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NEWS: Tessa Richards WHO European region commits to new health charter BMJ 2008; 337: a621 [Full text]

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New Charter puts social well-being at the centre of health systems, health and wealth interactions

Nata Menabde   (7 July 2008)

New Charter puts social well-being at the centre of health systems, health and wealth interactions 7 July 2008
Nata Menabde, Deputy Regional Director WHO Regional Office for Europe Send response to journal: Re: New Charter puts social well-being at the centre of health systems, health and wealth interactions	Health officials from the 53 countries that make up the WHO European Region, met in Tallinn, Estonia, to sign a European charter on health systems on 27 June 2008. As reported by the BMJ (1), this was a seminal event in developing a new vision on health and health systems as the new charter enshrines practical measures for both implementing and, most importantly, assessing the effectiveness of health systems. The Tallinn Charter: Health Systems for Health and Wealth (2) starts with the recognition that all WHO’s European Member States need to address major health challenges head on: demographic and epidemiological change, widening socioeconomic disparities, limited resources, technological development and rising expectations. While acknowledging the social, cultural and economic diversity across the Region, the decisive fact is that by signing the Charter the countries committed themselves to improve people’s health through strengthening their health systems. The Charter reaffirms the values embodied in the Declaration of Alma-Ata on primary health care (3) (which will soon celebrate its thirtieth anniversary), the 1996 Ljubljana Charter (4), and The world health report 2000 (5). Essential to WHO’s philosophy is that health is a fundamental right of all people and has value in itself. The WHO Regional Office for Europe has launched a broad policy dialogue to explore the social well-being that lies at the centre of the triangle of interactions between health systems, health and wealth. One of the keys to this dialogue is to provide the best possible evidence of how well performing health systems improve people’s lives and thus contribute to the well-being of nations. Governments concerned with productivity and wealth creation classically tend to invest in infrastructure that supports businesses such as roads, power and telecommunications; in contrast, many see health as a sunk cost and allocate fewer resources to health systems than to other, more apparently “productive”, sectors of the economy. WHO’s research shows that the importance of the health system for the general health of the population has been underestimated, as has been the impact of better health on economic growth. It is well known that the better off a country is, the healthier its people tend to be and, more importantly, the more interested they are in maintaining their health. What WHO’s extensive recent research shows – presented at the Tallinn conference (6) – is that the relationship also works the other way round: the healthier the population, the greater the wealth a country can produce, and that this is true for both rich and poorer countries. Workers not only live longer, but stay at their jobs longer; they are less sick in their old age (and so require less expensive medical care); and while working they remain more productive and tend to earn higher wages. As part of the preparation for the Charter, WHO conducted studies that produced empirical evidence of the link between the health and wealth of the population, as well as on strategies to improve the performance of health systems. As referred to in the BMJ article, the key idea is: “be effective, prudent and transparent when spending”. Like all investments, however, health systems do not inherently improve performance; strong leadership, coordination and analysis are needed to ensure that reforming investments are oriented to the goals of improving health and equity in health. Other important aims are ensuring that the system is responsive to the needs, preferences, and demands of the citizens, and protecting people from undue financial burden as a consequence of ill health or the use of services. Critically, there must be monitoring and evaluation to ensure that the effects of reforms are understood and to enable health ministries to be publicly accountable for their policies and actions. The findings of the Conference could be summarized by saying that good health systems are not a luxury that only rich countries can afford, but a fundamental part of the social and physical infrastructure that supports a country’s prosperity, cohesion, and social well-being. A country can achieve a healthy economy and productive population by investing in a well performing health system. 1. Richards T. WHO European region commits to new health charter. BMJ 2008;337:a621. 2. The Tallinn Charter: Health Systems for Health and Wealth. Copenhagen, WHO Regional Office for Europe, 2008 (http://www.euro.who.int/document/E91438.pdf). 3. Declaration of Alma-Ata, 1978. Copenhagen, WHO Regional Office for Europe, 2006 (http://www.euro.who.int/AboutWHO/Policy/20010827_1). 4. The Ljubljana Charter on Reforming Health Care, 1996. Copenhagen, WHO Regional Office for Europe, 2008 (http://www.euro.who.int/AboutWHO/Policy/20010927_5). 5. The world health report 2000. Health systems: improving performance. Geneva, World Health Organization, 2000 (http://www.who.int/whr/2000/en/index.html). 6. Publications by conference topic [web site]. Copenhagen, WHO Regional Office for Europe, 2008 (http://www.euro.who.int/healthsystems/Conference/20080623_8). Competing interests: None declared