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Projected trends in health status and the health sector in WHO European Region by 2020 First Meeting of the working group on EURO's future Copenhagen,

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Presentation on theme: "Projected trends in health status and the health sector in WHO European Region by 2020 First Meeting of the working group on EURO's future Copenhagen,"— Presentation transcript:

1 Projected trends in health status and the health sector in WHO European Region by 2020 First Meeting of the working group on EURO's future Copenhagen, 26-27 of September, 2005 Elena Varavikova, WHO HQ/EIP/SPO/QPS

2 In the 21 st century Health is…. Foreign policy Security policy Economic policy/Trade policy Demographic development Geopolitics

3 The growth of epidemics AIDS, SARS, Avian etc Global obesity/tobacco epidemics Increasing Global risk factors Unhealthy consumption The threat of bio terrorism

4 The lack of sustainable health systems Lack of health care coverage of the poor Insufficient national capacities for public health in rich and poor countries The dramatic fall of investment in universal health systems. Lack of human resources //export and brain drain

5 Systems default: Focus on disease A world of vertical programs and quick fix solutions A tendency to invest in technologies and drugs and not in social protection, health systems and people



8 Health and the European Union The health of most of the populations of the developed countries has never been better Professionally applied Public health measures Advanced medicine Increased maternal literacy Modern hygiene Life-style changes

9 Current challenges for European Health System Rapid advancement in Technologies Rising expectations about health care Patient Safety Subsequent costs and quality of care Demographical challenges (Aging; Migration; Low birth rate) Privatization of social services Macroeconomic context

10 Challenges for FSC Globalization Transition Population Challenge Social & Economic Challenge Ecological Challenge Political Challenge

11 Vision 2020 Continuous Development and Progress A. EU B Non EU Outstanding Challenges: Avian influenza Manmade catastrophe Natural catastrophe

12 Recent trends in life expectancy at birth since 1970: Estonia, Hungary, Poland, Russia, and the UK Recent trends in life expectancy at birth since 1970: Estonia, Hungary, Poland, Russia, and the UK Emergence of a new East-East gap in the 1990s e(0) in Russia, 2000: 59.2 (m) and 72.4 (f)

13 Long term trends in life expectancy at birth since 1890: France, Japan, Russia and the USA. Long term trends in life expectancy at birth since 1890: France, Japan, Russia and the USA. Historical gap, its reduction in the 1950s and the new health crisis in 1965-2000

14 Population of Russia, projections, 1950-2050.

15 Trends in SDRs for avoidable causes of death since 1965: Russia, Baltic countries and the UK, both sexes, per 100000

16 Components of the life expectancy gap between Russia and the UK in 1965-2000 according to potential impact of medical care (either preventive or curative) and health policies The gap is mostly due to CVD and external causes. Stroke is included into group of causes amenable by medical care (blood pressure control). Liver cirrhosis, poisonings by alcohol and lung cancer can be reduced by health policies. Improvement of medical care itself (with IHD excluded) can remove about 15-20% of the gap.

17 Alcohol Consumption in Russia Alcohol consumption plays a far greater role in the mortality crisis than had previously been thought. The decline in mortality in the mid-1980s (which co-incides with Gorbachev's anti-alcohol campaign) and the subsequent rise after 1988 parallels what is known about alcohol consumption in Russia. This has soared due to the upsurge of home brewing, the relatively cheap price of alcohol and the absence of any concerted attempt to counteract alcohol abuse. The direct effect of alcohol consumption on mortality is shown in the four- fold increase of deaths from alcohol-related conditions between 1988 and 1994. The indirect effects of alcohol are shown in the alarming increase in accidents and violence (a significant proportion of which may be alcohol- related). An important finding is that much of the increase in mortality from cardiovascular and respiratory disease among people of working age can be attributed to the effects of alcohol. (Acute episodes of very high levels of alcohol consumption can result in death from cardiac arrythmia and haemorrhagic stroke.)

18 CIA - Mapping the Global Future (2002) Russias energy resources will give a boost to economic growth, but Russia faces a severe demographic challenge resulting from low birth rates, poor medical care, and a potentially explosive AIDS situation. US Census Bureau projections show the working-age population likely to shrink dramatically by 2020. Russias present trajectory away from pluralism toward bureaucratic authoritarianism also decreases the chances it will be able to attract foreign investment outside the energy sector, limiting prospects for diversifying its economy. The problems along its southern bordersincluding Islamic extremism, terrorism, weak states with poor governance, and conflictare likely to get worse over the next 15 years. Inside Russia, the autonomous republics in North Caucasus risk failure and will remain a source of endemic tension and conflict. While these social and political factors limit the extent to which Russia can be a major global player, in the complex world of 2020 Russia could be an important, if troubled, partner both for the established powers, such as the United States and Europe, and the rising powers of China and India. The potential also exists for Russia to enhance its leverage with others as a result of its position as a major oil and gas exporter.

19 Copyright ©2003 BMJ Publishing Group Ltd. Men, T. et al. BMJ 2003;327:964 Fig 1 Age standardised mortality from all causes by region

20 Life expectancy at age 15 in Europe, men, 1970-2001.

21 Life expectancy at age 15 in Europe, women, 1970-2001.

22 Probability of men dying (per 1000) between 15 and 59 years


24 Rates of abortion in some European countries and the US CountryYear of most recent available figures Total number of legal abortions Abortion rate Germany 1 2000134 6098.0 per 1000 women aged 15-44 Finland 2 200010 9329.0 per 1000 women aged 15-49 Italy 3 2002126 1649.3 per 1000 women aged 15-49 Denmark 2 200015 68112.5 per 1000 women aged 15-49 Iceland 2 199994713.4 per 1000 women aged 15-49 Norway 2 200014 65513.7 per 1000 women aged 15-49 Sweden 2 200030 98015.6 per 1000 women aged 15-49 US 4 2001853 48516.0 per 1000 women aged 15-44 UK 5 2004185 40017.8 per 1000 women aged 15-44 (age standardised to the European population) Ukraine 6 1999495 80045.4 per 1000 women aged 15-44

25 Maternal Mortality, Kazakhstan and others, 1970-2001

26 Infant Mortality, Kazakhstan and others, 1970- 2001

27 Europe: Water; Food; Housing in 2020 Water – the Oil of the 21st Century? Food - malnutrition Housing – 52%

28 European water treaty Almost 140 million people in Europe (16%) do not have a household connection to drinking water Five million people (10%) do not have improved sanitation (connection to a public sewer, connection to a septic system, pour flush latrine, simple pit latrine, or ventilated improved pit latrine) More than 41 million people (5%) lack access to a safe drinking water supply. Poor quality drinking water cause more than 13 000 deaths from diarrhoea among children aged 0 to 14 years (5.3% of all deaths in this age group) every year. Ress.P European water treaty hailed as a milestone for public health BMJ. 2005 Aug 13;331(7513):368.

29 The Privatization of Water The four leading states of Western Europe all have different water systems. However, all four now encourage privatization. In France and in the U.K., the process is far advanced, while in Germany and Italy, private participation is still incipient but growing. Service providers in all four countries have historically kept prices below market levels and now must face large price increases in order to upgrade their plants and distribution systems to accepted European standards. To pay for the necessary infrastructure, and not raise water tariffs through the roof, government providers would have to raise taxes, increase borrowing, or both, which few politicians dare to do nowadays. Therefore, they have turned to private companies and their shareholders. The new European standards have, perhaps inadvertently, made increased privatization of water and sewerage in Europe inevitable. The U.K. model, though slandered by many for political reasons, has met these higher investment needs most rapidly, albeit with higher prices, which have given rise to deep, if unwarranted, consumer distrust.

30 Climate change.

31 Copyright ©2005 BMJ Publishing Group Ltd. de Vries, E. et al. BMJ 2005;331:698 Age specific incidence of and mortality from cutaneous malignant melanoma in the Netherlands, 1950-2005

32 Benjamin Disraeli What we anticipate - seldom occurs; What we least expected generally happened

33 1: epidemic, 2: probable pandemic, 3: pandemic Source: Potter, C.W: Textbook of Influenza by Nichols, Webster, Hay, Blackwell Science 1998 Recorded Influenza Pandemics 0 1 2 3 1883 * 1918-19 "Spanish Flu" 1957-58 "Asian Flu" 1968 "HK Flu"

34 Location of H5N1 Avian Influenza in the Russian Federation and suspected areas ( Aprx. 90.000 birds destroyed Infections mainly seen in wild ducks and geese and widespread

35 Europe and Central Asia Regional Brief Adults and children living with HIV/AIDS New infections in 2004 Adult prevalence rate* % Deaths due to AIDS in 2004.. 1.4 million (Range: 920,000 - 2.1 million).. 210,000 (Range: 110,000- 480,000).. over 1%.... 60,000 (Range: 39,000- 87,000) AIDS in Europe and Central Asia.

36 Most TB cases are in India and China 10 000 to 99 999 100 000 to 999 999 1 000 000 or more < 1 000 1 000 to 9 999 No Estimate The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. © WHO 2002


38 High rates of drug resistance mainly in former Soviet countries 0 5 10 15 20 FINLAND FRANCE N'LANDS SCOTLAND DENMARK SWEDEN POLAND SWITZLND Barcelona ENGLAND GERMANY CZECH SLOVAKIA NORWAY ITALY LATVIA Ivanovo Tomsk ESTONIA MDR cases (%)

39 Foreign-born make a large and growing contribution to TB in Europe 0 10 20 30 40 50 60 70 80 Portugal Finland Greece Ireland Italy Austria Germany Belgium France UK Netherlands Sweden Norway Luxembourg Denmark TB cases among foreigners (%)



42 70% tobacco deaths in 2020 70% tobacco consumption in 2000 70% of tobacco production in 1996 Tobacco and low and middle income countries

43 Current male smoking prevalence rates, by age group..

44 Current female smoking prevalence rates, by age group...

45 SDR, trachea/bronchus/lung cancer, 0-64 per 100000 Source: WHO/Europe, HFA Database, January 2005 Kazakhstan Kyrgyzstan Russian Federation Tajikistan Turkmenista n Uzbekistan EU

46 Current Tobacco Users (%), 13-15 years from Global Youth Tobacco Survey < 15% 15-25% > 25% Variable

47 Source: WHO/Europe, HFA Database, January 2005 Kazakhstan Kyrgyzstan Russian Federation Tajikistan Turkmenistan Uzbekistan EU SDR, diseases of circulatory system, 0-64 per 1000000

48 Stroke Mortality, Kazakhstan and others, 1970-2001

49 The public health implications of world trade negotiations Trade ministries from the World Trade Organization's (WTO's) 144 member states are presently deciding which public services to open to foreign competition under the complex liberalisation rules of the general agreement on trade in services (GATS). …..national autonomy over health policy is not preserved under GATS, and that accordingly, there is a role for international standards that protect public services from the adverse effect of trade and market forces. Skilled workforce migration

50 Poverty reduction, 1990-98 MDG goal: halving poverty by 2015 poverty incidence 1990 =100

51 Trends in probability of survival in Russian men by education (relatives study) 45 p20 = probability of living to 65 yrs when aged 20 yrs Murphy et al, submitted

52 WHS People(%) who noted worsening attitude to them on the part of the medical personnel for one of the following reasons: groups Outpatient clinic Inpatient Hospital -sex 0,20,7 -age > 60 > 60 60 + 6,82,012,68,82,615,8 -lack of money 9,215,1 -ethnic group russian russian title ethnic group title ethnic group other other0,30,2-2,20,50,21,08,7

53 Angina pectoris in the able-bodied age (%) WHS Angina pectoris in the able-bodied age (%) Positionsurbanrural Prevalence6,613,1 Visited in the last 12 months74,560,9 Not get all the medicines in the last 12 months 38,960,9 Could not afford48,635,7

54 Have not got (or have not fully got) medicines prescribed by the medical personnel (%) WHS Have not got (or have not fully got) medicines prescribed by the medical personnel (%)

55 WHS Comparative estimate of population distribution (%) in the relative body mass (BMI) for the ages of 20 to 74 BMI Russia USA* menwomenmenwomen > 18,490,62,41,13,5 18,5 – 24,99 48,542,037,945,3 25 >50,855,661,051,2 30 >6,516,312,817,1 *Health USA, 2000

56 4.9 5.3 7.8 3.6 3.7 1.2 7.7 Prevalence of diabetes among the adult population P. Home, 2001, Athens, Greece Russia 2.5% from the World Health Survey in Russia - 2.9%

57 The Paradigm Shift in Health Research ApproachBiomedical deterministic research Participatory social/ community research FocusIndividualCommunity DimesionsPhysical / pathologicalPsycho- social, cultural, economic, political TechnologyDrugs / vaccinesEducation and social processes Type of service Providing/ Dependanse creating / Social marketing Enabling / Empowering Autonomy Building Link with people Patient as passive beneficiary Community as active Participant ResearchMolecular biology Pharmaco – therapeutics Clinical Epidemiology Socio – epidemiology Social determinants Health Systems Social Policy

58 Towards a Fresh Vision Focusing on the Goal: Sustainable Improvement of Health status in WHO European Region in 2020 Understanding potentials and limitations of the role of WHO in the process Responding to the needs of adequate development

59 Strengthening public health: vision for EURO Improved Public health research, training and standards of practice - a priority Broad view of public health ( trauma, poverty) Adequately resources Strong and respected leadership, advocacy Appropriate information and surveillance systems (measurements, methods) Acting nationally and globally

60 Conclusions The societal transformation has had a major impact on peoples lives and health Central Europe is doing better than some FSC The aggregate trends related to social factors and will continue Mortality reversal (Russia) Emerging negative trends in mortality of Russian women LE will continue to deteriorate in Russia

61 To the positive attitude: Business carried on as usual during alteration on the map of Europe Winston Churchill, Speech, 9 November, 1914

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