The 70th Session of the WHO Regional Committee for Europe took place from 14 September to 15 September 2020. The European Region’s governing body met to discuss and take collective action on major health issues, such as health equity and primary health care. The decisions taken at the Regional Committee meeting feed into policies that drive much of the action towards improved health in the Region.
As a recognised non-state actor, EuroHealthNet has submitted two statements to the 70th Session of the WHO Regional Committee for Europe.
Provisional agenda Item 2b: The state of health in the WHO European Region, including lessons learned from the COVID-19 pandemic
The COVID-19 pandemic has painfully exposed health and social inequalities across Europe. EuroHealthNet partners responsible for public health have been at the front line for protection, advice, and delivering timely information since the beginning of the pandemic. We take this opportunity to express gratitude to all colleagues for their tireless efforts. We stand together with WHO Europe and its partners, ready to support a recovery which results not only in stronger health systems, but also in fairer and more resilient societies.
For many people there is no so-called “new normal” of personal adjustments to which they wish to return. By simply rebuilding we risk preserving the problems of the past. Instead, it is time to create systems and structures which work for everyone, not only the fortunate few. They should effectively face the challenges of tomorrow, whether these are new pandemics or the more “chronic emergencies” like non-communicable diseases, mental ill-health and climate change.
Growing evidence from the COVID-19 pandemic shows how it has exacerbated and highlighted pre-existing health inequalities1.
- Low skilled men have the highest death rate among working age adults2.
- Black people are more likely to die from COVID-19 than white counterparts3.
- Most fatalities are amongst those with underlying illnesses such as high blood pressure or diabetes4; while more socially and economically disadvantaged people suffer more from these largely-preventable diseases5.
- Migrants, asylum seekers, and Roma people who already experience health inequalities are among the 26% of people in Europe living in overcrowded spaces6. In confinement, women and LGBTI people are more exposed to interpersonal violence.
- Economic factors such as poverty and unemployment, especially in the context of an austerity policies7 are linked to depression, anxiety and suicide8. People who are unemployed or face financial hardship, families with children, and those with pre-existing mental health problems are all more likely to be vulnerable to these mental health impacts of economic recessions9.
The pressures on social protection systems and on health outcomes will be interrelated and complex but vital to address10. They will be felt most strongly by people in insecure or low skilled jobs, and by people from disadvantaged communities experiencing worse housing and living conditions and environmental inequalities11. Young people will be most affected by school closures and face subsequent challenges in seeking employment.
So, we all need to act. Protecting health is the responsibility of all. Good health starts in communities. We must critically look at how our health systems are structured, their sustainability, and their ability to prevent diseases and protect all, regardless of social status. We all need to act to make recovery fair and health-promoting, leading to a global “economy of wellbeing” and achievement of the Sustainable Development Goals.
As Member States and International Organisations including WHO Europe seek to balance mitigating the pandemic and ensuring an healthy recovery, we call on all partners to pool knowledge and experience for progress, not return to old ways which failed too many people.
We know what can work, thanks to numerous resources and evidence from individual countries, as well as WHO Europe work on health equity12. The new evidence from the pandemic has highlighted those needs and solutions, as well as identifying new problems and hopes. It is up to us all to apply that learning for good.
1 Bergamini, E. (2020). How COVID-19 is laying bare inequality. Bruegel.org. Available at: https://www.bruegel.org/2020/03/how-covid-19is-laying-bare-inequality
2 Wise, J. (2020). Low skilled men have highest death rate of working age adults. BMJ. 369:1906. Available at: https://www.bmj.com/content/369/bmj.m1906
3 Office for National Statistics (2020). Coronavirus (COVID-19) related deaths by ethnic group, England and Wales: 2 March 2020 to 10 April 2020. Available at: https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/coronavirusrelateddeathsbyethnicgroupengl andandwales/2march2020to10april2020
4 Stuckler, D., Reeves, A., Loopstra, R., Karanikolos, M., McKee, M. (2017). Austerity and health: the impact in the UK and Europe. European Journal of Public Health. 27(4):18-21. Available at: https://academic.oup.com/eurpub/article/27/suppl_4/18/4430523
5 McNamara, C. L., Balaj, M., Thomson, K. H., Eikemeo, T. A., Solheim, E. F., Bambra, C. (2017). The socioeconomic distribution of noncommunicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health. European Journal of Public Health. 27(1):22-26.
6 EU-SILC (2018). European Union Statistics on Income and Living Conditions. Available at: https://ec.europa.eu/eurostat/web/microdata/europeanunion-statistics-on-income-and-living-conditions
7 Bambra C. (2011). Work, worklessness and the political economy of health inequalities. Journal of Epidemiology and Community Health. 65(9):746-50.
8 Lund C, Brooke-Sumner C, Baingana F, et al.(2018). Social determinants of mental disorders and the Sustainable Development Goals: a systematic review of reviews. The Lancet Psychiatry. 5(4):357-69.
9 Frasquilho D, Matos MG, Salonna F, et al. (2016). Mental health outcomes in times of economic recession: a systematic literature review. BMC Public Health. 16(1):115.
10 Banks J, Karjalainen H, Propper C. (2020). Recessions and health: The long-term health consequences of responses to coronavirus. The Institute for Fiscal Studies. Available at: https://www.ifs.org.uk/uploads/BN281-Recessions-and-health-The-long-term-health-consequences-ofresponses-to-COVID-19-FINAL.pdf
11 WHO Europe (2019). Environmental health inequalities in Europe. Second assessment report. Available at: https://apps.who.int/iris/bitstream/handle/10665/325176/9789289054157-eng.pdf?sequence=1&isAllowed=y
12 WHO Europe (2019). The WHO European Health Equity Status Report Initiative. Available at: https://www.euro.who.int/__data/assets/pdf_file/0016/411343/HESRi-case-studies-en.pdf
Provisional agenda item 4 The European Programme of Work, 2020-2025: “United Action for Better Health in Europe”
EuroHealthNet welcomes the draft WHO European Programme of Work (EPW) 2020-2025. The emphasis it gives to the principle of “leaving no one behind” is excellent. Our response focuses on three topics.
- Addressing health inequalities;
- The transition to sustainable health systems which are better connected to the factors which influence health outcomes;
- Investing in the social side of health crisis preparedness.
Progress on improving life expectancy and other objective measures of health outcomes have started faltering, even reversing in some cases. Health inequalities were already rising before the COVID-19 pandemic. We need a committed approach at all levels, including political levels, to address health and wellbeing for population groups that experience vulnerability. The concept of vulnerability needs redefining to catch up with changing socio-economic realities. As a partnership of bodies responsible for public health and concerned about growing levels of health inequalities, we need the support from the EPW to encourage ambitious action for health equity and on the related Social, Economic, and Environmental Determinants of health (SEEDs).
All mechanisms should champion the importance of strengthening health promotion, preventative services, and other public health measures. We need to transform struggling curative systems into health promoting services, which are proactive in meeting emerging challenges and resilient to shocks and crises. Health promotion principles are closely related to behavioural sciences and to embedding healthier choices into health strategies, as also outlined in one of the EPW flagship initiatives. But for many people personal choices are a luxury. We need to create equitable opportunities and enhance the capability of all people and communities to improve health outcomes. The commercial determinants of health which have a harmful influence on behaviours and underlying determinants should also be carefully addressed.
During the COVID-19 pandemic we have seen a huge mobilisation for funds toward containment and crisis preparedness. This has mainly directed towards health care services and the economy. There is a need to address the acute needs of health professionals and boost hospital capacity. At the same time, financing crisis containment and preparedness through a psycho-social approach that promotes resilience, community and integrated social support have been considered to a lesser extent. This approach should be balanced against reinforcing a predominant bio-medical approach to health.
We need to build new and better bridges between public health and primary health care, and between the health sector (including mental health), the social sector, and the economy at his whole. We need to incorporate health equity impact assessments in recovery mechanisms and seek to cushion the health impacts of economic and labour market shocks. We need integrated and coordinated cross-cutting political action guided by the UN Sustainable Development Goals, the Health-in-all-Policies-strategy, and the overarching goal of reducing health inequalities1. Improvements are needed in public health workforce competences with regards to skills for health promotion, disease prevention, cross-sector task-shifting, and in digital health literacy. New financing mechanisms must be explored in order to scale up public health work. We are keen to contribute to this area of impact investments through our e-guide on Financing HealthPromoting Services.
If implemented in accordance with its vision, the Programme can help to address the needs of people along social gradients in the context of fair distribution of assets, power, and resources. We welcome the EPW’s reinforced emphasis on leadership and utilising capabilities of national health authorities’ via strategic guidance from WHO Europe in collaboration with relevant international institutions, including at EU level. EuroHealthNet has worked and grown in exactly these fields for over two decades so is ready, willing, and able to help delivery of the EPW to meet these objectives.
1 Siegrist J, Mekel O et al. (2020). Integrated health policy recommendations: Justifying health policy recommendations to mitigate indirect health effects oft he COVID-19 pandemic within public health actions. Bremen: Competence Network Public Health COVID-19, Germany Available at: https://www.public-healthcovid19.de/images/2020/Ergebnisse/Mitigation_englisch_2872020_FINAL.pdf