The European Action Plan for Strengthening Public Health

Dr Joanna NurseSenior Advisor, Public Health Services,

Health Systems and Public Health ServicesWHO, European Region

jnu@euro.who.int

Health Promoting Networks16th October 2012

Regional Committee Approval

•Resolution

•European Action Plan

•Including 10 Essential Public

Health Operations

Supported by Background Documents

•Review of public health services and

capacity

•Review of Legal and Policy Tools and

Instruments

•Review of institutional models for delivering public health services

Promotion

Strengthening Public Health Services and Capacity across the European Region

VISION: Sustainable Health and Well being

PURPOSE: Strengthen integrated public health services and reduce

inequalities

Protection Prevention

Public Health Challenges for the European Region – A Public Health Service for the 21st Century

• Inequalities and the Economic crisis

• Globalisation, migration and urbanisation and an ageing population

• Environmental degradation and Climate Change

• Public Health emergencies

• Changes in lifestyle behaviours and increasing prevalence of non-Communicable Diseases

• Emerging and re-emerging communicable diseases

Life expectancy in European country groups in 1950-2045: population health improvement and ageing

Source: UN Population Division, World Population Prospects 2008

Year

Life

exp

ecta

ncy a

t b

irth

(ye

ars

)

55

60

65

70

75

80

85

1950 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050

CIS countries

EU 12 countries

EU 15 countries

European Region

Other countries

GovernanceEPHO 6

PH WorkforceEPHO 7FundingEPHO 8

CommunicationEPHO 9

ResearchEPHO 10

Clustering of Essential Public Health Operations (EPHOs) - to deliver Public Health services

INTELLIGENCE

EPHO 1 + 2Surveillance

Monitoring

Informing

health assessments

and plans

EPHO 4

EPHO 3 EPHO 5

CORE EPHOs

Health Promotion

Disease PreventionHealth Protection

VISION: Sustainable Health & Well-Being

SERVICE DELIVERY

ENABLER EPHOs

WHO European country assessments

Where there are greater health inequalities there are generally less well developed public health services and capacities

Estimate of coverage and quality of EPHOs across the WHO European Region

CoverageEstimated percentage of countries that have some activities related to the EPHO

QualityEstimated degree to which activities fulfil the complete EPHO definition

NA

EPHO 2

EPHO 1

EPHO 4

EPHO 3

EPHO 5

EPHO 6

EPHO 7

EPHO 8

EPHO 9

EPHO 10

Estimate of coverage and quality of EPHOs in NIS countries

CoverageEstimated percentage of countries that have some activities related to the EPHO

QualityEstimated degree to which activities fulfil the complete EPHO definition

NA

EPHO 2

EPHO 1

EPHO 4

EPHO 3

EPHO 5

EPHO 6

EPHO 7

EPHO 8

EPHO 9EPHO 10

EPHO 1 2 3 4 5 6 7 8 9 10

Legally binding tools

21 12 306 31 2 41 3 1 0

0

Non legally binding

tools

37 25 90 39 15 259 11 5 5 2

Total

Number of tools

58 37 396 70 17 300 14 6 5 2

Number of Public Health policy and legal instruments classified in each EPHO

Source: WHO Regional Office for Europe, 2012

The contribution of prevention and treatment related to the decline in global CHD morbidity

Source: NEJM 2007: 2388Goldman USA, 1968-76

Beaglehole New Zealand, 1974-81

Hunink USA, 1980-90

IMPACT Scotland, 1975-94

IMPACT New Zealand, 1982-93

IMPACT England and Wales, 1981-2000

IMPACT USA, 1980-2000

IMPACT Poland, 1991-2005

IMPACT Czech, 1985-2007

IMPACT Sweden, 1986-2002

BMJ Finland, 1982-97

IMPACT Finland, 1982-97

IMPACT Iceland, 1981-2006

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

40

40

43

35

35

38

47

43

39

36

24

23

24

54

60

50

55

60

52

44

49

60

55

76

53

74

6

0

7

10

5

10

9

8

1

9

0

24

2

Treatments Risk factors Unexplained

%

Estimated expenditure on prevention and public health as % of total health expenditure

Source: Derived from global health expenditure database, 2012.

Public Health Challenges in Europe and the EPHOs that especially need to be strengthened

Strongest relevance

P

H C

hal

len

ges

EPHO

Relevant

Some relevance

EnvironmentalDeterminants

CLIMATE CHANGE

&DISASTERS:

•Heatwaves•Fires

•Drought•Floods

•Mudslides•Chemical Spills

•Food Security•Changes in

Infectious disease habitat

Social & Economic

Determinants

AGEING

ECONOMIC DECLINE

INEQUALITIES

URBANISATION

MIGRATION

TECHNOLOGY

Health Outcomes

NCDs

LONGERLIFE

EXPECTANCY

Health SystemImplications

INCREASED:DEMAND & COSTS

DECREASEDWORKFORCE

Solutions

SUSTAINABLEPREVENTION& PROMOTION

PRIMARYHEALTHCARE

PROTECTIONEmergency

preparedness

INNOVATIVEWIN – WIN-WIN APPROACHES

Risks & Projections RESEARCH IMPLICATIONS Innovative solutions

Summary of Public Health Challenges and Solutions for 2050

15th European Health Forum Gastein, 5 October 2012

GovernanceEPHO 6

PH WorkforceEPHO 7FundingEPHO 8

CommunicationEPHO 9

ResearchEPHO 10

The contribution of Health Promoting Networks in delivering the EPHOs

INTELLIGENCE

EPHO 1 + 2Surveillance

Monitoring

Informing

health assessments

and plans

EPHO 4

EPHO 3 EPHO 5

CORE EPHOs

Health Promotion

Disease PreventionHealth Protection

VISION: Sustainable Health & Well-Being

SERVICE DELIVERY

ENABLER EPHOs

Networks take a systems approach

ConnectedMind

ConnectedMind & Body

ConnectedFamilies

ConnectedCommunities

ConnectedEnvironment

Sustainable approaches to wellbeing

Win

Win

Win

Common Problems

Common Solutions

Common Solutions – Green Spaces

http://i.treehugger.com/files/th_images/parkwheel-thumb.jpg

Increase Urban Green Space

• Improves mental health & well being

• Increases social contacts

• Increases physical activity & reduces obesity

• Reduces violence & abuse

• Reduces inequalities

http://www.thedesignblog.org/images/mobile_green_space.jpg

Green Buildings - Japan

Benefits for Adaptation & Mitigation• Improves air quality – reduces pollutants & reduces CO2• Keeps Buildings Cool in Hot weather• Green Roofs insulate against cold weather• Assists in flood run- off

http://www.metaefficient.com/images/fukuoka_green_roof.jpg

Points for discussion in Workshop

• Identifying areas in common and of synergy

• Identify gaps and how to address them

• Improving communications and collaborative working

• Formalisation of collaborative process

• Priority areas to collaborate on

• Next steps and ways forward

-From Values

to Action -

Division of Health Systems and Public Health

Thank You !