health 2020 and the post-2015 development agenda

Positioning the Veneto Region at the coreof Global and European health policies

Venice, Italy, 3-4 December 2015

Health 2020 and the post-2015

development agenda

Positioning the Veneto Regionat the core of global and European health policies

3-4 December 2015,Scuola San Giovanni Evangelista

Venice, Italy

Dr Zsuzsanna JakabWHO Regional Director for Europe



Elisabeth Heseltine

Please change footer to "... core of global and European ..."



Life expectancy trendsLife expectancy at birth (years), males Life expectancy at birth (years), females

70

75

80

85

1980 1990 2000 2010 1980 1990 2000 2010

European Region EU15 Italy

Source: WHO Europe: European Health for All database



Proportion of the population aged ≥ 65 and birth rate

% of population aged 65+ years Live births per 1000 population

8

12

16

20

1980 1990 2000 2010 1980 1990 2000 2010





Mortality by broad cause, all ages

SDR, Infectious and parasiticdiseases, per 100000 SDR, Neoplasms, per 100000 SDR, Diseases of the circulatory

system, per 100000

SDR, Diseases of the respiratorysystem, per 100000

SDR, Diseases of the digestivesystem, per 100000

SDR, External causes of injury andpoisoning, per 100000

5

10

15

20

160

200

240

100

200

300

400

500

50

100

150

20

30

40

50

60

20

40

60

80

1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010

1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010


Source: WHO Europe: Mortality indicator database.



Premature mortality(0–64 years), by broad cause

SDR(0-64), Infectious and parasiticdiseases, per 100000 SDR(0-64), Neoplasms, per 100000 SDR(0-64), Diseases of the

circulatory system, per 100000

SDR(0-64), Diseases of therespiratory system, per 100000

SDR(0-64), Diseases of the digestivesystem, per 100000

SDR(0-64), External causes of injuryand poisoning, per 100000

5

10

15

60

80

100

50

100

10

20

30

10

20

30

25

50

75

1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010

1980 1990 2000 2010 1980 1990 2000 2010 1980 1990 2000 2010

European Region EU15 Italy Source: WHO Europe: Mortality indicator database.



Maximum value

Regional average

Minimum value

Inequalities in life expectancy: declining, but gaps persist



Interactive atlases of regional health

• The WHO Regional Office for Europe, jointly with the European Commission, has prepared interactive atlases of health inequalities at regional level for European Union countries.

• The atlases facilitate exploratory analysis of health status and inequalities at regional level.

• Freely available from http://data.euro.who.int/equity.

http://data.euro.who.int/equity



Example: brief overview of the health situation in the Veneto



Example: disposable income and life expectancy in the Veneto and the European Union



Improve health for all and reduce the health divide

Improve leadership and participatory governance for

health

Invest in health

throughout the life-

course, and empower

people

Tackle Europe’s

major health challenges:

noncommunicable and

communicable diseases

Strengthen people-centred health systems,

public health capacity and emergency

preparedness, surveillance and

response

Create resilient

communities and

supportive environmen

ts

Health 2020: four common policy priorities for health

Health 2020: strategic objectives



Health is central to development



Transforming our world:the 2030 agenda for sustainable development



Sustainable development goals

Sustainable Development Goals

matter to us



Sustainable development goals

Universal health coveragein every country of the world



Regional consultationOn the post-2015 development

agenda



Health goal

Goal 3:Ensure healthy

lives and promote well-being for all at

all ages

3.1 Reduce maternal mortality

3.2 End preventable

diseases

3.3 End epidemics of AIDS, TB, etc.

3.4 Mortality for NCDs

3.5 Substance

abuse

3.6 Road traffic

accidents

3.7 Access to sexual and

reproductive health

3.8 Universal

health coverage

3.9 Hazardous chemicals & pollution

Health as a target in other goals

Elisabeth Heseltine

3.4 should be Mortality from NCDs

Elisabeth Heseltine

3.7 should be Access to sexual and reproductive health care

Elisabeth Heseltine

3.3 Does this SDG really have the abbreviation etc.? It really takes away from the effect.



Health targets will be met only by joining policy action to that for other SDGs

Example: The health target to reduce premature mortality from NCDs will have to be implemented in partnership with sectors and policies responsible for education (SDG4) and economic growth and employment (SDG8).



The health goal will contribute to meeting other goals

Example: Health target 3.8 on achieving universal health care will directly contribute to attaining SDGs for poverty reduction (SDG1), reducing inequalities within and between countries (SDG10) and ensuring inclusive, safe, resilient cities (SDG 11).



Health and well-being in each and every goal



Transforming our world:the 2030 agenda for sustainable

development



RENEWED POLICY ENVIRONMENTFRAMED BY

HEALTH 2020



Intersectoral action: elements for success



National and regional prevention plans and Health 2020

• Reducing health inequities• Intersectorality• Improving governance• Focus on health promotion• Health as a tool for

development• Strengthening coherence• Evidence-based interventions• Strict evaluation of all steps• Equity lens• Life-course approach• Health in all policies



Health interests all Hinge for social cohesion: more cohesive society = healthier

society Democratic tool that favours democracy Catalyser of involvement of civil society Help individuals to become better citizens Improve “ownership” and empowerment of people for their health Increase health literacy Positive externalization towards sectors other than health Favour integration and alliances for common goals

Participatory approaches in prevention plans



Viral hepatitis is inadequately addressed throughout the WHO European Region

• 13 million people (estimated) live with chronic hepatitis B

• 15 million people (estimated) live with chronic hepatitis C

• 400 deaths related to viral hepatitis a day



Viral hepatitis – a silent killer



Re-emergence of polio: strong reminder to maintain commitments

Polio: poliomyelitis



Translating commitment into action

Goal 1. Sustain polio-free status

Goal 2. Eliminate measles and rubellaGoal 3. Control hepatitis B infectionGoal 4. Meet regional vaccination cover targetsGoal 5. Make evidence-based decisionsGoal 6. Achieve financial sustainability



Measles in the WHO European Region, 1993 and 2007–2014

20092010

20112012

20132008

2007

1993

9168

7075 7892

30604

33268

26786

32174

341982

16159

2014

98% REDUCTION



Vaccine-preventable diseases

Challenges:• High national level coverage with vaccines masks subnational pockets

of susceptibility.• Low commitment in some Member States to close immunity gaps

among adolescents and adults, refugees, migrants, religious groups• Poor response to measles and rubella outbreaks • Mass vaccination campaigns not accepted in many countries• Suboptimal vaccine demand• Polio outbreak in Ukraine and influx of refugees and migrants• High diphtheria and pertussis deaths in the Region in 2015• Italy: neither rubella nor measles has been interrupted, and vaccine

hesitancy in the general population and the health care community is a growing concern.



Vaccine-preventable diseasesAchievements:• High coverage with routine vaccines• Many new vaccines introduced across the Region (HPV,

rotavirus, pneumococcus).• Polio-free status enjoyed since 2002• Interrupted endemic transmission of measles (22

Member States) and rubella (23 Member States): fewer cases of measles and rubella in 2015 than in the 5 preceding years



Numbers of reported measles cases in Italy, 2003–2014

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014No. reported 10998 678 215 581 410 1619 173 864 1968 605 2256 1687

0

2000

4000

6000

8000

10000

12000

No. o

f rep

orte

d m

easle

s cas

es

Source: World Health Organization Regional Office for Europe. Centralized Information System for Infectious Diseases (CISID) Copenhagen, WHO Regional Office for Europe. Available at: data.euro.who.int/cisid/ (accessed October 18, 2015).



2010 2011 2012 2013 20140

10

20

30

40

50

60

70

80

90

6.1

85.5

6.2

19.927.7

34.241.3

31.3 30.520.2

Italy European Region Source: World Health Organization Regional Office for Europe. Centralized Information System for Infectious Diseases (CISID) Copenhagen, WHO Regional Office for Europe. Available at: data.euro.who.int/cisid/ (accessed October 18, 2015).

Measles incidence per 1 million population, Italy and the WHO European Region,

2010–2014



A European Region free of vaccine-preventable diseases, where all countries provide equitable access to high-quality, safe, affordable vaccines and immunization services throughout the life-course



Prevention and control ofnoncommunicable diseases (NCDs) Photo: iStockphoto



Age-standardized estimates of prevalence of overweight and obesity, adults ≥ 18 years, 2014

Source: Global status report on noncommunicable diseases 2014



FCTC : WHO Framework Convention on Tobacco Control



Smoking prevalence% of regular daily smokers in the population, age 15+

10

20

30

40

1980 1990 2000 2010





Age-standardized estimates of prevalence of current smoking of any tobacco product among adults, 2012

Source: Global status report on noncommunicable diseases 2014



Roadmap towards implementation of the WHO FCTC



Investing in health through a life-course approach: key strategic direction for Health 2020

Photo: iStock



Ministerial Conference 21–22 October 2015.Minsk, Belarus

A life-course approach increases the effectiveness of interventions, promoting timely investments with a high rate of return for public health and the economy.

Elisabeth Heseltine

Remove green line



0 20 40 60 80Health “gains” and “losses” are passed on to the next genera-

tion

Health and well-being accumulate over a lifetime

Photo: shutterstock.com



Strengthening people-centredhealth systems and public health capacity



New vision for health systems strengthening involves people


Venice, Italy, 3-4 December 2015Photo: Sara Barragán Montes

Migration and health: high on the agenda



Public health policies for

access of refugees and

migrants to health and well-

being

Photo: WHO/Santino Severoni



Supporting countries on refugee and migrant health policies



High-level meeting on refugee and migrant health

23–24 November 2015, Rome, Italy



High-level meeting on refugee and migrant health23-24 November 2015, Rome, Italy Protect and promote the health and well-being of refugees and migrants

and of the host population, in accordance with the principles of population health and human rights.

Integrate the needs of refugees and migrants into existing health structures, and strengthen the preparedness of health systems.

Reinforce data collection on refugee and migrant health and make it available to other countries as individuals move.

Demystify the perception that refugees and migrants bring communicable diseases; they do not pose a greater risk than other international travellers.

Direct efforts to the most vulnerable groups, e.g. children, women, older people and those in need of mental health care.

Ensure the continuity and quality of care.


Venice, Italy, 3-4 December 2015Photo: WHO/Sara Barragán Montes

Response to the conflict in the Syrian Arab Republic



Response to the conflict in the Syrian Arab Republic

Photo: WHO/Nedret Emiroglu



Response to the humanitarian crisis in Ukraine

Photos WHO/Alex Glyadyelov



Photos WHO/Alex Glyadyelov

Response to the humanitarian crisis in Ukraine



Health expenditureTotal health expenditure as % of GDP, WHO estimates Public-sector expenditure on health as % of total

government expenditure, WHO estimates

5

10

15

20

1995 2000 2005 2010 1995 2000 2005 2010


Source: WHO Europe: European Health for All database.



Public sector and out-of-pocket health expenditure

Public-sector health expenditure as % of total healthexpenditure, WHO estimates

Private households' out-of-pocket payments on health as %of total health expenditure

25

50

75

1995 2000 2005 2010 1995 2000 2005 2010


Source: WHO Europe: European Health for All database.



Public health care spending as a percentage of total health care spending, Italian regions, 2007

Total health care spending in the Italian regions as a percentage of GDP, 2007

Source: HiT Veneto Region, Italy. 2012. European Observatory on Health Services and policies



Out-of-pocket health spending by families as a percentage of total health spending, Italian regions,

2001 and 2007

Source: HiT Veneto Region, Italy. 2012. European Observatory on Health Services and policies

health 2020 and the post-2015 development agenda

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