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Chapter 1. Overview
CHAPTER 1
Overview
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This overview sets out the aims, scope and target audiences of the 2021 European Health Report and outlines the content of Chapters 2–4 and how these interrelate. Annex 1 includes more information on the selection of indicators and Annex 2 on the data used in the graphs, tables and maps presented in the Report. In addition, a supplement with indicator projections is available (Supplement to the European Health Report 2021: Projections for a selection of indicators for health-related Sustainable Development Goals). Main aims of the European Health Report 2021 and target audiences
The European Health Report is produced every three years as a flagship publication by the WHO Regional Office for Europe. The Reports provide an overview of population health – that is, the health status of the population of the WHO European Region – including health determinants, UHC and health inequalities. The Reports also analyse the Region’s progress towards its health
policy goals and targets to identify priority areas for further improvement. As a result, the European Health Reports provide guidance for action at Regional level by pinpointing areas for intensified support from the WHO Regional Office for Europe for Member States. The Reports do not aim to provide recommendations for action to individual Member States.
The past three European Health Reports (2012, 2015 and 2018) provided the baseline measurement and follow-up of progress towards the targets of the Health 2020 policy (1–3). The 2021 Report has been prepared in a transitional and exceptional year in which the Region started with implementing the EPW, and in which the COVID-19 pandemic caused by the SARS-CoV-2 infection continued to have a major impact on the health of our populations and health systems. At the time of writing, the measurement framework for the EPW was still under development. It was recently adopted at the 71st session of the WHO Regional Committee for Europe (4). Like the measurement framework for the global GPW13 (5), the EPW measurement framework strongly builds on the SDGs, which comprise the overarching policy framework to which all United Nations Member States have committed (Box 1.1).
Box 1.1.The SDGs and their relevance for health
The SDGs are linked to the 2030 Agenda for Sustainable Development (6). The 2030 Agenda was adopted by the United Nations in 2015 as a universal call to action to end poverty, protect the planet and ensure that by 2030 all people enjoy peace and prosperity. There are 17 SDGs and 231 unique indicators. The 17 SDGs are integrated: they recognize that action in one area will affect outcomes in others, and that development must balance social, economic and environmental sustainability. Countries have committed to prioritize progress for those who are furthest behind. The SDGs are designed to end poverty, hunger, HIV/AIDS, and discrimination against women and girls.
Box 1.1 contd
The creativity, knowledge, technology and financial resources from all of society are necessary to achieve the SDGs in every context (7). One of the SDGs, SDG 3, is specifically focused on ensuring health and well-being for all at all ages. However, as all SDGs are interrelated, all the other SDGs are also relevant for health, as depicted in Fig. 1.1.
Fig. 1.1. SDG 3 in relation to the other 16 SDGs
LIFE BELOW WATER PARTNERSHIPS FOR THE GOALS
LIFE ON LAND PEACE, JUSTICE AND STRONG INSTITUTIONS
EMPOWERING STRONG LOCAL INSTITUTIONS TO DEVELOP, IMPLEMENT, MONITOR AND ACCOUNT FOR AMBITIOUS NATIONAL SDG RESPONSES MOBILIZING PARTNERS TO MONITOR AND ATTAIN THE HEALTH-RELATED SDGS
PROMOTING HEALTH AND PREVENTING DISEASE THROUGH HEALTHY NATURAL ENVIRONMENTS
SUPPORTING THE RESTORATION OF FISH STOCKS TO IMPROVE SAFE AND DIVERSIFIED HEALTHY DIETS
NO POVERTY
PRIORITIZING THE HEALTH NEEDS OF THE POOR
ZERO HUNGER
ADDRESSING THE CAUSES AND CONSEQUENCES OF ALL FORMS OF MALNUTRITION
SUPPORTING HIGH-QUALITY EDUCATION FOR ALL TO IMPROVE HEALTH AND HEALTH EQUITY
QUALITY EDUCATION
FIGHTING GENDER INEQUITIES, INCLUDING VIOLENCE AGAINST WOMEN
GENDER EQUALITY
CLIMATE ACTION
PROTECTING HEALTH FROM CLIMATE RISKS, AND PROMOTING HEALTH THROUGH LOW-CARBON DEVELOPMENT
PREVENTING DISEASE THROUGH SAFE WATER AND SANITATION FOR ALL
CLEAN WATER AND SANITATION
RESPONSIBLE CONSUMPTION AND PRODUCTION
PROMOTING RESPONSIBLE CONSUMPTION OF MEDICINES TO COMBAT ANTIBIOTIC RESISTANCE
FOSTERING HEALTHIER CITIES THROUGH URBAN PLANNING FOR CLEANER AIR AND SAFER AND MORE ACTIVE LIVING
SUSTAINABLE CITIES AND COMMUNITIES
ENSURE HEALTHY LIVES AND PROMOTE WELL-BEING FOR ALL AT ALL AGES
PROMOTING SUSTAINABLE ENERGY FOR HEALTHY HOMES AND LIVES
ENSURING EQUITABLE ACCESS TO HEALTH SERVICES THROUGH UNIVERSAL HEALTH COVERAGE BASED ON STRONGER PRIMARY CARE PROMOTING NATIONAL R&D CAPACITY AND MANUFACTURING OF AFFORDABLE ESSENTIAL MEDICAL PRODUCTS
PROMOTING HEALTH EMPLOYMENT AS A DRIVER OF INCLUSIVE ECONOMIC GROWTH
DECENT WORK AND ECONOMIC GROWTH
REDUCED INEQUALITIES
INDUSTRY, INNOVATION AND INFRASTRUCTURE AFFORDABLE AND CLEAN ENERGY
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In this context, the main aims of the European Health Report 2021 are to:
• provide an overview of where the WHO European Region stands regarding progress towards the health-related SDGs, which should be achieved by 2030;
• provide insight into both the direct and indirect effects of the COVID-19 pandemic on population health in the Region;
• provide insight into current health inequalities in the Region and how the COVID-19 crisis is affecting these;
• describe how the WHO Regional Office for Europe through the implementation of the EPW aims to support Member States over the coming years in tackling the major challenges in the Region and building back better after the pandemic; and
• highlight the most important gaps in data and information that are currently hampering implementation of the EPW, GPW13 and SDGs, and describe how WHO will support Member States in strengthening their
HISs to improve the evidence base for informed decision-making.
The Report aims to provide insight into progress towards a subset of the SDGs, which are the goals of the 2030 Agenda. Implementation of the 2030 Agenda is a whole-of-society effort, in which not only policy-makers and the public sector but also other parties such as civil society and the private sector must contribute. Therefore, the findings of the Report will be of interest to a broad audience, including policy-makers, civil society organizations (such as patient associations, health worker associations, health advocacy organizations and other nongovernmental organizations (NGOs)), public health experts, academic institutions and the media.
Content of the Report
The Report has three main chapters. In addition to the full Report, a short publication of highlights is also available for a quick overview of key messages.
Chapter 2 assesses whether the Region is on track towards reaching the health-related SDGs. For the purpose of this Report, health-related indicators have been defined as not just the indicators within SDG 3 but also several indicators within other SDGs that represent topics within WHO’s direct scope of work (for example, childhood obesity, air pollution and violence against women) and that are used in the Impact Measurement Framework of the GPW13. This implies that not all SDG indicators that are relevant for health will be included in the Report. However, as the Report aims to provide guidance for action at Regional level, the choice was made to focus on those topics that are directly linked to WHO areas of work.
Chapter 2 outlines the latest available official WHO or United Nations data and, where data are available, time trends and main health inequalities.
Chapter 2. Taking stock of the health-related SDGs in the WHO European Region
The chapter highlights important data gaps for monitoring progress towards the health-related SDGs. For some indicators, only data for a very limited number of Member States are available; for other indicators, no recent data are available. These data gaps are further addressed in Chapter 4.
To inform targeted activities under the EPW, the SDG indicators are structured according to the three EPW core priorities:
• moving towards UHC
• protecting against health emergencies
• promoting health and well-being.
Through the focus on health inequalities, insight is provided into the effort still needed to make sure that no one is left behind in the WHO European Region.
As official statistics often lag by a few years, the impact of the COVID-19 pandemic on population health is not adequately captured in the data presented in Chapter 2. Therefore, Chapter 3 aims to provide insight into the scope and magnitude of the impact of the COVID-19 pandemic. It gives a comprehensive overview of both the direct and the indirect impacts of the pandemic on population health, while paying specific attention to UHC, mental health and health inequalities. The discussion mainly builds on emergent data and evidence from scientific literature and reports. Chapter 3 is complementary to Chapter 2: together, these chapters provide an overview of where the WHO European Region currently stands in relation to achieving the SDGs and what the biggest challenges are for the core priorities of the EPW.
Chapter 4. Building back better under the EPW and the role of HIS strengthening
Chapter 4 aims to describe how the WHO Regional Office for Europe, together with the Member States, will work under the EPW to overcome the challenges described in Chapters 2 and 3 and build back better after the pandemic. It starts with a description of the overarching priorities of the EPW and the more specific priorities set for the Region in the implementation of the EPW in the next biennium (2022–2023). A well-performing health information system (HIS) is a prerequisite for evidence-informed policy implementation and evaluation. Therefore, Chapter 4 also looks in more detail at the work within the WHO Regional Office for Europe that targets improving the evidence base for policy-making. Chapter 2 shows that monitoring progress towards the health-related SDGs is seriously hampered by lack of (recent) data for several key areas. Even before the COVID-19 pandemic, HISs in the WHO European Region were facing challenges, hampering the optimal use of health intelligence for decision-making. The pandemic has strained every HIS and exposed existing weaknesses. Chapter 4 describes the main tools and activities that the Regional Office will deploy to support Member States in strengthening their HIS and overcoming data gaps for key indicators to enhance evidence-informed implementation of the SDGs, the GPW13 and the EPW. Specific attention is paid to challenges and opportunities related to the digitalization of HISs.
References1
1 The European health report 2012: charting the way to well-being. Copenhagen: WHO Regional Office for Europe; 2013 (https://apps.who.int/iris/handle/10665/326381).
2 The European health report 2015: targets and beyond – reaching new frontiers in evidence. Copenhagen: WHO Regional Office for Europe; 2015 (https://apps.who.int/iris/ handle/10665/327873).
3 European health report 2018: more than numbers – evidence for all. Copenhagen: WHO Regional Office for Europe; 2018 (https://apps.who.int/iris/handle/10665/279904).
4 Seventy-first Regional Committee for Europe: virtual session, 13–15 September 2021: resolution: measurement framework for the European Programme of Work, 2020–2025. Copenhagen: WHO Regional Office for Europe; 2021 (EUR/RC71/R7; https://apps.who.int/ iris/handle/10665/345258).
5 Thirteenth general programme of work (GPW13): methods for impact measurement, version 2.1. Geneva: World Health Organization; 2020 (https://apps.who.int/iris/ handle/10665/341371).
6 Transforming our world: the 2030 Agenda for Sustainable Development [website]. New York: United Nations Department of Economic and Social Affairs; 2021 (https://sdgs. un.org/2030agenda).
7 What are the Sustainable Development Goals? [website]. New York: United Nations Development Programme; 2021 (https://www.undp.org/sustainable-development-goals).
1 All references were accessed on 26 October 2021.
