Whole government approach is needed to improve health across Europe, says WHO

A major shift in the way public health is managed across Europe will be needed in future if all countries are to achieve the best health standards for their citizens, says the World Health Organization.

Launching its draft health policy for the next 10 years, Health 2020, the WHO’s regional director for Europe, Zsuzsanna Jacob, said that more “horizontal, inclusive approaches” to health governance were needed, involving all sectors of society and people themselves.

“This necessitates a ‘whole of government’ approach towards health and wellbeing, which is at the heart of Health 2020,” said Ms Jacob. In its strategy document, WHO says that health across the European region is improving, but not by enough, and that, considering the burden of non-communicable diseases and communicable disease, governments could “do better” with what they know about the social determinants of health.

The strategy also acknowledges that the economic crisis is having an impact on the resources available for healthcare. It says: “Economic constraints are causing concern that the costs of newer and more extensive technologies may outrun the public financing available to provide affordable access for all sustainable, good quality healthcare.”

WHO points out that health is now seen as an important investment and driver for development, as well as one of development’s most important results. It says that public health capacities and services need to be strengthened across the region, with greater emphasis on and funding made available for health promotion and disease prevention.

The Health 2020 strategy has six main goals: harnessing the joint efforts of member states and the WHO regional office; creating better health, for example by increasing quality of life years and reducing chronic disease; improving governance for health; setting common strategic goals for member states; speeding up knowledge sharing and innovation; and increasing participation by EU citizens in shaping health policy.

There are echoes of UK prime minister David Cameron’s call for a “big society” approach to improving public services, with a separate WHO report on health governance emphasising the importance of the “joint responsibility of governments, businesses, communities and individuals.” The strategy calls for “smart governance” of health policy explaining: “The aim of smart governance is to promote joint action on health among different groups—supranational, national and local governments, civil society organisations, the private sector and citizens.”

The strategy also points out that health inequalities across Europe are growing and this is “socially unfair and costly to society as a whole.” It says that the changing sociocultural and demographic landscape of Europe—mainly through migration within the region and the increase in migrants to Europe—means “rethinking a wide range of assumptions about health, care and support, participation and empowerment, fairness and human rights.” As part of the strategy, it has commissioned a major report on the social determinants of health by Sir Michael Marmot of University College London (BMJ 2011;343:d5667, doi:10.1136/bmj.d5667). The interim findings were made available at the conference.

As expected, poorer health was found to be linked to low income, poor housing, and poor education, but also to social environment and cost of living.

In the discussion on the strategy, England’s chief medical officer Sally Davies said: “The UK is currently pursuing changes to the health system which will mean that the DoH [Department of Health] becomes a ‘social’ ministry as it won’t be directly running the NHS. We are moving directors of public health into local authorities to coordinate with their counterparts in housing, education, and social services. The Health and Social Care Bill, currently going through parliament, will include a requirement to address health inequalities and directors of public health will be mandated to address these in their local plans.”

The strategy will be discussed fully at a special conference in November and the final proposals will be presented to next year’s WHO regional meeting for adoption as official policy.