1. Health challenges in an enlarged Europe Report from Parallel Session A1 Dr. Natasha Azzopardi Muscat Ministry of Health - Malta

2. Session Objectives To describe ways in which health challenges are being addressed To map the roles of stakeholders in addressing these challenges

3. Common Challenges Getting health on the policy agenda Improving health and well being Reducing health inequalities Making the link between health and wealth Ensuring affordable, accessible, sustainable health care Guaranteeing harmonious and balanced co- existence of health care systems

4. Health on the policy agenda At a European level –Upcoming IGC At a national level –Involvement of Parliaments –Ministers for Public Health At regional levels In commerce and industry

5. Improving health and well being Successful health strategies –Political commitment and consensus –Ownership from stakeholders –Intersectoral approach –Explicit appropriate priorities for health gain –Settings and supportive environments –Build on strong institutions –Monitoring and evaluation of indicators

6. Reducing health inequalities Health inequalities reflect inequalities in the distribution of health determinants Health inequalities exist within all European countries Health inequalities exist between European countries Social gradient rather than a health divide requiring population wide differential impact policies

7. Making the link between health and wealth Knowledge that health can result from wealth and that poor health is linked to poor socio economic conditions Less known about effective interventions Knowledge that good health breeds wealth through enhanced competitiveness Less known about link between wealth and health care spending

8. Affordable, accessible, sustainable health care Demographic trends Expensive technology Funding of pharmaceuticals Development of primary care Efficient use of healthcare resources Reforms in financing and organisation across Europe.......but no evidence of quick fix solutions

9. Harmonious and balanced co- existence of health care systems Stark differences in health and health care systems across Europe Need to ensure adequate supply of health professionals throughout Europe through planning and ethical recruitment Accessibility to innovative medicines across Europe Patient flows – to what extent?

10. Diversity in an enlarged Europe The challenges may be similar but: The magnitude and extent of the problems is different The contexts are different The resources available to tackle the problems are different Therefore the appropriate responses may need to be different

11. A role for all stakeholders

12. Supra-national level Facilitating and supportive role Gathering of information Assisting with monitoring of progress Providing training opportunities Addressing macroeconomic issues Supporting initiatives between member states and regions

13. National level Long term prospects Parliament and political consensus Encourage ownership of health strategies Support implementation of strategies Monitor and evaluate progress Duty for collaboration with other MS

14. Regions Ensure efficient health care devlivery Support for national public health strategies Inter-regional collaboration Sharing of expertise and resources

15. Commerce and industry Duty to engage in health and health care Provide supportive workplace environments Invest in health and health care in partnership with governments

16. Health care professionals Associations, regulatory bodies, individuals Engaged in the issues relating to public health and sustainable health care Standards for training - academia Exchange of research and knowledge European wide human resource planning Harnessing professional flows for positive effects

17. Patients and citizens Drivers of the health care system The public health statistics Consumers of health care expenditure Responsibility for health Involvement in health politics Support for creating active civil society in the new MS

18. Conclusions We have what to build on –Knowledge –Legislation –Health strategies –Trained health care workforce –Infrastructure –Some success stories

19. Conclusions But there remains more to be done Interventional research Monitoring and evaluation Fostering real partnerships across Europe Expanding the base for collaboration Communicating clearly in a two way fashion with Europeans