Examples of investing in health from the South-eastern Europe Health Network

The 4th South-eastern Europe Health Ministerial Forum, taking place on 3–4 April 2017 in Chisinau, Republic of Moldova, is focused on the theme “Health, well-being and prosperity in south-eastern Europe by 2030 in the context of the 2030 Agenda for Sustainable Development”. It will bring health ministers together to explore pathways to closer partnership. Join the discussions on social media using #seeforum2017.

Established as an intergovernmental initiative for regional cooperation in 2001, the South-eastern Europe Health Network (SEEHN) has shown that the health sector contributes to reconciliation, peace and stability in a post-conflict environment. Its 9 current members – Albania, Bosnia and Herzegovina, Bulgaria, Israel (since 2011), Montenegro, the Republic of Moldova, Romania, Serbia and the former Yugoslav Republic of Macedonia – share a vision of promoting health as an integral part of economic development. In addition to participating in intercountry initiatives, each country is investing in health and generating results that inform other network members.

A new publication mapping out health expenditure and health status across the member states of SEEHN and offering examples of intersectoral investments in health for each will be presented at the Forum, and published online after the event.

Albania’s tobacco ban

Surveys in recent years indicate that over 50% of adults in Albania smoke. In response, the Government of Albania has initiated the introduction of a smoking ban. According to WHO, for less than 30 leks (approximately 0.25 euros) per person per year, Albania will be able to pay for the 4 “best buys” in tobacco control policy: raising tobacco excise taxes, enforcing a comprehensive national smoke-free law, enforcing a ban on tobacco advertising and promotion, and mandating large graphic warning labels on tobacco product packaging. This small investment will offer large dividends in health and prosperity for the country’s population.

Community-based mental health services in Bosnia and Herzegovina

Mental health reform, with an emphasis on respecting the human rights and dignity of people with mental disorders, has been a long-term goal of SEEHN. Community-based centres have been established in Bosnia and Herzegovina in order to provide integrated mental health services where people live. The services are focused on enhancing recovery and are based on evidence of what works best. Thanks to the commitment and political will of the public health community, local government units and civil society, 2 pilot centres have grown into a countrywide network that provides long-standing services.

Stronger tobacco law in Bulgaria

In Bulgaria, 45% of men and 25% of women smoke. The majority of smokers are 25–39 years of age. Following resistance to a law introduced in 2009 that made restaurants, bars, clubs and cafes 100% smoke-free, the health sector led an initiative with support from civil society organizations and the economy, finance, tourism, agriculture and other relevant sectors to establish a new, stronger law.

In addition to a complete ban on smoking in public places, the legislation adopted in 2016 bans the sale of tobacco with specific flavours and aromas; enables pictorial warnings on cigarette packs; forces tobacco producers and importers to inform the Ministry of the Economy of any new products 6 months before they are launched; and sets maximum levels of tar, nicotine and carbon dioxide in tobacco products. This success underlines the importance of political will and collaboration across sectors to achieve health goals.

Tackling obesity in Israel

In response to increasing obesity rates and levels of diabetes twice those of western European countries, the Government of Israel launched a national programme to promote an active, healthy lifestyle in 2008. Joint efforts to limit access to unhealthy foods in schools and promote healthy school meals and physical activity have resulted in plateaued obesity levels, and these are expected to fall in the coming years. The programme’s success depends upon intersectoral action, including joint planning, implementation and, to a limited extent, budgeting between the ministries of health, agriculture, education, and culture and sport.

Analysing air pollution in the former Yugoslav Republic of Macedonia

Levels of air pollution in the former Yugoslav Republic of Macedonia are among the highest in Europe. In the capital, Skopje, air circulation is low in the winter months; this often increases levels of particulate matter from traffic, industrial and household sources to dangerous levels.

A municipal analysis of the concentration of pollutants and the health response of an individual led to estimates of the health impact and economic cost of air pollution: it revealed that, in 2011, fine-particulate air pollution was responsible for 1350 deaths from cardiopulmonary disease and lung cancer, and for 770 hospital admissions. These health effects represent an annual economic cost of €253 million, or 3.2% of the country’s gross domestic product. These findings have strengthened the case for introducing greening interventions in key sectors to reduce the concentration of particulate matter and air pollution.

Improving universal health coverage in the Republic of Moldova

Legislation introduced in 2009 and 2010 provides all citizens of the Republic of Moldova with access to free primary health care services provided by family doctors. These reforms have expanded health insurance coverage to almost 80% of the population, increased the use of services and reduced financial barriers to accessing care. From 2008 to 2012, the proportion of people who said they did not seek care when they needed it due to financial reasons fell from 29.2% to 14.8%. Reforms will continue, with a particular focus on people with the lowest level of income living in rural areas.

Reducing salt intake in Montenegro

Montenegro’s 2014–2025 programme for reducing dietary salt intake aims to reduce salt intake to less than 5g per day per person by raising awareness, reducing salt content in processed foods and harmonizing national initiatives. From the outset, leaders have promoted intersectoral action involving the health, agriculture and private sectors to ensure sustainable action and broad support. Other sectors now take account of the health risks of high salt content, for example, when drafting regulations for labelling.

Improving access to health services for marginalized groups in Romania

A pilot activity to address health issues in Roma communities at the local level through the provision of Roma health mediators has grown into a whole-of-government and whole-of-society initiative. The Ministry of Health has now integrated these community services and formalized 2 field professions in the system: community nurses and Roma health mediators. To do so, it has worked together with other ministries, local government, civil society and development partners, as well as international organizations such as WHO and the European Commission. The scope of services provided now extends beyond ensuring child survival to promoting child well-being and increased social and economic capital in the country.

Inclusive education in Serbia

In Serbia, lack of primary school education is one of the major determinants of lifelong poverty and poor health. Many children, particularly those who are disabled or from the Roma population, do not attend primary school. From 2009 to 2017, the Government of Serbia, together with international donors, initiated a joint programme promoting inclusion of Roma people and other marginalized groups. The programme seeks to deliver services including support for early child development, mentor classes, Roma teachers’ assistants, homework support classes, programmes for parents, and language classes to ensure that marginalized children participate fully in preschool and primary education. These services have been institutionalized at municipal and national levels to ensure that sustainable funding and a legal framework enable them to continue.