Statement by Dr Hans Henri P. Kluge, WHO Regional Director for Europe, opening the Tallinn Charter 15th Anniversary Health Systems Conference
12 December 2023
Ms Karis, Minister Sikkut, honourable ministers, colleagues and friends,
What a great pleasure it is to open this meeting with you today.
It is a common perception that the world today is less safe, more unequal, more partisan and driven by unaccountable business interests than in the past. Growing dissatisfaction with the traditional political systems and with institutions, magnified by disinformation is a threat to the very fabric of our societies.
This is why we have designed this conference in a new way: engaging the health and care workforce, policy-makers and patients in producing the evidence base, as well as participating here today.
– Patients such as Mira Dzhutankeeva, a 67-year-old woman living with diabetes, from Alamedin District in Kyrgyzstan, interviewed for one of the case studies we have developed. We’ll be diving into these case studies in more detail this afternoon, and I encourage you to watch all 3 accompanying videos.
Mira said, “The most important thing – visit the doctor and take care of your health. I tell this to everyone”.
It’s a sentiment that I think sums up what many people – particularly older generations – feel when they think about their health and health systems.
But her simple statement assumes several things:
- you have access to a doctor;
- you can get the medicines and treatment you need;
- you trust the health system;
- you partner with it to make informed decisions about your health;
- you live in a place that nurtures health.
As we know, the reality today is that our health systems and our societies cannot guarantee these conditions.
And with the long shadow cast by COVID-19, the climate crisis and conflict, the context under which health systems operate is ever-more complex.
Generating more resources for health, delivering more services, and doing so more efficiently is the conundrum that keeps many of us awake at night.
When I introduced the European Programme of Work in 2020, its starting point was to respond to citizens’ legitimate expectations towards their health authorities.
The central premise of us coming together here in Tallinn takes this further, seeking to strengthen trust, to transform our health systems, building on the values of solidarity, equity and participation enshrined in the Tallinn Charter that all Member States agreed to 15 years ago.
So, in the next few minutes, let me look across the WHO European Region to see where we stand now regarding what Mira calls “the most important thing”, and what we need to do better: it’s a health systems check-up and prescription, if you will.
Firstly, do people have access to a doctor? And the answer is – it depends where you live, and your status. By 2030, critical workforce shortages are expected to lead to a global gap of 10 million health and care workers. I have spoken at length about this “ticking time bomb”. Although the European Region has the highest levels of health-care workers in the world, this coverage is uneven, and we lack health-care professionals in rural and underserved areas.
With many thanks to all Member States for their endorsem*nt, we now have a framework for action on the health and care workforce. It outlines what we must do urgently, to not only increase the number of nurses, doctors and other health professionals, but also protect them and ensure they have the skills to meet future needs.
Second, are people able to get medicines and treatment when needed? Today, we are launching a new report produced by the WHO Barcelona Office for Health Systems Financing that gathers evidence on financial protection from 40 countries across the European Region. The simple answer is “no”, far too many people today cannot afford to pay for health care.
A median of 6% of households experience catastrophic health spending – mostly paying for medicines – so they can no longer afford other necessities such as food or housing. This rises to 20% among the poorest fifth of the population. And financial protection has worsened over time in over two thirds of the countries analysed.
Dear friends, this is not the message I want to be sharing today – Universal Health Coverage Day. But progress is possible, and the report provides a checklist of good practices – such as making sure primary health care covers treatment as well as consultations and diagnosis. On this, let me congratulate Estonia for your efforts to reduce co-payments for outpatient medicines, and introducing a digital solution to remove administrative barriers.
Third, do people trust their health system, and health professionals? As part of the evidence base for this conference, the European Observatory on Health Systems and Policies has produced a series of 5 policy briefs. One of these looks at trust; trust matters.
It’s a complex concept to navigate, and we don’t have a full picture of trust and health systems. But a survey by Wellcome Global Monitor in 2020, for example, revealed that the percentage of people who answered “a lot” to the question “How much do you trust doctors and nurses in this country?” ranged from 14% to 77% in the 40 countries in the Region canvassed.
And we know that a lack of trust is linked with insecure living. Trust in other people is 40% lower among those living on a low income, compared with those on a high income.
To bolster trust among patients, taking action on pervasive practices that undermine trust – such as informal payments for health care – is crucial. We need to value trust, and nurture it.
A good way of doing so is to go beyond formal consultations, and instead use citizens’ assemblies, when developing policy. These bring a range of views together, engaging in open, informed discussions over a period of time, building greater buy-in among those who are affected by the decisions made.
Fourth, do health systems work in partnership with patients? Transforming our health systems is necessary, not only to improve health service delivery while containing costs, but also to realize the full potential of people to be health co-creators.
Primary health care [PHC] is the nearest we have to a panacea – emphasizing prevention, reducing the need for more expensive and intensive treatments, centring health-care provision firmly in the community, responding directly to misinformation, and allowing people to build relationships with multidisciplinary health teams.
Kazakhstan, long a PHC pioneer, has made the move to using multidisciplinary teams to deliver community-based services. Family doctors have furthered their non-clinical competencies in areas such as communicating with patients, and the autonomy of nurses in these teams has expanded to cover preventive work at individual and community levels, including counselling patients with noncommunicable diseases [NCDs]. Social workers and psychologists have also been incorporated, to identify the needs of groups in the community who live in vulnerable situations. This has driven PHC activities closer to the root causes of illness and helped to tackle the psychosocial aspects of health problems.
We need to use a PHC lens in every health system decision we make. And we must make it the anchor of resilient health systems, linked to fit-for-purpose hospitals, and effective leadership.
It is also where incorporating digital health solutions can be felt most directly – tackling NCD risk factors, offering long-distance services, delivering responsive mental health care, and just around the corner, implementing AI-enhanced personalized care.
The pandemic facilitated a turn towards digitalization in Greece, and the full implementation of a paperless electronic prescription system that does not require the patient’s physical presence. It enabled primary care services to respond effectively in extremely challenging circ*mstances, and eliminate barriers to access for chronic or acute conditions, as well as reduce the prescription processing burden for medical staff.
The opportunities of AI bring us back to the issue that transforming our health systems is dependent on trust. People, patients and health professionals must be absolutely certain that their data is safe and secure, and that the system is working in their best interests.
Which leads me to the fifth and final question on our health systems check-up – what are we doing to ensure that other sectors and society are nurturing health?
Evidence shows that widening health and economic inequities have fatal consequences: Member States that spend the least on health systems and human development had higher mortality rates – amounting to an estimated 600 000 preventable deaths across the Region – during the pandemic.
Since the Pan-European Commission on Health and Sustainable Development shared its conclusions over 2 years ago, we have intensified our efforts to promote the well-being economy.
I have been advocating to use the health and care sector – which accounts for 10% of total employment in the Region – as a lever for equitable, participatory and green development. A key strand of the Budapest Declaration on Environment and Health is for the health sector to set an environmental example and cut carbon emissions, reduce pollution and strengthen climate resilience.
Bringing the health, finance and economic sectors together around investing in healthy, prosperous, resilient societies for all is a recipe for better health, stronger social cohesion, inclusive economic growth, greater stability and peace.
So where do we stand now?
Dear colleagues, we stand at a crossroads. In 2024, 4 billion people across the globe will be going to the polls. The European Region will see 9 parliamentary elections, and 5 possible presidential elections next year.
We must demonstrate that health systems are working for both the people who use the services, and the professionals who deliver them.
We also need to leverage digital solutions to transform health and health innovation, including non-digital approaches, in order to enhance the efficiency, accessibility and quality of health-care delivery. For this, we are developing a Regional strategy for innovation, that seeks to advance and scale up health innovations and emerging technologies that have a sustainable and long-lasting impact on health systems.
Where we once could rely on Mira’s viewpoint as the norm, this is no longer a given.
I am committed to ensuring broad participation as we look ahead. One of the sessions on the agenda tomorrow, for example, is how to engage civil society and youth to promote trust and health system transformation.
Let us use the next 2 days to fully explore, understand and map out how we can move the implementation of the Tallinn Charter forward over the next 5 years, laying the foundation for a new vision for the health systems that will serve our children and grandchildren.
I would like to express my deepest thanks to you Ms Karis, and you Minister Sikkut, as well as to Estonia for your long-lasting commitment to strengthening health systems across the Region.
As they say in Estonia, “Tasa sõuad, kaugele jõuad” – steady row, far you’ll go.
