Health 2020, a written consultation of the WHO European Regional Office

WHO Regional Office for Europe invited the EFPC to participate in the written consultation on the new European policy for health, Health 2020. Today we issued our EFPC response, endorsed by our membership, which we hope will make Primary Care even more visible in all policies developed by the European Office of the World Health Organization.

Response to "the new European policy for health - Health 2020; Policy framework and strategy - Draft 1" and EAP/PHS documents of the WHO European Region
March 28, 2012

1. As a membership organization, the European Forum for Primary Care (EFPC) aims at strengthening primary care in Europe, emphasizing community orientation and interprofessional approach as outstanding features of primary care. As an essential bridge between cure and care activities and public health, strong primary care both provides health care to individuals and contributes to public health. The General Practitioner / Family Physician as the gatekeeper and "medical home" and a most needed guide in our complex health care systems is a core professional in Primary Care and ensures its medical quality. And primary care includes a range of other professions to establish the comprehensiveness of Primary Care.

2. EFPC applauds the initiative to develop Health 2020, as an energizing policy framework that reframes approaches, identifies new policy avenues and describes the key governance changes that are needed to maintain and improve health of the European population.

3. Health 2020 outlines in a comprehensive and thorough way some crucial challenges facing Europe in years to come.
EFPC share the report's concern over the fact that although the general health situation for Europeans seems to be improving judged by the major increase of their average life expectancy, a wide and even widening gap between and within countries when it comes to inequalities of health outcome and to accessibility to affordable health services, can be observed.

4. EFPC supports the comprehensive analyses made in the context of Health 2020 and the approaches for supranational, national and local action. Based on its members own observations in the community, EFPC agrees that it is not possible to reduce inequalities in health without reducing inequalities in society. Intersectoral action is indispensable. EFPC supports the acknowledgement of primary care as a key component of health care in Health 2020. This analysis is in accord with the World Health Report 2008 : "Primary Health Care, Now more than ever".

5. EFPC emphasizes the need to study and develop more evidence of the conditions under which investment in primary care and in health prevention and promotion effectively limits the rising costs of health care. The role of the general practitioner/family physician as the gatekeeper and "medical home" and a most needed guide in our complex health care systems should be strengthened and acknowledged.

6. EFPC strongly advocates a comprehensive approach to people?s health issues, avoiding service delivery that focuses on diseases or a set of diseases rather than on the need of individuals. The attention for chronic diseases should not lead to a new verticalisation of health services.

7. EFPC observes that an over-emphasis on prevention can lead to medicalisation of non-medical conditions, which has an upward effect on utilization of health care and costs.

8. Membership of EFPC covers more than 50 % of all European countries and therefore EFPC is a suitable vehicle for inter-country exchange of information and dialogue. EFPC offers the commitment and active support of its membership to the implementation of Health 2020, in particular in the following domains:

Development of frameworks for evaluation of primary care and further comparison between countries of primary care characteristics and services, as a basis for further research.

  • Research on optimal interfaces between primary and secondary care. This is based on the firm conviction that strong primary care needs strong secondary care, because only a health system that is performing well as a whole will be credible and acceptable for the population.
  • Experience and good practice in the cooperation and coordination between primary care, social services and community services, while addressing life style, aiming at preventing and reducing chronic disease.
  • Because of the long lasting relationship between professionals and individuals, primary care has a potential to contribute to health literacy and self care and thus empower individuals and reduce their dependence on health services. Experience and good practice can be provided, serving as examples and a basis for further policy development.
  • Research on further development of preventive services in primary care. This relates to building healthy communities, prevention of communicable and non-communicable diseases.
  • Experience, good practice and research initiatives for primary care services for minorities, among them Roma, thus contributing to reducing health inequalities.

9. Further, EFPC respectfully proposes amendments to the following text:
(page 14, draft 1, January 27, 2012 of Health 2020 short version):
The key Health2020 policy recommendations on strengthening the health care system response require the following policy directions:
to accelerate gains in health outcomes in the area of chronic diseases through people- centred health care systems, with primary care acting as a hub for other levels.
Suggested text:
to accelerate gains in health outcomes in the area of chronic diseases through people- centred health care systems, with primary care acting as the first level of care and the navigator to other levels of care.

Justification: Strong Primary Care is not just a hub or a reference service for other levels. It offers medical care of high quality, reducing the need for specialist or hospital based services. Actually, evidence that primary care successfully can substitute a number of secondary care services, and at lower costs, is abundant. This is especially true for prevention and treatment of chronic diseases. Primary Care that is seen and treated as a hub will quickly lose its competence and quality and results. The General Practitioner / Family Physician is a core professional in Primary Care and ensures its medical quality.

10. For the "European Action Plan for Strengthening Public Health Capacities and Services" we suggest to emphasize more the fact that at least 85% of all health related problems are solved within the Community with an important role of the Primary Care professionals. As a consequence the role of the Primary Care professional within health promotion and disease prevention should be also emphasized in the document. When it comes to investments in human resources, much more attention should be given to the Primary Care professional which has most frequently and most intensive contact with patients/citizens, even when they are not yet sick. For this reason more financial resources should be determined to the education/training of Primary Care professionals in providing health promotion and disease prevention and subsequently the execution of these tasks within their services.

11. If it comes to intersectoral action for health a stronger emphasis in the document can be given to the functions at community level. At the central place where citizens gather within communities, cooperation between the different services should be common. This cooperation stretches from the health care services, to police, to social work but also to public transport, housing cooperation's and of course planning departments of the local governments.

12. Further, EFPC respectfully proposes amendments to the following texts of the European Action Plan for Strengthening Public Health Capacities and Services:

EPHO 2: Identification of priority health problems and health hazards in the community Page 21
B. Control of environmental health hazards

2.B.8 System and procedures for risk assessment regarding consumer goods, cosmetics and toys
To be added: implementation of Injury Database

EPHO 5: Disease prevention
Page 23/24
Primary prevention might also include
5.A.5 smoking cessation, promotion of physical activity etc
Secondary prevention might also include
determining risk factors of common NCD, providing education on-site NCD
To be considered: tertiary prevention of conditions...provision of rehabilitation opportunities to disabling of caregivers, the silent patient

EPHO 6: Health promotion
Page 24/25
To be added: culture and problem-specific,
and might include: good clinical practice and good patient-doctor communication

A. Health promotion activities for the community at large...
To be added:
6.A.11 Prevention and control of leisure- and home injuries.
6.A.12 Prevention of domestic violence
6.A.13 Prevention of suicide and homicide

B. Capacity for intersectoral action

6.B.3. Intersectoral activities, including the leadership role of the ministry of health in ensuring....

A. "Health in all policies" approach regarding the following ministries
iii) Ministry of industry/trade
v) Ministry of family and social policies