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Virtual session, 13–15 September 2021 2 August 2021
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Provisional agenda items 2(b) and 14 ORIGINAL: ENGLISH
Progress report on the Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being
In resolution EUR/RC67/R3, the WHO Regional Committee for Europe requested that the WHO Regional Director for Europe report every two years, starting in 2019 and ending in 2029, on the implementation of the Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being.
The present progress report highlights activities undertaken towards implementation of the Roadmap in Member States and by the WHO Regional Office for Europe and its partners, pursuant to the resolution.
It is submitted to the Regional Committee for consideration at its 71st session in September 2021, in line with resolution EUR/RC67/R3.
Background
1. The Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being, was adopted by the WHO
Regional Committee for Europe at its 67th session in 2017 in resolution EUR/RC67/R3.
The Roadmap aims to strengthen the capacities of Member States to achieve better and more equitable and sustainable health and well-being for all, at all ages, in the WHO European Region. The Roadmap includes five interdependent strategic directions and four enabling measures and calls on the WHO Regional Director for Europe to strengthen the support available to Member States. This progress report is informed by two independent surveys and provides a summary of activities carried out by Member States and the WHO Regional Office for Europe (WHO/Europe) through the European Programme of Work, 2020–2025 – “United Action for Better Health in Europe” (EPW).
Progress and implementation at regional level
Processes to implement the 2030 Agenda for Sustainable Development have been advancing in European Member States
2. Voluntary national reviews (VNRs) are the reporting mechanism used by the 193 United Nations Member States to report on progress towards implementing the 2030 Agenda for Sustainable Development (2030 Agenda) and achieving the Sustainable Development Goals (SDGs). VNRs are reported to the United Nations High-level Political Forum on Sustainable Development. Between July 2016 and July 2020, 52 Member States of the European Region presented 60 VNRs, with eight Member States reporting twice.1 The assessment of the VNRs highlighted that Member States in the Region have set up SDG coordination bodies, which are often led at the highest level of government. Twenty Member States have established an SDG parliamentary committee that is responsible for monitoring, reviewing and reporting on the SDGs. Fifteen Member States reported subnational governance structures for the SDGs.
3. The health sector is either highly or moderately involved in the above multisectoral institutional arrangements. Approximately half of the health ministries in the Region have assigned an SDG focal point. Health ministries are accountable for actions to achieve SDG 3.
Only moderate levels of alignment between existing legal acts, policies or strategies and the 2030 Agenda have been reported. More recently, Member States have initiated integration of the SDGs and their targets into national health planning and policy development.2
4. The health sector has promoted the development of stakeholder platforms related to health such as commissions or councils. Some of these platforms are time-bound. The non- State actors most frequently participating are organizations of professionals (for example, medical associations and professional chambers), groups representing specific or general interests, and academic institutions.
1 See https://www.euro.who.int/en/health-topics/health-policy/sustainable-development-
goals/publications/health-and-well-being-in-the-voluntary-national-reviews-of-the-2030-agenda-for-sustainable- development-in-the-who-european-region-20162020-2020.
2 See https://www.euro.who.int/en/health-topics/health-policy/sustainable-development-
goals/publications/2021/health-and-well-being-and-the-2030-agenda-for-sustainable-development-in-the-who- european-region-an-analysis-of-policy-development-and-implementation-2021.
5. The health priorities and health-related SDG targets most frequently identified in VNRs and national development plans aim to strengthen universal health coverage (UHC), reduce premature mortality from noncommunicable diseases (NCDs), increase access to sexual and reproductive health care services, end epidemics of communicable diseases, reduce
inequalities, increase social protection, create gender equality, enforce human rights and promote healthier populations. The least addressed priorities were antimicrobial resistance;
road traffic accidents; medicines and vaccines; and maternal, child and adolescent health.
Only a few Member States referred to efforts to mainstream health across all SDGs. In most Member States, health and well-being is not recognized as a cross-cutting priority and is instead focused on specific thematic areas.
6. Strengthening health systems towards achieving UHC is a clear commitment made by all Member States. This includes providing access to high-quality essential health services;
safe, effective, high-quality and affordable essential medicines and vaccines; financial risk protection; community-based primary health care (PHC) services; and health promotion and disease prevention programmes. Challenges are recognized in all Member States and include ageing populations; increased demands for access to and use of new technologies,
medications and models of care; challenges related to the health workforce; fragmentation in health services delivery; higher expectations of high-quality and safe care; and inefficient public spending on health.
7. Several Member States reported having a policy, plan or strategy in place addressing health inequities. The activities most frequently carried out are those that aim to improve access to high-quality health and education services, protect from financial hardship and ensure high- quality conditions for early childhood development. The 2019 WHO/Europe report Healthy, prosperous lives for all: the European Health Equity Status Report3 cited four additional
barriers to health equity: poverty and not being able to make ends meet, living conditions, social and human capital, and employment and work. The COVID-19 pandemic highlighted the urgent need for joint social and health policies to advance progress in reducing inequity.
8. The management of national and global health risks gained momentum through the COVID-19 pandemic, while in earlier years, emergencies were addressed by either adhering to the Sendai Framework for Disaster Risk Reduction or referring to rare country-specific risks.
9. Realizing healthier populations throughout the life course and addressing health determinants through multisectoral action require a high level of cooperation across line ministries and institutions. High levels of collaboration are reported between health ministries and government ministries related to welfare and social protection, environment, water and sanitation, education, and labour and employment. Strengthening and implementing legal and regulatory measures in sectors outside the health sector that tackle shared risk factors was identified as a priority in most Member States, but only a few referred to actions being taken in relation to this priority. Challenges to collaboration include financial, cultural, logistic, political and human capacity issues. Examples of collaboration within government were mainly reported in relation to action on antimicrobial resistance, environmental health, nutrition and physical activity, and substance use and abuse. Member States highlighted the importance of strengthening efforts and increasing capacity to advocate for the co-benefits of health and well-being in achieving the SDGs. However, only 41% of Member States referred
3 See https://www.euro.who.int/en/health-topics/health-determinants/social-determinants/health-equity-status- report-initiative/health-equity-status-report-2019.
to using evidence-based and innovative mechanisms to incentivize non-health sectors to invest in actions for health and well-being.
10. Establishing healthy places and settings and resilient communities requires engagement with public agencies, spatial planners, voluntary bodies, businesses and other actors.
Examples of such action mentioned by Member States include the creation of spaces that are supportive for groups of all ages and all levels of ability, the empowerment of health-
promoting behaviours, the promotion of healthy workplaces, and the promotion of health in school curriculums.
11. The importance of prioritizing and increasing public funding for health and well-being at national and subnational levels has been brought to the attention of leaders worldwide.
Earmarked funding in annual national budgets is available to ensure implementation of the 2030 Agenda; however, rarely is this funding allocated for implementation of the 2030 Agenda within specific department or programme budgets, such as for health. External development assistance and remittances remain a vital source of financing for many middle- and low-income countries and countries receiving foreign aid and official development assistance.
12. One third of Member States reported having national plans or strategies in place with health literacy objectives, or specific plans or strategies for strengthening health literacy.
The need for ensuring easy access to health information, services and navigation assistance, as well as for information outreach through media and digital health, were identified as priorities.
Some Member States reported having a national strategy or plan to promote research and innovation, with growing needs for investment in research, infrastructure for digital health service delivery and e-health, and intergenerational cooperation for innovation. Digital innovation, including e-health, is recognized as a major opportunity to advance UHC, strengthen health literacy and reduce inequalities.
13. Fifty-two Member States have performed an SDG indicator baseline analysis. Forty-seven Member States have established a national statistics network or group that is responsible for collecting, monitoring and reviewing SDG indicators. National priority indicators are identified in consultation with relevant sustainable development committees. In many instances, the analytical capacities and capabilities are strengthened by expanding the role of national statistical bodies to monitor health-related SDG targets. National health information systems (HIS) contribute to this through data collection, monitoring activities and data analysis on SDG indicators. Forty Member States have identified their national key priority indicators. Very few Member States mentioned the development of their HIS and the establishment of e-health records.
14. While processes have been set up, current projections indicate that no Member State is projected to be fully on track to achieve all the health and health-related SDG targets.
15. Interventions must be significantly scaled up if the Region is to reach several of the health and health-related SDG targets by 2030. Some examples are as follows.
• Both globally and in the Region, SDG target 3.6 (by 2020, halve the number of global deaths and injuries from road traffic accidents) has not been met.
• In 2020, COVID-19 years of life lost (YLL) were two to nine times that for the common seasonal influenza (as compared to a median flu year for the same
Member State), between two and eight times higher than traffic-related YLL rates,
and between a quarter and a half of the YLL rates attributable to heart conditions, depending on the Member State.
• There are still large gaps in vaccination coverage (SDG target 3.b). COVID-19 has shown us that inequity in opportunities for good health, including vaccination, hurts everyone. The unprecedented COVID-19 vaccine rollout across the world offers us optimism that vaccines will bring us closer again.
• The Region continues to have the highest burden of multidrug-resistant
tuberculosis of all WHO regions and is not on track to meet the target relating to HIV (SDG target 3.3).
• Five major NCDs – cancer, cardiovascular disease, chronic respiratory disease, diabetes mellitus and mental disorders – account for an estimated 86% of the deaths and 77% of the disease burden in the Region (2020). The burden of disease from NCDs is decreasing in the Region. This has given rise to cautious optimism that the target of reducing premature mortality from NCDs by one third by 2030 (SDG target 3.4) will be achieved. The Region has made uneven progress towards achieving the nine voluntary NCD targets of the Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013–2020. Tobacco use is not decreasing rapidly enough to meet the target (SDG target 3.a), and the Region has the highest alcohol consumption of all WHO regions (SDG target 3.5).
No European Member State will reach the target of halting the rise in overweight (SDG target 2.2).
• Mental health conditions (SDG target 3.4) account for almost 20% of the burden of disease in the Region and affects one in four people at some time in life.
• Neoplasms, cardiovascular disease, musculoskeletal disorders, mental health and other conditions may result in disability. Globally, there is evidence that people with a disability have unmet health care needs.
• Despite a decline in death rates from interpersonal violence across the Region (SDG targets 5.2, 16.1 and 16.2), interpersonal violence ranks as the seventh most frequent cause of death among people aged 15–29 years. Inequalities in exposure to violence remain and continue to be a problem during the COVID-19 pandemic.
• Member States were quick to mobilize additional funds for the health system in response to the COVID-19 pandemic, but treating and preventing COVID-19 and addressing the impact of disruption to services will require continued investment in the years ahead. However, between 2013 and 2018, out-of-pocket payments grew faster than public spending on health in most of the lower-middle-income Member States in the Region and in around half of the upper-middle-income and high-income Member States. Spending on PHC accounts for less than half of all health spending. WHO has called for an additional 1% of gross domestic product in public funding to be spent on PHC.
• Air pollution (SDG target 3.9) remains the second leading cause of death from NCDs. Climate change threatens overall progress made in reducing the global burden of diseases and injuries (SDG 13). Unsustainable consumption and production adversely affect health by causing environmental degradation and increasing social inequities (SDG 12). People still die from poor water quality in the Region (SDG 6).
16. The COVID-19 pandemic has led to substantial disruptions to essential health services.
PHC, rehabilitation, and palliative and long-term care were strongly affected by the pandemic, with implications for some of the most vulnerable populations. Existing inequalities (SDG 10) have deepened, particularly for people experiencing multiple insecurities due to poverty, gender, ethnicity, education, occupation, migrant status, disability and discrimination, and new risks have emerged.
WHO/Europe support to its Member States
17. WHO/Europe has supported its Member States in the implementation of the
2030 Agenda, in line with the Roadmap, including by facilitating and engaging in national and regional high-level policy dialogues; conducting assessments on the progress towards achieving the SDG targets in Member States; providing factsheets, policy briefs, tools and methods;4 assisting Member States in developing VNRs; developing capacity through regional and national training initiatives; and promoting international legally binding instruments.
18. WHO/Europe has worked in partnership with its Member States, United Nations and other development agencies, and other stakeholders through multiple networks and platforms, including the United Nations systemwide Issue-based Coalition on Health and Well-being and the WHO–United Nations–Red Cross COVID-19 Platform. Furthermore, WHO/Europe supported Albania, Azerbaijan, Georgia, Kyrgyzstan, Republic of Moldova, Tajikistan, Turkmenistan and Ukraine through the Global Action Plan for Healthy Lives and Well-being for All. The Small Countries Initiative, the Regions for Health Network, the WHO European Healthy Cities Network and the European Environment and Health Process are all engaged in streamlining concrete action on achieving the SDGs within the Region. There have been extensive high-level interactions in relation to being united for action in the COVID-19 response and recovery.
19. New alliances have been created, such as the Pan-European Commission on Health and Sustainable Development, to advise on how to put health at the core of recovery from the COVID-19 pandemic within government agendas. Four flagship initiatives were launched through the EPW: the Mental Health Coalition, the European Immunization Agenda 2030, Empowerment through Digital Health, and Healthier behaviours: incorporating behavioural and cultural insights.
20. WHO/Europe is developing a new measurement framework for the European Programme of Work, 2020–2025, which now includes a subset of SDG targets and their respective indicators to measure progress towards achieving the SDGs. A first analysis will be available in November 2021. The measurement framework also sets intermediate regional- level milestones for 2025, aligned with existing policy and monitoring frameworks, to ensure that the Region stays on track towards reaching the goals outlined in the 2030 Agenda. HIS assessments were also conducted through the Support tool to assess health information systems and develop and strengthen health information strategies.
4 See https://www.euro.who.int/en/health-topics/health-policy/sustainable-development- goals/publications/2021/e4as-guide-for-advancing-health-and-sustainable-development-2021.
Conclusions and future plans
21. The EPW is an important instrument to advance the achievement of the health-related SDGs and their targets. Its two objectives of leaving no one behind and reinforcing the leadership capabilities of health authorities are promoting strong investment in human and social capital.
22. Sustainable development requires a coherent, coordinated, indivisible and integrated approach. There are nine years left to achieve the SDGs. The promotion of health at the highest level of government and across all SDGs is required if we want to achieve the SDGs and advance sustainable development. Equally, the promotion of the SDGs and the inclusion of the EPW priorities and flagship initiatives into newly developed national health policies can help identify the highest priorities for action.
23. Building institutional and human resource capacity, ensuring national-level accountability for the 2030 Agenda, and increasing the role of health stakeholders in the 2030 Agenda and across the economic, environmental and social domains of sustainable development are needed to achieve the health and health-related SDGs.
24. Further work needs to be carried out to better understand how to remove financial, political, organizational, cultural and logistic barriers to improve progress on the
2030 Agenda and to strengthen accountability, monitoring and evaluation.
25. Lessons learned from COVID-19 have highlighted a renewed focus and emphasis on a health-in-all-policies approach or on health in all multisectoral SDG-related efforts to create healthier populations. Areas that require further collaborative efforts include:
• reducing risks arising from human activities, including climate change, and shifting towards a green and healthy economy;
• coordinating activities that bridge a variety of areas, such as in the One Health approach;
• strengthening the health sector to participate and contribute to strategic political discussions in other sectors and to actively engage the health constituency in multisectoral policy platforms; and
• empowering public health actors to deploy scientific evidence to advocate for concepts such as health-in-all-policies, whole-of-government and whole-of- society approaches to health, as well as to understand and counter powerful commercial interests, and invest in the health sector’s capacity for leadership, advocacy and health literacy.
26. In the wake of COVID-19, action in these areas has increased in urgency, as there is a serious risk that the health sector, whose attention has been entirely drawn into addressing the COVID-19 emergency, might fail to see the paramount role it could and should play in the context of important strategic political and economic decisions, which governments are now examining in planning how to recover from this unprecedented crisis.
27. While UHC is the most prominent of the health development priorities, many issues remain, including the need to improve access to health and social services; prioritize and increase public funding for health at national and subnational levels and for investment
targets; and discover and develop medicines, medical technologies, digital solutions and organizational innovations. International donor-funded projects that support countries in reaching their SDG and UHC targets are now of even greater importance than ever.
28. Periodic assessments are needed and may help generate an understanding of how the monitoring and measuring of progress can strengthen accountability. The main challenges include lack of resources, human capacity and policy and legislative frameworks. Opportunities include using new technologies and electronic data, integrating or linking different components of HIS, harnessing big data for health, and using data more effectively.
29. The 2030 Agenda, the EPW and the COVID-19 pandemic all call for global
partnerships and acting in solidarity in new, creative and meaningful ways. This can only happen if health is promoted at the highest level of government and integrated into global agreements, for example, through the ongoing discussion on a global pandemic treaty.
30. The important partnerships of the European Region could be leveraged further to mainstream health and well-being across the SDGs and promote policy coherence at national and subnational levels. An alignment of the various networks’ strategic objectives should be undertaken, taking into account the new context of the COVID-19 response and the various reforms that are taking place, with the aim of building back better.
31. In this second year of the COVID-19 response, there will be a United Nations and stakeholder-wide transition in response priorities and activities, addressing not just the acute response across health and other sectors, but also the mid-and long-term response and future planning. This new phase will require deeper engagement across all United Nations agencies to achieve coordinated action.
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