Ljubljana Statement on Health Equity agreed – High-level Conference on Health Equity closes

The second day of the Conference introduced delegates to the “accelerate” strand, which focused on how to close the health equity gap and accelerate improvements for those left behind. Parallel sessions provided insights into and practical examples of people-centred integrated services; early interventions to reduce inequities across the life course; social inclusion, participation and empowerment; and health equity for achieving the Sustainable Development Goals.

Collaborating with people to accelerate health equity

Professor Mark Bellis, Director of Policy Research and International Development for Public Health Wales, spoke of initiatives introduced in Wales, United Kingdom, to address adverse childhood experiences and break the cycle of inequity and poor health outcomes. He described how teachers and police officers (front-line workers) in Wales are now trained in trauma and its impact on children’s health and well-being.

A simple, practical outcome of this training is that children returning to school after witnessing or experiencing abuse are offered a quiet area where they can speak to an adult. This means they see school as a safe place, return to the learning environment more quickly and exhibit less negative behaviour.

The parallel sessions yielded key reflections, including the need to change how we plan, implement and evaluate equity initiatives – creating them not only for people but also with people – and to develop them with equity sensitivity.

The sessions placed an emphasis on collaborating to develop partnerships and solutions that are inclusive and that connect across various agendas, including the 2030 Agenda for Sustainable Development. They highlighted the importance of integrating whole-of-government and whole-of-society approaches into local, national and international planning; of empowering and building capacity in human resources for health; and of reorienting primary care services with a stronger focus on leaving no one behind.

Plenary discussions

Introducing the plenary debate, delegates were asked through an interactive poll, “Which of these social capitals – having trust in others, having someone to ask for help, having control over life or feeling safe from crime and abuse – is statistically significant for accelerating health equity?” It was a trick question – the answer is all of the above.
Plenary speakers agreed on the fundamental need to work with others in a participatory manner to address health inequities, and that multiple sectors – economic, environmental, social, health, etc. – benefit from bridging the inequity divide.

“The empirical evidence is overwhelming that if we invest in the 5 conditions for health equity, these are the same essential conditions that will deliver growth,” said Professor Aaron Reeves of the University of Oxford, United Kingdom.

Second assessment report on environmental health inequalities in Europe launched

This report, launched in Ljubljana, Slovenia, shows that intra-country inequalities in environmental exposure persist, and in some cases may have even increased. This is despite significant improvements in environmental conditions in most countries. For example, in the case of housing inequalities, poor households in western European countries report 3.3 times more difficulty in keeping their homes warm compared to non-poor households.

Influence: placing health equity at the centre of sustainable development and strengthening partnerships

The last pillar of the Conference called on delegates to explore solutions and priorities to put health equity at the centre of sustainable development and inclusive economies. It emphasized new, strengthened partnerships and instruments that are effective in bringing social values into fiscal and growth strategies within countries and at the regional level.

Overall, discussions and presentations during the parallel sessions recognized that partnerships provide spaces for innovation, learning, exchange and reflection, and that they should include a plurality of voices – particularly those that have been excluded in the past.

Delegates expressed concerns about the sustainability of grassroots actions due to lack of funding, and noted that progressive policies, including pricing and taxation strategies to achieve equity, are likely to be targeted by commercial pressures. Addressing the compounding effects of commercial determinants of health on children and adults already at risk of poor health was a strong theme.

There was broad agreement that in order to counter the tactics deployed by large commercial players, wide-ranging coalitions are needed. The best available evidence, including equity impact assessments, must also be employed. Participants underlined that the legal framework protecting people’s rights needs to be strengthened, particularly for those who are often left behind.

On the final day of the Conference, these topics inspired lively plenary discussions that considered how to direct and strengthen alliances and build economic equity. Speakers representing justice advocacy organizations, nongovernmental organizations, governments, international banks and employee-owned businesses in the private sector called on delegates to reach out to unlikely partners – such as lawyers, academics, regional politicians, small businesses and ministries of employment – to seek dynamic alliances, work outside their comfort zones, speak the language of other sectors, tell a good story and dare to ask challenging questions to those driving the economic discourse.

Mr Håkan Linnarsson, Regional Commissioner of the Public Health Committee in Västra Götaland, Sweden, put it succinctly when he said that in order to defend and promote universal health coverage, health advocates must “engage and enrage”.

The Ljubljana Statement on Health Equity

Member States agreed to and expressed their strong support for the Ljubljana Statement by acclamation. They described it as a powerful instrument that articulates what Member States, United Nations agencies, international organizations and civil society organizations will do to progress towards health equity, and how they will do it.

One key development set down in the Statement is the establishment of a multidisciplinary health equity alliance of scientific experts and institutions. The alliance will generate cutting-edge evidence and methods for ministries of health and governments to make the case for, prioritize and scale up scientific, technological, social, business or financial innovations that will support systematic and effective action for health equity. This will enable champions of health equity to align with other equity agendas, nurture honest dialogue and innovations, and build a common path for sustainable change.

Representatives of the WHO European Healthy Cities Network, the WHO Regions for Health Network and the Small Countries Initiative read supporting statements. The Ljubljana Statement will be brought as a resolution to the 69th session of the WHO Regional Committee for Europe in Copenhagen, Denmark, in September.

Closing

As events drew to a close, Dr Piroska Östlin, Acting WHO Regional Director for Europe, thanked Minister Šabeder, State Secretary Bornšek and the Government of Slovenia for their commitment to health equity, and for their generosity in hosting the Conference. She thanked delegates for their engagement and honest dialogue, and called on them to take the Ljubljana Statement forward.

Summing up the proceedings, Dr Östlin said, “What we have also returned to time and again is that our most important partner is the child, the young person, woman or man, who is not able to thrive and prosper, who is not reaching their full potential in health, or in life. It is their voice, their lived experience, their passion, drive and resilience that we must nurture to make progress on health equity truly empowering.”