The European Action Plan for Strengthening Public Health Dr Joanna Nurse Senior Advisor, Public Health Services, Health Systems and Public Health Services WHO, European Region Health Promoting Networks 16 th 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 21 st 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 : population health improvement and ageing Source: UN Population Division, World Population Prospects 2008

Governance EPHO 6 PH Workforce EPHO 7 Funding EPHO 8 Communication EPHO 9 Research EPHO 10 Clustering of Essential Public Health Operations (EPHOs) - to deliver Public Health services INTELLIGENCE EPHO Surveillance Monitoring Informing health assessments and plans EPHO 4 EPHO 3EPHO 5 CORE EPHOs Health Promotion Disease Prevention Health 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 Coverage Estimated percentage of countries that have some activities related to the EPHO Quality Estimated 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 Coverage Estimated percentage of countries that have some activities related to the EPHO Quality Estimated 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

EPHO Legally binding tools Non legally binding tools Total Number of tools 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: 2388

% 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 PH Challenges EPHO Relevant Some relevance

Environmental Determinants 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 LONGER LIFE EXPECTANCY Health System Implications INCREASED: DEMAND & COSTS DECREASED WORKFORCE Solutions SUSTAINABLE PREVENTION& PROMOTION PRIMARY HEALTH CARE PROTECTION Emergency preparedness INNOVATIVE WIN –WIN-WIN APPROACHES Risks & Projections RESEARCH IMPLICATIONS Innovative solutions Summary of Public Health Challenges and Solutions for th European Health Forum Gastein, 5 October 2012

Governance EPHO 6 PH Workforce EPHO 7 Funding EPHO 8 Communication EPHO 9 Research EPHO 10 The contribution of Health Promoting Networks in delivering the Essential Public Health Operations INTELLIGENCE EPHO Surveillance Monitoring Informing health assessments and plans EPHO 4 EPHO 3EPHO 5 CORE EPHOs Health Promotion Disease Prevention Health Protection VISION: Sustainable Health & Well-Being SERVICE DELIVERY ENABLER EPHOs

Networks take a systems approach to improving health Connected Mind Connected Mind & Body Connected Families Connected Communities Connected Environment

Sustainable approaches to wellbeing Win Common Problems Common Solutions

Common Solutions – Green Spaces

Increase Urban Green Space Improves mental health & well being Increases social contacts Increases physical activity & reduces obesity Reduces violence & abuse Reduces inequalities

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

The WHO role in Implementing the European Action Plan 1.Future proofing public health challenges 2.Assessing Public Health Services and Capacity 3.Strengthening Essential Public Health Operations 4.Creation of tools and publications to strengthen Public Health services 5.Technical support for legislation, policy and organisational structures 6.Country level capacity building and training

The Public Health Services Programme – WHO Europe Goal: Promoting Health and Well-being, now and for future generations Aim: by Strengthening Public Health Services and Capacity – Implementation of the EAP PH Financing & Resources – EPHO 8 Workforce Development EPHO 7 Governance – EPHO 6 PHS Delivery: Protection, Prevention, Promotion – EPHOs 3,4,5 PH Intelligence – EPHOs 1, 2, 10 PH Challenges and Innovation – plus addressing inequalities Strengthening Public Health Services & Capacity in Sub-regions & Countries: SEEHN Network NIS Forum Communications & Advocacy – EPHO 9

Points for discussion in Workshop - collaboration and synergies Step one: Identifying areas in common and of synergy Identify gaps and how to address them Agree priority areas to collaborate on Step two: Improving communications and collaborative working Formalisation of collaborative process Next steps and ways forward

-From Values to Action - Division of Health Systems and Public Health Thank You !