a European Union survey published in 2012 indicated that half of citizens in participating countries were affected by low or inadequate health literacy.

During this technical briefing, delegates from Austria, Czechia and Germany, as well as the Organisation for Economic Co-operation and Development, explained the steps they are taking to measure and promote health literacy among citizens. They encouraged participants to join the Action Network on Measuring Population and Organizational Health Literacy.

Events leading up to RC68

Meeting between the Director-General and heads of WHO country offices

WHO representatives and heads of country offices from the Region met with Dr Tedros prior to the start of RC68. During the meeting, which covered topics such as United Nations reform and the importance of working with partners, the Director-General underscored that country office staff play a vital role in delivering on the goals of the 2030 Agenda and the GPW13. He expressed his commitment to making WHO agile and modern so that the Organization can turn its employees’ passion for health into help for the people it aims to serve.

Briefing for non-State actors (NSAs)

Delegates from 43 NSA organizations were briefed on the RC68 agenda; this is the highest number since WHO/Europe introduced these briefings. Over 100 NSA participants are attending RC68, which is also the highest number to date. After the briefing, in support of the initiative to make RC68 a healthy meeting, the delegates walked to the evening reception.

Press conference

On 14 September 2018, WHO/Europe and the Ministry of Health of Italy held RC68’s opening press conference. Dr Jakab and Minister Grillo presented the session’s agenda, focusing on the latest findings on health and well-being, migration and health, vaccination, health emergencies, men’s health, and financial protection in the Region. They briefed members of the press on progress in public health, as well as challenges and solutions. The press conference was widely covered by national and regional media.

Fifth session of the Twenty-fifth Standing Committee of the Regional Committee for Europe

Members of the Standing Committee reviewed the programme and agenda for RC68, and received a briefing from the Regional Director on significant events that had taken place since their last meeting.

Highlights for Day 2

• Further discussion of the proposed programme budget for 2020–2021
• A focus on the roadmap to implement the 2030 Agenda
• Realizing the full potential of the European Vaccine Action Plan 2015–2020
• New evidence on financial protection in Europe