Transcript Health, public health and the EU integration process

Health Challenges in an Enlarged Europe
Investing in population health
Opening Address
Chair: Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
WELCOME to the 6th EHF
FORUM A 1:
HEALTH CHALLENGES IN AN
ENLARGED EUROPE
Investing in population health
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
CONTENT
1. About the FORUM in general
2. Parallel Forum A1: Health challenges in an
Enlarged Europe Investing in
population health
3. Example of an accession country: HUNGARY
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
1. About the FORUM
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Central theme in Communication on the health strategy of
16/5/2000: openness and transparency
 European Health Forum (EHF) set up by Commission as an
important element of Health Strategy
 EHF: information and consultation mechanism to reach the
aims of the strategy and to communicate it to the public
in response to their needs
 EHF: ensures involvement of all stakeholders in policy
development and implementation as well as priority
setting for action
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Scope and purpose of EHF
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The Forum is an important instrument to increase
transparency and openness, help inform partners
about health policy at Community level and give them
a key input into the development of new initiatives.
 Commission is committed to maximising the impact
and effectiveness of the Forum. The Forum is
involved at an early stage of the policy process.
 It intends to report back and to give an opportunity to
revisit issues as appropriate.
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Organisation of the EHF
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Health Policy Forum defined membership by
invitation. It discusses key policy areas
 Open Forum focuses on one or two main topics for
discussion and all interested parties could attend;
 Virtual Forum uses information technology to
enable the exchange of information and to foster
discussions among the public health community
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
2. Present Parallel Forum A1 explores
 Instruments
for and best practice of investing
in health across Europe
 The enlarged health care market in an
enlarged Europe
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
FORUM on Investing in population health
„Generate healthy population” an economic, political
and welfare factor
 Countries have different approaches to address health
issues
 To place health high on the political agenda as part of
the overall development plan → key to success
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Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Expectations of European citizens
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Long, wealthy and healthy life
Health considered as value and investment
To be protected against illness/disease
To bring up children in healthy environment
Safe and hygienic workplace
Well informed choice on lifestyle
Access to high quality health service
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Governments’ response and rationale to healthy
population I.
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Economic factor
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Loss in GDP by disease and disability
Healthy workforce
Public health factor
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Good health indicators show good quality of life
in a country
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Governments’ response and rationale to healthy
population II.
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Comprehensive national public health
programme (Hungary, Latvia)
 National health promotion programme (Austria)
 National health policy in line with H21
(Kyrgyzstan)
 Screening programmes
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Governments’ response and rationale to healthy
population III.
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Health determinants approach
 NEHAP (nearly all European countries
 Settings approach
 Life cycle approach
 Any combinations of above
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Governments’ response and rationale to healthy
population IV.
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Modernisation of health care and financial system
(high on agenda)
 Challenges to be met:
 Extended life expectancy, growing elderly
population,
 Growing demand of patients, new, expensive
technology, cost containment measures
 EU integration (workforce, patient mobility)
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Commission’s response
to protect the health of the EU citizens
„add value”
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Communication on the Health Strategy of the EU
(May 2000)
 Proposal for public health programme
 Community Health Strategy (3 principles)
 Integration of health related work /Commission
 Sustainability of results
 Concentration of resources
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Vision of Commissioner
for „Europe of Health”
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EU public health framework (new MSs enrich European
scene)
Strengthen work on addressing health threats (European
Centre for Disease Prevention and Control)
Cross border cooperation of health systems and tackling
health determinants
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
High level reflection process
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Patients mobility (border regions)
 High quality services, with cost containment
 Quality of health services
 Input from accession countries (meetings in autumn),
new input EU health policy
ACQUIS
 Emphasis on primary prevention in the new MSs
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Minimum prerequisites of success in investment
in health
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Political commitment
Equity and solidarity as key principles
Intersectoral approach
Involvement of key stakeholders incl. industry
Public health programme/intervention
Public health infrastructure/personnel
Involvement of population
Communication strategy
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Health indicators
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Health indicators show a steady increase in health
status and life expectancy within EU Member
States
 Substantial differences are seen within and
between countries particularly if accession
countries are taken into account
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
3. Example of an accession counrty: HUNGARY
Public health, public health infrastructure and capacity
building
key to success
WHY?
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macro-economic rationale
public health rationale
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inequalities among the countries of Europe
inequalities within the countries
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Macroeconomics and health
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poor health status of the Hungarian population
4%
loss in GDP
health
an investment of high return
increased
competitiveness of the economy
financial implications
deficit in national budget
aggravated by the deficit of the health insurance
fund (significant share of public financing )
developing human and social capital
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Public health – epidemiological situation
in Hungary:
life expectancy at birth
 men 8 years
lower than the EU average
 women 6 years
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Epidemiological situation
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Good news
improving trend of
life expectancy at birth since 1996
infant mortality decline (10 yrs)
external causes of death,
suicide (4th place in Europe)
stomach cancer
HIV/AIDS low
syphilis, mumps, whooping
cough low
communicable discases 0.09
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Bad news
premature death highest in
accession countries
• high middle age mortality
cvd 3 times higher than EU average
cancer (51. place)
- lung (highest in Europe)
- breast
diseases of digestive system highest
in accession countries
smoking – highest in accession
countries
alcohol – 9,5l capita
environmental factors
• air, water
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
060101 +Life expectancy at birth, in years
80
75
Czech Republic
Estonia
Hungary
Latvia
Lithuania
Malta
Poland
Slovakia
Slovenia
EU average
CSEC average
70
65
1970
1980
1990
2000
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
2010
Source: HFA, 2003 June
Life expectancy at birth
Females
83
78
78
Year
Hungary
EU
98
20
00
96
94
92
90
88
86
84
82
80
70
98
20
00
96
94
92
90
88
86
84
82
80
78
58
76
58
74
63
72
63
78
68
76
68
73
74
73
72
Life expectancy (years)
83
70
Life expectancy (years)
Males
Year
Zsuzsanna Jakab
Source:
Secretary of State
Ministry of Health, Social and Family Affairs
HFA DB, WHO/EURO
Health Challenges in an Enlarged Europe
Investing in population health
Facing the challenge: Government Programme
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health as a priority
overall governmental responsibility for health issues
(„a government for health and shift towards a welfare
society”)
 a programme overarching government cycles,
integrating some previous initiatives and early start
„Decade of Health”
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
„Decade of Health” Programme
Integral part of the Hungarian Government Programme
Comprising 3 interdependent sub-programmes
 a National Public Health Programme named “Béla
Johan”
 a programme for consolidating and modernising the
health care system
 a programme for the reform of financing
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
„Decade of Health” – timing
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Public Health Programme: approved by Parliament on 7 April 2003
Full implementation in progress
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Consolidation, modernisation, financing:
 Concept scheduled to be discussed by Government in June
 Already in progress:
- Act on health institutions: adopted by Parliament
- additional resources for health services
- different forms of operation
- Act on the legal status of medical professionals:
presented to Parliament
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
„Béla Johan” Public Health Programme
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Main aim: to extend life expectancy by 3 years
in a decade (reduce the gap by half)
 The Programme is in line with the EU Public
Health Framework Programme + Health 21
 Best practices of EU countries in many technical
areas are being examined and adapted
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Public Health Priorities
7 priorities indicated by the Resolution of Parliament
 promote the health of children and youth
 improve the health of the elderly
 reduce cardiovascular morbidity and mortality
 prevent cancer, develop screening programme
 improve mental health
 improve environmental health
 prevent and reduce musculoskeletal disorders
(UN decade)
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
4 strategies of the Public Health Programme
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create supportive social environment for health
 develop healthy lifestyles, reduce risk factors
 reduce avoidable mortality, morbidity, injury
 develop health services and public health
institutions for improving the health of the
population
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Harmonisation with EU norms and standards
Adoption / implementation of high EU public health
standards and norms
favourable impact on the
health status of the Hungarian population
More than 200 pieces of legislation built into the Hungarian
legal system
a public health reform in itself
Main areas covered: medicinal products, medical devices, cosmetics, food
hygiene, chemicals, environmental health (air quality, drinking water,
bathing water, radiological hygiene, chemical safety), health at work,
epidemiology, tobacco control, etc
Underway: new tobacco legislation, blood and blood
products, preparing community legislation on cells and
tissues
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Expected long-term impacts of the transposition and
implementation of the acquis
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reduce disease burden by appr. 25%
improve primary prevention
 increase life expectancy at birth (by 3 years)
Examples: - food safety
- drinking water quality
- protection against carcinogenic agents at the
workplace and in homes ( housing )
- limitation of biological and chemical hazards
- protection from noise and vibrations
- environmental protection
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Public Health institutional development
Parallel to harmonisation, institutional system strengthened
Pre-accession funds well invested: major investment in the
Hungarian National Public Health and Medical Officers’ Service –
laboratories, information system, training programmes
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Main areas:
public health laboratories
chemical safety
epidemiology and communicable diseases
information system
microbiological laboratories
They serve early detection, modern diagnosis, prevention and treatment
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
The EU and the Hungarian Public Health
In fact two synergetic processes:
 Acquis, harmonisation – changing public health standards and
practices
 The „Decade of Health Bela Johan Public Health Programme”
in close inter-relation with the Community Action Programme
on Public Health
Impact:
→ improving life expectancy (by 6 years during 2 Gov. cycles)
→ better quality of services
→ consolidation and modernisation of the health system
→ contributing to its sustainable funding
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Review of Hungarian public health system:
inadequate to serve the public health
programme
(80 % CD-oriented whereas
80 % of public health problems NCD –
oriented)
Full reorganization starts
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Establishment of the School of
Public Health in Debrecen,
1996-present
to promote public health capacity – building
Major step forward
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs
Health Challenges in an Enlarged Europe
Investing in population health
Strategies investing population health
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Swedish approach: a comprehensive public health
strategy
Implementation of public health strategy in Estonia
Tackling health inequalities in UK
Health promotion at workplace: a European approach
(GER)
The role of patients in public health and health
services
Zsuzsanna Jakab
Secretary of State
Ministry of Health, Social and Family Affairs