Interview with Zsuzsanna Jakab: Make healthcare systems serve the interests of the people

23rd June 2015

The Vilnius Declaration established a broad consensus around key areas for attention in reshaping Europe’s healthcare systems to face the future. This has spurred progress, but further effort is required in reorienting systems to focus on non-communicable diseases and the requirements of an elderly population, says Zsuzsanna Jakab, WHO Regional Director for Europe

A lot of water has flowed under the health policy bridge since the Vilnius Conference of November 2013, but looking back it was a “real success” says Zsuzsanna Jakab, WHO Regional Director for Europe. “There was strong leadership from Vytenis Andriukaitis, then Lithuanian Minister of Health and now EU Commissioner, and good partnership with the EU member states, WHO, patients’ groups and industry, all working together to shape the agenda and move forward together,” Dr Jakab says.

For Dr Jakab, one important advance was that health promotion and disease prevention could be seen to be regaining a central position on the agenda, after being side-lined as a result of austerity-era cuts to health budgets.

Disease prevention and health promotion are at the heart of the WHO’s Health 2020 strategy, and the WHO has been working with Member States to enshrine these aspects, not only in public health policy, but also across other policy areas that impact on the social determinants of health. “Prevention and promotion are slowly getting back into a better mode, after being neglected in the past 10 – 15 years. While Vilnius was not the only spur for this, it was certainly an important contributing factor,” says Dr Jakab.

Member states have seen healthcare costs increasing remorselessly as a result of the rising tide of non-communicable diseases and have come to recognise that investing in prevention and promotion is a central element in reducing this pressure. “In addition, there is now convincing evidence that prevention is not only effective in the long-term, but also in the short- and medium-term – you don’t have to wait years and years to see the return on investment,” Dr Jakab notes.

The European Union has played a role here, by increasing the focus on public health, Dr Jakab believes. “There are many issues that cannot be resolved within the boundaries of individual countries, especially in view of globalisation. Tobacco is one case in point: you need a transnational approach to preventing illicit trade and trafficking.”

An EU-wide approach is also important in promoting health security, Dr Jakab says, noting the Cross-Border Directive on Health and the WHO’s international health regulations are aligned. The value and importance of this has been underlined by the Ebola epidemic. Here the weak healthcare systems in Guinea, Liberia and Sierra Leone were seen to intensify the toll taken by the outbreak.

“Ebola was an eye opener, in that it highlighted the extent to which you can only counteract outbreaks like this if you have strong health systems,” says Dr Jakab.

A WHO assessment of Europe’s health systems showed they would be well-prepared to deal with an Ebola outbreak. However, said Dr Jakab, things can always be improved. Although starting from a much weaker base, one of the consequences of the Ebola epidemic in the three most-effected countries in West Africa was that healthcare services were fragile. Childhood vaccination programmes and antenatal services came to a halt for example, amplifying the terrible effects of the Ebola epidemic.

“This points to the need to have strong and resilient primary care that will not be knocked off course in the face of a health emergency. In my view, putting an emphasis on this is an aspect where the European Region could derive huge benefits,” Dr Jakab says. Rather than – as at present – being optimised to deliver episodic, acute care services, systems should be reoriented and integrated around the patient and the current disease burden. “This is the only way to deal with the huge surge in disease burden from non-communicable diseases, which people are living with and managing every day,” says Dr Jakab.

While she acknowledges it is a huge challenge to make this change, Dr Jakab says that in order to extract the maximum value from the significant resources Europe devotes to its healthcare systems it is essential focus on non-communicable diseases and the ageing population. “As things stand, systems are organised and structured in a way that does not serve the interests of the people,” she says. “Patients need to be at the centre, there has to be seamless continuity of care.”

This shift requires both a different mindset on the part of providers and healthcare professionals, and changes to the physical infrastructure. “This is a difficult task and will take time and consultation,” Dr Jakab says. “However, it is the way to ensure there is universal access to high quality services that will meet the needs of the patients, because they are centred on the patients.”