Speech – Why the new Health 2020 policy framework is important and useful to every person here in Denmark, Europe and beyond

31 October 2012, Copenhagen, Denmark

Mayor Thomsen, Minister Krag, distinguished leaders of Danish healthy cities, dear colleagues,

It gives me great pleasure to be with you today to celebrate the adoption of the European Health 2020 policy framework and to share with you some thoughts on why this common European policy framework is vitally important to every person here in Denmark, Europe and beyond.

Dear colleagues, we live in amazing times. Who would have believed, 20 years ago, that 3 out 4 people on the planet would be linked by such mobile phones; that smart phones could put access to the world’s best public health information in each of our pockets. Global telecommunication advances have indeed revolutionized where and how we get information, the speed of information transfer, the capacity for single individuals to influence large mass audiences. Advances in medical technology, opening of borders, free-trade agreements and unprecedented investments in global health have moreover sped up the global movement and transfer of goods, services and people as well. Opportunities for advancing public health have never been so good.

At the same time, however, new global health challenges have emerged and are increasingly shaping and reshaping national and local agendas. Today the health of citizens in Horsens, Aarhus and Copenhagen are directly affected and often threatened by the capacities (or lack of capacities) of public health systems continents away to recognize and manage severe acute respiratory syndrome (SARS), avian influenza, swine influenza and other emerging infectious diseases. The effects of global warming – such as extreme weather events like the floods here in Denmark in 2010 and 2011, which affected sanitary systems and caused so much property damage (including to our WHO offices in Hellerup) – can only be controlled if all countries cooperate. More than ever before, we must embrace the reality that, as far as health and health security are concerned, we are all interconnected; that many public health challenges cannot be tackled without concerted efforts by local, national, regional as well as global communities.

Acknowledging and addressing this twenty-first-century reality underpins the rationale for our common European health strategy: Health 2020. It builds upon two key assumptions. First, in this interconnected world we are not passive players –we understand the causes behind the ill health of our people and that we can actively strive for health, well-being and prosperity. Second, our individual actions can be greatly amplified by collective action and in fact that our health destinies as peoples of Europe depend on it!

So the challenge that Health 2020 has taken up is to identify ways we as Europeans can collectively take action to benefit from new opportunities and address common challenges or, in other words, how we can facilitate a smooth and effective European journey: “We are all in the same (health) boat.” To this end, Health 2020 provides us with ground rules, a destination, navigational skills, and ways to actively engage all of us voyagers.

Ground rules: health policy etiquette

Ladies and gentlemen, while the first rule of the road is “you never know”, it is most helpful to have some rational expectation of how people will behave in our common boat, before you jump in. To this end, Health 2020 articulates Europe’s common ground rules for health. These common ground rules are simple but powerful. They basically state that policy actions should be value driven and evidence based, and ensure participatory stakeholder review.

The Health 2020 values build on those agreed by all countries of the world in the WHO Constitution in 1948, and view health as a fundamental right for all. They embody a commitment to equity, solidarity, dignity, respect for diversity and transparency. Moreover, Health 2020 calls for evidence- as opposed to eminence-based policies, which incorporate participatory stakeholder review and involvement: policies, in other words, that provide ample opportunity for input by local authorities, associations and parties of interest. These are much like the kind of initiatives the Danish ministry has been facilitating related to developing a common quality agenda on all levels and engaging local expertise in developing new, creative solutions to chronic illness.

Knowing that all parties (countries) have committed themselves to working toward value-driven, evidence-based and participatory, stakeholder-reviewed policies allows all of us to expect certain behaviour from our fellow “boat passengers”; to set standards for health policy behaviours; and hold each other accountable.

A destination: are we almost there yet?

Dear colleagues, I don’t know if this is your experience, but, whenever our family started on a long journey, the first questions my children would ask was, “Where are we going and how long till we get there?” And then, every five minutes, “Are we almost there yet?”

Indeed, knowing where you are going is a key determinant for setting a direction for our virtual global health boat journey. Importantly, within the Health 2020 framework, all 53 Member States in the WHO European Region have agreed on a common goal or health destination, that is, to: “significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health and ensure people-centred health systems that are universal, equitable, sustainable and of high quality.”

Moreover, countries are negotiating, within limits set by their current financial situation and administrative burdens, common targets, so that we can measure progress towards our common goal.

Navigational skills: matching action options to need

Having agreed common values and a goal, attention next turns to navigational skills to get to the goal. Some say that, when you don’t know where you are going, any road will get you there! But, when you do know where you are going, you need to have a strategy, action options and a plan.

Here is where Health 2020 really shines. Over its two years in development, we engaged with hundreds of researchers and practitioners across the whole European Region and beyond to review evidence and experience of what works in addressing twenty-first-century health challenges related to inequities, the emerging dominance of noncommunicable diseases (NCDs), changing demographics, migration challenges, new and re-emerging infectious diseases. Significant effort went into doing cost–benefit studies looking at the economic impacts of different policy actions (and inactions). From these reviews, effective and efficient policy options were distilled and identified. In addition, the WHO Regional Office for Europe contracted for some primary research related to social determinants (coordinated by Sir Michael Marmot) and new health governance approaches (coordinated by Professor Ilona Kickbusch).

Let me clear about this: the final Health 2020 documents are a treasure house of carefully selected evidence that can(and, dare I say, should) serve as an unprecedented resource for public health practitioners and for all other sectoral decision-makers whose policies affect health.

Health 2020 identifies and details four priority action areas:

• investing in health through a life-course approach and empowering people:
• tackling the Region’s major health challenges of noncommunicable diseases and communicable diseases;
• strengthening people-centred health systems, public health capacity and emergency preparedness, surveillance and response; and
• creating resilient communities and supportive environments

Moreover, Health 2020 identifies some of the new leadership skills needed to navigate our common health vessel. For example, the framework notes that much of the authority of today’s health navigators (leaders) arises not only from their position in the health system but also from their ability to convince others that health and well-being are highly relevant in all sectors. You here in Denmark are of course very familiar with these new skills and approaches as the national network of Healthy Cities has been working on “health in all plans” for quite a while now. Moreover, such insights and action plans figure largely in the recommendations of the inspiring study the National Board of Health requested Professor Finn Diderichsen, of the University of Copenhagen, to conduct on social inequalities in health in the Danish context. As noted in its introduction:

“The report points to a number of developments within existing policy areas, showing that reducing health inequality is not primarily the task of the health sector. It is a complex task requiring coordinated efforts from different sectors (e.g. the education, social, health and employment sectors) at different administrative levels (national, regional and local). As such, there are many approaches and professions at play and this report will hopefully constitute an important basis for the organization and prioritization of future efforts.”

Such studies and recommendations are vital not only for Denmark but for the rest of Europe and beyond. This brings me to another key attribute of Health 2020: its role as a platform for exchange and learning between countries, regions, cities and households. All these settings in our vast Region have very different starting points, and each requires its own leadership and the adaptation of even well-documented evidence-based approaches. All can be inspired and informed, however, by each other. Such cross-fertilization strengthens the capacities of all.

Finally, Health 2020 points to the need for all to work together to keep the boat moving in the right direction. And let me emphasize this last point. Health 2020 guidance applies not only to governments. It is meant to inform each and every one of us. Each and every one of us is a policy-maker in our own homes. The policies we set help determine the behaviours of our children, our institutions and our communities, and shape their health outcomes.

From Health 2020, we can all get useful guidance on dealing with common home-led health policy challenges as the following.

• How do I help my children not to take up bad habits?
• How do I influence my community to pass laws that make healthy choices easier?
• How do I work in partnership with my health care providers to co-manage my chronic illnesses?

I urge you to look inside the documents and draw inspiration and practical guidance from their content.

In conclusion, Health 2020 calls upon the whole of society to seize new opportunities for the health and well-being of present and future generations. Health 2020 supports and encourages all stakeholders to work together in a shared effort for a healthier, wealthier, safer, fairer and greener European Region.

We welcome you all on board and look forward to a healthy and happy journey together. Do you know where the life vests are stowed?