November 30, 2023

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Strengthening health systems in Europe

It would be an understatement to say that much has happened since we all last met in person in Marseille in 2019. Let me begin by saluting you all – everyone gathered here – the many old friends, and the many young professionals; the entire
public health workforce and the frontline health workers, who have made huge personal sacrifices over the past two and a half years.

The COVID-19 pandemic has been a watershed moment in the history of public health on our continent. Governments and public health authorities have had to make difficult choices and take bold actions to save people’s lives and protect the vulnerable.

We acted fast, and we acted firmly. And because of your courage and wisdom (you too, Professor Lauterbach) and your unflinching commitment to follow the science, we have saved lives.

Yet tragically around the world over six and a half million people have died – 2.1 million of those in our region alone. The ripple effects of the pandemic will be felt for decades. Consider – we now face an unprecedented mental health crisis
that is affecting at least 1 in 6 people in Europe, and costing EU governments at least 600 billion euros a year.

Last week in Greece, we listened to young people who spoke about their lived experience with mental health issues, made worse by the pandemic and its aftermath. Responding to this public health challenge, and others – not least long COVID –
will require concerted action from the highest political levels to the grassroots of society.

And yet, strengthening our health systems in response to the pandemic is not the only challenge we must address.

A devastating war, now in its ninth month, continues to cause immeasurable suffering in Ukraine and across Europe. To date, there have been over 660 attacks on health facilities and health-care staff, verified by WHO. This war makes the coming winter
one of the most challenging in recent times for all of us.

In the coming days, I will go for the fourth time this year to Ukraine to the frontline, to stand by people and health workers in the face of what will be a hard winter, to advocate and engage support for people’s physical and mental health needs
in the newly liberated areas.

Throughout the Region, the energy and cost-of-living crisis means that thousands of families will need to choose between paying for energy or other necessities; between staying warm and getting health care.

And today this energy crisis is being compounded by a global climate crisis that impacts public health and public health services, and demands urgent action now.

As we gather here in Berlin to discuss the future of health systems, world leaders are also discussing how to save our planet for the sake of our children and grandchildren.

All these challenges go hand in hand.

Dear colleagues, ladies and gentlemen,

I know I risk sounding too alarmist, but we have to accept the reality that we are living in constant crisis mode, in circumstances that are eroding the health gains made through the painstaking work of many in this room, and those who laid the path before

And if we truly want to recover and get back to improving the health and well-being of our populations, we need to move from business as usual, to a new paradigm in public health: to a “dual-track approach”.

In a world of ever-increasing health crises, at a time of economic and financial turmoil, we must accept and work within this new paradigm.

This means that, on the one hand, we must invest significantly in preparing for mounting and often overlapping emergencies. In this regard, our work in setting up a pan-European network for disease control is an important advance.

And on the other hand, we must ensure that we redouble our efforts to prevent illness, promote health and strengthen day-to-day essential health services.

At WHO we are firmly focused on this dual-track approach, and we have started taking concrete action.

Just yesterday here in Berlin, we convened a meeting of the NCD Advisory Council on Innovation for Noncommunicable Diseases, and are gathering the best developments to tackle and reduce the burden of NCDs.

Next year, we will host a global primary health care conference in Kazakhstan, which will mark the 45th anniversary of the Alma-Ata Declaration – a firm commitment from governments to ensure that everyone, everywhere is able to enjoy the highest
attainable standards of health.

I am glad to see that the Berlin Statement, which WHO/Europe strongly endorses, includes clear actions to advance this dual-track approach.

It does so firstly, by recognizing that health systems need to be resilient and robust in order to respond to emergencies and maintain essential services.

And secondly, by committing to reach beyond the health sector – and work with economic, social and political partners to strengthen health systems and improve people’s health.

The Pan-European Commission on Health and Sustainable Development reached a similar conclusion, and I must thank former [European Public Health Association] EUPHA President and dear friend and colleague, Professor Martin McKee, for leading the scientific
evidence base that informed the Commission’s final report.

This work will be taken forward as we prepare for the High-level Forum on Health in the Well-being Economy to be held on 1–2 March next year.

Thirdly, the Berlin Statement acknowledges the key role played by science and innovation in public health, and the need to commit to more and better investment in research and development.

And it is on this last point in particular that the public health workforce comes in.

And to leave no one behind – because returning to where I began, COVID-19 has impacted everyone, but particularly the weakest and most vulnerable among us. As public health professionals, we have a moral duty to work towards reducing health gaps
and promoting equitable access to health for all.

As a final reflection, allow me to quote Rudolf Virchow, who worked here in Berlin many decades ago and who firmly believed that:

“Die Ärzte sind die natürlichen Anwälte der Armen und die sociale Frage fällt zu einem erheblichen Theil in ihre Jurisdiction.”

“Physicians are the natural attorneys of the poor, and the social problems should largely be solved by them”.

Colleagues, this European Public Health Conference embodies the vision of delivering health for all through the power of partnership. There is great strength in the collaboration we represent.

Although the challenges we face are daunting, we face them together, and we will overcome them through close collaboration.

Thank you for your dedication and determination.