3rd Medical Faculty - Department of Preventive Medicine

1. 3rd Medical Faculty -Department of Preventive Medicine WHO Programs and Strategies of Public Health Alena Šteflová, M.D.,Ph.D. 2009/2010

2. WHO/ specialised UN agency WHO established in 1948 - 7 April ( World health Day) – after ratication of 23 countries Target: to promote technical cooperation for health among nations, to carry out programmes to control and eradicate disease, and to improve the quality of life.

3. World Health Organization "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" Definition of Health Preambule of Constitution Specializovaná agentura OSN „Its objective is the attainment by all people of the highest possible level of health“ Constitution, 1948

4. Structure of WHO • Headquarter (HQ): Geneve, general director Dr. Margaret Chan • ( previous GD LeeJong-wook died 2006) • WHA – World Health Assembly / the governing body of the organization/ meeets annually / in 200962nd WHA in Geneva • Executive Board consists from 32 experts, elected for 3years –preparatory of strategies and resolutions • WHO includs194 member states, divided into 6 geographical regions • AFRO Brazzaville/Congo - Africa • EMR Cairo/Egypt – Middle-East • AMR Washington/USA – South and North America • SEAR New Delhi/India – South-East Asia • WPR Manila/Philippines – West Pacific

5. Structure of WHO European region • EURO Copenhagen/Denmark – Europe • RD Zsuzsana Jakab since 1st Feb 2010 ( former Marc Danzon) • Over 870mil inhabitens ( including all countries of former Soviet Union) • Diversities within the region: industrial societies, agriculture, new democracies in East and Central Europe • Regional Committee – once per year ( Standing Committee) • Related strategies for the regions are adopted by member states • Country offices of WHO (Liaison Office) in 142 member states • for the Czech Republic / Prague • Participation of the Czech Republic since 1948 (figures separatly since 1993)

6. The main tasks of the WHO • Coordination and solution of the main acute health problems with the impact on global health • Preparedness of potential global pandemy ( SARS, Avian Influenza, Swine Influenza); the struggle with HIV/AIDS, Malaria, TB • Humanitarien help and crises management (disasters, political conflicts) • Health policy- support to member states/assistance, consultancy • Monitoring, assessment, HFA Database • reports, campaigns, printing documents, etc.

7. Transnational strategies of Health Policy European Union – does not have united strategy of health policy/health care mandatory implemented by member states • Harmonization of legislation, support of preventive programs and health promotion policy: Communitarian Program 2007-2013, 7th framework program – medical research WHO – creates frame for health policy as well as partial technical recommendations, guidelines, strategies in three main areas: • Lifestyl conductive to health • A healthy environment • Appropriate services for prevention, treatment and care;

8. The Health for All Policy Framework for the WHO European Region The basic conceptional programmes for implementation in respective countries accordingly to their conditions and priorities: Health for All to 2000 Health 21 – adopted at the 51st WHA , May 1998; supposed to be implemented through relevant regional ant national policies

9. Health 21 – the Health for All Policy Framework for the WHO European Region • The one constant goal is to achieve full health potential for all • Two main aimes for better health towards this goal – promoting and protecting people’s health throughout the course of their lives • - reducing the incidents of the main diseases and injuries • Three basic values form the ethical foundation • - health as a fundamental human right • - equity and solidarity in health • - participation of individuals, groups and communities

10. Health 21 - Four Main Strategies for Action • Multisectorial strategies to tackle the determinants • Health outcome driven programs and investments for health • Integrated family and community oriented primary health care, supported by a flexible and responsive hospital system • Involvement of relevant partners for health at all levels – home, school and worksite, local community and country that promotes joint decision making and implementation of action

11. Solidarity and Equity in Health • Closing the health gap between countries • Target 1- Solidarity for health in the European region • Target 2 - Equity in health

12. Better Health for People • Strengthening health throughout life • Target 3 - Healthy start in life • Target 4 - Health of young people • Target 5 - Healthy ageing • Target 6 - Improving mental health • Target 7 - Reducing communicable diseases • Target 8 - Reducing non-communicable diseases (CVD, cancers, DM, chronic respiratory and musculoskeletal disorders, teeth caries) • Target 9 - Reducing injury from violence and accidents

13. A Multisectoral Strategy for Sustainable Health • To create sustainable health through more health-promoting physical, economic, social and cultural environments for people • Target 10 - A healthy and safe physical environment • Target 11 - Healthier living • Target 12 - Reducing harm from alcohol, drugs and tobacco • Target 13 - Settings for health (at home, school, workplace and in the local community) • Target 14 - Multisectorial responsibility for health

14. Changing the Focus: an Outcome-Oriented Health Sector • To orient the health sector towards ensuring better health gain, equity and cost-effectiveness • Target 15 - An integrated health sector • Target 16 – Managing for quality of care • Target 17 – Funding health services and allocating resources • Target 18 - Developing human resources for health

15. Managing Change for Health • To create a broad societal movement for health through innovative partnerships, unifying policies, and management practices tailored to the new realities • Target 19 - Research and knowledge for health • Target 20 - Mobilizing partners for health • Target 21 - Policies and strategies for health for all

16. National Health Programs of the Czech Republic • HFA • The National Program of Health Restoration and Promotion in the Czech Republic – approved by the government in April 1992 • National program of health – long term strategy – approved by the government in 1995 • (successful community projects Healthy Cities, Health Promoting Schools, Healthy Workplaces, Regions for Health); state budget for the implementation of the national health program • H21 • The Czech version - A long-term Program for Improving the Health of the Czech Republic – Health for All in the 21st Century • Approved bythe Government of the CZH in 2002 –Resolution 1046

17. The global perspective

18. Communicable disease Non/ communicable diseases injuries 2001 75% 50% 25% Zdroj: WHR 2002 AFR AMR EMR EUR SEAR WPR

19. Major causes of death among children under five years Pneumonia 20% Other 29% Worldwide, about 10 million children died per year Deaths associated with undernutrition 54% Diarrhoea 12% Malaria 8% Perinatal Measles HIV/AIDS 22% 5% 4% Sources: For cause-specific mortality: EIP/WHO. For undernutrition: Pelletier DL et al. American Journal of Public Health 1993, 83:1130–1133

20. WHO global priorities EPIDEMY OF COMMUNICABLE DISEASES • HIV/AIDS • MALARIA • TB • Preparedness on potential global pandemy (SARS,ic influenza EPIDEMY NON – COMMUNICABLE DISEASES • TABACCO • ALCOHOL, DRUGS • NUTRITION • INJURIES

21. The WHO European RegionChild and adolescent health– emerging issues • HIV/AIDS • Obesity • Mental health • Injuries

22. HIV infections newly diagnosed in children, 1997–2002 – Europe 5000 Eastern Europe 4500 4000 3500 3000 Cases 2500 2000 1500 Western Europe 1000 Central Europe 500 0 1997 1998 1999 2000 2001 2002 Year of report Source: EuroHIV

23. Prevalence of overweight childrenin 31 countries grouped by region 25 North America North America (South) Western Europe (South) Western Europe United Kingdom United Kingdom 20 (Southwest) Eastern Europe (Southwest) Eastern Europe Scandinavia Scandinavia (Central) Western Europe (Central) Western Europe Overweight Prevalence (%) Overweight Prevalence (%) 15 (Northwest) Eastern Europe (Northwest) Eastern Europe 10 5 0 Italy Malta Spain Latvia Wales France Poland Croatia Canada Finland Estonia Ukraine Greece Austria Norway England Hungary Sweden Portugal Slovenia Scotland Denmark Lithuania Germany Switzerland Netherlands United States Czech Republic Belgium (French) Belgium (Flemish) Russian Federation The former Yugoslav Republic of Macedonia Source: HBSC

24. Increasing prevalence of overweight children in Europe 30 25 20 Prevalence % 15 10 5 0 1970 1980 1990 2000 2010 IOTF estimates.

25. Youth and depression Four percent of 12–17 years old and nine percent of 19 years old suffer from depression, making it one of the most prevalent disorders with wide-ranging consequences.

26. Youth and depression Depression is associated with youth suicide and is the third leading cause of death in young people. Source: World Health Report 2001

27. Road Traffic Injuries: a huge global public health problem • 1.2 million die a year • Up to 50 million are injured or disabled • 11th leading cause of death • 3rd cause of death and disability in 2020 • account for 2.1% of all deaths globally

28. RTIs: a huge European public health problem • 127,000 die a year • 2.4 million more are injured or disabled • One out of three deaths involve young people under 29 (about 43 800). • Of these, nearly 80% are males (about 33 600) • Over 2 million crashes happen every year • 65% crashes occur in towns (over 1.3 million) • One out of three deaths involves a pedestrian or a cyclist • Costs (in the EU15):about 180 € billion/year (equivalent to 2.0 % GDP)

29. Childhood (0-14) injury mortality is unequally distributed across Europe: highest and lowest in the world (2002) People in low-middle income countries are at 4 times the risk of dying from injuries than people in high income countries (HIC). Many cost-effective strategies exist as in HIC, which are among the safest in the world. Source: WHO, Health for All database, June2004

30. Global/regional strategies • Frame Convention of Tobacco Control (FCTC) • European Action Plan against Alcohol • Strategy of Environment and Health of Children / Budapest Conference • Declaration of mental health, Action plan / Helsinky 2005 • Global strategy of healthy nutrition, physical activities and health - Ministerial Conference in Istanbul – 2006 European Charter on Counteracting Obesity • Ministerial Conference on Health Systems in Tallin 2008

32. ZDRAVOTNÍ SYSTÉMY ZDRAVOTNÍ VÝKONY DOPAD NA EKONOMIKU VLIV NA EKONOMIKU ZDRAVÍ VLIV NA ZDRAVÍ BLAHOBYT LOGO KONFERENCE

33. COMMISSION ON SOCIAL DETERMINANTS OF HEALTH Sir Michael Marmot Chair of the Commission on Social Determinants of Health Professor of Epidemiology and Public Health, Royal Free and University College Medical School, London

34. What are the social determinants of health? "The poor health of the poor, the social gradient in health within countries, and the marked health inequities between countries are caused by the unequal distribution of power, income, goods, and services, globally and nationally, the consequent unfairness in the immediate, visible circumstances of peoples lives – their access to health care, schools, and education, their conditions of work and leisure, their homes, communities, towns, or cities – and their chances of leading a flourishing life. This unequal distribution of health-damaging experiences is not in any sense a ‘natural’ phenomenon….Together, the structural determinants and conditions of daily life constitute the social determinants of health."

35. Why treat people… then send them back to the conditions that made them sick?

36. Life expectancy at birth (men) (WHO World Health Report 2006; Hanlon,P.,Walsh,D. & Whyte,B.,2006)

37. Inequalities: Between Countries Life expectancy at birth (men and women): selected countries Glasgow Lenzie 82 (men) Japan Hong Kong Iceland Switzerland Australia China Brazil Russia Federation India Glasgow Calton 54 (men) Mozambique Sierra Leone Angola Zimbabwe Zambia National LE data HDP 2007/2008, Glasgow data: Hanlon et a l. 2006

38. Preston Curve in 2000 (Deaton, 2004)

39. Trends in life expectancy (Human Development Report, 2005)

40. Under 5 mortality (per 1000 live births) by wealth group (Houweling et al, 2007)

41. Mortality over 25 years according to level in the occupational hierarchy: Whitehall (Marmot & Shipley, BMJ, 1996)

42. Life expectancy of Indigenous Peoples (Bramley et al, 2005)

43. Infant mortality in Brazil by race and mother's education, 1990 (Pinto da Cunha, 1997)

44. Povertyis an issue throughout the Region Percent of children living below national poverty lines Source: UNICEF Innocenti Research Centre, Child poverty in rich countries

45. The widening trend in mortality by education in Russia,1989-2001 (probability of living to 65 yrs when aged 20 yrs) (Murphy et al, 2005)

46. What are the social determinants of health?

47. Why emphasize social determinants? • Social determinants of health have a direct impact on health • Social determinants predict the greatest proportion of health status variance (health inequity) • Social determinants of health structure health behaviours • Social determinants of health interact with each other to produce health

48. Social justice Empowerment as a means – material, psychosocial, political Creating the conditions for people to take control of their lives www.who.int/social_determinants

49. 28 August 2008

50. World Health Assembly ResolutionMay 2009 All member states: Tackle health inequities through action on the social determinants of health Impact of polices and programmes on health inequities; Health equity in global development goals