Over 500 health decision-makers - including ministers of health and finance - from 53 countries have set the WHO European Region on course to tackle both longstanding and new challenges to health systems, at the WHO European Ministerial Conference on Health Systems, which is taking place in Tallinn, Estonia.
The Conference made a public health breakthrough by providing, for the first time, a platform for debates on often sensitive and politically charged health issues, such as equitable access to health care, transparent health financing and accountability for public health spending.
In ministerial panel discussions, ministers of health from Armenia, Bosnia and Herzegovina, Bulgaria, Kazakhstan, Kyrgyzstan, Serbia and The former Yugoslav Republic of Macedonia, emphasized that a good health system is not a luxury for affluent countries alone, but a fundamental part of prosperity for all countries.
Speakers stressed that a health system involves much more than simply paying for doctors and hospitals. "It encompasses all parts of society and its various institutions that affect health. It includes the health ministry's ability to influence other ministries - such as transport, environment and education - to follow policies that improve the health of the population," said Dr Marc Danzon, WHO Regional Director for Europe.
Nevertheless, participants repeatedly stressed that investing in health is not enough ; performance matters. "If you call for more, not less, spending on health, based on the claim that it creates additional health and economic benefits, and at the same time you give the health ministry more intrusive powers that allow it to affect the policy-making decisions of sister ministries, then you must demonstrate the effectiveness of these measures," said Dr Nata Menabde, Deputy Regional Director, WHO Regional Office for Europe. This means being accountable for where money is spent, choosing the appropriate technology and showing that it was the best of the available options and properly used.
Ms Maret Maripuu, Minister of Social Affairs of Estonia, and President of the Conference, said, "We need to see health beyond health care. We need to realize that health stands on three rails: prevention, cure and care, which are all equally important components of an effective health system. We need to find a way to measure the performance in order to maintain the effectiveness."
In her keynote address, Ms Mary Robinson, President of Realizing Rights: the Ethical Globalization Initiative, stressed that health is a fundamental right of all people and has value in itself, and that it is in the interest of all governments to be more accountable for the performance of their health systems.
Professor Martin McKee, of the London School of Hygiene and Tropical Medicine, United Kingdom, emphasized the complex interrelationships between health systems, health and wealth. He noted the many difficulties in measuring health systems' performance, including finding effective indicators for the task, and the lack of systems for performance measurement in many WHO Member States.
The information and perspectives presented at the Conference have advanced the debate on health systems, health and wealth. Many countries are eager to improve the performance of their health systems, although they recognize the need to face challenges in, for example, the financing and governance of their systems.
A central issue for the Conference is the Tallinn Charter : Health Systems for Health and Wealth, which is expected to be adopted on Friday, 27 June by representatives of all 53 Member States in the WHO European Region. The Charter represents countries' strong and ambitious commitment to improving the health and wealth of their populations by strengthening their health systems. All countries in the Region are ready to take the next step with the Tallinn Charter, which promotes concrete policy and action. It calls for more transparency and accountability from countries, which will improve health systems' performance and allow better assessment of the achievements or failures of policies.
"The Tallinn Conference takes the agreements signed in Alma-Ata, Ottawa, Ljubljana and Kampala a step forward by defining specific policy goals that will improve health systems in our Member States," said Dr Marc Danzon. "We hope that the Tallinn Conference and Charter will help place health higher on political agendas by proving that investing in health is investing in countries' and people's well-being."
On the first day, keynote speakers at the Conference were :
- Professor Uwe Reinhardt, James Madison Professor of Political Economy and Professor of Economics, Woodrow Wilson School of Public and International Affairs, Princeton University, United States;
- Ms Mary Robinson, President, Realizing Rights: The Ethical Globalization Initiative
- Professor Martin McKee, London School of Hygiene and Tropical Medicine, United Kingdom; and
- Professor Peter Smith, Director, Centre for Health Economics, University of York, United Kingdom.
On Thursday, 26 June, Dr Margaret Chan, WHO Director-General ; Mr Andrus Ansip, Prime Minister of Estonia ; Ms Androulla Vassiliou, EU Commissioner for Health ; and Dr Nata Menabde, Deputy Regional Director, WHO Regional Office for Europe, addressed the Conference.
The Ministerial Conference is being recorded and webcast. A series of programmes is being published on the multimedia part of the official Conference web site to highlight the main issues. Each day, WHO produces news bulletins and conducts video interviews. These products and other information on the Conference are available through the web site of the WHO Regional Office for Europe (www.euro.who.int/healthsystems2008 and www.whoconference2008.org), along with more information for journalists, including the press programme.