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Progress towards the Health 2020 targets
Within only a few years of the development of the Health 2020 policy, increasing numbers of countries are adopting and using its principles and approaches to improve citizens’ health and well-being. The WHO European Region is on track to achieve the Health 2020 target to reduce premature mortality from cardiovascular diseases, cancer, diabetes mellitus and chronic respiratory diseases by 1.5% annually until 2020. Most of the progress in the Region is the result of improvements in countries with the highest premature mortality.
Alcohol consumption, tobacco use and overweight and obesity remain major public health problems in the Region. Europe has the highest rates of alcohol and tobacco use in the world and WHO estimates show rises in the prevalence of overweight and obesity between 2010 and 2014 in almost all countries. Despite high overall coverage for measles vaccination in the Region, immunity gaps in the population persist, resulting in ongoing endemic transmission and some countrywide outbreaks. The gaps between the highest and lowest reported values for the Health 2020 indicators linked to the social determinants of health – infant mortality, life expectancy, primary school enrolment and unemployment – have shrunk. Preliminary data suggest that this positive trend has continued since 2010, although absolute differences between countries remain large. Out-of-pocket payments as a proportion of total expenditure on health at the regional level (24%) have not changed since 2010. In 2012, this proportion was below the 15% threshold critical for preventing catastrophic levels of health expenditure in only 12 of the 53 countries in the Region.
Well-being and its cultural contexts
By adopting Health 2020, Member States mandated the WHO Regional Office for Europe to measure and report on the well-being of the European population in a holistic manner. Well-being is a unifying concept that is relevant to many government sectors. Engaging with well-being provides an important opportunity to take a whole-of-government approach to improving the health of the European population.
A growing body of evidence shows that:
○○ well-being can be reliably measured at the local and national levels;
○○ this shows something not captured by other metrics; and
○○ designing policies that take account of well-being can improve the delivery of health-related programmes, services and benefits.
Well-being is experienced at the subjective, individual level; it can also be described objectively through several indicators at the population level, such as education, income and housing. Engaging with the full complexity of subjective well-being demands a multidisciplinary, integrated health-research approach. This will require a more sustained use of different types of qualitative evidence to enhance the quantitative data available from wellbeing surveys.
Comparing subjective well-being data between groups from very different cultural contexts remains a challenge. Since cultural contexts strongly influence well-being, their importance to well-being and health more generally must be investigated more systematically.
New frontiers in health information and evidence
Some of the main problems with data collections used to inform the Health 2020 monitoring framework relate to data quality, regularity of collection and timeliness of reporting. Improvements in certification and coding practices will significantly strengthen the quality of cause-of-death data. Compliance by all Member States with the recommended level of detail of reporting to WHO would further increase the utility and comparability of indicators based on these data.
WHO and many countries have experienced a paradigm shift in public health from focusing on death and disease to focusing on health and well-being. More weight should be given in health information to subjective and qualitative data to ensure that it reflects this shift.
Exploring non-traditional sources of health information should be considered to improve reporting on health and well-being across the European Region. Historical records and anthropological observations may be useful sources of information on wellbeing.
Data sources such as social media, mobile phone data and electronic health records can add new insights to regular health statistics.
Health 2020 monitoring should be optimized by looking beyond the usual indicators and broadening its scope …”