Protection and promotion of public health. The publication was prepared on the basis of analytical information on the problems of the WHO global strategy to achieve health for all in the 21st century (Venediktov D.D., Ivanova A.E., Maksimov B.P.) Promoting the concept of health
The health care reforms showed a certain historical logic, and their most important stages were 1918, 1948, 1978 and 2000.
1918
Proclamation in Soviet Russia (1918) of the right of the people to protect health and the responsibility of the state for its provision, the unification of "the entire medical and sanitary business" in the hands of the People's Commissariat of Health (the world's first ministry of health), the use of all political force to solve medical and social problems states, development of new principles of healthcare organization.
1948
Nationalization of medical institutions and the creation of a national (public) health service in the UK, the creation of the UN Economic and Social Council (ECOSOC), the World Health Organization (WHO) and the Children's Fund (UNICEF).
1978
In 1973, the World Health Organization expressed the idea of "primary health care", which was understood as "the zone of first contact between a person (family, community) and national health systems", as their "integral part", "the main function and "central link". The concept was discussed at the International Conference of WHO and UNICEF in Alma-Ata (September 6-12, 1978) with the participation of delegations from 134 countries and representatives of 67 international organizations. As a result, the Alma-Ata Declaration and 22 recommendations were adopted. The Declaration proclaimed that the most important task of governments, international organizations and the entire world community is "the achievement by all the peoples of the world by the year 2000 of a level of health that will enable them to lead socially and economically productive lives." And the main tool for this is the development of national health systems, the main function of which is primary health care. These provisions have been elaborated in the recommendations.
The conclusions and decisions of the Alma-Ata Conference were confirmed by the World Health Assembly, and then by the UN General Assembly in 1979, as well as in other international and interstate decisions and declarations.
year 2000
The world community puts forward new tasks:
. sustainable development of society in harmony with nature,
. formation of a humanistic paradigm,
. protect and ensure the rights of man and peoples throughout the world,
. achievements in the 21st century "Health for All".
WHO has formulated 10 main goals (global tasks) within the framework of the Health for All in the 21st Century program:
1. Strengthening equity in health.
2. Improving opportunities for survival and improving the quality of life.
3. Reversing global trends in the five major pandemics (communicable diseases, non-communicable diseases, injuries and violence, alcohol and drug abuse, tobacco smoking).
4. Complete or partial eradication of certain diseases (poliomyelitis, etc.).
5. Improve access to water, sanitation, food and housing.
6. Promote healthy and counteract unhealthy lifestyles.
7. Improved access to comprehensive, quality health care.
8. Support for health research.
9. Introduction of global and national systems of medical information and epidemiological surveillance.10. Development, implementation and monitoring of Health for All policies in countries.
The idea and strategy "Health for All" reaffirms the inalienable human right to health, the responsibility of the individual and the whole society for the real provision of this right, the systematic development of health care on a national and departmental level, the development of cooperation in the formation of a global health system, as well as monitoring progress towards this ambitious goal.
This became possible thanks to the pioneering experience of the USSR and other socialist countries. Many provisions are repeated from our foundations of health organization.
A global health-for-all policy for the twenty-first century must be implemented through appropriate regional and national strategies. For our country, gravitating towards the European Region, it is the European experience in developing and implementing a unified strategy for "achieving health for all in the European Region" that is of the greatest interest.
The response to the demands of the 21st century, formulated in the World Declaration on Health, is the adoption of a new European strategy for achieving health for all - "Health - 21". Revising and refining the previous 38 regional targets for health for all in the light of past experience and new targets, Health 21 sets and defines 21 targets for the 21st century.
A. Principles and approaches:
1. Solidarity of the member states of EURO in the interests of health.
2. Equality of rights of various groups within countries in the protection of health.
B. Targeting the entire population and major hazards:
3. Healthy start in life.
4. Youth health.
5. Maintaining health in old age.
6. Improved mental health.
7. Reducing the prevalence of infectious diseases.
8. Reducing the prevalence of non-communicable diseases.
9. Reduction of injuries resulting from acts of violence and accidents.
B. Prevention and healthy lifestyle:
10. Healthy and safe physical environment.
11. Healthier lifestyle.
12. Reducing the harm caused by alcohol, addictive drugs and tobacco.
13. Healthy environment conditions.
14. Multisectoral commitment to health.
D. Change of orientation - focus on the end result:
15. Health integration.
16. Governance issues and quality assurance in health care.
D. Resources:
17. Financing of health services and allocation of resources.
18. Health workforce development.
19. Research and health information.
20 Mobilizing partners for health.
21. Policy and strategy for health for all.
The key goal of Health 21 in the European Region is for all people to realize their full "health potential".
The key goal can be achieved by:
. Ensuring equality in protection through solidarity of action;
. Strengthening and protecting the health of people throughout their lives;
. Reducing the prevalence and suffering caused by major diseases, injuries and disabilities.
Thus, the Health for All policy is based on three fundamental values that are its ethical basis. These are:
1. Recognition of health as the most important human right.
2. Equity in matters of health and its protection and the effective solidarity of countries and population groups within countries in these matters.
3. Participation in health care activities and responsible attitude in it of all strata and sectors of society.
Russia and the WHO global strategy
The objectives of the national strategy "Health for all Russians" can be divided into three categories:
- the first category includes two tasks that address the fundamental orientation of the health-for-all policy, namely: achieving equity and equity in health care and improving health and quality of life;
- the second category includes tasks that deal with the health of certain groups of the population - children, youth and the elderly;
- The third category includes tasks that address specific health problems: cancer and cardiovascular diseases, other chronic diseases, infectious diseases, accidents, mental health problems and suicide.
Specific health issues
Objective 6. Improve mental health
In Russia in the second half of the 1990s, about 6 million people used psychiatric services (42 out of every 1,000 population). During the year, an average of 7 people are diagnosed with a mental disorder for the first time, and 8 out of every 1,000 people are hospitalized for mental illness. For the first time, 1 person out of 1000 of the population is recognized as disabled due to mental illness.
The "price" of poor mental health is very high. One tenth of the life expectancy of the population is lost due to mental illness, including 2 years due to premature death and about 5 years due to a deterioration in the quality of life.
In Russia, there are two specific groups of territories that are fundamentally different in terms of the state and trends of mental health, the socio-demographic damage caused by it and the nature of its social determination, and, consequently, ways to reduce:
. The first group includes mainly regions of the European part of Russia;
. The second is the territories of the Volga region, regions and territories of the North Caucasus, the Urals and Western Siberia.
Mental health is increasingly becoming a socio-economic phenomenon, the scale of which is determined to a decisive extent by economic disadvantage, and themselves, in turn, give rise to disadvantage due to an increase in the number of people in need of social protection and support.
General conclusion:
the duration and quality of life of the population in connection with the state of his mental health directly depends on the choice of strategies for reforming the health services, in a broader sense, on the strategies for reforming society, which determine the "price of a person, his life and health."
Target 7. Reducing the prevalence of infectious diseases
By 2020, there should be a significant reduction in the prevalence of infectious diseases through systematic programs for the elimination and elimination, as well as the control of infectious diseases that pose a public health problem.
The difficult transition period to a new model of society, which began in the 1990s, affected the nature of infectious diseases. In 1997, 32.6 million cases of infectious diseases were registered. In 1996, compared with 1990, mortality from infectious diseases in Russia increased by 76%, the incidence of tuberculosis by 60%, and the incidence of syphilis by 48 times. A special problem in Russia is AIDS. In recent years, the number of outbreaks of acute intestinal infections and waterborne hepatitis A has increased. The prediction of epidemiologists about an increase in the incidence of hemorrhagic fever with renal syndrome (HFRS) in the territories of its natural foci (Volga-Ural region) came true. For a number of regions of the forest zone, the problem of tick-borne spring-summer encephalitis is relevant. In recent years, the epidemiological situation in terms of the incidence of malaria has been deteriorating. The annual increase in the number of cases is 30-40%. The unfavorable situation with the incidence of helminthiases, especially diphyllobothriasis and opisthorchiasis, does not change.
Compared with the countries of Northern Europe (Sweden, Norway, Finland), in 1998 the death rate of men in Russia from infectious diseases was 4 times higher, and that of women was 1.2 times higher.
General conclusion:
In recent years, the epidemiological situation in Russia has deteriorated sharply, a comparison of Russia with other countries in terms of mortality from infectious diseases indicates a more complex sanitary and epidemiological situation in our country.
Target 8. Reducing the prevalence of noncommunicable diseases.
By 2020, morbidity, disability and premature death associated with major chronic diseases must be reduced.
The main chronic diseases that determine the increased mortality of the Russian population are diseases of the circulatory system. The mortality rate from this class of diseases is largely determined by both factors affecting the population as a whole (natural-climatic, environmental and socio-economic), and the prevailing habits of the population, cultural and ethnic traditions and way of life.
The mortality rate from diseases of the circulatory system for the group of northern and northwestern territories of Russia exceeds the European average by 8-9 times.
Target 9. Reducing injuries resulting from acts of violence and accidents.
Injuries are the third leading cause of death and the first among the causes that determine the loss of the labor potential of the country's population. The number of crimes, terrorist acts, encroachments on the life and health of citizens with the use of firearms and explosive devices is growing. The number of victims of fires is growing by an average of 9% per year. More than 500 accidents are registered daily, in which more than 100 people die and more than 600 people are injured. Up to 60% of all deaths are people aged 16 to 40 years. The number of dead children is increasing by 15% annually. More than 80% of affected children become disabled.
Each cause of death has its own "sphere of greatest influence" on the age scale. For accidents, poisonings and injuries, these are people of working age. It is at this age that the difference in mortality between the Russian population and the population of developed countries is maximum.
Thus, the specificity of mortality from injuries and poisoning lies in its almost complete dependence on social factors.
Tasks for age groups
Task 3. Healthy start of life.
By 2020, all newborns, toddlers and school-aged children in the Region should be healthier, giving them a healthier start in life.
About a quarter of congenital anomalies in children are due to genetic abnormalities and environmental conditions, and maternal alcohol and drug abuse becomes an important factor. After the first month of life, the main cause of death is sudden death syndrome associated with smoking, drug addiction, adolescence of puerperas, infections in the second half of pregnancy, burdened by this pathology of the mother's history, the potential risk of HIV infection and drug addiction of newborns increases.
Task 4. Youth health.
By 2020, young people in the Region should be healthier and better equipped to fulfill their responsibilities in society.
In adolescence, attitudes towards nutrition, physical education, smoking are laid, a healthy lifestyle and sexual behavior are formed, and at the same time risk factors for chronic diseases of older age appear. The structure of health threats is changing dramatically, including alcohol and drugs, physical inactivity, delinquency, gang violence and unwanted pregnancy.
Task 5. Maintaining health in old age.
By 2020, people over the age of 65 should be able to realize their full potential in terms of their own health and play an active social role in society.
The key problem of the elderly is their functional dependence on outside help and closely related issues of physical activity. From 1991 to the present, the number of persons with disabilities has increased by 35.3%. The “attractiveness” of disability in Russia is growing as the standard of living of the population worsens and tension in the labor market grows, as a result of which the disability pension and the benefits accompanying this status become the only source of livelihood for previously socially adapted people with persistent health disorders.
Key milestones of the Health for All strategy
Target 1. Solidarity for health in the European Region.
By 2020, the current health gap between Member States in the European Region must be reduced by at least one third.
This objective is a key focus of the Health for All strategy.
Target 2. Equity in health care.
By 2020, the health gap between socioeconomic groups within countries must be reduced by at least one quarter in all Member States through significant improvements in the health of underserved populations.
This objective is also a key focus of the Health for All strategy.
For Russia, all the tasks to achieve health for all, formulated in the WHO European Strategy as some kind of universal guidelines, are relevant.
When planning such a large-scale work, it is important to formulate the basic principles and conditions on the observance of which its effectiveness will largely depend. One of these conditions is the compliance of the ideological principles of the "Health for All" concept with the methodological and organizational conditions for its development, implementation and monitoring. The idea of an intersectoral approach to public health requires the creation of an adequate organizational structure, perhaps in the form of a National Institutes of Health, whose main tasks may be:
. development of a science-based policy in the field of strengthening and protecting the health of the population, taking into account the regional specifics of the situation;
. development, in accordance with WHO recommendations, of the national program "Health for all Russians", which unites the efforts of various sectors and departments according to the criterion of health;
. creation of a population health monitoring system;
. objective informing the country's governing bodies (President, Government, Parliament, Security Council, Heads of administrations of constituent entities of the Russian Federation) about the state, trends and forecasts of public health, about the necessary measures to improve the situation.
The Health for All strategy reaffirms the inalienable human right to health, the responsibility of the individual and the whole society for the real provision of this right, the systematic development of health care at the national level and in departmental terms, the development of cooperation in the formation of a global health system, as well as monitoring progress towards this promising goal.
Significant changes in the twentieth century occurred in such important areas as medical science and public health, medical law and ethical traditions.
In medical science, the 20th century is associated with a deepening understanding of the essence of health and disease, the successes of general biology, microbiology, virology, immunology, the study of nervous and endocrine regulation, heredity and genetics; with the spread to biology and medicine of the achievements of the scientific and technological revolution. Scientific and technological revolution led to the re-equipment of medical science and practice with fundamentally new methods for studying, diagnosing and treating diseases. Progress was especially striking in the methodology of research of all biomedical problems.
Fundamentally new methods of prevention, diagnosis and treatment of many diseases have appeared in medical practice, tremendous achievements have been made in the fight against epidemics and infectious diseases, scientists and practitioners in surgery, oncology, and cardiology have made significant progress.
In the organization of health care, the main results of the twentieth century were:
Recognition of health as a social human right;
Awareness of the social system of health care and its multi-scale problems;
Fundamental reforms in the management and self-government of this system;
Development of international cooperation in this area.
Currently, the world community is putting forward new tasks:
Sustainable development of society in harmony with nature;
Formation of the humanistic paradigm;
Protecting and ensuring the rights of man and peoples throughout the world;
Achievements in the XXI century "Health for all".
The policy of achieving health for all in the twenty-first century is a perspective vision of this problem. This policy sets out the global priorities for the first two decades of the 21st century. In accordance with them, tasks are formulated that, on the one hand, define specific goals, and on the other hand, conditions for achieving and maintaining the highest possible level of health. Thus, "Health for All" is not a separate one-time task. This is an ideology, a scientific substantiation of those practical actions that should and can lead to a consistent improvement in the state of people's health.
The "Health for All" target was reaffirmed by the 51st World Health Assembly, which set the relevant report (A51/5) as the basis for developing future policies for WHO and states.
The World Health Organization has formulated 10 main goals (global tasks) within the framework of the Health for All in the 21st Century program:
Strengthening equity in health;
Improving opportunities for survival and improving the quality of life;
Reversing global trends in the five major pandemics (communicable diseases, non-communicable diseases, injuries and violence, alcohol and drug abuse, tobacco smoking);
Complete or partial elimination of certain diseases (poliomyelitis, etc.);
Improving access to water, sanitation, food and housing;
Promoting healthy and counteracting unhealthy lifestyles;
Improving access to comprehensive, quality health care;
Support for health research;
Implementation of global and national systems of medical information and epidemiological surveillance;
Development, implementation and monitoring of Health for All policies in countries.
Ultimately, the idea and strategy of "Health for All" once again confirms the inalienable human right to health, the responsibility of the individual and the whole society for the real provision of this right, the systematic development of health care in the national and departmental terms, the development of cooperation in the formation of a global health system and monitoring progress towards this long-term goal.
A global health-for-all policy for the twenty-first century must be implemented through appropriate regional and national strategies. For our country, gravitating towards the European Region, it is the European experience in developing and implementing a unified strategy for "achieving health for all in the European Region" that is of the greatest interest.
Since its introduction in 1980, the health-for-all policy has provided a comprehensive framework for action to improve health in the European Region and has had a very significant impact on health performance. The response to the demands of the 21st century, formulated in the World Declaration on Health, is the adoption of a new European strategy for achieving health for all - "Health - 21". Revising and refining the previous 38 regional targets for health for all in the light of past experience and new targets, Health 21 sets and defines 21 targets for the 21st century. They are not a rigid list of prescriptions, but together they define the essence of the regional strategy. This document reflects issues related to the global values, objectives and strategies of "Health for All", current health problems in the Region, as well as the political and socio-economic changes taking place in it and the opportunities provided by this. Health 21 provides decision makers at all levels with an ethical and scientific basis for assessing the health impact of their policies. Thus, health requirements are formulated for any social activity of any sectors and strata of society.
The key goal of Health 21 in the European Region is for all people to realize their full "health potential".
It can be achieved by:
Ensuring equality in health care through solidarity of action;
Strengthening and protecting the health of people throughout their lives;
Reducing the prevalence and suffering caused by major diseases, injuries and disabilities.
The specification of these goals is contained in the tasks aimed at:
Achieving solidarity for health among European countries (objective 1);
Achieving equity in health care within European countries (target 2);
Ensuring a healthy start in life (objective 3);
Improving the health of young people (objective 4);
Maintaining health in old age (task 5).
This means it should be:
Improved mental health situation (target 6);
The prevalence of infectious diseases has been reduced (target 7);
Reduced prevalence of non-communicable diseases (target 8);
Reduced injuries resulting from acts of violence and accidents (target 9).
To achieve the goals set, strategies have been developed in the following areas:
(a) Given the multifactorial nature of health, policies that bring about positive changes in this regard should contribute to the formation of health-friendly physical, economic, social and cultural "environmental" conditions for the population, i.e. - be multisectoral.
Creating a healthy and safe physical environment (objective 10);
Ensuring a healthier lifestyle (target 11);
Reduce the harm caused by alcohol, addictive drugs and tobacco (target 12);
Ensuring healthier environments where people live, work and play (target 13);
Strengthening the responsibility and accountability of various sectors for activities that affect health (target 14).
b) Given the role of health in providing health and the rising cost of health services around the world, the focus of the health sector on achieving results must be changed.
This strategy can be implemented by:
Formation of an integrated health sector, which means strengthening the interaction of various structures, with an emphasis on the role of an integrated system of primary health care (target 15)
Improving governance and quality assurance in health care (target 16);
Health services financing and resource allocation (target 17);
Health workforce development (Target 18).
c) With multisectoral involvement and ownership of the Health for All goals, change management and regulation for health must be ensured.
The strategy can be implemented by:
Conducting research and providing information support on health issues (task 19);
Engaging partners in action for health at all levels: families, schools, places of work, local communities, the region and the country as a whole (target 20);
Adoption and implementation of health-for-all policies and strategies (target 21).
Challenges facing Russia
In order to determine the directions of a possible national strategy "Health for all Russians", we can consider our achievements in comparison with the three main tasks recommended by WHO as universal guidelines for achieving health for all. These tasks can be divided into three categories:
1. The first category includes two objectives that address the fundamental orientation of the health-for-all policy, namely the achievement of equity and equity in health care and the improvement of health and quality of life.
(The choice of these groups as requiring special attention was influenced by the fact that in each of these groups people are relatively vulnerable in terms of their health and social status; maintaining health in these groups has its own unique characteristics and needs; finally, it is these groups in most benefit from effective intersectoral linkages).
3. The third category includes tasks that address specific health issues: cancer and cardiovascular disease, other chronic diseases, infectious diseases, accidents, mental health problems and suicide.
It is advisable to start the analysis of the situation in the Russian Federation with the third category of tasks, since the tasks of the second and even more so the first category are their kind of generalization for specific groups of the population (second category) and for the entire population (first category).
Improving Mental Health
In 2020, there should be an improvement in the psychosocial well-being of people and the availability of integrated services that will provide assistance to people with mental health problems.
In Russia in the second half of the 1990s, about 6 million people used psychiatric services (42 out of every 1,000 of the population). During the year, an average of 7 people are diagnosed with a mental disorder for the first time, and 8 out of every 1,000 people are hospitalized for mental illness. For the first time, 1 person out of 1000 of the population is recognized as disabled due to mental illness. The contingent of people using psychiatric care has expanded significantly, but at the same time it has become much easier. The nosological appearance of the contingent underwent significant changes. The number of patients with psychosis increased 1.5 times, non-psychotic disorders - 3.1 times, mental retardation - 3.8 times, alcoholism - 8.7 times. Thus, if in 1965 the nosological portrait of an average mental patient was determined by severe psychotic disorders, then after 30 years - alcoholism.
A comparative analysis of the registered levels of the population's access to psychiatric care indicates a significant underestimation (by 5 times) of mental disorders in the population. Thus, the recorded prevalence of mental disorders in Russia gives an idea only of the tip of the iceberg, describing only the most general contours of the problem of the mental health of the population. The “price” of poor mental health is very high. One tenth of the life expectancy of the population is the losses associated with mental illness, including 2 years due to premature death and about 5 years due to a deterioration in the quality of life.
In Russia, there are two large groups of territories that are fundamentally different in terms of the state and trends of mental health, the socio-demographic damage caused by it and the nature of its social determination, and, consequently, ways to reduce:
the first group includes mainly regions of the European part of Russia;
the second - the territories of the Volga region, regions and territories of the North Caucasus, the Urals and Western Siberia.
In terms of mental health of the population, the situation is more favorable in the European part of Russia. Among the factors that determine the situation with mental health, a more prosperous socio-economic background, characterized by the level and differentiation of incomes, the level of unemployment and tension in the labor market, comes first. The essence of this relative well-being is that economic motives have not become the dominant factors in the incapacity for work and disability of the mentally ill in the territories of the European part of Russia. Thus, mental health is increasingly becoming a socio-economic phenomenon, the extent of which is decisively determined by economic disadvantage, and themselves, in turn, give rise to disadvantage due to an increase in the number of people in need of social protection and support.
Thus, the duration and quality of life of the population in connection with the state of its mental health directly depends on the choice of strategies for reforming the health services, in a broader sense, on the strategies for reforming society, which determine the "price of a person, his life and health."
Reducing the prevalence of infectious diseases
By 2020, there should be a significant reduction in the prevalence of infectious diseases through systematic programs for the elimination and complete elimination, as well as the control of infectious diseases that are a public health problem
The problem of infectious diseases is also acute for Russia. It is known that during periods of acute social cataclysms, the incidence of so-called social diseases (tuberculosis, syphilis, etc.) rises sharply. The incidence of infectious diseases among the population of Russia varies greatly due to the activation or fading of the influenza epidemic. A special problem in Russia (as in many other countries) is AIDS. In recent years, the number of outbreaks of acute intestinal infections and waterborne hepatitis A has increased. The greatest epidemiological danger is represented by violations in the centralized water supply system, which cause up to 80% of outbreaks of infectious diseases of water origin. The prediction of epidemiologists about an increase in the incidence of hemorrhagic fever with renal syndrome (HFRS) in the territories of its natural foci came true. For a number of regions of the forest zone, the problem of tick-borne spring-summer encephalitis is relevant. In recent years, the epidemiological situation in terms of the incidence of malaria has been deteriorating. The unfavorable situation with the incidence of helminthiases, especially diphyllobothriasis and opisthorchiasis, does not change.
Thus, in recent years, the epidemiological situation in Russia has deteriorated sharply, a comparison of Russia with other countries in terms of mortality from infectious diseases indicates a more complex sanitary and epidemiological situation in our country.
Reducing the prevalence of noncommunicable diseases
By 2020, morbidity, disability and premature death associated with major chronic diseases must be reduced. The main chronic diseases that determine the increased mortality of the Russian population are diseases of the circulatory system. The mortality rate from this class of diseases is largely determined by both factors affecting the population as a whole (natural-climatic, environmental and socio-economic), and the prevailing habits of the population, cultural and ethnic traditions and way of life.
Reducing injuries from acts of violence and accidents
By 2020, there should be a significant and sustained reduction in the number of injuries, disabilities and deaths from accidents and violence in the Region
Injuries are the third leading cause of death and the first among the causes that determine the loss of the labor potential of the country's population. The number of crimes, terrorist acts, encroachments on the life and health of citizens with the use of firearms and explosive devices is growing. More than 500 accidents are registered daily, in which more than 100 people die and more than 600 people are injured. The number of deaths in traffic accidents in only three days exceeds the number of deaths in accidents during the year in aviation, sea and river transport as a whole. Up to 60% of all deaths are people aged 16 to 40 years. The number of dead children is increasing by 15% annually. More than 80% of affected children become disabled. Another characteristic feature inherent in this class of causes of death is the extremely high excess mortality of men. Data for Russia testify to the relevance of these observations for our country, because the mortality of men here is 3-4 times higher than that of women.
Each cause of death has its own "sphere of greatest influence" on the age scale. For accidents, poisonings and injuries, these are people of working age. It is at this age that the difference in mortality between the Russian population and the population of developed countries is maximum. Thus, the specificity of mortality from injuries and poisoning lies in its almost complete dependence on social factors.
Healthy start in life
By 2020, all newborns, toddlers and school-aged children in the Region should be healthier to give them a healthier start in life
Thus, about a quarter of congenital anomalies in children are due to genetic abnormalities and environmental conditions, and maternal alcohol and drug abuse becomes an important factor. After the first month of life, the main cause of death is sudden death syndrome associated with smoking, drug addiction, adolescence of puerperas, infections in the second half of pregnancy, burdened by this pathology of the mother's history, the potential risk of HIV infection and drug addiction of newborns increases.
Youth health
By 2020, young people in the region should be healthier and better equipped to fulfill their responsibilities in society
In the structure of the incidence of adolescents and young men (aged 15-24 years) in Russia, diseases of the respiratory system, nervous system and sensory organs, and digestion predominate, which account for almost 62% in total. According to epidemiological studies, no more than 14% of high school students are healthy. Up to 60% of school leavers suffer from at least one chronic disease. In senior classes, the prevalence of visual impairment and diseases of the digestive system increases up to 15%. The main causes of death in this group are accidents, homicides and suicides. Injuries are largely due to road traffic accidents and are often associated with intoxication. Murders are also more than half of the cases committed while intoxicated.
Another group of problems is related to the formation of a lifestyle that will affect later years. This group includes alcoholism, drug addiction, early sexual intercourse. At the same time, the number of births at 15-17 years of age is growing. Up to half of pregnancies occur with complications. Young mothers experience psycho-emotional difficulties, often not completing their education, more often becoming unemployed, more likely to give birth to premature babies and do not have parenting skills. The health of young women is deteriorating. Disorders of menstrual function are noted by 1206.2 adolescent girls per 100 thousand of this group, 599.2 - inflammatory diseases of the tubes and ovaries. Up to 23% of young women (18-23 years old) suffer from chronic gynecological diseases. Early sexual activity contributes to the spread of sexually transmitted diseases.
Thus, in adolescence, attitudes towards nutrition, physical education, smoking are laid, lifestyle, sexual behavior are formed, and at the same time risk factors for chronic diseases of older age appear. The structure of health threats is changing dramatically, including alcohol and drugs, physical inactivity, delinquency, gang violence and unwanted pregnancy.
Maintaining health in old age
By 2020, people over the age of 65 should be able to realize their full potential in terms of their own health and play an active social role in society. Persons of the elderly and senile age (60 years and older) in Russia are the most socially vulnerable and destitute. A negative trend in Russia is the growing number of pensioners receiving disability pensions. The increase in the rate of disability may be due to a combination of various factors. It should be noted that in the last five years, despite the deep socio-economic crisis, a number of legislative decisions were nevertheless adopted aimed at social support for the disabled. The increase in pensions and the expansion of benefits for various categories makes disability more "attractive" for people with persistent health problems and significant disability. Thus, the increase in the growth rate of disability over the past five years can be a largely stimulated process.
Half of all primary disability of the adult population is due to diseases of the circulatory system, another 10% - malignant neoplasms, 4-6% of new disabled people annually add diseases of the nervous system, injuries, mental disorders, diseases of the respiratory system and diseases of the musculoskeletal system. age are diseases of the circulatory system, giving about 75% of cases.
In Russia, there is a significant regional variation in life expectancy in a state of disability: from 1.4 years in the Sakhalin region to 6.4 years in the Belgorod region, i.e., it differs by 4.5 times. The current risk of disability in Russia reduces the hypothetical life expectancy of the population by 7.5 years. Another 3.7 years are losses due to the deterioration of the quality of life. Thus, the risk of disability turns out to be twice as significant as a factor in preserving life itself than as a factor in maintaining activity throughout life.
If we consider disability as an indicator of the health of the population, then it would be fair to expect that the level of disability, and, consequently, life expectancy in a state of disability, is higher in areas characterized by high mortality and, accordingly, low life expectancy of the population. However, the situation in Russia is not so unambiguous. Moreover, the opposite pattern is quite clearly traced. The higher the life expectancy, the greater the proportion of it will be lived in a state of disability, and the less - in a healthy state. And vice versa. Thus, for the Russian territories, the ratio is fair - the higher the mortality, the lower the disability. In Russia, people die before they have time to become disabled. Within the logic of a civilized community, these ratios are unambiguously negative characteristics of the state of health.
Thus, the key problem of the elderly is their functional dependence on outside help and closely related issues of physical activity. The “attractiveness” of disability in Russia is growing as the standard of living of the population worsens and tension in the labor market grows, as a result of which the disability pension and the benefits accompanying this status become the only source of livelihood for previously socially adapted people with persistent health disorders.
Solidarity for health in the European Region
By 2020, the current health gap between Member States in the European Region must be reduced by at least one third. This objective is a key focus of the Health for All strategy. By the mid-1960s, Russia had reached levels of life expectancy comparable to those of the major developed countries. With regard to women, this thesis is true in full measure, the life expectancy of men somewhat lagged behind the average European level (the gap was 2-5 years). Over the next two decades, the situation with mortality in Russia can be characterized by the term "stagnation" with a growing trend towards regression. The situation deteriorated more rapidly for men, whose starting positions regarding "European mortality" were already worse. Against the background of the positive dynamics of life expectancy in European countries, Russia's lag in terms of life expectancy has noticeably increased. In the 1970s, the gap was 2.5-3.5 years for women and 5-9 years for men. In the 80s, it increased to 3-5 years for women and up to 9-11 years for men.
In the mid-1980s, the evolutionary trend of mortality in Russia was interrupted. Partly as a result of the anti-alcohol campaign in Russia, the maximum value of life expectancy was achieved (64.9 years for men in 1986 and 74.6 years for women in 1988). From that time until 1995, the value of average life expectancy has steadily decreased. In 1993, the decline in this indicator can be called catastrophic: in one year, the average life expectancy for men decreased by 3.1 years, for women - by almost 2 years. In general, since the recorded maximum of this indicator, life expectancy has decreased by 7.3 years for men and by 5.5 years for women. The 1995 data did not record a further drop in life expectancy. 1996 was even marked by its slight increase (by 1.6 years for men and 0.4 years for women). These are certainly positive signs, especially against the background of the previous catastrophic dynamics. In part, this happened because we have reached the "natural limits" of life expectancy, determined by the current age structure of the population and, accordingly, the structure of causes of death. At the same time, in comparison with the previous fall, in principle the situation remains the same. As a result of an 8-year (1986-1994) decline in life expectancy, the gap in life expectancy between Russia and European countries increased to 7-10 years for women and 14-17 years for men. Behind these quantitative assessments are profound qualitative changes. It can be assumed that we have the life expectancy that is adequate to our standard of living.
According to the results of research by the Institute of Sociology of the Russian Academy of Sciences, in the system of personal values, after "work" and "family", "health" in the minds of Russian citizens occupies a high third place in importance. However, at the same time, health does not have an independent value, but is considered as a means of achieving other goals and needs of the individual, for example, a higher income, an apartment, etc. Such behavior indicates that people have no choice in the means of achieving the necessary benefits of life, and health in such conditions becomes a kind of bargaining chip, the subject of rather harsh exploitation, especially in today's economic and social reality. Thus, the problem of improving the health of the population is, first of all, the problem of changing the value of health, both in the system of values of the whole society and in the system of values of the individual.
Thus, the gap in life expectancy between Russia and European countries has increased to 7-10 years for women and 14-17 years for men, only the transformation of "health" from a means into an end, i.e. the acquisition of the status of a fundamental value creates the necessary prerequisites for the development, adoption and practical implementation of an adequate policy for the protection of public health.
Equity in health care
By 2020, the health gap between socioeconomic groups within countries must be reduced by at least one quarter in all Member States through significant improvements in the health of underserved populations. This objective is also a key focus of the Health for All strategy. Drawing conclusions about the situation with mortality in Russia on the basis of average data for the Russian Federation is possible only as a first approximation, since the data of more than 80 subjects of the Russian Federation demonstrate the extreme diversity of the levels of life expectancy achieved. The variation in the average life expectancy of men in different regions is more than 16 years, women - 17 years. These differences are huge. They even exceed those that separate Russia from the developed countries of the world. Thus, not only Russia as a whole lives in a different, relative to Europe, historical dimension (in terms of health and mortality), but in Russia itself there are parallel enclaves belonging to qualitatively heterogeneous types of medical and demographic situation.
Characteristically, even the territories with the highest levels of life expectancy are extremely far from achieving the central goal of achieving "health for all", according to which life expectancy at birth in the countries of the region should be at least 75 years for both sexes. It is important to emphasize that the level of life expectancy of 75 years is formulated by WHO as an achievable goal for the entire European Region, and not just for a group of developed countries. In Russia, only in three republics of the North Caucasus, and only for the female population, life expectancy has reached this level, and if for women in terms of life expectancy the gap from the European benchmark is about 10 years, then for men it is approaching 20-25 years.
There are several key features that characterize the qualitatively heterogeneous types of regional mortality in Russia.
The first is the age specificity of mortality. The main and practically the only factor in the heterogeneity of Russian territories in terms of life expectancy is the significant differences in mortality in working age, and mostly young ages, across territories. The risk of death for men aged 15-44 differs across Russian territories by more than 4 times, and the risk of death for women - more than 6 times. Differences in the magnitude of this risk at the age of 45-64 years - decrease by more than 1.5 times. The fluctuation in the risk of death in the interval from 0 years to 1 year is 24.3%, and the variation in the risk of death before the age of 15 years is 36.0%. In principle, this corresponds to the usual idea that Russian territories are relatively homogeneous in terms of infant mortality, which cannot be said about mortality in childhood and working age.
The second characteristic feature is the ratio of life expectancy between men and women. At present, only in a few countries (Nigeria, Upper Volta, Liberia, etc.) do men on average live longer than women, and a certain excess of the life expectancy of women over men is inherent in almost all countries. Data on the magnitude and differences in life expectancy for various countries of the world confirm the assertion that there is a direct and positive relationship between the level of life expectancy and the size of the gap in life expectancy between men and women. Every 10 years of increase in women's life expectancy corresponds to 9 years of increase in men's life expectancy, i.e. increase the said gap by 1 year. These differences are interpreted in the sense that the progress of civilization obviously gives women greater advantages than men. Russian data show a completely different pattern: the increase in life expectancy for women is slower than for men (for every 10 years of increase in life expectancy for women, there is 16 years of increase in life expectancy for men). The interpretation of the obtained pattern will also be completely different: in the event of a decrease in life expectancy in Russia, the gap in the life expectancy of men and women will increase - a trend that has no analogues in peacetime in any country in the world.
Conclusion
The presented data show that all the tasks to achieve health for all, formulated in the WHO European Strategy as some kind of universal guidelines, are relevant for Russia. Moreover, in many areas, the dynamics of health indicators in Russia is opposite to global trends. Thus, the situation objectively requires the adoption and implementation of reasonable measures to improve the health of the population.
When planning such a large-scale work, it is important to formulate the basic principles and conditions on the observance of which its effectiveness will largely depend. One of these conditions is the compliance of the ideological principles of the "Health for All" concept with the methodological and organizational conditions for its development, implementation and monitoring. The idea of an intersectoral approach to the problems of public health requires the creation of an adequate organizational structure - possibly in the form of the National Institute of Health, the main tasks of which may be: development of evidence-based policies in the field of promotion and protection of public health, taking into account the regional specifics of the situation; development, in accordance with WHO recommendations, of the national program "Health for all Russians", which unites the efforts of various sectors and departments according to the criterion of health; creation of a population health monitoring system; objective informing the country's governing bodies (President, Government, Parliament, Security Council, Heads of administrations of constituent entities of the Russian Federation) about the state, trends and forecasts of public health, about the necessary measures to improve the situation. A nationwide health action program is urgently needed today. It should be based on a clear concept of protecting the health of the people and a unified strategy.
The publication was prepared on the basis of analytical information on the problems of the WHO global strategy to achieve health for all in the 21st century (Venediktov D.D., Ivanova A.E., Maksimov B.P.).
The current burden of disease is underpinned by highly complex and interrelated factors (ageing, migration, the spread of noncommunicable diseases and mental health disorders, remaining problems of infectious diseases, efficiency and financial problems of health systems, poor public health in many areas). However, it is possible to find cost-effective ways to implement policies that will improve the health and well-being of the population. Health 2020 was developed through extensive consultations within and outside the WHO Regional Office for Europe, and based on a number of new scientific studies. The goal of Health 2020 is to “significantly improve the health and well-being of the population, reduce health inequalities, strengthen public health and ensure universal, socially equitable, sustainable and high-quality people-centered health systems.” The article highlights the main principles of the Health 2020 policy, the values underlying this policy, and its main provisions. It is emphasized that the Health 2020 policy is aimed at solving two interrelated tasks: improving health for all and reducing health inequalities; improving leadership and participatory governance for health. In addition to these two objectives, the Health 2020 policy framework contains four interrelated, interdependent and mutually reinforcing priority areas for strategic action: investing in health throughout the life course and empowering citizens; addressing the most pressing problems in the European Region related to noncommunicable and communicable diseases; strengthening people-centred health systems, public health capacity, emergency preparedness, surveillance and response; ensuring the strength of local communities and creating a supportive environment. It concludes that Health 2020 is a powerful stimulus for collective action across the WHO European Region to seize the opportunities that are opening up to improve the health and well-being of current and future generations.
Introduction
Health and well-being are universal humanitarian values, which today are also considered as inalienable human rights; they are essential components of equitable human, economic and social development and resources for everyone's daily life. The goals of health and well-being are increasingly given fundamental importance as a key factor in human development and security. Health is no longer viewed only in terms of consumption that requires financing, but is regarded as a capital asset that must be maintained, increased and improved in an equitable manner, as well as a positive concept that emphasizes social and individual resources, as well as physical potential. In this In this context, the lives of 900 million people in the 53 countries of the WHO European Region are at stake, and the challenge before us today is to increase the impact of the above principles so as to achieve equitable improvements in health outcomes in all these countries. Given the existing knowledge and technological advances, we can and must achieve better results.
Today, more attention is paid to health issues than ever before. Among the many determining factors are, for example, the impact of the forces of globalization and the increasing possibility of the rapid spread of infectious diseases. Health is a significant topic in discussions of trade, diplomacy and security. The healthcare sector is the most important independent branch of the economy, a source of many jobs, an incentive for the development of science and technology. The human rights aspects of health and health care play a significant role, but are often neglected. For example, problems of mobility and migration develop into prejudice and stigma. These are just some of the factors that confirm the critical importance of health issues.
Therefore, in order to meet the expectations of people, it is necessary to actively influence health and its determinants within the existing political, social, economic and infrastructural conditions. Such impact contributes to the development of communities and improved health outcomes. The presence of a wide range of determinants of health means that it cannot be the sole responsibility of the health sector, although the sector and its systems undoubtedly play a very significant role. Models of joint work with other sectors should be actively built, based on common priorities. Addressing the determinants of health directly related to the activity of these sectors results in additional societal benefits, including economic benefits.
The current burden of disease is underpinned by highly complex and interrelated factors, such as aging, migration, the spread of noncommunicable diseases and mental health disorders, persistent problems of infectious diseases, performance and financial problems of health systems, and the poor state of public health in many areas. However, strong evidence indicates that cost-effective policy pathways can be found to improve the health and well-being of populations. Such paths are based on the application of approaches that combine government leadership, creating a supportive environment, developing a sense of control and ownership, and empowering all stakeholders. A new type of governance for health for the 21st century is needed, based on the following principles: a social determinants of health approach; equity and sustainability; achievement of global and social goals through interrelated forms of formal and informal management and new strategic relationships; increasing the role, voice and active participation of people. This is both a serious challenge and an opportunity before us.
Health 2020
The European Region consists of 53 countries with a rich diversity of culture, historical heritage, level of development, material security and resources. Despite their differences, these countries, who came together at the annual session of the WHO Regional Committee for Europe in September 2012, unanimously endorsed and committed themselves to the new European health policy framework, Health 2020. Health 2020 has been developed through extensive consultation within and outside the WHO Regional Office for Europe, and based on a number of new research studies.
For example, a commissioned fundamental review of the social determinants of health and the health gap in the WHO European Region was commissioned to provide evidence-based policy recommendations for reducing social health inequalities in the Region, and to develop a framework for follow-up. The review was written under the direction of Michael Marmot as part of a two-year project divided into two phases. The full text of the final report was published in September 2013. It analyzes the levels of disparities in health between and within countries in the European Region and considers policy options to reduce such disparities. The results of the work of 13 task forces were used, as well as the conclusions and recommendations of the global Commission on Social Determinants of Health, containing the most important position that the sources of social inequities in health are the conditions in which people are born, grow up, live, work and age. , as well as the inequalities of power and distribution of resources that give rise to these conditions. Based on this evidence and analysis, the review authors formulated specific, practical recommendations for policy interventions to be implemented across age groups and generations that have the potential and functionality to reduce social inequities in health.
The second set of fundamental reviews on the principles and processes for implementing improved governance for health was prepared under the leadership of Ilona Kickbusch. These reviews were directly fed into the Health 2020 policy development process. This keynote analyzes new approaches to governance driven by the changing nature of the challenges of the 21st century. Its content is supplemented by a number of reference and analytical documents containing an in-depth analysis of the issues raised. The study revealed the ongoing process of dispersal of strategic leadership with the transition to a cooperation model, in which leadership is the product of joint activities of a wide range of actors operating at the state level (ministries, parliaments, departments, state bodies, commissions, etc.), at the level of society (commercial enterprises , citizens, local communities, global media, including networked social media, foundations, etc.) and at the supranational level (European Union, UN, etc.).
The results of this work were also used in the preparation of a section of the European Survey of Social Determinants and the Health Gap.
In September 2012, an analysis of resolutions adopted by the WHO Regional Committee for Europe over the previous 10 years, as well as resolutions of the World Health Assembly and declarations of ministerial conferences, was published. The results of this review of past commitments suggest that Health 2020 will allow many of them to be revisited and brought together in a coherent and innovative way, breaking down fragmentation and helping to achieve the goals set. However, there are a number of issues, such as the health of older people, care for some noncommunicable diseases, and the economics of health and disease, that require more attention today. The review also points to the need for more precise formulation and careful development of mechanisms and principles for the implementation of integrated strategies. Finally, it proposes that the resolutions of the WHO Regional Committee for Europe should provide a summary of progress towards meeting previous commitments.
In 2012, a review of lessons learned from intersectoral work was published. This paper documents the experience of applying the principle of health in all policies, and assesses the evidence and compares the effectiveness of various governance structures in influencing the social determinants of health and, ultimately, population health outcomes. The publication presents research findings showing how best to establish, use and strengthen intersectoral governance structures. It also provides illustrative examples of the tools and methods of governance available.
A paper on the economic aspects of disease prevention is being prepared for publication. It will analyze the growing and solid evidence that shows the cost-effectiveness of increased investment in health promotion and disease prevention.
Member States of the WHO European Region have adopted Health 2020 in two separate formats. From the document entitled “Health 2020: a European policy framework for whole-of-government and societal action for health and well-being”, policy makers and decision-makers involved in the implementation of practical strategies can draw on key values and principles in the form of strategic recommendations for implementing implementation of Health 2020 approaches. The expanded version, Health 2020: Policy Framework and Strategy, provides much more detail on the evidence-based reasoning and practice in health and well-being, and is intended for policymakers and policy makers at the operational levels. This document is intended to be a continuously updated policy and strategy guide that will take into account all the ongoing changes in factual information and practice. It is not prescriptive, but offers a practical basis for use in each country, taking into account existing circumstances, needs and aspirations.
The baseline data that informed the development of Health 2020 reflects the profound disparities in health outcomes across countries in the WHO European Region. The health of the population as a whole is improving, but deep inequalities remain in this area. There are sharp differences between countries, with a pronounced deterioration in performance from west to east. Here are other telling figures: a child born in the CIS is three times more likely to die before the age of five than a child born in the European Union, and maternal mortality rates in some countries of the Region are 43 times higher than others.
These countries certainly differ in terms of the quality of health services and access to them. However, all available evidence indicates that the above inequalities are largely due to differences in social and economic conditions. In addition, they are associated with behavioral factors, including tobacco and alcohol use, dietary habits and physical activity levels, as well as mental disorders, which in turn reflect the state of stress and adversity in people's lives.
Health 2020 is the answer to these challenges. Its goal is to "significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health, and ensure universal, socially equitable, sustainable and high-quality people-centred health systems." Health 2020 is based on the values embodied in the WHO Constitution, which states that the enjoyment of the highest attainable standard of health is one of the fundamental rights of every person, regardless of ethnicity, gender, age, social status and ability to pay for services. Other important values are fairness, sustainability, quality, transparency and accountability, the right to participate in decision-making and the protection of human dignity.
Summarizing the above, the following main principles can be identified in the policy framework:
Close attention to health and well-being as indicators of socio-economic development;
Comprehensive approach to the full range of determinants of health;
Taking into account the main priorities of the Region in the field of public health and effective practical solutions;
Introducing bold, innovative approaches to developing collective leadership to bring together multiple partners and mobilize broad political and public support for protecting and improving people's health to jointly identify optimal solutions;
Identification and practical consideration of the necessary prerequisites for the implementation of positive changes;
Finding ways to formulate economic arguments in favor of investing in health, including an objective rationale for the usefulness and effective approaches to implementing the principle of considering the interests of health in all policies;
Finding ways to empower citizens and patients as key conditions for improving health outcomes, the functioning of health systems and increasing satisfaction with the quality of services;
Implementing effective ways to seize opportunities, including new technologies, for networking, partnerships and communication;
Implementation across the WHO European Region of a common mechanism to ensure and maintain unity and coherence of statements within the health community;
Identification of gaps in knowledge and identification of priority areas for scientific research;
Establish a permanent communication platform for the exchange of practical experience among policy makers and public health advocates throughout the Region.
Health 2020 values and key messages
The dominant components of the current burden of disease are noncommunicable diseases and mental health disorders. Their causes are rooted in the social and economic conditions of people's lives and in lifestyle characteristics that are themselves socially mediated. These diseases arise as a result of an individual's interaction with multiple determinants of health throughout life. Evidence strongly suggests that socially equitable access to early childhood development opportunities, quality education and employment, decent housing and income are strong preconditions for health.
Health 2020 argues for addressing the root causes of problems and addressing their root causes. Modern economic research not only reveals the economic burden that disease brings with it, but also shows that these problems can be solved with much more attention to health promotion, disease prevention and public health. At the same time, health inequalities across the social gradient should be reduced in every possible way and targeted support should be provided to those who are most vulnerable and socially excluded. However, in many countries, policies outside the health sector currently do not pay adequate attention to health or equity issues.
In most of them, the health share of the government budget is large, but the cost of health care services is growing faster than national income. Many cost items are also rising due to increased supply from providers, in particular as new treatments and technologies become available, and as people increasingly expect protection from health risks and access to high-quality health care services. Health systems, like other sectors, need to adapt and change, especially in health promotion and disease prevention. In doing so, particular attention should be paid to the development of people-centred and participatory services, as well as integrated care, such as primary and secondary or medical and social care. Reviews show that reductions in coronary heart disease deaths in several high-income countries are due to more than half the reduction in population levels of exposure to risk factors such as smoking. The remaining share of the reduction in mortality is mainly due to clinical prevention measures, and this share appears to be increasing. These reviews provide a strong rationale for a combination approach that combines population-based risk reduction with high-quality clinical care for patients with existing diseases. Despite this, the OECD estimates that countries in the WHO European Region spend on average only 3% of their health budgets on health promotion and disease prevention.
Key strategic goals, objectives and content of Health 2020
Improving health for all and reducing health inequalities;
Improving leadership and participatory governance for health.
In addition to these two objectives, the Health 2020 policy framework contains four interrelated, interdependent and mutually reinforcing priority areas for strategic action:
Investing in health throughout the life course and empowering citizens;
Solving the most urgent problems of the Region related to non-communicable and infectious diseases;
Strengthening people-centred health systems, public health capacity, emergency preparedness, surveillance and response;
Ensuring the strength of local communities and creating a supportive environment.
Work in all four priority areas involves action on a wide range of interdisciplinary issues. The new type of governance for health needed for this will be built around the following principles: the social determinants of health, equity and sustainability; achievement of global and social goals through interrelated forms of formal and informal management and new strategic relationships; increasing the role, voice and active participation of people.
Governments achieve greater positive health impacts when they link policies, investments and services and focus on reducing inequalities. Governments are responsible for developing and implementing national intersectoral strategies that combine elements of planning and control with goals and objectives for key areas of activity, such as caring for the health of people at all stages of life, strengthening health systems and public health, and expanding rights and opportunities of citizens. Such intersectoral strategies include, for example, the use of fiscal measures, the implementation of interventions in specific settings of residence such as schools or workplaces, the promotion of secondary prevention measures, including risk assessment and screening.
Mental health disorders, which are one of the most important causes of long-term stress and disability, deserve special attention. One in four people in the European Region will experience some kind of mental health problem at some point in their lives. Research data provide a better understanding of the destructive links between mental health disorders and social exclusion, unemployment, homelessness, alcohol and other substance abuse. A particularly urgent but challenging task is to improve the early diagnosis of depression and the prevention of suicide through community-based interventions. This problem has gained particular importance during the recent economic crisis, when the frequency of suicides increased, for example, in Greece by 17%, in Ireland by 13%. Evidence suggests that the increase in suicides, as well as other negative health effects associated with the economic downturn, can be significantly reduced by well-targeted social protection measures and active labor market policies.
The provisions of Health 2020 are fully consistent with the WHO General Program of Work and other international processes and instruments. This policy fully supports the growing global effort to combat noncommunicable diseases, as reflected in documents such as the United Nations Political Declaration on Noncommunicable Diseases (2011), the WHO Framework Convention on Tobacco Control and the WHO Global Strategy on Diet, Physical Activity and health. There is still a need to continue the fight against infectious diseases, in particular to achieve full implementation of the International Health Regulations, to improve the exchange of information and to improve mechanisms for joint epidemiological surveillance and infection control.
Working on addressing complex and interrelated determinants of disease in today's context is about making strategic decisions despite the uncertainty and incompleteness of scientific knowledge. Under these conditions, the approaches of narrowly rational, linear thinking are inapplicable. In situations where it is impossible to fully predict the broad systemic effects of multiple interventions, it is required to involve expertise related to synergetics and complex systems theory. In practical terms, to overcome the difficulties associated with uncertainty, small-scale interventions that allow learning from experience and making adaptive adjustments are increasingly important.
Health 2020 prioritizes strengthening patient-centred health systems and building their capacity to deliver high-quality and efficient services. These systems must be viable and financially sustainable, fully fit for purpose and based on objective scientific knowledge. A reorientation is needed to prioritize disease prevention, integrated service delivery, continuity and continuity of care, continuous quality improvement, support for self-care capabilities, and bringing services as close to the place as possible in a safe and cost-effective manner. residence of patients. The Health 2020 policy framework, as for WHO globally, maintains the priority of universal health access and commitment to the principle that primary health care is the cornerstone of health systems in the 21st century. All of these processes at the health system and public health levels require a more flexible, multi-skilled and team-oriented workforce.
A significant contribution to the creation of the Health 2020 policy is associated with the development of the European Action Plan on strengthening public health capacities and services, which was approved by the WHO Regional Committee for Europe in 2012 as one of the fundamental elements of the implementation of this policy. The Action Plan aims to improve public health services and infrastructure, including public health aspects in the operation of preventive and curative services. It contains a set of 10 horizontally linked essential public health operations to provide a unifying and guiding framework for European health authorities to develop, monitor and evaluate policies, strategies and interventions to reform and improve public health. In order to improve health outcomes, action is needed in the following areas: significant strengthening of public health functions and capacities; development of organizational mechanisms in the field of public health protection; scaling up measures to protect and promote health and prevent disease.
Building resilience is seen as a key factor in protecting and promoting health and well-being at both the individual and community levels. Strong and resilient communities have the resources to respond proactively to emerging and adverse circumstances, or are able to quickly build up such resources. They also show readiness for economic, social and environmental changes, more effectively confront crises and overcome difficulties.
One of the most important determinants of health are environmental hazards; many types of health problems are associated with exposure to such factors, including, for example, air pollution and the effects of climate change. These factors also interact with the social determinants of health.
Policy implementation process and future work at the country level
There is no doubt that countries embarking on Health 2020 for health development are in different contexts and have different opportunities. Nevertheless, the policy framework is intended to remain relevant and practical regardless of differences in country starting positions. Specific goals for countries include ensuring strong political commitment to improving health and putting health at the forefront of the policy agenda, mainstreaming health in all policies, enhancing policy dialogue on health and its determinants, and increasing accountability for health outcomes.
Health 2020 provides evidence-based pathways to achieve these goals. To facilitate collaboration with countries and the implementation of Health 2020, the WHO Regional Office for Europe is compiling a package of services and tools to provide systematic support to Member States in addressing horizontal policy issues that are key to this policy, and to establish programmatic links and entry points for implementation of the policy framework. For each component of the package, a list of priority high-impact services, guidelines and practices will be provided. The package will be updated regularly to reflect progress made in countries and to include promising practices and expertise.
As an initial step, countries should develop a national health policy with associated strategies and plans. Based on the results of a thorough needs assessment, the following questions should be answered: “What results does the country hope to achieve in terms of improving health outcomes while adhering to the principle of social justice?”, “What multisectoral policies and programs will be implemented, for example, in relation to noncommunicable diseases?”. The Health 2020 toolkit will help you find the best answers. For public health, the European Action Plan for Strengthening Public Health Capacities and Services and the accompanying self-assessment tool are a useful guide. The Health 2020 policy is not for theoretical study, and its documents should not gather dust on the shelves, but serve as a guide to action!
Methods such as health impact assessment and economic analysis are valuable tools for determining the potential benefits of certain policies for health and social equity. Both qualitative and quantitative health data can be used.
Encouragingly, a number of countries are already developing national Health 2020 policies with supporting programs and plans. Other countries are using elements of the Health 2020 policy framework in line with its values and principles. The WHO Regional Office for Europe has begun providing systematic support to countries in their efforts to implement Health 2020 during the period 2014–2015. As another initiative, the Regional Office will help develop new forms of networking between countries, institutions and citizens, including online collaboration mechanisms.
The implementation of Health 2020 will require the active participation of many organizations and structures throughout Europe with an interest in health development and public health. In particular, cooperation with the EU will become a solid foundation and a source of new opportunities and additional benefits. Similarly, many other organizations and networks should be involved: they are so numerous that it is impossible to list them by name. There are differing views on private sector involvement, but private sector involvement, with the necessary respect for ethical principles, can make a significant contribution to achieving the goals of Health 2020.
An example of an active network that can significantly advance the implementation of Health 2020 is the WHO European Healthy Cities Network. About 69% of the European Region's population lives in cities, and urban environments can provide citizens and families with excellent opportunities for success and well-being. A city can be an engine of economic prosperity and a healthy environment through improved access to services, cultural and recreational facilities. Often, however, cities are also centers of poverty and ill health. Certain circumstances of urban life, especially segregation and poverty, further contribute to and exacerbate these inequalities, contributing to the disproportionate impact of health-damaging and socially undesirable patterns of response to economic and social deprivation.
Cities and city governments can have a significant impact on people's health and well-being through a variety of policies and interventions, including in areas such as combating social exclusion and providing support, promoting healthy and physically active lifestyles, safety and environmental issues , working conditions, readiness to cope with the consequences of climate change, elimination of harmful impacts and domestic inconveniences, urban planning and design taking into account the interests of health, active involvement and wide participation of citizens in collective processes. The WHO European Healthy Cities Network provides many examples of good practices across the WHO European Region and will be one of the strategic drivers for implementing Health 2020 at the local level.
The WHO Regional Office for Europe will collaborate effectively with all such partners and networks throughout the Region, based on the following principles: involvement of a wide range of stakeholders; promoting policy coherence; exchange of statistical health data; pooling efforts in the implementation of epidemiological surveillance; participation in the development and implementation of common strategic platforms, as well as in the conduct of assessment missions, workshops, individual consultations, technical dialogues and case studies.
Accountability and targets
Political commitment to the entire process described above at the global, regional, national and subnational levels is essential. At the 2013 session of the WHO Regional Committee for Europe, countries agreed to the following overarching or main targets:
1. By 2020, reduce premature mortality among the European population.
2. Raise the average life expectancy in Europe.
3. Reduce injustice in Europe (social determinants benchmark).
4. Raise the level of well-being of the people of Europe.
5. Universal coverage and the "right to health".
6. National targets/targets set by Member States.
Conclusion
In today's environment, efforts to improve people's health need to carefully consider the wide and complex range of determinants and influences, as well as the multisectoral and multidisciplinary nature of policies and interventions. Health 2020, by aiming to dramatically increase the priority and resources of efforts on social determinants, health promotion and disease prevention, fully reflects this reality. The complex nature of the determinants of health in today's society, which is characterized by a wide variety of characteristics, an abundance of horizontal links and a massive flow of information, requires any policy to necessarily use a whole-of-government approach and the principle of involvement of the whole society.
The available amount of scientific and practical knowledge is sufficient to improve people's health and reduce the scale of unfair differences in this area. WHO aspires to a world in which the health gap is reduced and universal access to preventive and curative services is ensured; in which countries have sustainable and strong health systems based on primary health care that meet people's expectations and needs; internationally agreed health goals achieved; non-communicable diseases are brought under control; countries are successfully coping with disease outbreaks and overcoming natural disasters.
Health 2020 can help achieve all of these goals. It is a powerful impetus for collective action across the WHO European Region to seize the opportunities that are opening up to improve the health and well-being of current and future generations. The Director-General of WHO said in the foreword to the publication on Health 2020: “The foundations contain a synthesis of all that we have learned in recent years about the role and importance of health. Achieving the highest level of health at all stages of life is the fundamental right of everyone, and not the privilege of a select few. Good human health is a valuable resource and a source of economic and social stability. It plays a key role in reducing poverty and also contributes to and reaps the benefits of sustainable development.” Accordingly, Health 2020 is a powerful impetus for collective action across the WHO European Region to seize the opportunities that are opening up to improve the health and well-being of current and future generations.
Authors: Zsuzsanna Jakab, WHO Regional Director for Europe, WHO Regional Office for Europe, Copenhagen, Denmark; Agis D. Tsouros, Director, Policy and Governance for Health and Well-being, WHO Regional Office for Europe, Copenhagen, Denmark.
The Health 2020 policy states that government action can successfully lead to a real improvement in health, provided that various sectors work together to solve two interrelated strategic objectives:
improving health for all and reducing health inequalities;
improving leadership and collective leadership for health.
Improving health for all and reducing health inequalities.
Countries, regions and cities that set common goals and pool resources for health and other sectors can significantly improve the health and well-being of their residents. Priority areas include early childhood education and the quality of education in general, working and employment conditions, social protection and poverty reduction. At the same time, approaches such as increasing the resilience of communities to negative external influences, social inclusion and cohesion can be used; accumulation of resources for well-being; gender mainstreaming; and development of individual and community resources for health protection and promotion, such as individual skills and a sense of ownership. Setting targets to reduce health inequalities can act as an impetus for action and is an important mechanism for assessing health development at all levels.
Reducing social inequalities makes a significant contribution to health and well-being. The causes of social inequalities are complex and deeply rooted in different periods of a person's life, exacerbating the disadvantage and vulnerability of people. Health 2020 highlights the growing concern about ill health, both in individual countries and in the Region as a whole. In the WHO European Region, the maximum variation in life expectancy at birth is 16 years, with significant differences for men and women, and maternal mortality rates are 43 times higher in some countries of the Region than others. These deep health inequalities are also associated with behavioral factors, including tobacco and alcohol use, dietary and physical activity patterns, and mental disorders, which in turn reflect stress and social insecurity.
Addressing the social and environmental determinants of health will successfully reduce many inequalities. Research shows that effective interventions require policy environments that bridge sectoral boundaries and deliver integrated programmes. For example, the evidence clearly shows that integrated approaches to child well-being and early development lead to more favorable and socially equitable outcomes in both health and education. Health determinant-friendly urban planning and beautification is essential, with city mayors and municipal governments playing an increasingly important role in promoting health and well-being. Participation of all stakeholders, accountability and sustainable funding mechanisms enhance the effectiveness of such local programs.
…but should also aim to reduce health inequalities.
Countries have significant disparities in key lifestyle indicators, including smoking prevalence, obesity, levels of physical activity, and chronic life-limiting diseases.
In addition, the bottom 20% of the population are likely to delay seeking health care for fear of financial catastrophe due to having to pay for services out of their own pocket.
Education and health go hand in hand.
There is compelling evidence that education and health are interrelated. According to research results, the number of completed school years is one of the most important factors correlated with the level of health.
The 2003 Human Development Report (United Nations Development Programme) states:
“Education, health, nutrition, and water and sanitation are mutually reinforcing, so that investment in one of these areas improves outcomes in others.”
Improving leadership and collective leadership for health.
The leadership function of ministries of health and public health agencies remains vital to reducing the burden of ill health across the European Region and needs to be further strengthened. The health sector is responsible for the following activities: development and implementation of national and subnational health strategies; setting goals and targets for improving health; assessment of health impacts from other sectors; providing high-quality and effective medical care; providing essential public health functions. The impact of health policy decisions on other sectors and stakeholders must also be considered.
Ministries of health and public health authorities are increasingly acting as initiators of intersectoral interactions in health and acting as representatives and advocates of health interests. In doing so, they highlight the economic, social and political benefits of good health, as well as the adverse effects of ill health and health inequalities on the performance of any sector, the whole state and the whole society. This leadership role requires skills in diplomacy, drawing on evidence, reasoning and persuasion. The health sector also acts as a partner to other sectors when health promotion can contribute to achieving their goals. At the UN High-Level Meeting on the Prevention and Control of Noncommunicable Diseases and at the World Health Assembly, all countries endorsed collaborative approaches called the whole-of-government approach and the whole-of-society approach. approach).
Authorities at all levels are considering ways to create formal structures and mechanisms to ensure coherence of efforts and intersectoral problem solving. This can strengthen coordination and compensate for existing imbalances in the distribution of power. There is increasing evidence of the strategic benefits of adopting the principle of health in all policies. This approach aims to raise the priority of health on the policy agenda, develop a strategic dialogue on health and its determinants, and ensure accountability for health outcomes. Methods such as health impact assessment and economic analysis are valuable tools for determining the potential impact of certain policies on health and social equity. Health impact assessment requires the collection and validation of qualitative and quantitative health data. Research on well-being, in particular under the auspices of organizations such as the OECD, can also provide useful input.
Whole-of-government approach.
Whole-of-government responses are multi-layered, from local to global, and increasingly involve groups outside the government. Indispensable conditions for the implementation of this approach are the development of an atmosphere of trust, common ethical principles, a culture of concerted action and new skills. It emphasizes the need for better coordination and integration, oriented towards the state's overarching social goals.
In countries with federal systems of government, or where regional and local governments are politically autonomous, a whole-of-government approach can be strengthened through broad consultations between different levels of government. A common requirement for all levels and all systems is accountability.
Inclusion of health interests in all strategies.
The Health in All Policies principle aims to make governance for health and well-being a priority not only for the health sector, but also for other sectors. This principle works in both directions, ensuring, on the one hand, that all sectors are aware of their role in protecting health and act in accordance with this role, and, on the other hand, taking into account the impact of people's health on the activities of their respective sectors.
Governments are also striving to create structures and mechanisms that enable the active involvement of a wider range of stakeholders.
Particularly important is the participation of citizens, civil society organizations and other groups (such as migrants) who make up civil society. Active and committed social groups are joining forces to address health issues at all levels of governance, from global to local. Among the many examples of their activities are the following: summits under the auspices of the United Nations, devoted to health issues; Inter-Parliamentary Union; the WHO Healthy Cities and Communities movement; global anti-poverty movements; advocacy for specific diseases such as HIV; national health target setting initiatives; regional health strategies of specific organizations such as the EU. All this work plays an important role in promoting health and raising the priority of health issues.
Effective community-wide leadership helps achieve better health outcomes. Scientific research demonstrates a strong interdependence between responsible leadership, new forms of leadership and broad participation of all stakeholders. In the 21st century, health leaders can range from many individuals to sectors and organizations. Leadership comes in many forms and requires creativity and new skills, especially in dealing with conflicts of interest and finding new ways to solve intractable complex problems. WHO, together with Member States, has a special responsibility to provide such leadership and support ministries of health in achieving their goals.
Empowering citizens, consumers and patients is key to improving health, health system performance and patient satisfaction with health services. The voice of civil society, including individuals, patient associations, youth organizations and older people, is essential to draw attention to environmental conditions, lifestyle factors or products that are detrimental to health, and gaps in the quality and conditions of care . It is also key to generating new ideas.
The principle of participation of the whole society.
The principle of whole-of-society participation is not limited to specific institutions: it has a mobilizing influence on local and global culture and media, rural and urban communities, and all sectors of policy that are strategic to health, such as education, transport, environmental protection, and even urban design. A good example is the global food supply chain approach to addressing obesity.
Whole-of-society approaches are a form of participatory leadership that can complement public policy. At the same time, special attention is paid to the coordination of activities through the use of generally accepted values and the strengthening of mutual trust among a wide range of different actors.
This approach, through the involvement of the private sector, civil society, local communities and individual citizens, enhances the ability of communities to cope with threats to health, safety and well-being.
The contribution of civil society.
Civil society is a key player in the process of planning, facilitating and practically achieving positive change. The WHO European Region is at the forefront of building innovative partnerships with civil society, including with populations at higher risk (such as people living with HIV) and with nongovernmental organizations that advocate for and provide support to these groups. A number of pan-European networks and organizations have been created to bring together a growing number of people living with HIV.
Working together on shared strategic health priorities.
The Health 2020 policy framework includes four priority areas for strategic action:
investing in health throughout the life course and empowering citizens;
addressing the most urgent problems of the Region related to non-communicable and infectious diseases;
strengthening people-centred health systems, public health capacity, emergency preparedness, surveillance and response;
increasing the "strength" of local communities and creating a supportive environment.
In a spirit of coherence and consistency, these four priority areas are built on "categories for setting WHO's priorities and programmes". These categories have been adopted globally by Member States and have been adjusted to reflect the specific requirements and experiences of the European Region. They also draw on relevant WHO strategies and action plans at the regional and global levels.
The four priority areas are interconnected, interdependent and complementary. For example, action throughout the life-course and empowerment of people will help contain the epidemic of noncommunicable diseases, as will increased public health capacity, which in turn will better manage outbreaks of communicable diseases. Governments achieve greater positive health impacts when they link policies, investments and services and focus on reducing social inequalities. The WHO Regional Office for Europe will strengthen its role as a resource for evidence-based policy development and examples of such integrated approaches. Monitoring of regional progress in the implementation of Health 2020 will be carried out using the main targets.
Achieving these four priorities requires integrated governance approaches that promote health, equity and well-being. Smart governance aims to bring about positive change, promotes innovation, and is focused on investing resources in health promotion and disease prevention. New approaches include leadership through collaboration, through citizen engagement, through a combination of regulation and persuasion, and through independent agencies and expert bodies. There is a growing need to use evidence to inform policy and practice, adhere to ethical standards, increase transparency and strengthen accountability in areas such as privacy protection, risk assessment and health impact assessment.
Health 2020 recognizes that countries have different starting positions, are in different contexts and have different capacities. Health policy decisions often have to be made in the face of uncertainty and imperfect knowledge. However, for many aspects of health care reform, broader systemic effects cannot be fully predicted. The solution of complex problems, such as obesity, comorbidity and neurodegenerative diseases, is especially difficult. The use of results from sociological, behavioral and political science research, including such areas as social marketing, behavioral economics and the science of neural activity, is becoming increasingly important. Research demonstrates the value of implementing small-scale but comprehensive interventions at the local and community levels to build learning experiences and then adapt. Collaboration across the European Region can enhance the development of expertise: each country and sector can both learn from each other and make valuable contributions.
The main targets of the health policy 2020.
The overarching objective of Health 2020 is to achieve tangible improvements in the health of the people of the Region. In this regard, Member States have jointly formulated the following regional goals:
1. By 2020, reduce premature mortality in the population of the European Region.
2. Increase the average life expectancy for the population of the European Region.
3. Reduce health inequalities in the European Region.
4. Increase the level of well-being of the population of the European Region.
5. Ensure universal service coverage and the right to the highest attainable standard of health.
6. Set national health goals and targets in Member States.
A set of voluntary indicators endorsed by Member States can be used to monitor progress towards national health targets.
The Health 2020 process is supported by health information systems.
Health information systems and services need to be improved in all Member States of the WHO European Region. The WHO Regional Office for Europe assists Member States in assessing and ensuring the technical improvement of such systems and provides countries with information on health issues through the following channels:
Cooperation with international partners to ensure standardization, increase the level of international comparability and quality of health data;
Collaboration with a network of institutions and agencies directly involved in health information and evidence;
Actively collect, disseminate and provide easy access to health data and research results.
Topic: WHO Health for All 21st Century Strategy
LEARNING QUESTIONS:
1. Tasks facing the world community.
Currently, the world community is putting forward new tasks:
Sustainable development of society in harmony with nature;
Formation of the humanistic paradigm;
Protecting and ensuring the rights of man and peoples throughout the world;
Achievements in the XXI century "health for all". The policy of achieving health for all in the twenty-first century is a perspective vision of this problem.
The policy of achieving "health for all in the twenty-first century", adopted by the world community in May 1998, is aimed at realizing the strategic concept of health for all. It originated during the 1977 World Health Assembly and proclaimed at the Alma-Ata Conference in 1978. This policy sets out global priorities and targets for the first two decades of the twenty-first century, which should enable the world to achieve and maintain both the highest attainable level of health throughout the life cycle.
Health for all – all people in all countries should have at least a level of health that allows them to lead an active productive and social life in the community in which they live
A global health-for-all policy for the twenty-first century must be implemented through appropriate regional and national strategies. For our country, which gravitates toward the European region, it is the European experience in developing and implementing a unified strategy for "achieving health for all in the European region" that is of the greatest interest.
The key goal of Health 21 in the European Region is for all people to realize their full "health potential". Health potential - the maximum achievable level of human health
2. The main goal and strategies of the global health for all policy.
The goal can be achieved by:
Ensuring equality in health care through solidarity of action;
Strengthening and protecting the health of people throughout their lives;
Reducing the prevalence and suffering caused by major diseases, injuries and disabilities.
Four main action strategies have been selected to ensure scientific, economic, social and political sustainability as a constant prerequisite and driving factor in realizing the goals of HEALTH21:
Multisectoral strategies to improve the determinants of health - taking into account physical, economic, social, cultural and gender perspectives - and using health impact assessments;
Results-oriented programs and investments to develop health care and clinical care;
An integrated primary health care system focused on serving the family and community levels and supported by a flexible and responsive hospital system (hospital); and finally
Participatory and collaborative health action involving relevant health partners at all levels - home/family, school and workplace, locality/community and country - and facilitating collaborative decision making, enforcement and accountability.
Twenty-one HFA targets have been formulated for the European Region. They should become a kind of yardstick for assessing progress and achievements in improving and protecting health and reducing risk factors for health. These objectives represent the basis for the design and development of health policy in the European Region.
The 2005 update emphasizes the following key principles underpinning the health for all policy.
The ultimate goal of health policy is the full realization of the existing health potential by all people.
Closing disparities in health status between and within countries (i.e. strengthening solidarity) is of great importance for public health in the region.
Community participation is a key condition for health development.
Health development can only be achieved through intersectoral strategies and intersectoral and intersectoral investment aimed at improving the determinants of health.
Each sector of society is responsible for the consequences that its activities have on people's health.
3. European Region: Twenty-one targets for health for all
The concretization of these goals is contained in the tasks.
Target 1 – solidarity for health in the European Region.
By 2020, the current health gap between the Member States of the European Region must be reduced by at least one third.
Target 2 - health equity
By 2020, the health gap between socioeconomic groups within countries must be reduced by at least one quarter in all Member States through significant improvements in the health of underserved populations.
Task 3 - a healthy start in life
By 2020, all newborns, toddlers and preschool children in the region should be healthier, giving them a healthy start in life. This implies:
Target 4 - youth health
By 2020, young people in the region should be healthier and better equipped to fulfill their responsibilities in society.
Task 5 - maintaining health in old age
By 2020, people over the age of 65 should be able to realize their full potential in terms of their own health and play an active social role in society.
Goal 6 - Improving Mental Health
By 2020, there should be an improvement in the psychosocial well-being of people and the availability of comprehensive services that will provide assistance to people with mental health problems.
Target 7 - Reducing the prevalence of infectious diseases
By 2020, there should be a significant reduction in the prevalence of infectious diseases through systematic programs for the partial and complete elimination, as well as the control of infectious diseases.
Target 8 - Reducing the prevalence of non-communicable diseases.
By 2020, morbidity, disability and premature death associated with major chronic diseases should be reduced to the lowest possible levels in the entire region.
Target 9 - Reducing injuries from acts of violence and accidents
By 2020, there should be a significant and sustainable reduction in the number of injuries, disabilities and deaths due to accidents and acts of violence in the region.
Target 10 - healthy and safe physical environment
By 2015, the population of the region should live in a safe physical environment, free from exposure to pollutants hazardous to health, within levels exceeding international standards.
Suggested Strategies
Target 11 - a healthier lifestyle
By 2015, people in all walks of life must adopt a healthier lifestyle.
Target 12 - Reduce the harm caused by alcohol, addictive drugs and tobacco
By 2015, the adverse health effects associated with the consumption of dependence-producing drugs such as tobacco, alcohol and psychoactive drugs are expected to be significantly reduced in all Member States.
Task 13 - healthy environment conditions
By 2015, people in the region should be better able to enjoy a healthy physical and social environment at home, at school, in the workplace and in the local community.
Target 14 - Strengthening the responsibility and accountability of various sectors for activities that affect health
By 2020, all sectors must recognize and accept responsibility for health.
Target 15 - Integrated health sector
By 2010, the population of the region should have better access to family- and community-centered primary health care, supported by a flexible yet stable hospital system.
Target 16 - Build an integrated health sector, meaning increased synergies between different entities, with an emphasis on the role of an integrated primary health care system
By 2010, Member States must ensure that health sector governance - from population-based programs to individual patient care at the clinical level - is results-oriented.
Target 17 - Financing health services and allocating resources
By 2010, Member States should have stable funding and resource allocation mechanisms for health systems based on the principles of equitable access, cost-effectiveness, solidarity and optimal quality.
Target 18 - Development of human resources for health
By 2010 All Member States must ensure that health workers and workers in other sectors acquire the necessary knowledge, skills and abilities in matters of health protection and protection.
Target 19 - Research and health information
All Member States should have in place research information and communication systems that can better facilitate the acquisition, use and dissemination of health-for-all data.
Target 20 - Mobilizing partners for health
By 2005, the implementation of the health-for-all policy must ensure the participation of individuals, groups and organizations in both the public and private sectors, as well as the whole of civil society, uniting them in commonwealth and partnership to work for health.
Target 21 - health-for-all policies and strategies
By 2010, all Member States should not only have but also implement health-for-all policies at country, regional and local levels, supported by appropriate institutional structures, governance processes and innovative leadership.
BIBLIOGRAPHY
1. Abramenkov organization of healthcare and the right to health - Foreign economic relations. - 2006. - T. 21. - No. 1. - P. 28-31.
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3. European Health Report 2002. WHO Regional Office for Europe, Copenhagen. European Series, No. 97.-156 p.
4. Report on the state of health in Europe. Public health action to improve the health of children and the general population. – WHO Regional Office for Europe. 2005.
5. Health21: policy framework for health for all in the WHO European Region. European Health for All Series No. 6.- Copenhagen, 1999.-310 pp.
6. Macroeconomics and health: investment in health for economic development. Report of the Commission on Macroeconomics and Health. - WHO. Geneva, 2001.
7. Policy framework for health for all in the WHO European Region. Update 2005 - European Health for All Series, no.