Title: Priority for public health in Europe
1Priority for public health in Europe
Primary Health Care, A Solution? An Old Remedy?
Peter WS Chang, MD, MPH, ScD
Desiderius Erasmus Roterodamus 1469-1536
2Overview
- Before Alma-Ata/PHC/HFA
- What were in the Alam-Ata, what were not
- Why HFA did not deliver?
- Priority for public health in Europe
- What are needed beyond
3Reflections on health care, primary care
- Health care started from primary care.
- The healers received and examined, advised, then
helped did not turn the patients away or
referred to others. - Primary health care with advantage of providing
continued care, fully satisfy patients need. - New health care is fragmented.
4Dr. Halfdan Mahler, 1973-1988
"Methods of promoting the development of basic
health services" by WHO's Executive Board in
1973, co-sponsorship with UNICEF to convene "The
International Conference on Primary Health Care"
in Alma-Ata in 1978.
5Declaration of Alma-Ata
- A set of guiding values for health development, a
set of principles for the organization of health
services, and a range of approaches for
addressing priority health needs and the
fundamental determinants of health. - Broadened the medical model to include social and
economic factors, and acknowledged that
activities in many sectors, including civil
society organizations, shaped the prospects for
improved health. Fairness in access to care and
efficiency in service delivery were overarching
goals. - "It is the first level of contact of individuals,
the family and community with the national health
system bringing health care as close as possible
to where people live and work, and constitutes
the first element of a continuing health care
process."
6When I took office in 2007, I made clear my
commitment to direct WHOs attention towards
primary health care
.. health systems had to be scaled up through
dynamic collaboration among governments,
international partners, non-governmental
organizations and the private sector .
combating disease and improving health in
developing countries is being enhanced by new
technologies, service-delivery mechanisms and
partnerships.
7World distribution of health workers
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10Margaret Chan, Lancet 2008
- Primary health care increasingly looks like a
smart way to get health development back on
track. - The Millennium Declaration and its Goals breathed
new life into the values of equity and social
justice, this time with a view towards ensuring
that the benefits of globalization are more
evenly distributed between countries. - In August 2008, the Commission on Social
Determinants of Health issued its final report.
Its arguments make a compelling call for close
attention to health in all government policies,
in all sectors. the report champions primary
health care as a model for a health system that
acts on the underlying social, economic, and
political causes of ill health. - World Health Report on primary health care. Timed
to commemorate the Alma-Ata anniversary, the
report offers practical and technical guidance
for reforms that can equip health systems to
respond to health challenges of unprecedented
complexity.
11- EXECUTIVE BOARD 124th Agenda item 4.5 EB124/8
Jan. 2009 - Primary health care, including health system
strengthening - - renewal of primary health care
- recognize the potential of primary health care
for providing a - stronger sense of direction and unity in
segmented and fragmented - health systems
- - the framework integrates health into all
policies - need for improved health systems performance
based on the values of - primary health care
- Commission on Social Determinants of Health
underlying social, - economic, and political causes of ill health,
and of the methods most - likely to provide solutions
- - renewed focus on primary health care
How can political commitment avoid fail to
deliver?
124 Broad Policy Areas for Essential Changes
- dealing with health inequalities by moving
towards universal coverage -
- putting people at the centre of service delivery
-
- integrating health into public policies across
sectors -
- - providing inclusive leadership for health
governance
13Can primary health be a solution for all (health
system)?
14Can primary health be a solution for all (health
system)?
Can primary health care help health system
survive the financial crisis than the others?
15Priority for public health in the new Europe
16How does it work in Europe?
- One member country, one commissioner
enterprise and industry Günter Verheugen
consumer protection
Meglena Kuneva
healthy Androulla Vassiliou
environment Stavros Dimas
development humanitarian aids Louis Michel
17EU competences in health care system?
- Alzheimer's disease and other dementias Health
Security and Bio-terrorism - Blood Tissues Cancer
- Communicable Diseases Cross-border Healthcare
- European Health Examination Surveys Extreme
weather conditions - Health Reports Health Indicators
- Health Environment Health Workforce
- HIV/AIDS Injury Prevention and Injury Database
- Major and chronic diseases Mental Health
- Nutrition Patient Safety
- Pharmaceutical Forum Rare Diseases
- Scientific Committees Tobacco
18European health agencies
- Governed by European public law has its own
legal personality. - European Centre for Disease Prevention and
Control (ECDC) mobilise and reinforce the
synergies between the existing national centres
for disease control. - provide authoritative scientific advice on
serious health threats, recommend control
measures, allow quick mobilisation of
intervention teams, enable a rapid and effective
EU-wide response. From early 2005
onwards.European Environment Agency (EEA)
collect, prepare and disseminate timely,
targeted, relevant and reliable information on
the state and trends of the environment. is open
to countries that do not belong to the European
Union but share its concern for the environment.
co-operates actively with other relevant bodies
and international organisations.European
Monitoring Center for Drugs and Drugs Addiction
(EMCDDA) collect and disseminate 'objective,
reliable and comparable information' on the
phenomenon of drugs and drug addiction in Europe.
works in partnership with non-EU countries as
well as with international organisations - European Agency for the Evaluation of Medicinal
Products (EMEA) protection of public and animal
health. works as a network, bringing together the
scientific resources of the EU and EEA-EFTA
Member States, ensure the highest level of
evaluation and supervision of medicines in
Europe. - European Agency for Safety and Health at Work
(EU-OSHA) bring together and share the region's
vast pool of knowledge and information on
OSH-related issues, particularly preventative
measures.European Food Safety Authority (EFSA)
provide independent scientific advice on all
matters with a direct or indirect impact on food
safety. cover all stages of food production and
supply, from primary production to the safety of
animal feed,
19Overview of European health strategy (1)
- an important priority for Europeans
- (Europeans) expect to be protected against
illness and disease - bring up (our) children in a healthy environment
- demand workplace safe and hygienic
- travelling (within the European Union) with
access to reliable and high-quality health advice
and assistance
20Overview of European health strategy (2)
- Public authorities (in Member States) have a
responsibility to ensure that these concerns are
reflected in their policies. - (The European Union) has a vital role to play
through the obligations placed on it by the
European Treaties. - Cross-border health threats, influenza, free
movement of patients and medical personnel
EU
individuals
community
States
21Overview of European health strategy (3)
- A coherent and coordinated approach to health
policy first set out in the European Community
health strategy in May 2000. - A new Health Strategy 'Together for Health A
Strategic Approach for the EU 2008-2013 adopted
on 23 October 2007.
224 principles and 3 strategic themes
Overview of European health strategy (4)
- taking a value-driven approach,
- recognising the links between health and economic
prosperity, - integrating health in all policies,
- strengthening the EU's voice in global health.
23Overview of European health strategy (5)
- 4 principles and 3 strategic themes
- Fostering Good Health in an Ageing Europe,
- Protecting Citizens from Health Threats,
- Dynamic Health Systems and New Technologies.
24The Strategy is supported by financial tools both
in DG SANCO and in other sectors, such as the 7th
Framework Programme for Research, and Regional
Policy funding. The Health Programme 2008-2013
Funding EUR 321,500,000
Overview of European health strategy (6)
25Overview of European health strategy (7)
To improve citizens health security
Developing EU and Member States capacity
to respond to health threats, health
emergency planning, preparedness measures
Actions patient safety, injuries and accidents,
risk assessment, community legislation on blood,
tissues and cells.
26Overview of European health strategy (8)
To promote health and reduce health
inequalities Action on health determinants
nutrition, alcohol, tobacco, drug consumption,
social and environmental determinants
Measures on the prevention of major
diseases and bridging health inequalities
across the EU Increasing healthy life years
and promoting healthy ageing.
27Overview of European health strategy (9)
To generate and disseminate health information
and knowledge Action on health
indicators, disseminating information to
citizens Focus on Community added-value
action to exchange knowledge in areas such as
gender issues, childrens health or rare
diseases.
28Marc DanzonWHO Regional Director for Europe
- Europe is in a period of extensive innovation in
primary care - (Efforts) help close the gap between the
expectations of health policy-makers about the
major role that primary care should play, , and
the day-to-day performance of real health systems - how primary care can best be institutionalized
within modern health care systems? - whether primary care ought to be in the health
systems drivers seat yet to be determined.
Organizational reform in European primary
care Richard B. Saltman, Ana Rico, Wienke
Boerma Open University Press, 2006
29- 24 November 2008
- Home care in Europe the solid facts
Quality in Primary Care 2008
30The PHAMEU projectPrimary Health Care Activity
Monitor for Europe
- coordinated by NIVEL and a network of
institutes organisations in EU - to establish
a sustainable health information and knowledge
system on the state and development of primary
care systems in Europe. - - monitor the degree of development of primary
care systems by means of a measurement instrument
applicable to all national situations in Europe,
able to capture the essential elements of primary
care. - Expect a primary care monitoring instrument
providing country descriptions, international
comparisons, trends in primary care, implications
for primary care policy. - Duration from 1 November 2007 until 1 November
2010.
31GP density/ Role of GPs as doctor of first
contact with health problems
http//www.phameu.eu/
- Heterogeneity and distribution in Europe
32What are the problems?
- In-suf?cient coherence and coordination
- Character and conditions of primary care so
diverse - Constantly rising health expenditures, the health
needs of growing subgroups of the population,
such as the chronically ill, the elderly and
those in need of hospice services in their homes,
are not well met (McKee and Healy, 2001) - Unmet needs, unnecessary treatments,
medicalization, other threats to patients safety - side effect of specialization and
sub-specialization in health care, by which
professional inward-directedness tended to grow
at the expense of attention to integration with
other disciplines
33Expanded horizon of health care services
- Problems of coordination are likely to arise at
key interfaces between primary and secondary
care, between curative care and public health
services, and between specialities within
particular subsectors - Growing importance of anticipatory medicine and
prevention. - Poor communication between primary care,
hospitals, and medical specialists has been well
documented in many health care systems
34Why PHC preferred?
- Relationship between strong primary care systems
and health outcome measures (Starfield,1992). - The strength of primary care systems in countries
related to cost-containment and health outcomes
(Starfield 1994 Delnoij et al. 2000 Shi 2002
Macinko et al. 2003). - If more health care providers were directly
accessible in a country, patients showed a higher
satisfaction with general practice than in
countries where more referrals were required
(Madelon W. Kroneman et al, 2006)
35- strong primary care system is the linchpin of
effective health care delivery and can help
resolve the lack of continuity and responsiveness
in health care in general (Saltman and Figueras,
1997 WHO, 2002). - strong primary care based systems are cheaper to
operate than more open systems, health outcomes
are better (Star?eld, 1994 Doescher et al.,
1999 Shi et al., 2002 Macinko et al., 2003). - only a few OECD countries have been able to
improve essential features of primary care since
1970 (Macinko et al. 2003)
36Other disciplines in primary care
- Nursing, community nurses
- Pharmacist
- Physiotherapist
- Midwife
- Other home helpers
- How to integrate these resources?
37Time to develop new players and indicators
- Considering the population distribution, health
care provider distribution, transportation/communi
cation, availability of GP, other helpers
38Factors in new indicators for PHC
- Disease incidences
- Hospitals, specialties,
- Health professionals
- Ambulance
- Transportation
39New players for PHC to join? When?
- eBusiness/ eHealth model?
- Internet
- Email
- Google-messenger/video-MedWeb? (ebanking?)
- Skype-video
40- Thank you for your attention.
Dr. and Mrs. Landsborough (1913)
John Snow 1813-1858
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42Almere health care experiment
- 1978, first Dutch model of PC
- Suburb of Amsterdam, 165,000 population, 6500
increase each year - Design a well-developed coherent system of
primary care, with a minimum amount of secondary
level facilities. - A foundation was created to employ all GPs,
physiotherapists, pharmacists, dentists, midwives
and auxilliary staff, social workers and
community nurses - The goal reduce referrals to medical
specialists. - Reduce use of antibiotics particularly by
children, as were tonsillectomies. - At least one female GP in every health centre,
43- Coordination, teamwork, integration
- - offers diagnostic, curative, rehabilitative
and palliative services in response to the bulk
of these problems - - offers prevention to individuals and groups at
risk in the population served - - takes into account the personal and social
context of patients - - is provided by a variety of disciplines,
either within primary care, secondary care or
related sectors - - assures patients continuity of care over time
as well as between providers.