A European Strategy for Child and Adolescent Health and...

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Community Community HealthHealth

Vivian BarnekowChild and Adolescent Health and Development

WHO Regional Office for Europe

A European Strategy for A European Strategy for Child and AdolescentChild and Adolescent

Health and DevelopmentHealth and Development

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0

10

20

30

40

50

60

70

1970 1980 1990 2000 2010

EUROPEEU-15 (MSs prior 1.5.2004) averageEU-10 (MSs after 1.5.2004) averageCIS-12 averageCARK-5 average

060401 +Probability of dying beforeage 5 years per 1000 live births

Probability of dying before age 5 yearsProbability of dying before age 5 yearsProbability of dying before age 5 years

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Some Facts and FiguresSome Facts and FiguresSome Facts and Figures

Lifestyles:Lifestyles:Up to 67% of 15 year-olds drunk on at least

two occasions Average age of first use of injecting

drugs between 16 and 19 in Eastern Europe, Central Asia and falling 60-70% of young people tried cigarettes by age 15Health Behaviour in School Age Children

(HBSC) study shows clear correlation between socio-economic status and diet

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Prevalence of overweight childrenin 31 countries grouped by region

Prevalence of overweight childrenPrevalence of overweight childrenin 31 countries grouped by regionin 31 countries grouped by region

Source: HBSC

Ove

rwei

ght P

reva

lenc

e (%

) North America

Scandinavia

United Kingdom(South) Western Europe

(Central) Western Europe(Northwest) Eastern Europe

(Southwest) Eastern Europe

0

5

10

15

20

25

United Stat

esCan

ada

Malta

SpainPortu

galIta

lyGree

ceWale

sEnglan

dSco

tland

Slovenia

Hungary

The form

er Yugosla

v Rep

ublic of M

aced

oniaCro

atia

Finland

Norway

Denmark

Sweden

Austria

Belgium (F

rench

)Fran

ceGerm

any

Belgium (F

lemish

)Switz

erlan

dNeth

erlan

ds

Czech

Rep

ublicPolan

dEsto

niaUkra

ine

Russian

Federa

tion

Latvia

Lithuan

ia

Ove

rwei

ght P

reva

lenc

e (%

) North America

Scandinavia

United Kingdom(South) Western Europe

(Central) Western Europe(Northwest) Eastern Europe

(Southwest) Eastern Europe

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0

5

10

15

20

25

30

1970 1980 1990 2000 2010

Prev

alen

ce %

IOTF estimates.

Increasing prevalence of overweight children in Europe

Increasing prevalence of overweight Increasing prevalence of overweight children in Europechildren in Europe

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Striking inequalitiesStriking inequalitiesStriking inequalities

• Over ten-fold difference in infant and child mortality rates

• Inequalities growing within countries

• Over-representation of women and children among the poor

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Relative povertyRelative povertyRelative poverty

Percent of children living below national poverty lines

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Why Children and Adolescents?Why Children and Adolescents?Why Children and Adolescents?

• A moral and legal obligation to protect and promote the rights of children

• An investment in early stages of life has life-long impact - affecting economic development and sustainability

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What is the strategy and what is it not?What is the strategy and what is it not?What is the strategy and what is it not?

• One size-fits-all

• Prescriptive

• A set of pre-decided regional targets

• A theoretical recommendation

• A framework to develop own policies and programs

• Policy options based on best evidence

• Impetus to set own national targets and indicators

• Linked to implementation

It IS:It is NOT:

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The goalThe goalThe goal

To enable children and adolescents in Europe to reach their full potential for health and development and to reduce the burden of avoidable disease and mortality

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Three strategy objectivesThree strategy objectivesThree strategy objectives

1. A framework for evidence based review and improvement of national policies and programmes for child & adolescent health and development from a life course perspective

2. Promote multisectoral action to address main health issues for child and adolescent health

3. Identify the role of the health sector in development and coordination of policies and service delivery to meet needs of children and adolescents

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Four guiding principlesFour guiding principlesFour guiding principles

• Life-course approach – from prenatal life to adolescence

• Equity – account explicitly for needs of the most disadvantaged

• Intersectoral action

• Participation of public and young people

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Seven priority areas for actionSeven priority areas for actionSeven priority areas for action

1. Mothers and neonates

2. Nutrition

3. Communicable diseases

4. Injuries and violence

5. Physical environment

6. Adolescent health

7. Psychosocial development and mental health

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Key issues through the life-courseKey issues through the lifeKey issues through the life--coursecourse

Before and

around birth

First year of life

Early childhood

Late childhood

Adolescence

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Key issues through the life-course- examples

Key issues through the lifeKey issues through the life--coursecourse-- examplesexamples

Before and

around birth

First year of life

Early childhood

Late childhood

Adolescence

•Maternal health•Access to essential obstetric

and newborn care•Exclusive breastfeeding

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Key issues through the life-course - examples

Key issues through the lifeKey issues through the life--course course -- examplesexamples

Before and

around birth

First year of life

Early childhood

Late childhood

Adolescence

•Continued breastfeeding•Complementary feeding from 6 months•Immunisation•Physical and mental stimulation

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Before and

around birth

First year of life

Early childhood

Late childhood

Adolescence

Stimulation through communication and playNutritionDetection of developmental and learning difficultiesPrevention of communicable diseases

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Before and

around birth

First year of life

Early childhood

Late childhood

Adolescence

•Healthy lifestyles•Mental health and psychological development•Prevention of child abuse and neglect

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Before and

around birth

First year of life

Early childhood

Late childhood

Adolescence

•Healthy lifestyles•Prevention of risk behaviour•Prevention of substance misuse•Youth friendly services•Mental health and psychological development•Prevention of exploitation and child labour•Social interaction and community life

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A multi-sectoral approachA multiA multi--sectoralsectoral approachapproach

Sector Possible contributions

Finance •Fiscal policy – taxation and subsidies•Redistribution of government resources

Education •Curriculum development•School environment•Provision of extra-curricular child-friendly services•Role modelling•Food provision

Education (universities and colleges)

•Curriculum development•Student environment•Research strategy

Social welfare •Psycho-social support•Targeted benefits•Housing standards•Home safety

Environment •Standards for the built environment•Town and city planning•Water and sanitation regulations

Agriculture and the Food Industry

•Primary production•Food standards and composition•Food fortification and supplementation•Marketing•Pricing policy•Consumer education

Transport •Road design•Vehicle specifications•Safety legislation

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How can policy makers use the strategy?

How can policy makers How can policy makers use the strategy?use the strategy?

Gives practical help to formulate national strategies

Gives evidence based answers

Enables decision-makers to build necessary capacity

Goes beyond the health sector

Identifies most important factors in developing national strategy in accompanying toolkit

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A toolkit for implementationA toolkit for implementationA toolkit for implementation

Gender tool

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The Assessment ToolThe Assessment ToolThe Assessment Tool

• Identify current policies and strategies that contribute to child and adolescent health

• Clarify the goals and objectives for which these policies and strategies have been formulated.

• Map the existing policy provision• Assess the extent to which these are based on

evidence.• Identify any gaps in policy provision.

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The Assessment ToolThe Assessment ToolThe Assessment Tool

• Identify whether the necessary information systems are in place to assist in policy formulation, implementation management, and outcome evaluation.

• Identify the sectors and key players involved in planning, implementation, evaluation and accountability.

• Assess the extent to which national and regional policiesand strategies have been implemented in practice.

• Determine the adequacy of the existing infrastructurerequired for the implementation of national policies and strategies.

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Policy OptionsPolicy OptionsPolicy Options

LEGISLATION(e.g. smoking in public places, wearing seat belts, environmental

improvement, maternity leave, child rights)

REGULATIONS(e.g. consumer protection, food labelling,

industrial and vehicle emissions, speed limits)

ORGANISATIONAL CHANGE(e.g. new services, improved access)

PUBLIC EDUCATION(e.g. mass media campaigns)

PROFESSIONAL DEVELOPMENT(e.g. training of health professionals, professional regulation)

BUDGET ALLOCATION(e.g. increased health or education budget)

FISCAL MEASURES(e.g. taxation, corporate subsidies, financial penalties, investment

funds, tax exemption)

WELFARE POLICY(e.g. food coupons, welfare benefits, housing support)

RESEARCH(commissioned research, information dissemination)

PERFORMANCE RELATED PUBLIC SERVICE FUNDING(e.g. funds follow targets)

CURRICULUM DEVELOPMENT(e.g. primary and secondary school knowledge and skills

development)

ENVIRONMENTAL CHANGE(e.g. transport planning, water and sewage supply, playground

design)

OTHER(please specify)

OTHER(please specify)

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Information ToolInformation ToolInformation Tool

• Assesses current availability and utility of information systems

• Process is country-led self-assessment• Addresses the themes related to Strategy• Uses a structured and systematic approach

to assess suitability of current information

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The Information ToolThe Information ToolThe Information Tool

“Do your country’s information systems produce the information necessary for ensuring …”

1. Adopt a population-based approach2. Cover health determinants (across Life Course)

3. Address equity and inequalities4. Use data from other sectors5. Look at health systems (availability, access, quality)

6. Support policy priorities and underpinning influences

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The Action ToolThe Action ToolThe Action Tool

1. identifies policies and interventions that have proven effective in protecting the health of children and adolescents, and promoting their development.

2. provides guidance to national, regional and local policy-makers in reviewingand developing strategies and work plans.

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The Action ToolThe Action ToolThe Action Tool

• 7 priorities areas plus chronic disease• Key issues through the life cycle• Actions by different sectors• Role of the health system• Points to evidence-based guidance

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The Gender ToolThe Gender ToolThe Gender Tool

• Uses sex disaggregated quantitative and qualitative information and gender analysis

• Based on the life course approach

• Identifies gender issues in each priority area of the CAH Strategy

• Identifies information needs relevant from a gender perspective in each priority area

• Identifies actions by the health system and intersectorial actions

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ImplementationImplementationImplementation

The strategy in practise-

does it work?

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The objectives of the implementation phase

The objectives The objectives of the implementation phaseof the implementation phase

• Increase the political commitment towards the development of national strategies

• Certify the integration of the guiding principles of the European Strategy

• Improve the provision of preventive and curative child health services

• Ensure that specific information systems are in place to support child and adolescent health and development

• Ensure the incorporation of the Millennium Development Goals and the Convention of the Rights of the Child in the development of the European Strategy

• Ensure existence of required staff, specialized skills and professional knowledge when developing and implementing the European Strategy

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Results Outputs Outcomes

Participation of youth/NGOs Proportion of Service availability targetedAccess to services population Quality of services receiving the

intended interventions

Determinants of Health

Socioeconomic and demographic factorsEnvironmental and behavioural risk factors

Health status

Mortality

Morbidity/ disability

Growth

Development

Well-being

Imple-mentation

of European

Strategy for Child and

Adolescent Health and

Development

Process Initiated developmentof strategyCapacity building workshopsAssessing inequitiesAddressing different population groupsRespecting conventions/declarations

Input Technical supportBudgetary allocationsMultisectoral workgroupInformation systems

The indicatorsof the implementation phase

The indicatorsThe indicatorsof the implementation phaseof the implementation phase

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How do we measure this?How do we measure this?How do we measure this?

• Survey – Based on a questionnaire – Baseline data has been collected and data

analysis is being carried out at the moment– Follow up will take place in Spring 2008

• Case studies – during 2007 in Armenia, Albania, Hungary,

Uzbekistan

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Why do both a survey and case studies? Why do both a survey and case studies? Why do both a survey and case studies?

The Survey• Simple, comparable

data• Many respondents

from the entire region• Repeatable• Questionnaire also

works as check list for the individual country

The Case studies• Extensive

descriptions and analysis

• Respecting and considering the contextual factors

• Leaving space for new knowledge to emerge

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The Purpose of the SurveyThe Purpose of the SurveyThe Purpose of the Survey

• To assess which political and organizational actions that are being carried out as a result of the implementation of European Strategy.

• To get comparable information from partners and national counterparts on specific aspects of the implementation of the strategy.

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Getting started with the European StrategyGetting started with the European StrategyGetting started with the European Strategy

• Objective: – Increase the political commitment towards the

development of national strategies• Indicator:

– Initiated development and implementation of the National Strategy

• Question: – Has the country initiated the implementation (such

as workshops, meetings, materials, review of current government policies etc.) of child and adolescent health strategies based on the European Strategy?

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Results: Getting started with the European Strategy

Results: Getting started with the European Results: Getting started with the European Strategy Strategy

Almost 53% of the countries already initiated the implementation of the strategy.

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InequityInequityInequity

• Objective: – Certify the integration of the guiding principles of

the strategy

• Indicator: – Understanding of inequities between different

population groups

• Question: – Have assessments revealed substantial inequities in

child and adolescent health among different population groups?

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Results: InequityResults: InequityResults: Inequity

35% of the countries have detected substantial inequities in child and adolescent health. Some of these countries have already addressed these gaps as a result of the European Strategy.

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National Databases on Child HealthNational Databases on Child HealthNational Databases on Child Health

• Objective: – Ensure that specific information systems are in place

• Indicator: – Existence of a national database of child and

adolescent health data

• Question: – Does a national database of relevant child and

adolescent data exist?

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Results: National Databases on Child Health

Results: National Databases on Child Results: National Databases on Child Health Health

A national database on child and adolescent health and development exist in 17 out of the 34 member states.

27 of the 34 countries in some sense monitor child and adolescent health in a national database.

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To early for conclusions but we already know that…

To early for conclusions To early for conclusions but we already know thatbut we already know that……

• ..more than half of the countries that completed the questionnaire have initiated a review/development of a national strategy for child and adolescent health and development

• ..CAH gaps and different population groups are being addressed in the national strategies as a result of the European Strategy

• ..capacity building workshops in the countries as well as governmental budgetary allocations of dedicated resources for CAH enhance the consideration of different vulnerable population groups and gaps within child and adolescent health

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More informationMore informationMore information

www.euro.who.int/childhealthdev

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Thank you!Thank you!

This paper was produced for a meeting organized by Health & Consumer Protection DG and represents the views of its author on thesubject. These views have not been adopted or in any way approved by the Commission and should not be relied upon as a statement of the Commission's or Health & Consumer Protection DG's views. The European Commission does not guarantee the accuracy of the dataincluded in this paper, nor does it accept responsibility for any use made thereof.

A European Strategy for Child and Adolescent Health and...

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