Greek Government hosts broad policy dialogue on public health reform

The Ministry of Health of Greece, together with WHO/Europe, organized a policy dialogue on public health reform that took place in Athens on 28–29 March 2017 under the Strengthening Capacity for Universal Coverage (SCUC) initiative. The policy dialogue aimed to create a common understanding of the urgent need to shift from an emphasis on curative care to one on health promotion and disease prevention. It helped participants to identify structural challenges facing current public health services, clarify public health challenges related to migrants and refugees, establish a common commitment to all-of-government and all-of-society approaches, and agree on emerging priorities and principles for a national public health strategic plan.

More than 250 participants attended the policy dialogue, engaging in dynamic discussions over the course of the 2 days. They included representatives of the European Commission, the Greek Government, the Ministry of Health, WHO, other ministries and state agencies, local authorities, professional and patients’ associations, academia, and nongovernmental organizations.

WHO/Europe’s Division of Policy and Governance for Health and Well-being supported the event in collaboration with the Division of Health Systems and Public Health.

High-level political support for reform

The policy dialogue’s opening session demonstrated strong and committed political support for health reforms at the highest national level. In his opening address, Minister of Health Dr Andreas Xanthos highlighted the key role of public health in ensuring the safety and security of Greek citizens and in protecting them from various health threats.

Dr Xanthos also spoke passionately about social, fiscal and other major determinants of health in Greece and about the need to, in his words, “moralize” the health system – to move towards more systematic prevention, not only among risk groups but also among the general population.

Dr Zsuzsanna Jakab, WHO Regional Director for Europe, reaffirmed WHO’s support for the ongoing reforms in Greece. These reforms aim to produce a fundamental shift in the country’s health policies towards universal health coverage and a people-centred health system. This transformation reflects the spirit of the United Nations Sustainable Development Goals and embodies the values and principles of the European health policy framework Health 2020.

Dr Jakab stated, “People outside the health sector are often sceptical about investing in health, but I always tell them if they really care about social and economic development, they have to invest in health. More than that, health should be a real priority for the Government and all sectors should work together to implement policies addressing the root causes of poor health – social, environmental and behavioural determinants.”

Dr Jakab also emphasized the importance of addressing inequalities in health, which are costly for society and the economy, and represent both a moral and an economic imperative.

“Public health, along with primary health care and quality hospital services, represents one of the key pillars of the health system,” said Secretary General for Public Health Dr Giannis Baskozos, setting the scene for the technical sessions that followed. He added, “The initiated reform is very ambitious but feasible. We expect at the end of these 2 days of dialogues to have fewer questions and more answers, fewer theoretical reflections and more practical solutions – all of them to be reflected in our strategic plan.”

Summary of technical sessions: global and regional challenges and opportunities for Greece

In her introduction to the technical sessions, Dr Piroska Ostlin, Director of the Division of Policy and Governance for Health and Well-being at WHO/Europe, described how the 2030 Agenda for Sustainable Development provides a historic opportunity that Greece should seize to improve the health and well-being of its population. She argued that with its emphasis on building stronger partnerships and whole-of-government, whole-of-society approaches, Health 2020 provides an excellent stepping stone for improving health across the Sustainable Development Goals.

The first day’s technical sessions covered, among other topics, the key population health challenges facing Greece in the 21st century; the need for a new paradigm if Greece is to effectively reform its public health services; and innovative examples of all-of-government, all-of-society approaches from other countries. These sessions included keynote speeches, presentations and moderated panel discussions with local and external experts and WHO/Europe staff, and comments and questions from the audience.

The second day of the policy dialogue was devoted to identifying and analysing key public health challenges as well as suggestions for potential solutions and ways to implement them. Discussions took place within a number of working groups moderated by local and external experts; key points from each were presented in the final plenary session.

Dynamic discussions emerged on specific aspects of reforms, including: linking primary health care with public health services; prevention and control of noncommunicable diseases; social inequalities and public health; antimicrobial resistance and hospital-acquired infections; public health emergencies; vaccines management and vaccinations; designing a structure for a modern public health service; developing human resources for public health; and sustainable financing for public health.

Integrating migrant populations into the national health system

A separate technical session on the first day was dedicated to issues related to migration and health. With over 62 000 refugees and migrants stranded in Greece, there is an urgent need for public health care reform to effectively integrate migrant populations into national health systems. Efforts in this area are in line with the Strategy and action plan for refugee and migrant health in the WHO European Region.

The policy dialogue served as a first step in the Greek Ministry of Health’s mission to incorporate services for refugees and migrants into the country’s primary health care reform, with a focus on vaccination plans and preventive care.

The dialogue convened representatives from a wide range of multisectoral governmental and nongovernmental institutions working with refugee and migrant populations in Greece, including the ministries of health, employment, migration policy, and education, the Greek Centre for Disease Control and Prevention, and the National Health Operations Centre. The session also enabled the exchange of experiences between Italy and Greece, 2 of the countries on the front lines of large-scale migration in the Region.

Turning discussion into action

In his concluding remarks at the end of event, Dr Hans Kluge, Director of the Division of Health Systems and Public Health at WHO/Europe, reminded participants that significant results at the population level can be achieved only if primary health care services are complemented with public health interventions reducing the burden of diseases.

He also highlighted the importance of turning discussion into action, saying, “We have enough ideas and inputs for a strategic plan on public health for Greece and we are sure that such a plan will be produced very soon and approved. It may not be perfect, but the most important thing is to implement it!”

Dr Kluge concluded with the ancient Greek mantra Η ισχύς εν τη Ενώσει: “United we stand!”

Background

The SCUC initiative is carried out with funding from the European Union through a grant agreement between the European Commission and WHO/Europe. Its general objective is to contribute to improving health and health equity in Greece, especially among the most vulnerable in the population, by helping the Greek authorities to move towards universal health coverage and to strengthen the effectiveness, efficiency and resilience of their health system.