Dear President of the Regional Committee, my very good friend Minister Azhar Giniyat, my big brother Dr Tedros, ministers, ladies and gentlemen,
What a pleasure to see all of you back in person, one year after the formidable Regional Committee we had in Tel Aviv in Israel. I want to say a very big thank you, toda raba, particularly to my friend Dr Ashi Salomon, the man who arranged everything from the big vision to the smallest transport detail.
No doubt this Regional Committee will be as memorable as last year. It is taking place in the country where, 45 years ago, the most significant pages of WHO’s history and contemporary public health were written through the Alma-Ata Declaration on primary health care.
And there are many more celebrations to have. It is the 5th anniversary of the Astana Declaration on primary health care, the 15th anniversary of the Tallinn Charter on Health Systems for Health and Wealth, 25 years of the European Observatory on Health Systems and Policies, and, of course, 75 years of our Organization, the World Health Organization. It has been a year of commemorating key historical moments to improve health and health systems in the Region and beyond.
Sadly, 2023 has also been a year when health crises have continued to rage through our Region: a devastating war in Ukraine, with now more than 1700 child casualties; 2 major earthquakes in Türkiye; a mass population movement from Karabakh to Armenia, compounded by an explosion at the gas station with many people burned, where immediately we provided assistance; and now hundreds and hundreds of children being killed in the war in Israel and Gaza.
Just like Dr Tedros, at WHO/Europe we strongly condemn the atrocious, unjustified attacks by Hamas on the innocent Israeli people. We call for the immediate release of all hostages which were taken into Gaza, many of them elderly people and children, who are in need of medical care. We call upon all parties to engage under the rules of international humanitarian law, particularly protecting citizens and health-care workers.
The WHO European Region, my friends, is no longer the disaster-resilient region that we believed it was. Yes, we learned a lot of lessons from the COVID-19 pandemic, from successfully controlling mpox and moving towards elimination, from swiftly controlling the polio outbreaks thanks to the political commitment of the governments of Tajikistan, Israel and Ukraine – but we just cannot let our guard go down.
Many Member States have asked us to work towards resilience as an answer to the permacrisis. Resilience means bouncing back stronger from a crisis, and the programme of the Regional Committee fits very well into this vision, building upon the dual-track approach which I called for in Tel Aviv last year. I recognize 3 pillars of a resilient WHO European Region, which is the title of my annual address to you today:
- resilient governance
- resilient health systems
- resilient people.
I will now take you through these 3 pillars.
Resilient governance
The first pillar is resilient governance. What does it mean? It means governance which is participatory, which is aligned with global processes and which ultimately works towards a resilient WHO.
Let’s start with participatory governance. During the meetings of the WHO governing bodies, many of you Member States expressed the wish to exercise your role as a governor of WHO, to be even more participatory.
I myself have always shared this wish from the beginning of my mandate. I’ve believed that WHO can only exercise its mandate by listening to the real and changing needs and expectations of the Member States. Participatory governance will strengthen the trust of the Member States; ensure transparency and accountability; and, very importantly, harness the huge experience in all Member States to drive WHO regional policies.
I would like to warmly thank Professor Marat Shoranov, Chair of the Standing Committee of the Regional Committee (SCRC), Ms Anna Wechsberg, Vice-Chair of the SCRC, and all SCRC members for their strong support to us in implementing many initiatives since Tel Aviv to strengthen participatory governance. Here are just a few examples:
• We commissioned an external review of WHO/Europe governance involving Member States and non-State actors.
• We made changes in the programme of the Regional Committee this year, particularly by moving governance, budget and management to Day 2 so there would be ample time for debate.
• We made many efforts to increase drastically the number of Member State briefings, both virtually and physically, including during the governing body meetings in Geneva.
Let us also remember that we conducted 2 special sessions of the Regional Committee under watertight conditions. I would like to thank Ms Egle Granziera from WHO headquarters for the tremendous support.
In between the governing body meetings, I always keep both the SCRC and the European Executive Board members informed of graded emergencies and my own country missions.
Upon your request, we worked very hard to make the process of elections and nominations even more transparent and predictable, and we put a lot of effort into alignment between the capitals and the permanent missions in Geneva.
I would like to thank here Ms Gabrielle Jacob, who has assumed her new role as Regional Adviser on Governance, and also to warmly thank our friend Mr Willy Palm for a tremendous job on governance in the last 3 years. I have asked Mr Palm now to support our WHO Representation Office in Brussels temporarily in the context of the European Union (EU) presidencies.
Ultimately, for me, the best way to increase the participatory nature of WHO/Europe governance is through my country missions. Since Tel Aviv last year, I have conducted 33 country missions, which gave me the unique opportunity to interact directly with ministers of health, senior health officials, all of you, patients and civil society. I must say that I stand in awe of all your health-care workers, who are doing an amazing job in very difficult circumstances.
The second feature of resilient governance is alignment with global processes. A first dimension of alignment, I see, is with the agenda of the United Nations Secretary-General to work as one. This is the Secretary-General who recently held the Sustainable Development Goal (SDG) Summit, which sought renewed impetus towards the SDGs.
How did we contribute and align as a region? One example: In March, we convened for the first time the WHO/Europe High-level Forum on Health in the Well-being Economy, which was opened by no one less than the Prime Minister of Iceland, our good friend Ms Katrín Jakobsdóttir, who in a very inspiring speech demonstrated that with high political commitment, a whole-of-government approach, social participation, and new fiscal strategies and metrics, it is possible to shape an economy which goes beyond mere benefits and promotes the health and well-being of everyone in society.
Let’s not forget that 81% of Europeans believe that reducing inequities should be at the top of the political agenda. Trust is built when ordinary people feel the concrete benefits of policies which are designed to protect their lives and livelihoods. This is critical if we want to rebuild socially inclusive societies that are healthy.
I myself had a unique opportunity to see how an economy of well-being works on the ground when I was invited by the Prime Minister to Reykjavik in magical Iceland. There, I could speak to the people of Iceland, the Prime Minister, my very good sports friend Minister of Health Willum Þór Þórsson, and Minister of Foreign Affairs Bjarni Benediktsson, who patiently explained to me Iceland’s learning around fiscal strategy for the well-being economy, and committed to go with us to Davos next year.
Can you imagine how proud we were 1 month ago, when the Prime Minister met with the United Nations Secretary-General and informed him of our pioneering work and invited him to our Region to participate at the second WHO/Europe High-level Forum on Health in the Well-being Economy?
The second dimension of alignment is obviously with the WHO global policies. We are working very hard now to provide strong, pan-European input into the 28th United Nations Climate Change Conference, which for the first time will have a dedicated Health Day on 3 December in Dubai. Please, everyone, support that Health Day, because it was our Region which brokered new political commitments towards health and the environment through the historical Budapest Declaration on the triple crisis of biodiversity loss, climate change and environmental pollution at the Seventh Ministerial Conference on Environment and Health.
And the Patron of the Conference was President of Hungary Ms Katalin Novák herself. I want to say a very big thank you – köszönöm – to Minister of Interior Mr Sándor Pintér, to State Secretary for Health Mr Peter Takács, to Minister of Energy Mr Csaba Lantos, who was with us the whole time, and, of course, to my good friend Minister of Foreign Affairs Mr Péter Szijjártó.
We were also walking the talk during the Conference. I remember that Minister of Energy Mr Csaba Lantos was hosting an amazing ministerial lunch, which was vegan, and he was looking to me and he said, “Dr Kluge, my children will never believe that for the first time in my life I am eating Hungarian goulash without meatballs.”
The third dimension of alignment is what I call interregional collaboration: strengthening the unity and the internal coherence of WHO. In March, I co-hosted with WHO Regional Director for the Eastern Mediterranean Dr Ahmed Al-Mandhari, and WHO Regional Director for Africa Dr Matshidiso Moeti, the second WHO High-level Interregional Meeting on the Health of Refugees and Migrants, in Sharm El Sheikh, Egypt. We started it in Istanbul last year, and Dr Moeti will host the third one next year in Africa.
Four months later, we launched an intercountry platform in our Region to exchange innovative practices between 7 neighbouring countries hosting displaced populations from Ukraine. This was the initiative of the Ambassador for Global Health of Slovakia, my good friend Professor Jozef Šuvada. Thank you so much for pushing that innovation.
Many of you know how close I am with the South-East Asia Region, ever since I left working in Myanmar and the Democratic People’s Republic of Korea. That’s why I was delighted when WHO Regional Director for South-East Asia Dr Poonam Singh invited me, together with Dr Tedros, in August to Gandhinagar, Gujarat, to the ministerial meeting on ending tuberculosis (TB), which actually paved the way for a strategic partnership among authorities on TB and multidrug-resistant TB.
We also joined forces with the WHO Western Pacific Region on digital solutions for a rapidly ageing population. In March, Director of the Pan American Health Organization Dr Jarbas Barbosa da Silva Jr., Assistant Secretary for Global Affairs of the United States Department of Health and Human Services Ms Loyce Pace, and myself, signed a new transatlantic partnership agreement to strengthen global health systems and to include some innovative workstreams, for example, to work with the Inuit community in the Arctic. We should not forget that it’s our Region which holds the bulk of the Arctic, and we should be proud of it.
That’s why I was so humbled to be the first Regional Director in history to go on a mission to Greenland. I did it together with Dr Søren Brostrøm, at that time the Director-General of the Danish Health Authority, whom I would like to thank for his support and the support of Denmark for my mission. I have stunning admiration for the Minister of Health of Greenland Ms Mimi Karlsen and Dr Nike Berthelsen, Head of the Department of Health, for their leadership during the COVID-19 pandemic, and for our camaraderie.
After hours and hours sailing through the ice flows to arrive at one fishing village, we met Aka, one of those many unsung primary health-care heroes, who is serving her community with empathy, with self-made expertise – because she’s a part-time health assistant, part-time boat mechanic – and with telemedicine, which is literally saving lives in Greenland.
Dear friends, this interregional dimension makes our countries stronger at home and more visible abroad, and it’s a great platform, post-pandemic, to work together towards attaining global health equity, including on climate change financing and vaccine technology transfer.
One thing that I learned during the COVID-19 pandemic is that traditional Global North–Global South humanitarianism is no longer working, and we have a lot to learn from lower-income regions, not least on community care.
The third feature of resilient governance is you, my governors, because you want a resilient WHO, one which bounces back stronger from a crisis. This means a WHO which is empowered, which is financed, which is agile and country-focused, and which is ultimately science-driven.
First, we need to be empowered. We are only as strong as the teeth that you are giving us. That’s why I would like to warmly thank every one of you for having facilitated, since I became Regional Director, my meetings with 40 countries’ presidents or heads of government, which is very important coming out of the pandemic, with a cost-of-living crisis, with an energy crisis, with a lot of pressure on domestic health budgets. WHO stands together with you, heads of state, prime ministers, to keep health and the health workforce at the top of the political agenda.
I would like to illustrate this with one story in the history of WHO/Europe. Recently, the President of Tajikistan, His Excellency Emomali Rahmon, invited WHO/Europe for the first time to the annual meeting of the 5 presidents, the C5, of Central Asia. For the first time, we got a Central Asian roadmap on health and well-being endorsed, which now tremendously empowers the health leadership across all 5 Central Asian countries.
Thank you so much, Excellency Emomali Rahmon. Thank you to the President of Kyrgyzstan, His Excellency Sadyr Zhaparov; to the President of our beautiful host country Kazakhstan, His Excellency Kassym-Jomart Tokayev; to the President of Uzbekistan, His Excellency Shavkat Mirziyoyev; and to the President of Turkmenistan, His Excellency Serdar Berdimuhamedov.
You see that the President of Azerbaijan, His Excellency Ilham Aliyev, was also invited. The roadmap is around strengthening the International Health Regulations; a TB-free central Asia; health and the environment around the Aral Sea, which is very, very important; One Health; and noncommunicable diseases.
We have worked months for this but, honestly, all the credit goes to the 5 ministers of health – to Dr Azhar Giniyat, who from the very beginning has been a great, great supporter; to my friend from Kyrgyzstan, Minister of Health Dr Alimkadir Beishenaliev, who was very supportive; of course, to my brother from Tajikistan, Minister of Health and Social Protection Dr Jamoliddin Abdullo Abdullozoda; to my brother from Turkmenistan, Minister of Health and Medical Industry Dr Atageldi Germanov; and finally, of course, to my brother from Uzbekistan, Dr Amrillo Inoyatov.
Bravo to the force. Central Asia, my friends, is one of the very few applicants to the Pandemic Fund for One Health, and they received it. We gave a lot of support, together with the World Bank. I want to thank Assistant Director-General of the Universal Health Coverage and Life Course Division Bruce Aylward, who is with us, and who from the very beginning has been a very strong supporter of this proposal.
Second, we need to be financed sustainably and predictably. Over the last 4 years, we saw an almost 3-fold increase in the resources managed by WHO/Europe, from US$ 365 million to US$ 991 – almost US$ 1 billion dollars.
This unprecedented increase demonstrates the demand on WHO in this Region for normative technical emergency response work and, of course, a strong backing of the European Programme of Work. I want to thank all of you, the countries, for helping us to increase and, more importantly, to diversify this funding base. By the way, this was my campaign commitment to you 4 years ago: to have a clean financial balance sheet.
There was a historical trend at WHO/Europe at the end of each biennium: we finished with debt and we had to ask for a loan. For the second consecutive biennium, we have a clean financial balance sheet and we don’t have to ask for a bailout. I could never have done this without your trust. I have always felt that you have my back, and I could never have done it without the incredible dedication of the WHO/Europe workforce. I’m very proud of them, and of my relationship with the Staff Association. In particular, I want to thank President Anita Stefin for our monthly free, frank and friendly talks.
Thank you in particular to Germany for the great financial support to WHO, and to the EU and the United States of America. We also tapped in some unprecedented sources, for example, Novo Nordisk, the Islamic Development Bank, and the Asia–Europe Foundation with Japan.
I have to say, Dr Mina Gaga, Alternate Minister of Health of Greece, a very big thank you to your Prime Minister, my good friend Mr Kyriakos Mitsotakis, who gives enormous support to our youth mental health programme and to quality of care, which is so important.
My request to you, dear delegates, is to please support Dr Tedros and all of us in the investment round in November next year.
Third, we need to be agile and country-focused. The large emergencies since 2020 presented an immediate, exponential change, impacting all business operations at WHO/Europe. The staff increased by 43%, mainly due to an increase of 87% in the country offices. Like my big brother Dr Tedros said, for the first time in history we have parity: 50% in Copenhagen, 50% in the country offices. This is the translation of the European Programme of Work, in which all of you put your trust when I became the Regional Director.
Despite the sudden expansion, we did maintain both gender and geographical distribution: 55% of our staff is female and we have 83 nationalities. No other major WHO office has this. My friends, I want to tell you that diversity at WHO/Europe is not an empty word.
One of my first initiatives was the implementation of a business process automation project, because I inherited a completely paper-based office. We’re almost there, evidenced by the fact that the WHO Regional Office for Africa is now adopting our systems.
We also saw that this was a period with an unprecedented number of attacks on our information technology infrastructure, which so far – touch wood – we have managed, closing 100% of cybersecurity vulnerabilities identified by the auditors. There was one business operation area which was quite new for WHO/Europe – procurement; it was quite low at US$ 55 million per biennium, but has now tripled to US$ 164 million.
We did maintain strong support, proper training and oversight to our country offices, which all of a sudden had to manage huge amounts of funding according to financial rules and regulations. Perhaps the thing I am most proud of is that the external audits of WHO/Europe in 2022 resulted in a report with zero high-risk recommendations, which is available for every one of you.
I could never have done this without my right hand for business operations, Mr David Allen, who was like a rock by my side during the many, many sleepless nights. Of course, we realized that this new context of business operations meant a lot of pressure on our staff, and that’s why in 2021 we started to implement annual staff health and well-being surveys.
Reports show signs of burnout among about 30% of staff, and 60% face unsustainably high workloads. I have taken this as a top priority. We have a dedicated unit reporting directly to me and my office with special support from the Coordinator for the Prevention of Sexual Abuse and Harassment for – and this is very important – zero tolerance, and from the ombudsperson, the staff physician and the staff counsellor.
All of this, dear delegates, dear friends, means that WHO/Europe is the fastest-growing major WHO office in the world. It also meant that our business model was completely outdated. That’s why, after consulting my governing board two times for every major decision, I consult the SCRC. Two times I consulted Dr Tedros, and 2 times I consulted the Assistant Director-General of Business Operations Mr Raul Thomas, and I want to thank Raul. After that, I decided in July to open a new WHO enabling hub in Türkiye, in Istanbul, which now permits us to fast-track the recruitment of 32 staff into business operations alone, and still save US$ 1 million.
I would like to thank my very good friend and brother, Minister of Health of Turkey Dr Fahrettin Koca, for always prioritizing WHO, and also His Excellency President Recep Erdoğan, who met with me and who is now personally overseeing the construction of a vibrant UN City in Istanbul.
Finally, we need to be science-driven. Remember my commitment to you in Tel Aviv last year, to commission an external review of how WHO/Europe is generating and disseminating evidence to inform policy and offer credible scientific advice to its Member States.
Here, I would like to say a very big thank you to Professor Martin McKee of the London School of Hygiene & Tropical Medicine, and to his colleague Una, who worked, very importantly, hand in hand with Dr Jeremy Farrar, Chief Scientist of WHO, to conduct this. There is a summary included in your background documents.
I want to assure you that I’m very committed to strengthening the scientific leadership of WHO/Europe, including its quality assurance mechanisms, its relevance, and its broad and timely dissemination of perhaps fewer documents, but of slightly higher quality.
Dear delegates, of course, I realize there is much more that we can do on governance, and we shall do more. WHO is a Member State-driven organization, and this shall never be forgotten. I commit to you as your Regional Director that we will diligently implement the recommendations of the review of governance under the guidance of the SCRC, and report back to you next year at the Regional Committee in Copenhagen.
Resilient health systems
The second pillar of a resilient WHO European Region is resilient health systems. I remember when we were in Tel Aviv last year, we were exhausted but we were hopeful. With the bulk of the COVID-19 pandemic behind us, we thought that our health systems would bounce back stronger from the crisis – but we did not. So, what happened? Three challenges.
The first: we are facing a tremendous health and care workforce crisis. Last year, I called it a ticking time bomb. Frankly speaking, it has become quite dramatic. This is part of a larger picture associated with demographic ageing, the increasing needs and expectations of a sicker population, and a shortage of the labour force across all sectors.
I remember during the July heat wave, Deputy Prime Minister of Malta Dr Chris Fearne and I had discussions on how we should prepare our health systems to withstand the extreme weather events due to climate change that come in the summer, a moment when health systems can usually breathe a little bit before the autumn. Again, they were under a lot of pressure and again, the health workforce could not rest. Dr Fearne and I called for a high-level discussion at the EU, at WHO and even at the United Nations General Assembly, not least for the small island states. Thank you very much, Malta, for this leadership.
The second big challenge is related to medicines, both an unprecedented shortage of very essential medicines and the rising cost of innovative medicines. Actually, this links very much with one of the biggest health threats in the world, which is antibiotic resistance (AMR). Yes, several antibiotics have been receiving regulatory approval, but, my friends, if you look at them, very few have really innovative characteristics.
Here, I would like to thank Sweden for their great leadership during the EU Presidency, particularly Minister for Social Affairs and Public Health Mr Jakob Forssmed and Minister for Healthcare Ms Acko Ankarberg Johansson, who put AMR very high on the agenda, and allowed us to broaden it to the pan-European context with a consultation in Stockholm on our roadmap on AMR, which I count on all of you to support on Wednesday.
The third challenge is that, as more and more ministers are telling me, it is becoming difficult to keep the same level of investment in health and health systems as we are just coming out of the COVID-19 pandemic.
What a paradox. We just lost 7 million people in the world, unnecessarily. What does it mean, concretely? It means that we are not doing well on universal health coverage. Catastrophic out-of-pocket payments have been on the rise since 2010, with between 2% and 40% of all households being pushed into poverty due to ill health.
We are lagging behind on many amenable health system indicators. Honestly, shamefully, and in contrast with other WHO regions, our maternal mortality increased 17% between 2016 and 2020. If people cannot afford to pay to go to the doctor or for their medicines, it is not only a practical problem – it’s an ethical problem, because people lose their trust in governments and they lose their trust in us, the health authorities.
Then again, there are many good examples. Recently, in beautiful Tbilisi, Georgia, I remember that you, Dr Tamar Gabunia, discussed with Dr Zurab Azarashvili how you managed our joint work on price regulation – reference pricing to decrease the price of oncology drugs by 45% – so now Georgia can procure double.
It’s the same for Belgium: Deputy Prime Minister Mr Frank Vandenbroucke made a budget available of €5.5 million for young people up to 24 years of age who have financial difficulty, so that they can go to the doctor and to specialists. These are the innovations.
So, the way to strengthen our health systems and make them resilient can be expressed in 2 words: trust and transformation. This will be the central tenet of the high-level meeting on 12–13 December in Tallinn, Estonia, where we all wait for you to go forward on resilient health systems.
The question is, how? There are three keys:
- The first is to transform and to create trust. People need to be the agents of transformation.
- The second is to digitize. Digital solutions need to be the modulator of transformation.
- The third, as discussed globally yesterday, is to make primary health care the anchor of resilient health systems linked with fit-for-purpose hospitals, and with leadership.
What does this mean? It means that you have to give the people more influence and power over their health and care, be it by making appointments themselves, by having access to their own medical file, or by having governments that recognize that health and care workers are the beating heart of the health system.
Here, I would like to applaud Professor Alexandru Rafila, my good friend and the Minister of Health of Romania, who organized and administered probably the most important meeting this year on the future of the health and care workforce in Bucharest – mulțumesc. Thank you so much.
The very powerful Bucharest Declaration focuses on three issues which were mentioned time and again: retention, particularly in the rural areas; working conditions; and mental health and well-being. Thank you so much, Professor Rafila, and also for being here and championing, on Wednesday, the health workforce resolution.
Again, we saw amazing innovations at that fantastic meeting. I remember my good friend, Minister of Health of Serbia Professor Danica Grujicic, explaining that she made family medicine a mandatory speciality. I remember my other good friend, Minister of Health of the Republic of Moldova Dr Ala Nemerenco, putting in so much effort to have financial allowances for young specialists in the rural areas, which has increased recruitment and retention there.
Regarding digital solutions – any digital solutions we implement should be safe and ethical, including artificial intelligence. This is very important, and I speak here as a previous clinical family doctor myself. Health-care workers have to be involved from the very beginning in the development of those solutions, because what you often see is that digital solutions increase their workload instead of decreasing it. And we cannot leave elderly people and people in rural areas behind.
The key duty for WHO in digital health is to safeguard equity. Here, I want to say a very, very big obrigado, thank you, to Minister of Health of Portugal Dr Manuel Pizzaro, who organized in September the second WHO Symposium on the Future of Health Systems in a Digital Era in the European Region. There was a lot of exchange and innovation.
I myself was there at the ministerial panel. I remember very well, for example, Minister of Health of Armenia Dr Anahit Avanesyan explaining how, in Armenia, the whole of primary health care is digitalized. One concept I had never heard before was intergenerational learning: digitally savvy children were educating the grandmothers and doctors in rural areas to give them confidence with technology. Amazing.
The third key to resilient health systems is primary health care. As we heard yesterday from 70 countries here, we have to cater increasingly to mental, physical and societal needs through multidisciplinary teams.
So, what we expect from resilient primary health care is that it caters for prevention – this is the handshake with public health -, for compassionate care, which robotics cannot give, including palliative care, rehabilitative care, for sexual and reproductive health services – where, frankly speaking, I am a bit concerned looking at the Region –, for quick and accurate diagnoses for effective treatment that does not push people into poverty, and finally, to be a guide to the patients on complex care pathways, for example, the person with cancer who is in shock, or the person with a rare disease who cannot find his or her way.
Yesterday, we celebrated the 45th anniversary of the Alma-Ata Declaration. Rahmet, thank you, Dr Azhar Giniyat, for your leadership and for having mobilized, as you see, the Head of State yesterday. President Tokayev himself was with us, putting primary health care as the top priority. This is the leadership that we need, and I felt very inspired, because I was here five years ago in Astana, and I felt that we did succeed in creating a global primary health-care movement rooted in strong ethical values and principles.
At the same time, like the President was saying, we should be businesslike and pragmatic, implementing very effective, tailored solutions. The example here I would like to give is from North Macedonia, which has done a lot of work to increase the package of noncommunicable diseases that general practitioners can prescribe for, and have the drugs for, in primary health care. Congratulations to Minister Fatmir Mexhiti.
Primary health care – yes, but as primary health care is transforming, hospitals must transform as well, and there has to be a strong link. Here, I would like to say çox sağ ol, thank you, to my good friend Dr Teymur Musayev, Minister of Health of Azerbaijan, who organized a very important meeting, I believe, for 20 countries, with 250 participants, on the future of hospitals.
There were some very pivotal conclusions, I remember, on the contribution of hospitals to the local economy, on how hospitals can empower rural care, on transformation and on climate change. Thank you so much, Dr Teymur Musayev, for your leadership. Ultimately, we are going to pull this off only if there is a strong link between political and public health leadership.
And that’s why, really, I would say un grand merci to France for working with us with the Bordeaux School of Public Health to prepare now for the second WHO European Public Health Leadership Course. Merci beaucoup. We started the Course with the Italian National Institute of Health – grazie mille – in Rome. It was the first course to educate public health professionals with the new skills and competencies to tackle both today’s and tomorrow’s challenges.
One of those skills is called global health diplomacy. Recently, our WHO Representation Office in Brussels organized the first WHO senior leadership dialogue on global health diplomacy. What does it mean? We have to be scientists, but also masters in what I call the very delicate choreography of political negotiations to know at which time to open which door to place health at the heart of the policy conversations.
Finally, because we have such a rich variety of countries in our Region, the subregional modus operandi remains very important. And here I would like to express my great appreciation to you, mon cher ami, Dr Jean-Claude Schmit, Chief Medical Officer of Luxembourg, and Minister Paulette Lenert, for having hosted the fantastic 9th High-level Meeting of the Small Countries Initiative in beautiful Luxembourg, which for the first time included ministers from Bhutan, Seychelles, Barbados, North Macedonia and the Republic of Moldova. Merci beaucoup, Jean-Claude.
Resilient people
The third, and maybe the most important, pillar of a resilient WHO European Region is resilient people. What do we need for this? First, peace. Second, equity. Third, social participation.
First, peace. Peace, my friends, is an absolute prerequisite for both mental and physical resilience. The United Nations Children’s Fund estimates that there are about 1.5 million children in Ukraine at high risk for depression, anxiety, post-traumatic stress disorder and other mental health events with potential lifelong implications.
Recent media reports estimate that there are now more than 20 000 amputees who need a prosthesis – a massive scale not seen since the Second World War. Reports of partners suggest that every single day – yesterday, today, tomorrow – there is one new spinal cord trauma injury. As of today, WHO has officially certified 1300 attacks on health care in Ukraine, 8 in Israel, 62 in Gaza.
My friends, what happened? I thought all of us were committed to health for all. I was raised as a medical doctor in a family of doctors and nurses to believe that a person in a white coat is untouchable. How can we kill our doctors and nurses? How can we bomb hospitals? There is no health without a health workforce. The health workforce is the gold of our health system and society.
There is no health without peace. There is no peace without health. The most important medicine that we need today is peace.
Second, equity. What is all of this, this permacrisis? My friends, what it means is that all these crises actually bleed into each other. They interconnect, they blur the artificial divisions we tend to make between noncommunicable diseases, communicable diseases, the environment and health, and the health crisis of one country versus the crisis of other countries.
The experience of the last 4 years makes it tragically simple to predict who will die first when the next crisis comes around the corner:
- the people with the least power and resources in society;
- the people with the lowest health reserves – the youngest, the oldest and, in some societies, the women; and
- the people with preexisting chronic conditions.
In Italy, among the COVID-19 patients who died in the hospital, two thirds had hypertension, one third had type 2 diabetes. In Spain, among the COVID-19 patients with the most severe clinical manifestations, more than 40% had cardiovascular disease.
Only when everyone in our beautiful Region, in every corner, has equitable access to the same level of knowledge and resources, will we be able to create a resilient society, bouncing back stronger from a crisis.
So, our goal should be to work with all other sectors to ensure that every individual citizen or migrant, independent of socioeconomic status, independent of sexual orientation, independent of ethnicity, has the same access to secure housing, nutritious food, education, affordable health care, and a social safety net, particularly during emergencies. This is where social participation goes hand in hand with the economy of well-being.
Third, social participation. What we need to do is put programmes and policies in place that nurture people’s participation, and that foster a culture of informed and active citizenship by empowering individuals and the communities in our Region, be it through health promotion, health education, health literacy, or behavioural and cultural insights. Only then will we create a resilient society.
I remember my dream when I came 4 years ago to all of the countries campaigning. My dream, I told you, was a Region with a culture of health where everyone is empowered to make healthy lifestyle decisions.
Let me give you a concrete example. We all know the many health benefits of regular physical activity. Regular physical activity improves cognitive development, motor skills, self-esteem, and social integration among children and adults, and prevents breast and colon cancer and diabetes.
That’s why in February, it was very important that I launched with the Secretary-General of the Organisation for Economic Co-operation and Development our joint flagship report, “Step up! Tackling the burden of insufficient physical activity in Europe”.
It’s amazing that we found that 1 out of 2 adults in our Region never, ever, engages in any form of physical activity. If all adults, and this study was in the 27 EU countries alone, would follow WHO recommendations, meaning 18 minutes a day of moderate physical activity such as walking or, as they do in Denmark, biking, we could save more than 10 000 premature deaths a year and €8 billion or 0.6% of the health-care expenditure.
For this, we need leadership. Here, I want to commend Dr Azhar Giniyat for always showing the way on physical activity, and my brother, Dr Tedros, who was there as well at the Walk the Talk Health for All Challenge, with the students too, encouraging all the students to be physically active.
We need leadership, and at the same time we need a bottom-up approach. We need to see the youth as equal partners in health and well-being decision-making. That’s why I was so proud on 25 September in our television studio in Copenhagen, where we launched formally for the first time the Youth for Health Network. If we engage with them – it’s a tremendous thought. We have never had, by the way, in history, such a large generation of young people in the whole world.
I want to give a concrete example from Slovenia, from the youth-led nongovernmental organization No Excuse Slovenia. The youth went to the schools with a peer-to-peer approach, talking with the pupils and making them active advocates for stricter tobacco control policy, and for this they received the WHO World No Tobacco Day Award in 2019. Congratulations, Slovenia.
Dear friends, I am finishing with the summary. Many of you have asked us to work towards a resilient Region. For this, we need to work together on three pillars:
- We need to work together on resilient governance, which means governance that is participatory, this is aligned with global processes and that ultimately creates a resilient WHO.
- We need to work together on resilient health systems with 2 words in mind – trust and transformation – and with the people as the agents, with digital solutions as the modulators, and with primary health care at the core, connected with fit-for-purpose hospitals and strong public health and political leadership.
- Finally, we need to work together towards resilient people. What we need here, first and foremost, is peace, peace and peace – to protect the civilians and the health-care workers in wars, and to ensure that everyone in a white coat is untouchable. We can do it. It’s the history of our Region.
That’s why I would like to finish with a beautiful proverb in the Kazakh national language, from the famous Kazakh poet Abai: Абыройлы адам адамзат үшін жұмыс істейді. Or, in Russian, Достойный трудится для человечества. A person with dignity works for humanity.
Source : WHO