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Priority for public health in Europe


What were in the Alam-Ata, what were not. Why HFA did not deliver? ... Reflections on health care, primary care. Health care ... Dr. Halfdan Mahler, 1973-1988 ' ... – PowerPoint PPT presentation

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Title: Priority for public health in Europe

Priority for public health in Europe
Primary Health Care, A Solution? An Old Remedy?
Peter WS Chang, MD, MPH, ScD
Desiderius Erasmus Roterodamus 1469-1536
  • Before Alma-Ata/PHC/HFA
  • What were in the Alam-Ata, what were not
  • Why HFA did not deliver?
  • Priority for public health in Europe
  • What are needed beyond

Reflections on health care, primary care
  • Health care started from primary care.
  • The healers received and examined, advised, then
    helped did not turn the patients away or
    referred to others.  
  • Primary health care with advantage of providing
    continued care, fully satisfy patients need.
  • New health care is fragmented.

Dr. Halfdan Mahler, 1973-1988
"Methods of promoting the development of basic
health services" by WHO's Executive Board in
1973, co-sponsorship with UNICEF to convene "The
International Conference on Primary Health Care"
in Alma-Ata in 1978.
Declaration of Alma-Ata
  • A set of guiding values for health development, a
    set of principles for the organization of health
    services, and a range of approaches for
    addressing priority health needs and the
    fundamental determinants of health.
  • Broadened the medical model to include social and
    economic factors, and acknowledged that
    activities in many sectors, including civil
    society organizations, shaped the prospects for
    improved health. Fairness in access to care and
    efficiency in service delivery were overarching
  • "It is the first level of contact of individuals,
    the family and community with the national health
    system bringing health care as close as possible
    to where people live and work, and constitutes
    the first element of a continuing health care

When I took office in 2007, I made clear my
commitment to direct WHOs attention towards
primary health care
.. health systems had to be scaled up through
dynamic collaboration among governments,
international partners, non-governmental
organizations and the private sector .
combating disease and improving health in
developing countries is being enhanced by new
technologies, service-delivery mechanisms and
World distribution of health workers
(No Transcript)
(No Transcript)
Margaret Chan, Lancet 2008
  • Primary health care increasingly looks like a
    smart way to get health development back on
  • The Millennium Declaration and its Goals breathed
    new life into the values of equity and social
    justice, this time with a view towards ensuring
    that the benefits of globalization are more
    evenly distributed between countries.
  • In August 2008, the Commission on Social
    Determinants of Health issued its final report.
    Its arguments make a compelling call for close
    attention to health in all government policies,
    in all sectors. the report champions primary
    health care as a model for a health system that
    acts on the underlying social, economic, and
    political causes of ill health.
  • World Health Report on primary health care. Timed
    to commemorate the Alma-Ata anniversary, the
    report offers practical and technical guidance
    for reforms that can equip health systems to
    respond to health challenges of unprecedented

  • EXECUTIVE BOARD 124th Agenda item 4.5 EB124/8
    Jan. 2009
  • Primary health care, including health system
  • - renewal of primary health care
  • recognize the potential of primary health care
    for providing a
  • stronger sense of direction and unity in
    segmented and fragmented
  • health systems
  • - the framework integrates health into all
  • need for improved health systems performance
    based on the values of
  • primary health care
  • Commission on Social Determinants of Health
    underlying social,
  • economic, and political causes of ill health,
    and of the methods most
  • likely to provide solutions
  • - renewed focus on primary health care

How can political commitment avoid fail to
4 Broad Policy Areas for Essential Changes
  • dealing with health inequalities by moving
    towards universal coverage
  • putting people at the centre of service delivery
  • integrating health into public policies across
  • - providing inclusive leadership for health

Can primary health be a solution for all (health
Can primary health be a solution for all (health
Can primary health care help health system
survive the financial crisis than the others?
Priority for public health in the new Europe
How does it work in Europe?
  • One member country, one commissioner

enterprise and industry Günter Verheugen
consumer protection
Meglena Kuneva
healthy Androulla Vassiliou

environment Stavros Dimas

development humanitarian aids Louis Michel
EU competences in health care system?
  • Alzheimer's disease and other dementias Health
    Security and Bio-terrorism
  • Blood Tissues Cancer
  • Communicable Diseases Cross-border Healthcare
  • European Health Examination Surveys Extreme
    weather conditions
  • Health Reports Health Indicators
  • Health Environment Health Workforce
  • HIV/AIDS Injury Prevention and Injury Database
  • Major and chronic diseases Mental Health
  • Nutrition Patient Safety
  • Pharmaceutical Forum Rare Diseases
  • Scientific Committees Tobacco

European health agencies
  • Governed by European public law has its own
    legal personality.
  • European Centre for Disease Prevention and
    Control (ECDC) mobilise and reinforce the
    synergies between the existing national centres
    for disease control.
  • provide authoritative scientific advice on
    serious health threats, recommend control
    measures, allow quick mobilisation of
    intervention teams, enable a rapid and effective
    EU-wide response. From early 2005
    onwards.European Environment Agency (EEA)
    collect, prepare and disseminate timely,
    targeted, relevant and reliable information on
    the state and trends of the environment. is open
    to countries that do not belong to the European
    Union but share its concern for the environment.
    co-operates actively with other relevant bodies
    and international organisations.European
    Monitoring Center for Drugs and Drugs Addiction
    (EMCDDA) collect and disseminate 'objective,
    reliable and comparable information' on the
    phenomenon of drugs and drug addiction in Europe.
    works in partnership with non-EU countries as
    well as with international organisations
  • European Agency for the Evaluation of Medicinal
    Products (EMEA) protection of public and animal
    health. works as a network, bringing together the
    scientific resources of the EU and EEA-EFTA
    Member States, ensure the highest level of
    evaluation and supervision of medicines in
  • European Agency for Safety and Health at Work
    (EU-OSHA) bring together and share the region's
    vast pool of knowledge and information on
    OSH-related issues, particularly preventative
    measures.European Food Safety Authority (EFSA)
    provide independent scientific advice on all
    matters with a direct or indirect impact on food
    safety. cover all stages of food production and
    supply, from primary production to the safety of
    animal feed,

Overview of European health strategy (1)
  • an important priority for Europeans
  • (Europeans) expect to be protected against
    illness and disease
  • bring up (our) children in a healthy environment
  • demand workplace safe and hygienic
  • travelling (within the European Union) with
    access to reliable and high-quality health advice
    and assistance

Overview of European health strategy (2)
  • Public authorities (in Member States) have a
    responsibility to ensure that these concerns are
    reflected in their policies.
  • (The European Union) has a vital role to play
    through the obligations placed on it by the
    European Treaties.
  • Cross-border health threats, influenza, free
    movement of patients and medical personnel

Overview of European health strategy (3)
  • A coherent and coordinated approach to health
    policy first set out in the European Community
    health strategy in May 2000.
  • A new Health Strategy 'Together for Health A
    Strategic Approach for the EU 2008-2013 adopted
    on 23 October 2007.

4 principles and 3 strategic themes
Overview of European health strategy (4)
  • taking a value-driven approach,
  • recognising the links between health and economic
  • integrating health in all policies,
  • strengthening the EU's voice in global health.

Overview of European health strategy (5)
  • 4 principles and 3 strategic themes
  • Fostering Good Health in an Ageing Europe,
  • Protecting Citizens from Health Threats,
  • Dynamic Health Systems and New Technologies.

The Strategy is supported by financial tools both
in DG SANCO and in other sectors, such as the 7th
Framework Programme for Research, and Regional
Policy funding. The Health Programme 2008-2013
Funding EUR 321,500,000
Overview of European health strategy (6)
Overview of European health strategy (7)
To improve citizens health security
Developing EU and Member States capacity
to respond to health threats, health
emergency planning, preparedness measures
Actions patient safety, injuries and accidents,
risk assessment, community legislation on blood,
tissues and cells.
Overview of European health strategy (8)
To promote health and reduce health
inequalities Action on health determinants
nutrition, alcohol, tobacco, drug consumption,
social and environmental determinants
Measures on the prevention of major
diseases and bridging health inequalities
across the EU Increasing healthy life years
and promoting healthy ageing.
Overview of European health strategy (9)
To generate and disseminate health information
and knowledge Action on health
indicators, disseminating information to
citizens Focus on Community added-value
action to exchange knowledge in areas such as
gender issues, childrens health or rare
Marc DanzonWHO Regional Director for Europe
  • Europe is in a period of extensive innovation in
    primary care
  • (Efforts) help close the gap between the
    expectations of health policy-makers about the
    major role that primary care should play, , and
    the day-to-day performance of real health systems
  • how primary care can best be institutionalized
    within modern health care systems?
  • whether primary care ought to be in the health
    systems drivers seat yet to be determined.

Organizational reform in European primary
care Richard B. Saltman, Ana Rico, Wienke
Boerma Open University Press, 2006
  • 24 November 2008
  • Home care in Europe the solid facts

Quality in Primary Care 2008
The PHAMEU projectPrimary Health Care Activity
Monitor for Europe
  • coordinated by NIVEL and a network of
    institutes organisations in EU - to establish
    a sustainable health information and knowledge
    system on the state and development of primary
    care systems in Europe.
  • - monitor the degree of development of primary
    care systems by means of a measurement instrument
    applicable to all national situations in Europe,
    able to capture the essential elements of primary
  •  Expect a primary care monitoring instrument
    providing country descriptions, international
    comparisons, trends in primary care, implications
    for primary care policy.
  • Duration from 1 November 2007 until 1 November

GP density/ Role of GPs as doctor of first
contact with health problems
  • Heterogeneity and distribution in Europe

What are the problems?
  • In-suf?cient coherence and coordination
  • Character and conditions of primary care so
  • Constantly rising health expenditures, the health
    needs of growing subgroups of the population,
    such as the chronically ill, the elderly and
    those in need of hospice services in their homes,
    are not well met (McKee and Healy, 2001)
  • Unmet needs, unnecessary treatments,
    medicalization, other threats to patients safety
  • side effect of specialization and
    sub-specialization in health care, by which
    professional inward-directedness tended to grow
    at the expense of attention to integration with
    other disciplines

Expanded horizon of health care services
  • Problems of coordination are likely to arise at
    key interfaces between primary and secondary
    care, between curative care and public health
    services, and between specialities within
    particular subsectors
  • Growing importance of anticipatory medicine and
  • Poor communication between primary care,
    hospitals, and medical specialists has been well
    documented in many health care systems

Why PHC preferred?
  • Relationship between strong primary care systems
    and health outcome measures (Starfield,1992).
  • The strength of primary care systems in countries
    related to cost-containment and health outcomes
    (Starfield 1994 Delnoij et al. 2000 Shi 2002
    Macinko et al. 2003).
  • If more health care providers were directly
    accessible in a country, patients showed a higher
    satisfaction with general practice than in
    countries where more referrals were required
    (Madelon W. Kroneman et al, 2006)

  • strong primary care system is the linchpin of
    effective health care delivery and can help
    resolve the lack of continuity and responsiveness
    in health care in general (Saltman and Figueras,
    1997 WHO, 2002).
  • strong primary care based systems are cheaper to
    operate than more open systems, health outcomes
    are better (Star?eld, 1994 Doescher et al.,
    1999 Shi et al., 2002 Macinko et al., 2003).
  • only a few OECD countries have been able to
    improve essential features of primary care since
    1970 (Macinko et al. 2003)

Other disciplines in primary care
  • Nursing, community nurses
  • Pharmacist
  • Physiotherapist
  • Midwife
  • Other home helpers
  • How to integrate these resources?

Time to develop new players and indicators
  • Considering the population distribution, health
    care provider distribution, transportation/communi
    cation, availability of GP, other helpers

Factors in new indicators for PHC
  • Disease incidences
  • Hospitals, specialties,
  • Health professionals
  • Ambulance
  • Transportation

New players for PHC to join? When?
  • eBusiness/ eHealth model?
  • Internet
  • Email
  • Google-messenger/video-MedWeb? (ebanking?)
  • Skype-video

  • Thank you for your attention.

Dr. and Mrs. Landsborough (1913)
John Snow 1813-1858
(No Transcript)
Almere health care experiment
  • 1978, first Dutch model of PC
  • Suburb of Amsterdam, 165,000 population, 6500
    increase each year
  • Design a well-developed coherent system of
    primary care, with a minimum amount of secondary
    level facilities.
  • A foundation was created to employ all GPs,
    physiotherapists, pharmacists, dentists, midwives
    and auxilliary staff, social workers and
    community nurses
  • The goal reduce referrals to medical
  • Reduce use of antibiotics particularly by
    children, as were tonsillectomies.
  • At least one female GP in every health centre,

  • Coordination, teamwork, integration
  • - offers diagnostic, curative, rehabilitative
    and palliative services in response to the bulk
    of these problems
  • - offers prevention to individuals and groups at
    risk in the population served
  • - takes into account the personal and social
    context of patients
  • - is provided by a variety of disciplines,
    either within primary care, secondary care or
    related sectors
  • - assures patients continuity of care over time
    as well as between providers.