November 2013

Vilnius Declaration: Call for Action

Sustainable Health Systems for Inclusive Growth

We call on European governments and the European Union to take immediate action:

To increase investment in health promotion and disease prevention;

• Healthcare costs can be significantly reduced through investment in community-based prevention and health promotion programmes.
• The introduction of fiscal measures for health promotion such as improving the affordability and accessibility of fruit, vegetables and whole grains whilst taxing foods high in salt, sugar and fat, alcohol and tobacco.
• Investment in cost-effective preventative measures – such as smoking bans, vaccination, screening for cancer, increasing physical activity and tackling problem drinking - would significantly reduce the burden of mortality and non-communicable diseases in Europe, acknowledging that not all diseases are preventable.
• We need to invest more in primary, secondary and tertiary prevention as well as health literacy.
• A holistic approach to health, healthcare and public health is necessary as many drivers of good - and ill – health lie beyond the healthcare system. 
• Poverty and social exclusion, as well as the health in all policies approach must be addressed and the importance of a well-funded and accessible welfare state is paramount particularly in times of crisis.
   

To ensure universal access to high quality people-centred health services;

• European health systems must deliver high quality and safe healthcare and public health services, accessible to all including equal access –within and between Member States - to modern and cost-effective medicines.
• Continuity of care including access for excluded, vulnerable and minority groups, is essential.
• A partnership approach between all stakeholders in the health sector at national and European levels should be promoted to identify effective solutions to improve equity of access to healthcare.  
• To ensure patients and the public are empowered and supported in the management of their own health, and that their representative organisations are adequately involved in the development of policies and programmes through a whole-of-society approach.
• To ensure that the health service is a responsible employer, implementing effective recruitment and retention strategies, including continual professional development and an adequate skills mix.

To ensure that health system reforms including workforce planning are evidence-based and focus on cost-effectiveness, sustainability and good governance;

• Investment in health systems should ensure that funding for health is secure, solid and based on principles of solidarity as well as sustainability.
• Ensuring that principles of accountability, transparency and good governance are applied throughout the policies and processes surrounding health, health systems and public health is essential in order to ensure resilience of our health systems and promote confidence amongst European populations.
• Member States and the European Union should ensure that the effects of austerity do not adversely undermine health, access to healthcare or the quality of health services.
• Investment in prevention and promotion, transformation of health systems aligning financing and service delivery reforms towards continuum of services around primary health and community care and the health workforce, including through European Structural and Investment Funds, the use of the European Semester and other appropriate mechanisms, would greatly improve health and social outcomes.
• Cost effective investments in healthcare innovations, including innovation in systems and practices as well as social innovation and public health innovations - accessible to all citizens - will benefit research, knowledge and employment whilst improving health and the productivity of health systems and reducing disease.
• Implement effective, cost-effective and equitable pricing and reimbursement systems and improved co-operation between regulatory agencies on pharmaceuticals and other essential goods.

We call for European leaders to work with us to help ensure that European health systems are people-centred, sustainable and inclusive, and deliver good health for all.

We call on Member States, European institutions and the World Health Organisation to work together to achieve these goals and offer our support as European civil society in their delivery.

Vilnius, 20 November 2013

Background

Our call for action

Health has a significant role to play in Europe’s success and economic future. We believe that EU 2020 headline targets and objectives will not be achieved without healthier Europeans, which requires improved health outcomes and reductions in health inequalities. We are ready to play our part, as one of Europe’s largest sectors. But to do that we call on European leaders to work with us to help ensure health systems are sustainable, inclusive and fit for purpose for all of us living in Europe.

Why we make this call:

• Given the impact of the economic crisis on Europe, the health of its people and the organisation and sustainability of its health systems;
• Given the recent figures released by the OECD which show an alarming reduction in the levels of investment in health promotion and disease prevention;
• Given that Article 168 of the Treaty of the European Union requires “a high level of human health protection” to be ensured in the definition and implementation of all EU policies and activities and provides for EU level coordinating action to complement national policies to improve public health;
• Given that the implementation of the strategy to achieve Europe 2020 objectives of smart, sustainable and inclusive growth, the yearly cycle of economic policy coordination entitled the ‘European Semester’, is impacting on the traditional national competences of financial and organisations of healthcare through an increase of health governance at European level;
• Following the work of the Finnish Presidency of the Council in 2006 in the development of the ‘Health in all Policies’ approach;
• Following the adoption of 2011 Council Conclusions on “modern, responsive and sustainable health systems”, which invited Member States and the Commission to identify effective ways of investing in health to ensure modern, responsive and sustainable health systems;
• Following the adoption of the WHO European Health Policy Health 2020 and the WHO European Action Plan to Strengthen Public Health at the Regional Committee in 2012 in Malta;
• Following the discussions during the High Level Meeting on the Impact of the Economic Crisis on Health and Health Systems in Oslo, 2013, held under the auspices of the World Health Organisation European Region (WHO Europe);
• Following the adoption of 2013 Council Conclusions on “Towards social investment for growth and cohesion”; and the recognition of the importance of a healthy population, supporting health determinants and health care as well as the adoption of the Staff Working Document on Investing in Health (SWD 2013 43);
• Following the adoption of the 2008 Tallinn Charter “Health Systems for Health and Wealth” and the follow up meeting in October 2013 addressing the Tallinn Charter in the context of the WHO Europe Health 2020 policy framework;
• In the context of the 35 year anniversary of the Declaration of Alma-Ata, calling for urgent action by all governments to protect and promote the health of all people, addressing the status and the Way Forward of primary care;
• In the context of the Reflection process on modern, responsive and sustainable health systems;

We remind European political leaders and policymakers that:

• Health spending is an investment, increases productivity and supports sustainable growth  and investing in health should be acknowledged as a contribution to economic growth and social cohesion;
• Policymaking and decisions regarding investment in health and reform must be evidence based and undertaken with a strategic approach;
• Health is one of the priorities for Europeans and people living in Europe, and through addressing the challenges, hopes and expectations of Europe’s population it strengthens trust and commitment in the European project and democratic processes;
• Europe is facing a number of challenges, including the aging population, an increase in chronic disease, new technology development and reduced financial and human resources, that are relevant for all Member States that if addressed appropriately are opportunities to reform and redress investments for a sustainable future;
• The growing inequalities in life expectancy and outcomes between and within European Member States in the recent decade;
• Increasingly clear evidence that access to modern services, technology and medicine is worse in Europe’s poorer Member States, which also exhibit worse health outcomes;
• New economic governance at European level is impacting on health governance, and it is essential for Member States to ensure adequate coordination including  co-ordination, monitoring and reporting at EU level;
• Health promotion and disease prevention are essential for the long-term sustainability of health systems and a productive population able to meet economic and social objectives.

The participants of the 2013 Vilnius Conference note the importance of each of these developments for the future of health development in and beyond the EU. We recognise our responsibilities to act, particularly in times of economic and social crisis. In turn we emphasise the important role of stakeholders and citizens in addition to Member States and EU Institutions, and call on Europe’s leaders to ensure the vital role and needs of citizens’ health are properly incorporated in a strong vision for Europe.