1. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) Dr Piroska Östlin Programme Manager

2. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Presentation outline 1. What is Health 2020 and why it is needed? 2. Health 2020: Strategic objectives and common policy priorities based on evidence 3. Health 2020 policy implementation

3. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Why Health 2020? Significant improvements in health and well-being but … uneven and unequal Europe’s changing health landscape: new demands, challenges and opportunities Economic opportunities and threats: the need to champion public health values and approaches

4. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Overall health improvement (+ 5 years life expectancy) but with an important divide in the Region CIS: Commonwealth of Independent States EU12: countries belonging to the European Union (EU) after May 2004 EU15: countries belonging to the EU before May 2004 Source: European Health for All database. Copenhagen, WHO Regional Office for Europe, 2010. 4

5. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Significant improvements in health and well-being, but ….uneven and unequal Life expectancy trends in Sweden 2000-2010, by education, men Source: European Review of SDH, 2013Source: WHO HFA database, 2012

6. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Significant improvements in and well-being, but ….uneven and unequal Additional life expectancy at the age of 30 by educational attainment, women, 1986–2004, Hungary Source: Hablicsek, 2007 Source: WHO HFA database, 2012 Primary education not completed Primary education Secondary education Higher education All education levels

7. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Trends in probability of survival in men by education: Russian Federation 45 p20 = probability of living to 65 yrs when aged 20 yrs University Less than secondary Source: Murphy et al 2006

8. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Alarming and unacceptable health inequities for Roma in Europe – MDG 4 (child health) © WHO/Djordje Novacovic Under-five and infant mortality rate in Serbia Source: MICS, Serbia 2012

9. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Child (aged 0-6) vaccination rates in the countries of Central and Southeast Europe in 2011 Source: http://europeandcis.undp.org/ourwork/roma/show/A40774B7-F203-1EE9-B5BE1384077AB8B5

10. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Percentage of households unable to afford prescription medication in 2011 Source: http://europeandcis.undp.org/ourwork/roma/show/A40774B7-F203-1EE9-B5BE1384077AB8B5

11. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden What is Health 2020? Health 2020 is a value-based action-oriented policy framework, adaptable to different realities in the countries of the WHO European Region. Health 2020 is addressed to ministries of health but also aims to engage ministers and policy- makers across government and stakeholders throughout society who can contribute to health and well-being.

12. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Building on public health history WHO Constitution Declaration of Alma-Ata Health for All H EALTH 21 Tallinn Charter Integrated policy frameworks can and have inspired health-generating actions on all levels.

13. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Reducing health inequities through actions on the social determinants of health is strongly emphasized in the new European policy framework for health and well-being (Health 2020) Health 2020 aim - To significantly improve health and well-being of populations, to reduce health inequities and to ensure sustainable people-centred health systems.

14. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Increasing attention to inequity For richer, for poorer Growing inequality is one of the biggest social, economic and political challenges of our time. But it is not inevitable … – The Economist, special edition, 13 October 2012 (http://www.economist.com/node/21564414)http://www.economist.com/node/21564414

15. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Working to improve health for all and reducing the health divide Improving leadership, and participatory governance for health Investing in health through a life- course approach and empowering people Tackling Europe’s major health challenges Strengthening people- centred health systems Creating resilient communities and supportive environments Health 2020 strategic objectives and priorities for policy action

16. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Health 2020: a policy informed by evidence ”Without knowledge action is useless and knowledge without action is futile.” Abu Bakr (573-634) “Don't invest in anything that you don't understand. Do your research first.” Paul Clitheroe (1955 -)

17. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden New evidence informing Health 2020 Report of social determinants of health and the health divide in the WHO European Region Governance for health in the 21 st century Promoting health, preventing disease: the economic case Intersectoral governance for Health in All Policies: structures, actions and experiences Review of the commitments of WHO European Member States and the WHO Regional Office for Europe between 1990 and 2010

18. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Evidence that will make a big difference A strong human rights and social justice case A strong economic case Current economic difficulties are reasons for action and not inaction

19. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden The CSDH – Closing the gap in a generation The Marmot Review – Fair Society, Healthy Lives Social injustice is killing on a grand scale!

20. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden The root causes of health inequities “Health inequities arise from the societal conditions in which people are born, grow, live, work and age, referred to as social determinants of health”. (Rio Political Declaration on Social Determinants of Health, 2012)

21. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden What good does it do to treat people’s illnesses, and then send them back to the conditions that made them sick? Sir Prof. Michael Marmot

22. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Aims of the European Review of the Social Determinants of Health and the Health Divide To inform Health 2020 by: Assessing the magnitude and trends of health inequities in the WHO European Region Identifying the causes of current patterns of health inequities Providing recommendations for action that can be adapted to different country contexts

23. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Main findings a) Health inequities found in all European countries b) Evidence of increased health divide c) Presence of social gradient d) Health inequities, among and within countries, explained by the different conditions in which people are born, grow, live, work and age

24. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Four areas for action to address health inequalities – emphasizing priorities

25. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Do something, do more, do better... If countries have very little in place in terms of policies on social determinants of health, “some” action matters Where policies do exist, they can be improved to deal with large and persistent health inequities There is scope to do better on inequities in the poorest and in the richest countries of Europe

26. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Countries are taking up the Health 2020 challenge

27. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Applying the Health 2020 lens to country situation analysis Integrated approaches to implementing the four priority policy areas of Health 2020 Implementing whole-of- government and whole-of- society approaches Strengthening public health capacities and services Introducing Health 2020 to different stakeholders across sectors Addressing SDH, equity, gender and human rights Strengthening monitoring and evaluation Developing Health 2020- based national and subnational health policies, strategies and plans Operationalizing new concepts and evidence Health 2020 implementation package

28. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Health 2020 monitoring framework 1. Reduce premature mortality by 2020. 2. Increase life expectancy. 3. Reduce inequalities in health. 4. Enhance the well-being of the population. 5. Ensure universal coverage and the right to the highest attainable level of health. 6. Set national goals and targets related to health in Member States.

29. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Follow up Major role in WHO/Europe assistance to Member States linked to Health 2020 implementation (e.g. BCA) Specific policy dialogue, situation analyses - both country and multicountry-based Mainstreaming of the social determinants of health in public health programmes and Action Plans Continued provision of medium and longer-term technical assistance

30. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Political and social commitment Social policies can be judged by their likely impact on health equity The review provides evidence that makes this judgement possible, and recommendations for action What is now needed is the political and social commitment of governments, civil society, transnational bodies and academic institutions to translate this into reality

31. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Health 2020 lays the foundation for a healthier European Region “So many factors affect health, and health has an impact on so many areas of our lives that progress on public health can only come from whole-of-society and whole-of-government efforts. That is why there is a role for everyone to play in implementing Health 2020, from prime ministers, to civil society, to citizens.” – Zsuzsanna Jakab, WHO Regional Director for Europe

32. Dear prime minister, minister, mayor or member of parliament: Good health underpins social and economic development and strengthens policies across all sectors. However, the economic and fiscal crisis facing many countries presents serious challenges and potentially risks undermining the positive progress that has been made. Nevertheless, it also presents an important opportunity to refocus and renew our efforts to improve the health of all people. All sectors and levels of government and society contribute to health creation. Your leadership for health and well-being can make a tremendous difference for the people of your country, state, region or city and for European Region as a whole. Your support for Health 2020 is truly essential.

33. Addressing health inequities through the new European Policy Framework for Health and Well-being (Health 2020) 6 December 2013, Stockholm, Sweden Thank you!