WHO’s ambitious new European health strategy

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e5928 (Published 05 September 2012) Cite this as: BMJ 2012;345:e5928
  1. David J Hunter, professor of health policy and management
  1. 1School of Medicine, Pharmacy, and Health, Centre for Public Policy and Health, Wolfson Research Institute, Durham University Queen’s Campus, Stockton on Tees TS17 6BH, UK
  1. d.j.hunter{at}durham.ac.uk

Political will must be galvanised for Health 2020 to succeed

It may seem the wrong moment to launch an ambitious European health policy framework and strategy and invite governments to adopt it, as the World Health Organization’s Regional Office for Europe is asking its 53 member states to do. However, the architects of Health 2020,1 2 WHO’s flagship strategy that has been in preparation for almost two years and will be launched at the 62nd Regional Committee in Malta, 10-14 September 2012, regard the timing as propitious. They insist that, although the economic and fiscal crises facing Europe present major challenges, they also present opportunities to renew efforts to improve the health of European people. The argument that lies at the heart of Health 2020 is that “good health is essential for economic and social development.” It echoes Derek Wanless’s recommendation a decade ago to the UK government that it should emphasise public health more strongly to ensure the survival of the NHS.3

WHO issues its European health report every three years. The 2012 report provides the context that explains why the Health 2020 strategy needs to be taken seriously.4 Although people across Europe are generally living longer, often in better health, these improvements are not being shared equally. Substantial health inequalities persist between and within countries and are increasing in some cases, as set out in WHO’s European review of social determinants of health and the health divide (chaired by Michael Marmot), which is one of the background documents to Health 2020.5

Health 2020 seeks to put public health back at the centre of WHO’s mission via two linked strategic objectives: firstly, improving health for all and reducing health inequalities; and, secondly, improving leadership and governance for health, including the voice of civil society (see box 1). Although the Tallinn Charter,6 with its focus on strengthening health systems, is a building block for Health 2020, the new strategy’s emphasis is on public health that depends as much or more on what happens outside the health sector and ministries of health as within them.

Box 1 Four priority areas for policy action

  • Investing in health through a life course approach and empowering people

  • Tackling the region’s major health challenges of non-communicable and communicable diseases

  • Strengthening people centred health systems; public health capacity; and emergency preparedness, surveillance, and response

  • Creating resilient communities and supportive environments

Health 2020 recommends a whole of society and whole of government approach to health. It is accompanied by a European action plan for strengthening public health capacities and services, which European member states will be invited to endorse next week.7 The action plan, which is regarded as an essential pillar of the implementation of Health 2020, makes it clear that the capacity of public health services and systems across the region varies markedly and that strengthening this capacity in countries with weak services is a priority.

Countries will be supported to meet the strategy’s headline targets, summarised in box 2, through a collection of documents that provide a range of examples and resources on which they may draw as they implement the proposals. These documents include a report on health governance in the 21st century and an assessment of the economic case for taking action in the arena of public health.8 9

Box 2 Six headline targets

  • Reduce premature death in the European region by 2020

  • Increase life expectancy in the European region

  • Reduce inequalities in health in the European region

  • Enhance the wellbeing of the European region population

  • Ensure universal coverage and the right to the highest attainable level of health

  • Set national goals and targets related to health in member states

Health 2020 is designed to be a dynamic document that will be continuously updated while also providing links to key evidence and implementation tools; this is new for WHO. Whether it will succeed in triggering a wide social movement to improve health, as some within WHO hope, is not clear, although a whole of society focus is a central plank of its implementation plan.10

The impact of Health 2020 will be determined by the extent to which governments of different political persuasions show real as opposed to rhetorical commitment to the notion of a whole of government, whole of society, cross policy approach to the practice of health. This will be the key test of the new policy framework that sets it apart from its predecessors. Success in implementing public health in this way has eluded most governments, including that of the United Kingdom. The messy reality and complexity of health policy making is acknowledged in Health 2020, and a second report on governance that is in preparation will provide examples from Australia, Finland, Norway, and Germany, to name but a few, of what can be achieved.

Health 2020 is evidence of the determination of WHO to go beyond a grand statement of intent and to inform and support government action. It is a refreshing and welcome shift from focusing on analysis to supporting delivery of healthcare policy. A key challenge is that political will in many member states is currently against state investment and intervention to improve health and to tackle its social determinants, although political landscapes are subject to rapid and sudden shifts. A few economists, and others, are calling for a new political economy that will abandon neoliberalism and replace it with a public service ethos that puts greater value on the community as a whole.11 WHO is an international body that has sought to pursue its mission through unanimity among its members, and this can make advocating bold action tricky. Yet, with sufficient political will, countries can find a route to implementing better public health strategies.12

The success of Health 2020 rests not only on the actions of European member states but also on WHO’s ability to navigate a delicate course through the treacherous waters swirling through Europe. For the ambitions of Health 2020 to be realised, WHO will need to use different skills and expertise from those it has traditionally relied on, such as epidemiology and data analysis. Complementary skills in implementation and policy science, knowledge exchange and transfer, and the understanding of how to bring about transformational change in complex systems are now urgently needed.


Cite this as: BMJ 2012;345:e5928


  • Competing interests: The author has completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares: no support from any organisation for the submitted work; DJH worked as a special adviser for WHO Europe between December 2010 and July 2012 in the production of the European Action Plan (EAP), which will accompany the policy framework and strategy, Health 2020, when launched at RC62 in Malta, 10-14 September 2012; the EAP will serve as one of the mechanisms for implementing the health strategy by member states. DJH was also a member of the drafting group which produced Health 2020 in both its short and long formats; his role was to comment on various drafts between December 2011 and May 2012; DJH received standard a consultancy fee from WHO for his work on Health 2020 and the EAP;

  • Provenance and peer review: Commissioned; not externally peer reviewed.