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Health gaps in Europe: EU


Health gaps in Europe: EU s old and new members Albena Arnaudova WHO/Europe Representation to the EU WHO European Region: 53 countries We compare because we know ... – PowerPoint PPT presentation

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Title: Health gaps in Europe: EU

  • Health gaps in EuropeEUs old and new members
  • Albena Arnaudova
  • WHO/Europe Representation to the EU

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WHO European Region 53 countries
EU 15 MS EU MS before 2004
New EU MS after 2004
Accession/Candidate Country
ENP Country
Source HFA database
We compare because we know there exist
  • Consistent patterns of differences in health
    status between these groups of countires
  • Consistent lack of awareness about these
  • Crosscountry comparisons, in groups or per
    individual countries, are an essential tool for
    policy making.
  • N.B. Sometimes the picture is mixed some east
    European countries perform equally or better than
    some western European countries, especially if
    one compares the financial resources available.

Poor and rich? REAL GDP GROWTH the trends
Some demographic essentialsLife expectancy at
birth the trends
Disability-adjusted life expectancy, men
EU-15 71.7 (2002)
Slovenia, Poland 65 Baltics - 62 Russia,
Ukraine, Moldova 58.6 - 59.8 (2002)
Source WHO/HFA database
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The new EU members group is not uniform
  • Probability of dying before age of 5
  • 5,1 - EU15 9,9 new members
  • 19,7 Romaina
  • 8 Poland, 7,5 Hungary, 4,4 Cyprus
  • Life expectancy at birth
  • 79,7 EU15 74 new members
  • 78 Slovenia 76 Czech Republic
  • 72 Bulgaria
  • 70 Latvia, Lithuania

What do people suffer from?The 10 health
questions books present comparable data on
  • Cardiovascular diseases the leading cause of
  • Cancer
  • Mental disorders
  • Intentional and untentional injuries
  • Repiratory diseases
  • Infectious diseases

What do people suffer from?Cardiovascular
diseases the trends
What do people suffer from?Cancer the trends
The new EU members group is not uniform
  • Deaths from malignant neoplasms
  • 173 - EU15 201 new members
  • 230 Czech Republic, 211 Poland
  • 156 Bulgaria, 123 Cyprus
  • Deaths from diabetes, all ages
  • 13, EU15 12,7 new members
  • 22 Malta, 18,7 Slovenia
  • 15,6 Estonia, 12 Slovakia
  • 7,8 Latvia

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The new EU members group is not uniform
  • Mental disorders and disease of the nervous
  • 31 - EU15 15 new members
  • 29,8 Estonia, 22 Hungary
  • 11 Romania, 12 Slovakia
  • Smoking related causes of death
  • 200, EU15 390 new members
  • 548 Lithuania, 509 Romania
  • 407 Bulgaria, 477 Hungary
  • 283 Poland, 215 Slovenia

Some causes
  • The socio-economic determinants of health have
    different pattern in different parts of the
  • N.B. The present situation is a result of 15
    years accumulation of these factors.
  • In societies in transition
  • Reforms shake the whole society and its support
  • Increasing number of people fall under the
    poverty line.
  • Access to services is constrained.
  • Quality and appropriateness of health services
  • Increasing pockets of population with high
  • Lifestyle patterns, environmental risks
  • Governance and health systems

The underlying factors
  • Lifestyle and socioeconomic context
  • - traditional risk factors alcohol, tobacco,
  • - men with poor education especially vulnerable
    mortality much higher among men with the least
    education compared to the well educated (link
    with alcohol)
  • - possible impact of low levels of social support
    and lack of control over ones live
  • - direct effects of factors linked to material
    deprivation and poverty
  • Health care health systems dimension

Is it only about rich and poor? The economical
situation explains many of these results
but not all!
Can anything be done to accelerate health gain?
Or should countries wait until they get richer,
as the only alternative
Health has to do with
economic development
democracy and values
health system effectiveness
Health Systems Constraints are impeding the
implementation of major global initiatives for
health and the attainment of the Millennium
Development Goals
Lancet, 2004
While little can be done to accelerate the
economic growth, a lot can be done to improve the
performance of health systems. Strengthening
Health Systems aims at helping Member States
overcome such challenges

Health systems in the EUs new members
  • Not such a thing as a EU new member health system
  • Common challenges (transition, pre-accession)
    but diversity
  • Varying political socio-economic contexts
  • Differing speed and pendulum effect for some

Health system challenges in the new EU members
  1. Strengthening health financing
  2. Reconfiguring the continuum of care
  3. Improving the quality of health services
  4. Investing in public health
  5. Stepping up the stewardship role of the Ministry
    of Health

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Strengthening health financing
  • Cost pressures against insufficient resources
  • Most new EU members neighbours adopted Social
    Health Insurance
  • Challenges to the new health insurance systems
  • Ability to raise taxes, unemployment, informal
  • Commitment to universal coverage but access
  • Low compliance and burden on labour costs
  • Significant (informal) out of pocket payments
  • Financial sustainability improved with economic
  • Moving towards performance related payment
  • But major implementation constraints
  • (skills, information systems)

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Reconfiguring the continuum of care
  • Restructuring hospitals
  • Political obstacles to hospital closure but some
  • Reduction in bed numbers is not enough
  • Developing cost effective alternatives
  • Improvement of hospital performance
  • Further investment in facilities and equipment
  • Further management autonomy
  • Decentralization of ownership to municipalities
  • But poor capacity and skills
  • Strengthening primary care
  • - Progress with the introduction of
    family medicine
  • - GP privatisation / self contracted
  • - But lower income and professional
  • - Limited gate keeping effectiveness
  • - Step up training programmes, setting
    of professional bodies and incentive policies

Age-standardised death rates(0-74) from treatable
causes, 1990/91 2000/02
Source Newey, Nolte, McKee Mossialos, 2004
Improving the quality of services
  • Strengthening quality improvement systems
  • Evidence base medicine is still a challenge,
    widespread use of ineffective interventions
  • Some progress with accreditation systems
  • Increased use of guidelines and protocols
  • Improving the quality of health professionals
  • Addressing over supply and skill mix
    imbalances e.g. public health, nursing, family
  • Strengthening professional standards,
  • Incentives and motivation
  • Addressing Brain drain and Domino effect

Investing in public health
  • Restructuring public health services
  • Fragmentation and under investment
  • Strengthening intersectoral action / Health in
    All Policies
  • Blocks to intersectoral action medicalization,
    lack of collaboration, obstacles enforcing
  • Advocacy Health is Wealth
  • The contribution of health to the economy
  • Human capital and economic productivity

Stepping up stewardship role of Ministries of
  • Central in implementation of reforms
  • Pluralism of provision, privatisation, market
  • Advocacy, information transparency regulation
  • More difficult to steer than to row
  • Feasibility, credibility and capacity issues
  • Difficult change in culture command and control
  • Weak status of MoH against SHI, MoF,....

Strengthening Health Systems in support to
Member States
Our message Beyond health care health
systems for health and wealth (Health
Systems)Invest in health, invest in the future
(Wealth)Strengthened health systems save more
lives (Health)
WHO European Ministerial Conference on Health
Systems Health Systems, Health and
Wealth Tallinn, June 2008
Key objectives of the WHO European Ministerial
Conference on Health Systems- Better
understanding of the impact of health systems on
peoples health and on economic growth in the WHO
European Region - Take stock of recent
evidence on effective strategies to improve the
performance of health systems, given the
increasing pressures on them to ensure
sustainability and solidarity. - Explore the
dynamic relationship between health
systems/health/ wealth.
Global health indicators keep improving But not
in all places, not for all social groups and not
at the same speed.
Globally we know a lotdistribution of income
and wealth
  • Richest 20 of the worlds population hold 75 of
    the worlds wealth
  • Poorest 40 holds 5 of the worlds wealth
  • Corresponds approx to 2 billion people living on
    less than 2 a day

Human Development Report 2005
Between social groups we know a lotMortality
according to level in the occupational hierarchy
Between social groups we know a lot The
widening mortality gap between the social
classes England and Wales
Source Tackling Health Inequalities a programme
for action Dept of Health 2003
Is there a gap in knowledge then?
  • The Regions of Europe
  • How does health status differ between Regions?
  • How to improve knowledge and make it available to
    regional policy makers?
  • What can be done to bring health gains equally to
    all Regions?
  • How can WHO help do that?