Sustainable Development and Public Health Helmut Brand Professor of European Public Health...

“Sustainable Development and Public Health”

Helmut BrandProfessor of European Public Health

helmut.brand@inthealth.unimaas.nl

Gro Harlem Brundtland, MD, MPH

74-79 Minister of the Environment of Norway

81 Prime Minister of Norway

87 “Our common future” (Brundtland Report)

86-89, 90-96 Prime Minister of Norway

98-03 Director General WHO

Photo: Harry Wad

Concepts for Sustainable Development and Public Health

Health sustainability challenges of 21st century societies:

1. Demographic and financial pressure through the ageing of societies

2. New epidemiological developments: increase in overweight and obesity, increase in mental health problems

3. Health system organisation and financing: from acute care to prevention

4. New and re-emerging infectious disaeses: SARS, HIV, Tb

5. Health inequalities

6. Health impact of global warming and climate change: interdependence of health sustainability and environmental sustainability

Kickbusch I. Policy Innovations for Health, Springer, 2009, p. 9

Obesity

1998

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2007

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2007

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% CDC 2009

The challenge of obesityin the WHO European Region and thestrategies for response, WHO 2007

?

Data from Northrhine Westphalia, Germany

Obesity at school entry

Data from Northrhine Westphalia, Germany

low medium high Educational level of parents

total

Obesity atschool entry

Inequalities

65

70

75

80

85

1970 1980 1990 2000 2010 2020

EU members before May 2004 EU members since 2004 or 2007CIS

Life expectancy at birth, in years

Between groups of countries

WHO HFA Database

65

66

67

68

69

70

71

72

73

74

75

1970 1980 1990 2000 2010

EstoniaLatviaLithuaniaEU members since 2004 or 2007

Life expectancy at birth, in years

In groups of countries

WHO HFA Database

Between groups in a country

Between groups in a city

Pandemics

Demographic Change

the ratio is the number of elderly persons aged 65 and over divided by the number of persons aged 15 to 64

“Medicalisation” or“Compression” of morbidity ?

Climate Change

Legend

0.00 - 0.120.12 - 0.180.18 - 0.270.27 - 0.410.41 - 0.620.62 - 0.780.78 - 0.850.85 - 0.910.91 - 0.970.97 - 1.041.04 - 1.101.10 - 1.161.16 - 1.231.23 - 1.271.27 - 1.311.31 - 1.351.35 - 1.391.39 - 1.591.59 - 1.881.88 - 2.322.32 - 2.992.99 - 3.983.98 - 5.475.47 - 7.707.70 - 11.05

Death Frequency on the 12th of August 2003 in comparison to expected values (yearly averages 1998-2002)

Robine JM, Cheung SL, Le Roy S, Van Oyen H, Griffiths C, Michel JP, Herrmann FR. The 2003 Heat Wave Project

70.000 excessdeaths in 2003

Temperature1% increase in temperature = 1-4% increase in mortalityFoodborne infectionsVector borne diseases

Ultraviolett radiationSkin cancerMalignant melanomaCataracts

WaterFloddingFaecal bacteriaHygienic problems

AirOzoneAllergic disorders (hay fever, asthma)

Increased migrationIntra country migrationHumanitarian assistanceDisplaced populations from non EU Member States

Vulnerable groupsSocio economic gradientElderlyChildren

Mental disaesesfollowing disaster experience

A good overview in: COMMISSION STAFF WORKING DOCUMENT,Accompanying document to the WHITE PAPER“Adapting to climate change:Towards a European framework foraction.”COM(2009)147 final

Health Impacts of Climate Change

Health Systems

WHO European Ministerial Conference on Health Systems:„Health Systems, Health and Wealth“.Tallinn, Estonia, 25-27 June 2008.

The contribution of regions to health and wealthTechnical report for the WHO European Ministerial Conference on HealthSystems: “Health Systems, Health and Wealth”, Tallinn, Estonia,25–27 June 2008

www.euro.who.int/Document/E91414.pdf

Prescription:Apply three times a day in caseof financialcrises !!

Health and wealth are interdependent.

HEALTH OUTPUT

Labourproductivity

Laboursupply

Education

Savings

From: Bloom DE, Canning D. The health and wealth of nations.

WHO 2007

0

2

4

6

8

10

12

1980 2000 2002 2004 2006

OECDUKGermany

Health Expenditure as % of GDP

OECD 2009

EU Health Strategy

Expanding EU:growing health gaps Ageing

Population

Climate Change, Pandemic and Bioterrorism Threats

Lifestyle Related Diseases

Migration &Cross Border

Healthcare

New Technology and Innovation

Globalisation

Citizens wantmore

control

White paper on Nutrition Communication on Alcohol

Tobacco control strategy

Health information and Health PortalProject HLS-EU

ECDC

Interactions with WHO

Health Services InitiativeProject EUREGIO II

Health investments through Structural Funds etcProject Euregio II/III

E-HealthPublic Health Genomics

Cross-sectoral work

EC 2007

“Sustainable Development and Public Health”

Helmut BrandProfessor of European Public Health

Faculty of Health, Medicine and Life SciencesMaastricht University, The Netherlands

helmut.brand@inthealth.unimaas.nl