Talking about the European Region does not mean speaking of a homogeneous situation, also from the point of view of health. To realize how complex and articulated the European scenario is, just think that in Ukraine, Romania, Moldova and Turkey twice as many children die before the age of five if the figures are compared with so-called industrialized countries. Not to mention the infectious diseases, the use of alcohol and tobacco, which reflect a Europe still deeply layered and with several countries still extremely dependent on their history.
The issue is not trivial because if it is true that Europe wants to brand itself as a unique community and pursue common objectives, it is necessary to take the issue of health policies very seriously. Health is in fact a major resource and asset for societies, because good health benefits all sectors, including economic growth.
This is the viewpoint of the World Health Organization that in September 2012 has launched Health 2020, the new European policy framework for health and well-being, involving the 53 Members States of the WHO European Region. The philosophy of Health 2020 is very clear: its aim is not to make national and local health systems even but to make them evenly better. This is at once a challenge and a turning point. A challenge that basically translates into two points: first, the need to improve health for all and reduce the health divide and, moreover, the need to strengthen leadership and participatory governance for health.
Specifically, Health 2020 is based on four priority areas: investing in health through a life-course approach and empowering people; tackling the most important challenges of noncommunicable and communicable diseases; strengthening people-centred health systems and, finally, creating resilient communities and environments.
This is the general main trend. Whereas, in more pragmatic terms, Health 2020 strives to achieve measurable impact on health in the whole Region. The goals are six: reducing premature mortality; increasing life expectancy; reducing inequalities and enhancing the population wellbeing; ensuring universal coverage and the right to the highest attainable level of health and finally setting national standards for health in member states.
The objectives of Health 2020 are therefore clear and ambitious, but the problem that arises, however, is how to actually implement these objectives, taking account of the various health and political ecosystems, and the diversity they entail.
The WHO strategy is to use the small European countries as examples and catalysts of the project throughout the European Region. Exactly this strategy was discussed last week in San Marino, during the international meeting “Implementing the Health 2020 vision in countries with a small population”, sponsored by San Marino and coordinated by the WHO Regional Office for Europe based in Venice, Italy. The meeting saw the participation of Ministers and senior representatives in the field of Health of Andorra, Cyprus, Iceland, Luxembourg, Malta, Monaco, Montenegro and San Marino. Interestingly, also these eight small states present a situation far from being homogeneous, from both the health management and the political point of view, in line with the entire European scene. Further details in terms of this diversity can be analyzed.
A first overview covers the real GDP per capita, a parameter mentioned over and over again when it comes to Europe. Whether you consider the whole of Europe or the eight small states too, the differences between the various nations in this regard are remarkable. For example, while Monaco has about the same number of inhabitants of San Marino, it has a GDP three times greater at the same time.
A second parameter – this time about the health care industry – emphasizing the deep heterogeneity of Europe concerns the annual costs of health care. Data taken by the WHO dossier Core Health indicators in the WHO European Region 2013, show that the percentage of GDP that each state has devoted to the health sector in 2011 is quite different between countries. And the same applies to the public sector health expenditure and the private households “out of pocket” expenditure.
The question of the distribution of infectious diseases contributes greatly to feed this need to make the European landscape more homogeneous. Also, according to WHO spreadsheets in fact the proportion of new HIV cases varies greatly from country to country, especially from Eastern Europe to the West and the same trend can be observed in the case of TB. Not coincidentally, one of the declared goals of Health 2020 is tackling the most important challenges of noncommunicable and communicable diseases throughout the European Region.
To summarize, even focusing on few types of data, without considering the whole and more complex situation in a comprehensive way, we realize that if the European systems want to see an improvement in the health care sector, a coordination action is a must. And, most of all, a very challenging one.