NCD&OSH_4_joint-session-6./Info 1
NCD EG on Non-Communicable Diseases related
to Lifestyles and Social and Work Environments
4th NCD EG meeting 23-25 May 2012
in Helsinki, Finland
(24-25 May jointly with NDPHS/ OSH TG (Occupational
Safety & Health Task Group)
Reference NCD&OSH_4_joint-session-6./Info 1
Title Review of the EUSBSR Action Plan – proposal by the Northern
Dimension Partnership in Public Health and Social Well-being
(NDPHS) (input proposed by the NCD EG)
Submitted by NCD-Secretariat
Summary / Note NCD EG secretariat sent 08.05.2012 this requested feed-back to
NDPHS Secreatariat.
Requested action For reference and information on NCD EG position
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Review of the EUSBSR Action Plan – proposal by the Northern Dimension
Partnership in Public Health and Social Well-being (NDPHS)
Current structure
Proposed new structure
Priority Area 12.
To maintain and reinforce attractiveness of
the Baltic Sea Region in particular through
education and youth, tourism, culture and
health
Priority Area xxx (a separate PA).
To improve and promote people’s health
(public and individual) , including its social
aspects
Coordinated by
1) Tourism: Mecklenburg-Vorpommern
(Germany)
2) Health: Northern Dimension Partnership in
Public Health and Social Well-being
3) Education and youth: Hamburg
Coordinated by
Northern Dimension Partnership in Public
Health and Social Well-being
Presentation of the issue: Do you think the description of the issue is still relevant? Based
on the implementation up to now and your experience, would you like to update it, to modify
it, to narrow it down, to highlight some specific aspects?
Unlike other Priority Areas included in the current EUSBSR Action Plan, Priority Area 12
covers four different sub-areas, health being one of them. The description of the health
component in itself is still relevant. However, the approach of combining four different
issues in the Priority Area 12 needs to be revised. The NDPHS’ view is that the four
issues do not have much in common to substantiate combining them. Furthermore, this
approach is misleading in various respects and undermines their value, visibility and
importance vis-à-vis other sectors. Despite this, the NDPHS together with other
stakeholders engaged was able to make good progress in the health sub-area.
Furthermore, as the coordinator of the health component in the EUSBSR Action Plan,
the NDPHS plans to put more emphasis on social aspects and wellbeing linked to
health. In this effort it will engage regional stakeholders having specialist expertise in this
area, among them the BSN-ESF, the network of the Managing Authorities for the ESF
between the Member States concerned. This will help address issues such as social
exclusion, inequity and combating poverty, which often are root-causes of ill-health. At
the same time, poor health can cause exclusion and poverty, and lead into a viscious
circle , which becomes very expensive to society. In focusing on public health and
investing in human capital recognizing health as a resource and prerequisite for
economic growth, we can better contribute to the implementation of the new Europe
2020 Strategy.
Considering the above, the NDPHS requests that public health (including its social
aspects) be made a separate Priority Area in the upcoming, reviewed version of the
EUSBSR Action Plan.
The “Presentation of the issue” does not require substantial modifications, as compared
to the current text in the description of the health sub-area in the Priority Area 12. The
most important proposed addition, however, is an explicit reference to the challenges
posed by the ageing society and the crucial role that health plays in overcoming those
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challenges. Furthermore, the role of health in promoting prosperity and the social
dimension need to be emphasized.
If so, please suggest a new drafting of it. To which objective (1. to save the Sea; 2. to
connect the Region; 3. to increase prosperity) should it be linked?
It is proposed that the new text of the “Presentation of the issue” within the (separate)
Priority Area “To improve and promote people’s health (public and individual), including
its social aspects” (linked to the objective “to increase prosperity”) would read as follows:
“The prosperity of the region is based on human capital; consequently a healthy
population is a critical factor behind sustainable economic development of enterprises
and societies. 1Improvement of people’s health and social well-being is particularly
important in the context of the ageing society, one of the greatest regional challenges
in the 21st century. Unless counteracted, a decline in the working age population and
a higher number of people with chronic non-communicable diseases will put an
immense pressure on the national budgets and will lead to loss of productivity in the
decades to come. By investing in health improvement and promotion, the economic
gain will be two-fold: (i) healthy people are more likely to stay at the labour market
longer and remain productive and (ii) reduced spending on treatment of ill health.
Currently the Baltic Sea Region is an area of considerable disparities in health and
social conditions. It features places where social and economic problems lead to high
levels of mortality due to non-communicable diseases, violence, alcohol- and drugabuse and the spreading of infectious diseases. Social exclusion and poverty are not
unheard problems either. Further, growing cross-border movement of people need to
be paralleled by actions addressing inequalities in health status and in the level of
health protection.
Consequently, this priority area focuses on improving and promoting health of people
in the Baltic Sea Region, including social aspects of health, as an important
precondition for ensuring sustainable and healthy societies enjoying economic growth
and for containing future health and social care related costs.”
Baltic Sea Region added value: some partners have suggested removing this section. In
any case, can you explain, how according to you, the EUSBSR has best addressed the
issues identified in your priority area? What are these issues? What are the "success
stories", the "good practices" and the "good outcomes" which are linked to the
implementation of the Strategy (process-related and content-related)?
The cross-cutting dimension of the Strategy may appear to be one prominent element of
value added. Have you experienced it in your priority area? If so, in what way? Have you
developed contacts in other priority areas, with whom? Have you set-up cross-cutting
working groups, organisations, have you designed and/or implemented projects with a crosscutting dimension? If not, do you intend to do it? Could you identify actions and/or projects,
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Our societies are aging, which is the positive outcome of our previous successful work on public health and
economic and social developments. In our region there are still many countries where improvements in life
expectancy are badly needed. Having more older people is not the problem per se. On average, the most
expensive time in life is our last year, no matter at which age it occurs. Reorganizing our societies and
supporting elderly people to maintain their functionality can turn them into a resorce rather than a burden. The
biggest risk to our human capital is caused by increasing unhealthy lifestyles leading into early loss of health
and work ability due to hazardous and harmful alcohol consumption, use of tobacco, overweight and obesity and
low physical activity (sedentary lifestyle), accidents and violence , and mental ill-health, which cause aover 80
per cent of our disease burden.
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or areas where you would think it advisable to work more closely with other priority area
coordinators/partners? If so, what are they?
NCD Expert Group’s suggested input:
.”To improve and promote people’s health (public and individual) , including its social
aspects”:
3. References
The key landmarks in the healthy lifestyle promotion and non-communicable disease
prevention and control are the following documents of the World Health Organization and
UN, which all Northern Dimension Partnership countries have endorsed:
 The WHO Framework Convention on Tobacco Control (FCTC) by the World Health
Assembly in 2003 (http://www.who.int/tobacco/framework/fi nal_text/en/ ) ;
 The Global Strategy on Diet, Physical Activity and Health endorsed by the World
Health Assembly in 2004
(http://www.who.int/dietphysicalactivity/strategy/eb11344/strategy_english_web.pdf) ;
 The Global Plan of Action on Workers’ Health 2008-2017 endorsed by the World
Health Assembly in 2007
(http://www.who.int/occupational_health/WHO_health_assembly_en_web.pdf)
 The Resolution 61.17 on the Health of Migrants by the World Health Assembly in
2008 (http://apps.who.int/gb/ebwha/pdf_files/A61/A61_R17-en.pdf) ;
 The 2008–2013 Action Plan for the Global Strategy for the Prevention and Control of
Non-communicable Diseases endorsed by the World Health Assembly in 2008
(http://www.who.int/nmh/publications/9789241597418/en/index.html ) ;
 The Global Strategy to Reduce the Harmful Use of Alcohol adopted by the World
Health Assembly in 2010 (http://www.who.int/substance_abuse/msbalcstragegy.pdf) ;
 The report of the 1st Global Ministerial Conference on Healthy Lifestyles and Noncommunicable Diseases Control including the Moscow Declaration of the above
mentioned Conference (http://www.euro.who.int/moscow-declaration-ob-healthylifestyles-and-ncds ) ;
 Action plan for implementation of the European Strategy for the Prevention and
Control of Non-communicable Diseases 2012-2016
(http://www.euro.who.int/ncd-actionplan ) ;
 Political declaration adopted at the UN General Assembly - 19 September 2011 on
the Prevention and Control of Non-communicable Diseases
(http://www.un.org/ga/search/view/doc.asp?symbol=A%2F66%2FL.1&Lang=E) ;
 European action plan to reduce the harmful use of alcohol 2012-2020
(http://www.euro.who.int/en/who-we-are/governance )
Due to the present very active period (see above) on global and European level to
overcome modern-day plague, namely lifestyle related chronic diseases, disability and
premature mortality, the EUSBSR can bring a strong booster to developments of the Baltic
Sea area and Northern Dimension region. Innovations are needed on policy and practical
levels, and they need to be adapted and tested in national circumstances through flagship
projects and lessons be learned from each orthers’ successes and failures.
Main problems: Based on your evaluation of the two previous points (presentation of the
issue and BSR added value), do you think the description of the main problems is still
relevant? If not, please suggest a new drafting, highlighting what the main problems that
should be focused on are.
NCD Expert Group’s suggested input:
The main problems are viewed in a narrow way through the argumentation of
environmentalists (water, air, transport and climate change. In principle, theree is nothing
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wrong with it, except that if the human health and social aspects are neglected, the problem
statement provides a biased view.
The importance of public health gets a new basis if we view it in the light of economic losses
through causes that could prevent premature loss of life. In the Baltic Sea Region countries
loose human capital in the range of 9000 – 3000 years per 100.000 inhabitants. Considering
that in the Baltic Sea Region live about 60 million people it can be estimated that we loose at
least ca. 66 billion euro every year due to premature loss of life of preventable causes2.
Just if we could reduce preventabler mortality by 10 per cent, the annual gain would be about
6-7 billion euro. An this is only the top of the iceberg, as on top of it we would need to
calculate the expenses caused by morbidity, invalidity and human suffering. Changing the
trend would give a strong booster to economic development which would allow better
invetments to other sectors including education, culture and environment
Actions: There is a strong consensus that the distinction between "strategic actions" and
"cooperative actions" should be removed. They will all be called: actions and they should
provide an appropriate reply to the focused problems identified.
Can you analyse all the existing actions (strategic and cooperative) mentioned in the current
version of the action plan and indicate which ones should be updated, modified, reinforced,
reworded, removed (you will find in annex 2 a list of actions and projects that might be taken
out, because to our knowledge, nothing has happened so far as regards their
implementation, unless there are good reasons not to do so)? Please suggest a new drafting.
NCD Expert Group’s suggested input:
Strategic and cooperative actions can be pooled under one heading without major problem.
When it comes to actions and projects focusing on public health and social well-being they
should not be removed. On the contrary, they should be strengthened. Until now the
problem has been that public health and social well-being, especially focusing on lifestyle
related issues, have had very poor project funding opportunities. There has simply not been
an address to focus applicatons on. In addition, public health initiatives are not well suited for
economic activity, because preventive health action is not a market produc on individual
demand. Therefore, in order to implement them, funding must continue to come to a great
extent in grants. Projects on curative services are not needed under EUSBSR, as they are
well funded by pharmaceutical and insurance companies, in addition large research funds.
Flagship projects: The list of flagship projects mentioned in the current action plan should
be carefully scrutinised. Can you list those that:
 should be taken out (while explaining why),
 are up and running in a satisfactory way,
 did not manage to secure financing (and explain why, and what should be done),
 have other problems (describe which problems)
 have been completed (and what the results are)?
Each project (except those that must be taken out) should be filed under the action it directly
or more directly relates to. It could also be decided that those that have been completed will
be filed in an annex to the action plan with a short paragraph describing the achievements
and results and with a hyperlink to a relevant website.
As for new ideas or flagship projects to be inserted in the reviewed action plan, they should
follow the criteria that have been agreed upon in the taskforce on roles and responsibilities
(see fiche in annex 3). If the project fulfils all criteria listed in this annex and if the procedure
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the cost of one lost year according to national economic principle is the same amout as GNP per capita., which
ranges in our region (2010) between 11.000 USD (Latvia) to 48.000 USD (Sweden).
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described has been followed, it could be considered as a flagship project and associated to
one of the actions of the priority area.
If it does not fulfil all criteria and has complied with the procedure, it should be inserted in the
action plan as an idea (related to one of the actions) that is likely to become a flagship
project when all criteria have been fulfilled.
NCD Expert Group’s suggested input:
The following two Flagship projects have not been funded as no source for tesources has
been available. Both topics are extremely timely and efforts continue to identify necessary
funding source. The fact that public health would have a stronger status in EUSBSR could be
an important additional positive factor.
a) Prevention of over-weight and obesity among schoolchildren (ages 7-15)
b) Effective and efficient implementation of national NCD- prevention strategies
Funding sources: if you have identified or even secured funding sources (European,
national, regional, local, other) for your actions or projects in the current or future period,
please mention them in this section.
NCD Expert Group’s suggested input:
Healthier people: management of change through monitoring and action St.
Petersburg/ Kalininsky district 2012-2013 (total budget 250 000 Euro of which
200.000 Euro EU grant)
Indicators and targets: Please indicate in this new section the indicators and targets that
illustrate best, according to you, the main objectives and achievements you want to reach in
your priority area (for the record, what is the objective, the indicator related to it, the baseline
situation and its year of reference, the target and its deadline (and intermediate targets and
deadlines when you find them useful), and the reliable source(s) of information and
statistics).
NCD Expert Group’s suggested input:
The potential years of life lost (PYLL) rate describes life lost due to premature death in a
population. From a social point of view, this is equal to loss of human capital. The rate is
calculated on the basis of the difference between the age at death and the expected length
of life, and it is determined by the cause of death according to the ICD-10. The method
reviews the time of death in relation to pre-defined life expectancy. The rate is agestandardized and expressed as a sum of all deaths per 100,000 person- years.
The PYLL rate provides comparable information about the wellbeing of a population
concerning all death causes. It provides supplementary information for planning and
decision-making for health policies. In the Baltic Sea Region countries the PYLL-indicator
ranges from about 9000 – 3000 years per 100.000 inhabitants. Considering that in the Baltic
Sea Region live about 60 million people it can be estimated that we loose at least ca. 66
billion euro every year due to premature loss of life of preventable causes. Just if we could
reduce preventabler mortality by 10 per cent, the annual gain would be about 6-7 billion euro.
The target for progress can be set to 10 per cent reduce premature avoidable mortality
(PYLL) in NDP countries’ populations. Additional target could be 10 per cent reduction in
the DIFFERENCE of premature avoidable mortality (PYLL) between BSR countries’
populations. As an economic idicator the amount of annual financial benefit to national
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economies can be calculated. In the same way we can calculate the price of non-action (=
“laissez- faire”) .
Any other suggestions or comments: In case you would need to add further elements.
NCD Expert Group’s suggested input:
An additional important fact to strengthen the role of public health and social inclusion in the
EUSBSR is that in the Northern Dimension Countries some EU free-market polcies have in
fact brought with them considerable additional burden and negatve health related side
effects. As alcohol has been handled as a normal market good and nor a potentially
hazardous and harmful addictive substance, European deregulation of import in recent
years has increased alcohol related mortality, morbidity and social harm (child neglect,
violence and accidents) . Hence new action to overcome the caused harm is needed and in
fact a moral oblication for EU. In nutrition policies the causal links are not as clear, but
nevertheless through sensible nutrition policies we could increase fruit and vegetable intake
at the same time while reducind obesitogenic and biabetogenic high caloey and sugar
content products.
Conclusions of your analysis
Status of the priority area: Based on your review of all the points abovementioned, can you
draw some conclusions on how your priority area could/should evolve? In particular, will it be
or does it need to be more focused? Can it be merged with one or more priorities, and if so
how and with which ones? Can some actions be transferred to other priority areas? Do you
have any other suggestions?
One of the conclusions drawn by the NDPHS from the first two years of the
coordination of the implementation of the health sub-area in the EUSBSR Action Plan
is that the idea of combining education, tourism, culture and health in one Priority
Area has been wrong and does not work. These four sectors do not have much in
common (and certainly vastly less than some other, currently separate, PAs) to
substantiate combining them into one Priority Area. Keeping health as a sub-area not
only does not support efforts of organizations and people engaged in this component
of the Strategy but just the opposite – it undermines the value and importance of
these efforts as well as sends misleading signal and causes confusion among actors
not engaged in the coordination of the Strategy.
To that end, on 18 November 2011, following the respective decision by the NDPHS
Committee of Senior Representatives, the NDPHS Secretariat sent a letter to the DG
REGIO (cc. to the EUSBSR NCPs) with a request to include health (and social
matters, if possible) as a separate Priority Area (PA) in the EUSBSR Action Plan.
Furthermore, the ministerial-level Partnership Annual Conference held on 25
November 2011 emphasised that “both health and social dimension should be given
in the EUSBSR Action Plan a status adequate to their role and importance in the
region’s societies.”
Although organization and delivery of health care is a national competence, regional
cooperation in health is advantageous and essential. The main health-related
challenges (including those regarding social issues linked to health), that the Baltic
Sea Region countries are currently facing, are the same. Consequently, it is only
logical to coordinate the responses to common challenges, in order to bridge gaps
and speed up innovation processes, avoid duplication of efforts and limited
resources, and allow for well-informed policy and decision making. The ongoing
process of the review of the EUSBSR Action Plan provides an opportunity to
recognize a key role of health and social well-being in contributing to smart and
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inclusive growth, thereby making it an important component in the implementation of
the EU 2020 Strategy.
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