Video message - Actions to address health inequalities through the WHO European strategy Health 2020

23 January 2014, Brussels, Belgium

Dear participants to the Final Conference on Equity Action, unfortunately I am unable to be with you today. Nevertheless, I take the opportunity to address you by means of this short video.

Allow me to start by thanking the organizers of the Conference. I want to send my greetings to the representatives of the European Commission and all the experts and representatives of European countries and institutions that have been engaged with the activities and projects that have been part of the joint action on health inequalities.

The organizers of the Conference have asked me to speak about addressing health inequalities through the WHO European strategy, Health 2020. I am delighted to do so. I shall briefly highlight three issues:

• the main elements of Health 2020 framework
• the relevance of Health 2020 to action on health equity
• the urgency for sustained commitment, partnerships and cooperation.

Dr Erio Ziglio, who is attending the Conference, will be able to discuss these issues with you further.

Allow me then to start with the first of these three issues.

Main elements of Health 2020 framework

What is Health 2020 about? I know that many of you were involved in the long process and consultation that led to the endorsement of Health 2020 by all 53 Members States, so I shall just outline some of the main elements of the framework.

In essence, Health 2020 is a framework to advance health, equity and well-being in countries.
Health 2020 is characterized by two strategic objectives and four priority areas. The overall goal of Health 2020 is “to improve health and well-being of populations, to reduce health inequities and to ensure sustainable people-centred health systems with further strengthened public health capacities”.

The two main strategic objectives are:

• working to improve health for all and reducing health inequalities;
• improving leadership, and participatory governance for health.

Health 2020 seeks to achieve this through action in four priority areas:

1. investing in health through a life-course approach;
2. tackling Europe’s major health challenges of noncommunicable and communicable diseases;
3. strengthening people-centred health systems and public health capacities, emergency preparedness and response; and
4. creating resilient communities and supporting environments.

As you can see, the issue of addressing health inequalities is central to the goal of Health 2020 and is a cross-cutting theme throughout all of its priority areas.

Let me now outline the second issue.

Relevance of Health 2020 to action on health equity

We have clear scientific evidence that health across the 53 countries in the WHO European Region has improved, but not enough and not equally.

I gather from the Conference programme that you will be addressed by Professor Sir Michael Marmot. I am sure that with his address you will be confronted with the hard evidence and trends of health inequalities in Europe. Surely Professor Marmot will share with you the findings and the recommendations of the European review of the social determinants of health and the health divide. He chaired this review for the WHO European Region, which informed Health 2020. Professor Marmot also carried out a similar exercise with focus on European Union (EU) countries. So there is no need for me to dwell on the magnitude and pathways of health inequalities in Europe.

What I do want to emphasize is that in our Region we can do better to promote health and reduce health inequalities among and within our countries. This is what Health 2020 is designed to achieve! Health 2020 brings together new thinking and approaches for action to promote population health and reduce health inequities.

Health 2020 asks those wishing to tackle health inequalities to think about improving health and well-being in new ways. In addressing health inequalities the Health 2020 framework leads us beyond actions on health systems or changing life styles.

In Health 2020, population health is linked to societies and the way they function. This includes the risks and strengths that shape the lives of individuals, families and communities throughout the entire life-course. For example, we know the importance of early childhood experience, active labour market policies and welfare to tackle the health effects of unemployment and to improve health system access at times of austerity. Yet influencing life circumstances in these ways is not easy, and involves facing profound political, social and economic challenges.

Urgency of sustained commitment, partnerships and cooperation

Many health problems today are complex and require more than simple linear solutions. There is perhaps no greater “wicked problem” than health inequities. In some countries in the European Region, life expectancy is almost 20 years less than some other countries. There are also marked inequalities within countries. Reduction of inequities is not only a priority for the health sector. It is at the heart of policy objectives to reduce poverty, build safe and sustainable communities, increase human capital and reduce social exclusion. These are areas that are high in our WHO health agenda and, of course, crucial in current and future EU processes. These provide platforms for common action and synergies to reduce health inequities.

To do this, there is no doubt that we need strong and new forms of cooperation and partnerships. We need to find new mechanisms of governance for health that deal with the complex determinants of health inequities which scar Europe. We must recognize that, alongside national governments, we have regional and local administrations, the private sector, nongovernmental organizations, institutions, communities and individuals, all needing to be involved. This calls for wider and more inclusive cooperation, partnerships and action at all levels of policy-making.

Today, there are also expectations from citizens for more transparent and open policy-making. Holding decision-makers accountable for the effects of their decisions is no longer the pursuit of a few interest groups, but a fundamental measure of good governance. Likewise, involving people in decisions that affect their living and working conditions and opportunities is not just desirable but essential.

If we are to implement the spirit of Health 2020, we need to work in a different way. In order to promote population health and tackle decisively health inequities, governments or health ministries cannot act alone. In the European context, we have unique opportunities to work more cooperatively at all levels.

This means governing for health on a whole of government and whole of society basis. Success in tackling health inequalities will be defined not only in terms of positive returns for the health sector but also goals such as social inclusion, poverty reduction, sustainable development.

In the European context, we have unique opportunities to work more cooperatively at all levels. We need to sustain and increase our efforts for European, national and subnational cooperation to tackle health inequalities. This is complex to plan and deliver successfully, but essential if we are to be effective.

Conclusions

Ladies and gentlemen, health in Europe is a resource that is not equally distributed within our societies. Health 2020 is a framework for action designed to reverse this. It focuses on new ways of working, governance and leadership to deal with today’s health problems.

Health 2020 is a framework that helps to address the determinants of health inequalities with actions across the whole of government and society.

Asking policy-makers, practitioners and society at large to think wider, broader and in a more strategic and “upstream” way is perhaps the fundamental challenge for the uptake of Health 2020. Yet, in every country there are those, like the participants here today, that understand the issues and the way forward, who see what is needed and what needs to be done. I am sure that the many lessons and promising practices you are discussing during the Conference will help make Europe a better place for health and equity.

I congratulate you on the initiatives of this joint equity action partnership and I wish you a very productive Conference!