Health 2020: WHO's missing link?

Abstract

WHO's European office is making progress with its innovative new strategy to tackle the region's health problems. But will member states and the rest of WHO take note? Robert Walgate reports. With 76% of WHO's (2012–13) funding being voluntary, a budget reduction of 13% from its current (2010–11) biennium, and fundamental reform underway in which member states seem keen to restrict WHO's role to technical advice, observers, shaking their heads over the future of the agency, have called for inspiration. And now they might have it, in the form of Health 2020, a radical reconceptualisation of health underway at the European Regional Office of WHO in Copenhagen. But will member states take notice? Perhaps, yes, because Health 2020 is a “process of consultation” between WHO Euro and its 53 diverse member states, from the 27 members of the European Union across to Valdivostok, embracing the largely Muslim republics of Central Asia, and, in the south, Israel. When the WHO Regional Director for Europe, Hungarian Zsuzsanna Jakab, took up her post, she established studies in the social determinants of health (reported recently in The Lancet), health governance, and economics of public health (still underway). These were done to illuminate and sharpen her vision to improve health status in Europe today. With the region's ageing populations, increasing rates of non-communicable diseases (NCDs), and spiralling treatment costs, the whole government must be brought in, alongside ministries of health and health systems, in a new “movement for public health” believes Jakab. This is Health 2020. Health 2020 will build partnerships to tackle the complex determinants and drivers of health and health equity. According to the leader of the process, Agis Tsouros, “Health 2020 is the over-arching framework for the whole WHO Euro, so it builds on all our key strategies including—as a major part—health systems strengthening”. So Health 2020 contains all. But with member states and WHO facing budget cuts and restrictions, how can this visionary plan be acted on? After all, Health 2020 seems to be asking for expansion when member states want WHO to become a smaller, technical, standard-setting agency among the other major actors and donors now on the global health stage. “Well I think we're focusing, rather than broadening”, Jakab told The Lancet, “and WHO has to focus. There was too much in too many small activities in WHO, too much driven by the money, available for this and that, rather than focusing on the real priorities.” “We will have to focus further in Health 2020, and a key priority will have to be the NCDs because that is the main disease burden in the region… I am also very clear that without strengthening public health we will not get very far”, said Jakab. “Because if you don't invest in prevention, health promotion, and protection, then the costs of the health-care system will continue to increase. None of the countries can live with this.” “So I want to focus on two to three major priorities, but to do that we need to rethink the whole governance of health in the 21st century…Because if we continue to focus just on the health ministers and the day-to-day crises of the health-care system we will never make the improvements of health status that we need.” As Ilona Kickbusch, author of Jakab's governance study, put it at the 14th European Health Forum, Gastein, last month: “We need a pluralist notion of democracy” in health, including the whole of government, industry, and non-governmental organisations. Health 2020 shares this vision. “We have very good evidence that if you invest in prevention, results will come in the short and medium term”, said Jakab. “For a long time we thought the results would only be long term. And that's why governments were less interested. But now we have all this evidence that they decrease cardiovascular disease mortality—for example—within a few years. This will come out of our economics study…. So when we come out with the final version of Health 2020 [due by September, 2012] my intention is also to show how it can be useful at a time of economic decline.” Moreover, Margaret Chan, WHO Director-General, told The Lancet “I want to see Health 2020 gel with reform process”. On Nov 27, WHO Euro will convene a high-level meeting on Health 2020 priorities in Jerusalem. The results of this meeting are expected to feed into WHO's Executive Board meeting in January, 2012. In Geneva, many member states on the executive board have called for WHO priorities to be left to the members. In practice this means back to ministries of health. In WHO Euro, however, member states are looking to Health 2020's vision to define “best buys across the whole field of public health”, said Tsouros. “We can provide the framework for straitened times”, he said.