The product of an extensive two-year consultation process across the European region and beyond, Health 2020 concentrates on two strategic objectives:

 

1.     To improve health for all and reduce health inequalities by developing universal policies to improve the health of everyone and so reduce the absolute effect of social determinants on all people, targeting interventions to focus on those most affected, and developing policies to address the social gradient in health directly, through interventions that are proportionate to the level of health and social need.

 

2.     To improve leadership and participatory governance for health by  more effectively engaging broad public participation in policy-making, addressing the demand to consider public values, priorities and concerns, and adopting approaches that build community resilience, social inclusion, cohesion and assets for well-being.

 

Under these strategic objectives, the framework sets out four priorities. Drugs, alcohol and tobacco are mentioned under three of these priorities.3

 

Tobacco, alcohol and illicit drugs are covered in relation to children and adolescents, and vulnerable groups, specifically migrant groups and Roma. The framework calls for integrated approaches and joint working.

-    Children and adolescents: Joint working by the health, education, social protection and labour and employment sectors may be assisted by a framework of accountability of each sector for the health of children and adolescents and health-related issues, for example via a set of jointly owned targets and indicators, linked to financing. Developing a national health information system with well-defined indicators would also allow trends in the health and development of children and young people to be monitored, both for the population as a whole and across the social distribution.

-    Migrants: Policies to promote social inclusion might include measures to combat discrimination across a range of sectors including education, employment, social protection, housing and environment, health.  

 

Together with physical inactivity and unhealthy diet, alcohol use and tobacco use are listed as key behaviours that aggravate the onset of some of the most common non-communicable diseases including cardiovascular disease, cancer, diabetes and mental disorders. In this context, tobacco control interventions are identified as the second most effective way to spend funds to improve health, after childhood immunisation, and increasing the price of tobacco through higher taxes as the single most effective way to reduce tobacco consumption and encourage tobacco users to quit.

 

To reduce the harmful use of alcohol, options listed in the framework include:

-    domestic taxation on alcohol,  accompanied by an effective enforcement system;

-    regulating the days and hours of retail sales;

-    establishing an appropriate age for purchasing and consuming alcoholic beverages, and other policies to raise barriers against sales to and consumption of alcoholic beverages by adolescents;

-    an upper limit for blood alcohol concentration, with a reduced limit for professional drivers and young or novice drivers;

-    promoting sobriety checkpoints and random breath-testing;

-    supporting initiatives for screening and brief interventions for hazardous and harmful drinking in primary health care and other settings, which should include early identification and management of harmful drinking among pregnant women and women of child-bearing age; and

-    developing effective co-ordination of integrated and/or linked prevention, treatment and care strategies and services for alcohol-use disorders and comorbid conditions, including drug-use disorders, depression, suicide, HIV infection and TB.

 

Injuries, be they intentional or unintentional, are responsible for 9% of the deaths in the WHO European Region but 14% of the burden of disease. Within countries, injuries and violence are strongly linked to socio-economic class and cause health inequities. There are cross-cutting risk factors for the different types of injury, such as alcohol and drug misuse, poverty, deprivation, poor educational attainment and unsafe environments. The WHO policy framework emphasises that developing preventive strategies requires addressing the underlying structural factors and modifying individual and population-level risk behaviours.  

With regard to communicable diseases, the WHO European Region is experiencing serious challenges in the rates of TB and HIV infection, among other diseases. The re-emergence of TB is linked to a failure of health systems to implement services that are responsive to people’s needs. Although TB is not the exclusive preserve of any social class, the disease is often linked to poor socioeconomic conditions and other determinants, including crowded accommodation and homelessness. As with HIV, people who inject drugs and prisoners are at higher risk of acquiring TB, as are alcoholics and homeless people. Moreover, TB and HIV infection are a deadly tandem, as TB is a leading killer among people living with HIV.   

 

The need to refocus health care services around people’s needs and expectations and to make them more socially relevant is seen as the main challenge in reforming health services.  The WHO policy framework notes that particular attention needs to be paid to low-income and vulnerable populations, such as internal and external migrants, Roma populations, groups living in remote mountainous areas and drug users. Outreach programmes and other new models of delivery that can reach these difficult-to-reach groups need to be developed.  

 

1. Department of Health (2013) Healthy Ireland: a framework for improved health and wellbeing 2013–2025. Dublin: Department of Health. www.drugsandalcohol.ie/19628 . See also commentary at Pike B (2013) Healthy Ireland – implementation matters. Drugnet Ireland, (46): 15–16.www.drugsandalcohol.ie/20136

2. World Health Organization (2013) Health 2020: a European policy framework and strategy for the 21st century. Copenhagen: WHO Regional Office for Europe.  www.drugsandalcohol.ie/20480 . In 2012 the Health 2020 policy framework was adopted by the 53 member states of the WHO European Region. In 2013 the WHO Regional Committee for Europe published Health 2020 in two forms: a shorter policy framework, which sets out the main values and principles, and a longer policy strategy, which gives more detail regarding evidence and practice.

3. The other  priority is ‘Creating resilient communities and supportive environments’.