Allocution de bienvenue au Sommet des maires du Réseau européen des Villes-santé de l’OMS

Your excellences, ministers, governors, mayors, ladies and gentlemen, friends and colleagues. On behalf of WHO, I would like to extend an open and warm welcome to all of you for coming to participate in this important Summit of Mayors of the WHO European Healthy Cities Network.

It is truly my pleasure to be here with you this afternoon, and to welcome you all to this Summit, held in this beautiful city of Almaty in Kazakhstan. I would like to start by extending my sincere gratitude to the city of Almaty – and to the Mayor of Almaty, Bauyrzhan Baibek – for their generous hospitality, for hosting this event at this important time and for inviting us all to this beautiful and historic city.

Astana Global Conference link

The year 2018 marks two important anniversaries relevant to those of us gathered here today – and, in fact, two key milestones for the entirety of the public health community: 40 years of the Declaration of Alma-Ata, which was adopted at the 1978 International Conference on Primary Health Care, held just down the road from here in this city; and 30 years of the WHO European Healthy Cities Network.

Here in Almaty today and tomorrow we are celebrating 30 years of Healthy Cities, and at the end of the week the global health community will come together in Astana to mark the 40th anniversary of the Alma-Ata Declaration at the WHO Global Conference on Primary Health Care.

The Declaration of Alma-Ata was a key factor in the foundation of WHO Healthy Cities 30 years ago, and it is fitting that these two celebrations are officially linked: this Summit being a preconference event to the Global Conference in Astana.

The political outcome document of this Summit, the Almaty Acclamation of Mayors: Cities at the frontline of health and well-being for all is currently open for consultation and up for adoption here tomorrow. It also provides the official link between the two events. The document provides the strong political commitment that we need to ensure that healthy cities are best placed to support primary health care moving forward, and the implementation of the outcomes of the Global Conference in Astana later this week. I strongly urge you all to adopt it.

Political leadership

Adoption of the Almaty Acclamation tomorrow would represent another milestone in the political leadership of the Healthy Cities Network.

Political will and political leadership are crucial to achieving improved health and well-being for all – our goal as an organization through the implementation of Health 2020, the European policy and strategic framework for health and well-being, and the United Nations 2030 Agenda for Sustainable Development.

It is also the central element of the Healthy Cities Network. It has been the inspiring, charismatic and sustained political leadership that has been the beating heart of the Network – that has allowed it to flourish for so long – making it the longest running city network in the world.

But while I want to take the opportunity to thank you for this leadership, it is also a time where I will call on you. As the Network embarks on the new phase, Phase 7, from January 2019 – as it has aligned itself to the United Nations 2030 Agenda – this political leadership is needed more than ever.

In this important time for us all, I call on you, as political leaders, to lead us into the healthier and happier future that the Network committed to through the adoption of the Copenhagen Consensus of Mayors: Healthier and happier cities for all at the Summit of Mayors held in Copenhagen in February earlier this year. The Consensus provides the political vision of the Network until 2030 – now we need to implement it. The Belfast Charter for Healthy Cities, which was adopted at the International Healthy Cities Conference in Belfast, United Kingdom, earlier this month, is the first step towards doing just that throughout Phase 7.

The Copenhagen Consensus is fully aligned with the United Nations 2030 Agenda for Sustainable Development and the 17 global Sustainable Development Goals, the SDGs. This was adopted by all United Nations Member States in 2015, and provides renewed political impetus to the agenda of sustainable development, and focuses specifically on leaving no one behind. It calls for transformative approaches to achieve this, and represents a paradigm shift in how we engage with people.

Healthy Cities has at its heart innovation and transformative approaches. It has been a leader in driving forward our common values of contributing to a healthier world for all, and leaving nobody behind. Healthy cities are essential partners to achieving the successful implementation of the SDGs. Without you we simply would not be able to succeed.

Your political leadership is not simply necessary to achieve international agendas, such as the 2030 Agenda and Health 2020, however. It is also crucial to all factors necessary for improving health and well-being, as the WHO, as cities and as a global community. This is especially true of the topics that are featured in this Summit: primary health care, universal health coverage, equity, migration, integrated services at the local level, multi- and intersectoral action, governance and public health.

Healthy cities and the role of primary care and local authorities

Healthy cities and primary health care are inextricably linked. Your work as healthy cities to strengthen health literacy and strive to create empowered and resilient communities that encourage increased individual and community ownership and responsibility for their health and well-being is essential for primary health care. Your cities need to have health services at the local level that are designed to facilitate and respond accordingly to the needs and assets of their populations.

The role of primary health care in local communities. Primary health care bridges public health, social services, education and other important sectors. We need to put people and local communities at the centre of the services that we design and deliver. Primary health care connects these services and bridges also care in the community with other specialized health services. Care closer to people, closer to the places where they live and work translates into better health outcomes.

Healthy lives begin at home. It is clear our health begins at home and rightly so, people-centred services are the mantra of the 21st century. This importantly extends to our communities, where public and green space, multiple modes of safe and clean transit, healthy and affordable food options, and other essential goods and services must put people first to realize their full potential. Healthy cities are a key enabler to people leading healthy and productive lives.

Addressing the determinants of health and well-being and tackling the main health risk factors begins with work locally and in our communities. Primary health care can provide a platform for realizing a population approach, as was put forward by the European Region's Primary Health Care Advisory Group at its first meeting in 2017.

Universal health coverage

Primary health care is indispensable to overcome the growing burden of noncommunicable diseases – as well as to achieve progress towards universal health coverage, or UHC, another key topic of discussion during this Summit.

The essence of UHC is a strong and resilient people-centred health system with primary care as its foundation, with community-based services, health promotion and disease prevention as key components. In line with the principles set out in WHO’s Constitution, the Organization will support countries to strengthen their health systems to progress towards UHC. Moving towards UHC is a political choice, with important social and economic benefits; it requires support from all levels of government.

UHC is one of the three key goals of WHO’s 13th General Programme of Work (GPW 13), adopted by all 194 WHO Member States at the World Health Assembly in May 2018. GPW 13 commits to ensuring healthy lives and promoting well-being for all, at all ages “by advancing universal health coverage – 1 billion more people benefitting from universal health coverage”.

Focusing on increasing equity and accessibility is necessary for us to build the sustainable future called for in the 2030 Agenda, and UHC is a crucial element of achieving this. In order to do so, we must work together, with you and your cities.

Public health dimension

The public health dimension of primary health care, of universal health coverage and of the associated topics that will be discussed both here in this Summit and at the Global Conference in Astana later this week is crucial, and should be emphasized.
Healthy cities act as a vehicle to build public health capacity at the local level, and your Almaty Acclamation of Mayors will help do this.

School health services

A key public health element of primary health care that is linked directly to healthy cities is school health services. The WHO European Healthy Cities Network works strongly with the Schools for Health in Europe Network, and every single WHO healthy city has made a commitment – though the adoption of the 2017 Healthy Cities Pécs Declaration – to work towards every school within a WHO healthy city being a WHO healthy school. I am delighted that the city of Almaty is one of the forerunners to achieving this goal.

School health services often fall under the responsibilities of local government and city authorities, and not the national health services. This provides a governance challenge in linking the different levels of government. These health services need to be funded and provided by schools, but also have a link to the national health system.

The provision of adolescent-friendly services allows health services to reach adolescents where they spend most of their time. School health services are an effective way of providing access to these services for adolescents, leading to healthier and happier children, and improving school attendance and performance.

A school nurse, for example, can assure confidential counselling and contribute to reducing the mental health burden among adolescents.

Mental health

Healthy cities, however, can do even more for mental health.

As a global and growing phenomenon, urbanization poses significant challenges to mental health and mental health services, including homelessness, violence and drug abuse, as well as loneliness.

This is recognized in the recently adopted Belfast Charter for Healthy Cities, which views poor mental health both as a consequence and a cause of inequity, poverty and exclusion. Promoting early diagnosis, initiating community-based interventions, extending and maintaining counselling and mental health services, increasing employment opportunities and expanding debt advice services can all play a crucial role in promoting good mental health. Cities, through ensuring the accessibility and integration of their services, and design and implementation of progressive and people-centred city policies, play a key role in ensuring this.

Migration

Another crucial topic of the utmost relevance to primary health care and public health that will be discussed during the Summit is the public health aspects of migration. People continue to flee from seemingly hopeless experiences in search of an improved life. Our response to it will be what shapes the future health-care landscape for the European Region, its people and its new arrivals.

Globally, refugees and migrants tend to be particularly concentrated in cities, as compared to other parts of the country. Therefore, how cities respond to addressing the public health aspects of migration is crucial.

Levels of internal migration are also increasing in many countries, causing the rapid expansion of cities, placing pressure on services and how they can respond. In addition, migrants are also moving to smaller metropolitan areas, which are becoming new arrival destinations.

In fact, as we have seen throughout the Region, the receiving of migrants creates an economic, social and cultural opportunity for countries and cities. This also calls on humanity to evolve its thinking, to fight discrimination, embrace diversity and improve social cohesion. This, however, requires a coordinated governance response that is coherent between all levels of government.

Subnational level

From a health perspective, the subnational level is strongly supported by WHO throughout the European Region. Through both the Healthy Cities Network and the Regions for Health Network (RHN), WHO is supporting the local level, including several regions which are restructuring their health systems based on health reforms in line with Health 2020 principles and the 2030 Agenda.

The subnational level of governance is of paramount importance when it comes to how primary health care is organized. The RHN is developing – in collaboration with the WHO geographically dispersed office on primary care, based here in Almaty – a case study publication on the role of regions in shaping their primary health care services, for example.

Local responses to global aims must be genuinely local, sensitive to circumstances and culture, and seen to be meeting local needs. It will be essential that global aims set out in the outcome document of the Global Conference in Astana later this week ¬– the Global Declaration on Primary Health Care – are adapted at the local level in a language that is understandable, accessible and relevant to your cities.

This brings me back to the Almaty Acclamation of Mayors. This is the first step in the localization process of the Global Declaration on Primary Health Care, which will be endorsed this week in Astana.

The Almaty Acclamation is your tool, as city and regional politicians, to implement this Global Declaration, and its aims and ambitions. Healthy cities implement global policies at the local level and ensure that local priorities are recognized at the global level.

Forty years ago, the Declaration of Alma-Ata was endorsed here in this city, and inspired a generation of health leaders and professionals with a shared commitment to achieve health for all. Today and tomorrow, 40 years later in this same city, you have the opportunity to ensure that the next global declaration on primary health care has the same impact on the local level as on the global level, to ensure that it is a tool that helps the people in your cities live the healthier and happier lives that they deserve.

I urge you to take this opportunity.

Thank you.