WHO European region commits to new health charter

A European health charter was adopted last week by health ministers from the 53 countries of the European region of the World Health Organization, together with the WHO itself, the World Bank, Unicef, the International Organization for Migration, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

The formal commitment to the charter was made at the end of a three day conference on health systems, health, and wealth, held in Tallinn, Estonia, on 25-27 June.

The charter enshrines a commitment to strengthen the region’s health systems and make them more accountable. It also commits member states to making their health systems more responsive to people’s needs, particularly poor and vulnerable people.

The charter is based on three central tenets. Firstly, investing in health systems not only improves health and social wellbeing but also helps boost economic development.

Secondly, it is not acceptable for people to become impoverished by ill health. Globally WHO estimates that 150 million people a year suffer financial catastrophe as a result of paying for their health care, and 100 million are pushed below the poverty line.

Thirdly, health systems are as much about promoting health, preventing disease, and ensuring health is considered in policies outside the health sector as they are about providing healthcare services.

During three days of discussion many ministers of health and finance, policy makers, and academics emphasised the need to prove that investment in health services is good for the economy, given that expenditure on health is growing faster than the economy in most countries.

Evidence collated on the economic costs of ill health and the association between health and wealth was presented in two reports prepared for the meeting by the European Observatory on Health, The Economic Cost of Ill Health in the European Region and Health Systems, Health, and Wealth: Assessing the Case for Investing in Health Systems (www.euro.who.int/observatory).

Both reports draw on a wide range of studies to make the case for supporting investment in health. One recent modelling exercise cited in the second report shows that in many western European countries the welfare gain associated with improvements in life expectancy between 1970 and 2003 amounted to 29-38% of gross domestic product. By contrast, in countries where life expectancy fell between 1990 and 2003, including Georgia, Moldova, and Russia, the effect on gross domestic product was negative.

In the European region, the percentage of government spending devoted to health varies markedly (BMJ 2008;336:1390; doi: 10.1136/bmj.a344), but Nata Menabde, WHO’s deputy regional director for Europe, underlined that there was no “optimal” size for a health budget.

“What matters is how it is spent,” she said. “Health systems must show that they use their money in a prudent and transparent manner.”

The same message was put forward by Peter Smith, director of the Centre for Health Economics, York University. He took delegates back to 1858 when Florence Nightingale made a “passionate plea for uniform hospital statistics.” Since then governments, he said, had been extremely slow and health professionals reluctant to accept the importance of assessing and publicly reporting performance. When the 2000 WHO report, which ranked countries by the performance of their health systems, was published in 2000, it “created a torrent of debate” (BMJ 2000;320:1687; doi: 10.1136/bmj.320.7251.1687).

Acknowledging that reliable and uniform comparative health indices of performance are hard to collect, he and many other speakers emphasised they were essential to improving health outcomes, increasing the quality of care, responding effectively to patients’ needs, and identifying and reducing health inequity.

Welcoming the inception of the charter, Margaret Chan, director general of WHO, warned, “Health systems will not gravitate towards increasing equity and efficiency without deliberate policies. [The] Tallinn [charter] pushes a strong and important political message,” she said, “and it’s a global one.”

Cite this as: BMJ 2008;337:a621