The publication was prepared based on the materials of an analytical report on the problems of the WHO global strategy to achieve health for all in the 21st century (Venediktov D.D., Ivanova A.E., Maksimov B.P.). Health for all in the 21st century: problems of global strategy World

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Health 2020: European policy framework and strategy for the 21st century
(2013)

World Health Organization

Regional Office for Europe

Summary.

In September 2012, representatives from 53 countries in the European Region meeting at the WHO Regional Committee for Europe adopted the framework for a new values- and evidence-based regional policy healthcare - Health 2020. The main goal of this policy is to improve health for all and reduce health inequalities through improved leadership and governance for health. She's focused on the most important problems health today. The policy framework identifies four priority areas for strategic action and is innovative in its focus on action across all levels and sectors of government and society. At the same time, the importance of developing resources to increase the resilience of communities to negative external influences, empowering citizens and creating favorable conditions environment. Aspects relevant to strengthening the role of health and public health systems are outlined in detail. Health 2020 was adopted in two forms: a document for decision makers and policy makers, A European policy framework to support whole-of-government and societal action for health and well-being, and a more detailed version, Health 2020: a policy framework and strategy. " Implementation of the Health 2020 policy in countries is today a fundamental priority for the Region.

Keywords:

Health systems plans

Delivery of health care

Regional health planning

International cooperation

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Introduction

Health 2020 is a value-based and evidence-based strategic policy framework to support the health and well-being of people in the WHO European Region. We hope that by displaying modern problems and difficulties, opportunities and ways further actions, it will deepen understanding and provide encouragement to all those seeking to take advantage of these new opportunities to improve the health and well-being of current and future generations in the European Region. Health 2020 is a policy for everyone: not only for managers and specialists, but also for civil society, communities, families and citizens.

Why is Health 2020 important? It presents a socio-economic imperative for action, clearly demonstrating that health and well-being are essential conditions for successful economic and social development. This policy includes the following aspects: health as a human right; a whole-of-government and whole-of-society approach to achieving equitable health outcomes; strong and active governance and leadership for health; mechanisms for collaboration and alignment of priorities with other sectors; the importance of relying on and empowering local communities and individuals; the role of partnerships.

In 2012, the WHO Regional Committee for Europe adopted Health 2020 in two documents, which are included in this summary publication. From the document entitled “A European policy framework to support states and societies for health and well-being”, policymakers and decision-makers involved in implementation practical strategies, can learn the core values ​​and principles needed to implement real life Health 2020 approaches. It reflects today's major health challenges and the opportunities for improving health in an equitable manner, making a compelling political, social and economic case for health action, aligned with key policy objectives and priorities.

A more extensive document, Health 2020 policy framework and strategy, provides much more detailed contextual analysis, key effective strategies and interventions, as well as evidence and detailing the potential needed for policy and practice to improve health and well-being. The focus is on innovative and evidence-based policy and practice to assist those involved in developing and implementing strategies at the operational level. The Health 2020 policy framework and strategy is intended to be a continuously updated guide to the latest developments in evidence, practice and performance.

Taken together, both documents provide a flexible framework for policy and practice in Member States of the European Region, drawing on many years of global and regional strategic experience. Health 2020 is fully aligned with the WHO reform process and will be actively promoted by the WHO Regional Office for Europe to Member States, who will be provided with comprehensive in-country support tailored to their specific needs and priorities. To meet these challenges, WHO must work in partnership, and all participants in the development of Health 2020 must be actively committed to making it a reality.

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Health 2020: a European policy framework to support

actions of the entire state and society in the interests of health and well-being

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Preface.

Health 2020: a European policy framework to support whole-of-government and societal action for health and well-being sets out some promising and ambitious targets for protecting people's health. These frameworks were adopted by all 53 Member States of the WHO European Region at a critical time. As 2015 approaches, the target date for achieving the Millennium Development Goals, new policy will help determine the place of health in the subsequent set of global goals.

The fundamentals contain a synthesis of everything we last years learned about the role and importance of health. Achievement highest level Health at all stages of life is the fundamental right of everyone, and not the privilege of a select few. Good human health is a valuable resource and a source of economic and social stability. It plays a key role in poverty reduction and also contributes to and benefits from sustainable development. It is critical that good health outcomes can no longer be seen as the result of just one sector: sustainable improvements in people's health, while respecting social equity, are the result of effective, participatory policies that cover all components government controlled, as well as the collective efforts of the entire society.

The reader will be convinced that these provisions run like a red thread throughout the entire strategy. The Region faces serious challenges that need to be addressed. Unfair disparities between and within countries reflect the economic and social barriers that divide people. As economic burdens worsen and health care costs rise, the risk of social exclusion increases, and too often those whose health needs help most are excluded. At the same time, we know that society expects services based on the latest and greatest advances in medicine, which, coupled with the changing disease patterns of an aging population, creates incredible pressure on budgets. New approaches and perspectives are needed to make universal health coverage a reality for countries in the Region. Future progress requires a shift in the mindset of policymakers, health care providers and citizens, away from a focus on coping with disease and towards a focus on promoting health and well-being. Achieving success requires political support, technical and organizational innovation, and changes in the way financial and other resources are allocated and used.

The European Policy Framework is closely linked to WHO's Twelfth General Program of Work and is a practical reflection of WHO's reform agenda to make the Organization more effective in responding to the needs of Member States in a rapidly changing world. In the European region, as in other regions, in order to achieve the final results envisaged in the framework of this policy, it is necessary that international organizations cooperate not only with individual line ministries, but also with all relevant sectors of the state, with colleagues in other international organizations, activities which has an impact on health, as well as with business structures, scientific and academic institutions and civil society. These European policy frameworks point the way forward to new approaches to improving health and well-being for people around the world.

Margaret Chan CEO WHO

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Preface.

It gives me great pleasure to present to you the framework of the European health policy, Health 2020. Heads of state and government, city mayors, policymakers, healthcare professionals and community activists - for each of you, Health 2020 has information that will help you make more informed and wiser decisions, taking into account aspects of health, safety and economic viability.

The 21st century healthcare landscape is characterized by increasing interdependence at the global, regional, national and local levels and an increasingly complex set of interconnected factors affecting people's health and well-being. For example, one of the generally significant current tasks is to analyze and combine into a single complex many different active forces and industry services (such as housing provision, water and energy supply, nutrition and medical and preventive care) necessary to maintain the health and well-being of citizens, families and the entire society. We all know well that ill health reduces life potential, creates despair and suffering, and leads to resource depletion. Overcoming these challenges at any level - individual, organizational, community, municipal and national - requires thoughtful, strategic and well-coordinated action. Therefore, the 53 Member States of the WHO European Region jointly developed and adopted Health 2020 as a guiding framework to support such action.

Health 2020 is a detailed strategic vision of public health as a dynamic network of stakeholders at all levels of society, designed to support action with a common purpose across the Region. All recommendations arising from Health 2020 are based on reliable evidence. Numerous experts took an active part in its development. We are committed to ensuring that Health 2020 is the unique body of evidence on public health policy that is available.

Based on a broad review of published data, accumulated practical experience and an unprecedented consultative process involving stakeholders across the Region, the work to create Health 2020 has stimulated extensive rethinking of current mechanisms, processes, relationships and organizational tools public health. As a result, Health 2020 can now be used as a unique regional resource to help us all learn from our experiences, set new priorities and find more effective ways to coordinate action across all sectors of society to improve individual and public health and increasing the level of well-being.

Health 2020 recognizes and welcomes the wide diversity of health systems and approaches across the European Region. The goal of this policy is not to bring all national and local health systems to the same standard, but to make them all more advanced. In adopting Health 2020, countries set two general tasks: first, to achieve better health for all and reduce the health gap; the second is to strengthen leadership and collective governance for health.

Outlining ways to address these challenges, Health 2020 proposes new forms of strategic leadership for health, according to which concern for the health and well-being of citizens is considered the responsibility of the entire society and the entire state, and also fully supports active public participation in the formation and implementation of strategies.

The Health 2020 policy contains a socio-economic argument for improving health outcomes and sustainable scientific basis the need for investment and action in a comprehensive approach to promoting health, preventing disease and improving people's well-being. Action on social determinants is described, which consists of developing approaches to mainstream health into policies across all sectors to improve the health of everyone and thereby reduce the absolute impact of social determinants on the entire population, and to implement targeted interventions that include those most in need of help.

Health 2020 outlines new systems of collective leadership to support innovative approaches to social mobilization for equitable, sustainable and responsible health development.

It contains a wide range of effective, innovative responses to today's challenging public health challenges. A set of strategies and interventions is proposed to overcome the most current problems health arising at various stages of human life, including diseases of both non-infectious and infectious nature. Health 2020 highlights the connections between clinical interventions and actions that address equity and the social determinants of health, as well as the necessary resource investments in the health system - such as human resources and better medicines, strengthening the health financing system and optimizing strategic leadership for health.

By focusing on a shared set of values, evidence and experience, Health 2020 provides a platform for developing partnerships and collaboration. Health 2020 calls for the inclusion of all sectors of society as a central element in the planning, development, implementation and monitoring of health strategies at all levels. The policy makes a strong case for empowering citizens, consumers and patients as the most important factor, contributing to improved health indicators. It also calls for the active participation of themselves professional workers healthcare.

What will help from WHO consist of? The Regional Office will support countries in adapting Health 2020 in the following areas: analysis of the public health situation; identification of available resources and assets; full assistance in the formation of political commitment at the level of presidents and prime ministers; providing strategic advice and monitoring progress; supporting leadership and effective governance for health; formulating proposed mechanisms for implementing a whole-of-government approach and participation of the whole society; assistance in building institutional and human resources capacity.

Two key documents outlining the Health 2020 policy have been developed. The European policy framework for supporting states and societies for health and well-being can provide policymakers, decision makers and practitioners with the key values ​​and action principles needed to translate Health 2020 into action in a locally relevant way. The longer version, Health 2020 policy framework and strategy, provides more detail on the evidence-based argument and is intended for those involved in policy formulation and implementation at operational levels.

I am confident that the Health 2020 policy can make additional valuable contribution in our individual and collective work aimed at improving the health and well-being of people, to serve as a unique resource for achieving a better future and prosperity for individual countries and the Region as a whole, for the benefit of all its peoples. By building on the values ​​and approaches of Health 2020 and proactively aligning our daily practices with them, we can make Europe healthier - for ourselves and for our children.

Zsuzsanna Jakab WHO Regional Director for Europe

“The enjoyment of the highest attainable standard of health is a fundamental right of every person.”

WHO Constitution

Dear Prime Minister, Minister, Mayor, Member of Parliament!

People's health is the basis of social and economic development and contributes to a more effective solution of tasks in all sectors of society. Meanwhile, the economic and financial crisis facing many countries has created serious challenges and risks that threaten the progress achieved. But the crisis also offers significant opportunities to refocus and renew efforts to improve the health of all people.

All areas and levels of government contribute to the protection and promotion of health. Your leadership in advocating for health and well-being can make a huge positive difference for the people of your countries, provinces, regions and cities, as well as for the European region as a whole.

Your support for Health 2020 is truly critical.

“We are committed to ensuring that improving health and well-being for all is seen as one of the inalienable rights person. However, good health cannot be bought with money. A balanced policy aimed at ensuring social justice has a greater chance of success. We must address the root causes (of ill health and injustice) using a social determinants approach that involves the whole of government and the whole of society.”

Margaret Chan, WHO Director-General

All 53 Member States of the WHO European Region have decided to create new general principles politics - Health 2020. Their common goal- “to significantly improve the health and well-being of populations, reduce health inequalities, strengthen public health, and ensure universal, equitable, sustainable and high-quality people-centred health systems.”

Health 2020 takes into account the diversity of countries in the Region. The policy framework speaks to a variety of audiences, both inside and outside government, to inspire them and provide solutions to the complex health challenges of the 21st century. They reaffirm the values ​​of Health for All and, based on the evidence contained in the accompanying documents, highlight two key areas and four priority areas for strategic action. Building on the experience of previous Health for All strategies, the Framework aims to provide guidance for both Member States and the WHO Regional Office for Europe.

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Health is the most important social resource.

Good human health benefits all sectors and the entire society - it is an invaluable resource. Health and well-being are a key driver of economic and social development and have vital importance in the life of every person, every family and every community. Ill health, on the other hand, leads to loss of life potential, human suffering and resource depletion in all sectors. Empowering people to take control of their health and its determinants helps develop communities and improve quality of life. Without the active participation of people themselves, many opportunities to promote and protect their health and well-being are lost.

The factors that underpin the prosperity and well-being of a society also determine the health of people - strategies that take this principle into account are more effective. Equitable access to education, meaningful employment, availability of comfortable housing and a decent level of income - all this contributes to maintaining health. In turn, health contributes to increased labor productivity, the formation of more productive labor resources, healthier aging, as well as reduced costs of sickness benefits and social care and reduced loss of tax revenue to the budget. The most reliable way to ensure the health and well-being of the population is the joint work of all sectors of the state aimed at the social and individual determinants of health. Good people's health contributes to economic recovery and development.

Health efficiency and cost-effectiveness are interlinked - optimizing the use of resources in the health sector is key. Both the direct and indirect impact of the health sector on the economy are important: this is important not only because of how the sector affects people's health and economic productivity, but also because it is currently one of the largest sectors in the world. economies of all middle- and high-income countries. The healthcare sector is a major employer, land owner, builder and consumer. It is a powerful driving force for scientific research and innovation, as well as a significant field of international competition for people, ideas and products. Its importance will continue to grow, and with it the significance of its contribution to broader societal goals.

The health of people in the WHO European Region as a whole has improved significantly in recent decades - but not everywhere or to the same extent; This state of affairs is unacceptable. Many populations and geographic regions lag behind in health, and health inequalities often widen between and within countries when economic instability occurs. At the same time, ethnic minorities, certain categories of migrants and nomadic groups such as the Roma people (Gypsies) are disproportionately affected. Changing patterns of disease, demographics, and migration may hinder progress in improving health outcomes; Solving this problem requires improving management mechanisms and strategic leadership. The rapid increase in chronic diseases and mental disorders, lack of social cohesion, environmental threats and financial uncertainty further complicate efforts to improve health and threaten the sustainability of health systems and social security. Creative, innovative approaches with strong support are the need of the hour.

Rio de Janeiro Political Declaration on Social Determinants of Health (2011)

“Health inequities stem from the conditions in society in which people are born, grow, live, work and age, which are called the social determinants of health.”

Conference participants stated:

“We reaffirm that inequities [in health] within and between countries are politically, socially and economically unacceptable, discriminatory and largely preventable, and that promoting health equity is essential to sustainable development And best quality life and prosperity for all, which in turn promotes peace and security.”

What is a social gradient?

A social gradient in health means that as the socioeconomic status of individuals and/or communities improves, their health also progressively improves. Thus, the problem of social inequities in health affects everyone. This phenomenon is global in nature and is relevant for all countries, regardless of income level.

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A strong value basis: achieving the highest possible level of health.

Health 2020 is based on the values ​​​​founded in the WHO Constitution: “The enjoyment of the highest attainable standard of health is a fundamental right of every person.” Countries in the WHO European Region recognize the right of everyone to health and are committed to the principles of solidarity and universal and equal access to services as values ​​that underpin the organization and financing of health systems. Their goal is for people to achieve the highest level of health, regardless of their ethnicity, gender, age, social status or ability to pay. Fundamental values ​​include fairness, sustainability, quality, transparency, accountability, protection of human dignity and the right to participate in decision-making.

Investing resources in health makes direct sense.

Increases in health care spending correlate with growth in gross domestic product (GDP) 92% of the time. Over the past three decades, health care spending in most Organization for Economic Co-operation and Development (OECD) countries has begun to rise, outpacing OECD real GDP growth of 1% on average. In 1950, healthcare spending in the United Kingdom was 3% of GDP. Even in the US in 1970, health care spending was only 7% of GDP. Average health care spending in OECD countries rose from 5% of GDP in 1970 to 9% in 2010.

Prevention is effective.

For example, experience in Poland shows that healthier diets and reduced smoking can reduce the incidence of chronic heart disease and overall premature mortality rates.

The most effective tobacco control policy is to increase taxes on tobacco products. In countries of Eastern Europe and Central Asia, a 10% price increase would prevent 0.6 to 1.8 million premature deaths.

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There is a strong social and economic case for improving people's health.

The challenges governments face with healthcare costs are greater today than ever before. In many countries, the share of government budgets spent on health is higher than ever before, with the cost of services rising faster than GDP. However, in at least some of them, the data show a lack of correlation between health care spending and health outcomes. Many health systems are unable to contain costs as financial constraints make it increasingly difficult to raise the necessary funds to protect health and provide social protection. Costs are increasing primarily due to increased supply from suppliers; it's about new treatments and technologies and how people increasingly expect protection from health risks and access to high-quality health services. Before embarking on any health system reform, it is necessary to carefully analyze the deep-rooted economic and political interests, as well as the possibility of social and cultural opposition. Ministries of health cannot overcome all these difficulties by relying solely on their own resources; solving such problems requires the use of intersectoral approaches.

Last year's consultations highlighted WHO's international role in strengthening health systems in a changing world. In working to improve health systems that do not yet deliver adequate, equitable health services to all people, WHO faces many of the same challenges that countries face:

how to ensure that the program of this work is clear and specific;

how to create better functional links between programs, partners, donors, aid organizations and countries; And

how to provide the capacity to address current issues and identify future challenges.

The following four principles underpin WHO's response to this problem:

a single Program of Action with six building blocks;

health systems programs that focus on results;

a more effective role for WHO at country level;

WHO's role in international program by health care systems.

Main goal The Action Program is to promote a common understanding of what a health system is and what it means to strengthen health systems. It also provides a framework to support countries in scaling up health systems and services using a “diagonal” approach: collaborative, coordinated action to overcome barriers to achieve desired health outcomes and sustainable gains across the system. To be most effective, the process must be country-focused and based on the priorities set in comprehensive national health plans.

There is no single set of best practices that can be used to improve performance. The Four Fundamental Principles and the WHO Program of Action chart a course that must be given the highest international priority. Working with countries and international health partners, WHO will use its strengths to immediately strengthen health systems and services and save millions of lives.

"Health for everyone" is the World Health Organization's (WHO) global strategy for health development, adopted in 1980 by all 189 WHO member countries.

In 1998, a new version of the strategy was adopted - “Health for All in the 21st Century”, the main goal of which is to achieve the highest possible level of health for all residents of the world's regions.

One ongoing goal is for all people to achieve their full “health potential.”

Two main goals:

strengthening and protecting people's health throughout their lives;

reducing the prevalence and suffering caused by major diseases, injuries and disabilities.

Three fundamental values ​​as the ethical basis of Health-21:

health as one of the most important human rights;

equity in health and health and effective solidarity between countries, groups and populations within countries and between both sexes;

health participation and ownership/accountability of individuals, groups, populations (communities) and institutions, organizations and sectors.

Four main action strategies have been selected to ensure scientific, economic, social and political sustainability as an ongoing prerequisite and driving factor in the implementation of the Health 21 goals:

Multisectoral strategies to address the determinants of health, taking into account physical, economic, social, cultural and gender perspectives and to ensure the use of health impact assessments:

results-based programs and investments to advance health care and clinical care;

a comprehensive primary health care system focused on family and community-based care, supported by a flexible and responsive hospital system and, finally,

collaborative health action, with broad participation and involvement of relevant health partners at all levels - home/family, school and workplace, local/community and country - and promoting shared processes of decision-making, enforcement and accountability.

solidarity for health in the European Region;

health equity;

healthy start in life;

youth health;

maintaining health in old age;

improvement mental health;

reducing the prevalence of infectious diseases;

reducing the prevalence of non-communicable diseases;

reducing injuries from violence and accidents;

healthy and safe physical environment;

healthier lifestyle;

reducing the harm caused by alcohol, addictive drugs and tobacco;

healthy environment conditions;

multisectoral commitment to health;

integrated health sector;

governance issues and quality assurance of health care;

health services financing and resource allocation;

development of human resources for health;

research and health information;

policies and strategies to achieve health for all;

mobilizing partners for health.

Subject: WHO Strategy “Health for All – 21st Century”

STUDY QUESTIONS:

1. Challenges facing the world community.

Currently, the world community is putting forward new tasks:

Sustainable development of society in harmony with nature;

Formation of a humanistic paradigm;

Protecting and ensuring human rights and peoples around the world;

Achievements in the 21st century "health for all". The policy of achieving health for all in the 21st century represents a forward-looking vision of this problem.

The policy of achieving "health for all in the twenty-first century", adopted by the world community in May 1998, is aimed at implementing the strategic concept of health for all. It originated at the 1977 World Health Assembly and was proclaimed at the Alma-Ata Conference in 1978. The policy sets out global priorities and targets for the first two decades of the twenty-first century to ensure that the world can achieve and maintain both the highest attainable level of health possible throughout the life cycle.

Health for all - all people in all countries should have at least a level of health that enables them to be active in their productive and productive activities. social life in the community where they live

The global policy to achieve health for all for the twenty-first century must be implemented through appropriate regional and national strategies. For our country, which gravitates towards the European region, it is the European experience in developing and implementing a unified strategy to “achieve health for all in the European region” that is of the greatest interest.

The key goal of Health21 in the European region is for all people to achieve their full “health potential”. Health potential – the maximum achievable level of human health

2. The main goal and strategies of the global policy to achieve “health for all”.

The goal can be achieved by:

Ensuring equality in health care through solidarity of action;

Strengthening and protecting people's health throughout their lives;

Reduce the prevalence and suffering caused by major diseases, injuries and disabilities.

Four main action strategies have been selected to ensure scientific, economic, social and political sustainability as an ongoing prerequisite and driving factor in achieving the HEALTH21 goals:

Multisectoral strategies aimed at improving the determinants of health - taking into account physical, economic, social, cultural and gender perspectives - and using health impact assessments;

Results-based programs and investments to advance health care and clinical care;

An integrated primary health care system, focused on family and community-based services and supported by a flexible and responsive hospital system; and finally

Collaborative health action, with broad participation and involvement of relevant health partners at all levels - home/family, school and workplace, local/community and country - and promoting shared decision-making, enforcement and accountability processes.

Twenty-one HFA targets have been formulated for the European Region. They should become a kind of yardstick for assessing progress and achievements in improving and protecting health and reducing health risk factors. These objectives provide the basis for the design and development of health policy in the European Region.

The 2005 update emphasizes the following key principles underpinning health for all.

The ultimate goal of health policy is the full realization by all people of their existing health potential.

Addressing health disparities between and within countries (i.e. increasing solidarity) is of great importance for public health in the region.

Community participation is a key condition for health development.

Health development can only be achieved through cross-sectoral strategies and cross-sectoral and cross-sectoral investments aimed at improving the determinants of health.

Each sector of society is responsible for the effects that its activities have on people's health.

3. European region: twenty-one targets to achieve “health for all”

The specification of these goals is contained in the tasks.

Objective 1 – solidarity for health in the European Region.

By 2020, the current health gap between Member States of the European Region should be reduced by at least one third.

Objective 2 - health equity

By 2020, the health gap between socioeconomic groups within countries should be reduced by at least one quarter in all Member States by significantly improving the health of underserved populations.

Objective 3 - healthy start in life

By 2020, all newborns, children younger age and children preschool age in the region should be healthier, which will provide them with a healthy start in life. This implies:

Objective 4 - youth health

By 2020, the region's youth should be healthier and better equipped to take on their responsibilities in society.

Objective 5 - maintaining health in old age

By 2020, people over 65 years of age should be able to achieve their full health potential and play an active social role in society.

Objective 6 - improving mental health

By 2020, it is necessary to ensure an improvement in the psychosocial state of people and the availability of comprehensive services that will provide assistance to people with problems related to mental health.

Objective 7 - reducing the prevalence of infectious diseases

By 2020, there should be a significant reduction in the prevalence of infectious diseases through systematic programs for partial and complete elimination, as well as control of infectious diseases.

Target 8 - reducing the prevalence of non-communicable diseases.

By 2020, morbidity, disability and premature mortality associated with major chronic diseases, should be reduced to the lowest possible levels throughout the region.

Target 9 - Reduce injuries from acts of violence and accidents

By 2020, there should be a significant and sustained reduction in the number of injuries, disabilities and deaths due to accidents and violence in the region.

Objective 10 - healthy and safe physical environment

By 2015, the region's population should live in a safe physical environment, free from exposure to pollutants hazardous to health at levels exceeding international standards.

Suggested Strategies

Objective 11 - healthier lifestyle

By 2015, people in all walks of life should adopt healthier lifestyles.

Target 12 - reducing the harm caused by alcohol, addictive drugs and tobacco

By 2015, the adverse health effects associated with the use of addictive substances such as tobacco, alcohol and psychoactive drugs are expected to be significantly reduced in all Member States.

Task 13 - healthy environment conditions

By 2015, the region's population should have best opportunities to enjoy a healthy physical and social environment at home, at school, in the workplace and in the local community.

Target 14 - strengthening the responsibility and accountability of various sectors for activities that affect health

By 2020, all sectors must recognize and take responsibility for health.

Objective 15 - Integrated Health Sector

By 2010, the region's population should have better access to family- and community-focused primary health care, supported by a flexible yet sustainable hospital system.

Objective 16 - the formation of an integrated health sector, meaning strengthening the interaction of various structures, with an emphasis on the role of an integrated primary health care system

By 2010, Member States must ensure that health sector governance - from population-based programs to individual care at the clinical level - is results-based.

Target 17 - health services financing and resource allocation

By 2010, Member States should have stable financing and resource allocation mechanisms for health systems based on the principles of equitable access, cost-effectiveness, solidarity and optimal quality.

Objective 18 - development of human resources for health

By 2010, all Member States should ensure that health workers and workers in other sectors acquire necessary knowledge, skills and abilities in matters of protection and health.

Objective 19 - Research and Health Information

All Member States should have research information and communication systems that can better support the acquisition, use and dissemination of evidence to support health for all.

Objective 20 - mobilize partners for health

By 2005, the implementation of a health-for-all policy must involve individuals, groups and organizations in both the public and private sectors, as well as civil society as a whole, bringing them together through collaboration and partnership to work for health.

Target 21 - Policies and strategies to achieve health for all

By 2010, all Member States should not only have, but also implement health-for-all policies at national, regional and local levels, supported by appropriate institutional structures, governance processes and innovative leadership.

BIBLIOGRAPHY

1. Abramenkov healthcare organization and the right to health - Foreign economic relations. - 2006. - T. 21. - No. 1. - P. 28-31.

2. The world health report 2000. Health systems: improving performance. World Health Organization. - Geneva, 2000. - 232 p.

3. Report on the state of health in Europe 2002. WHO Regional Office for Europe, Copenhagen. - European series, No. 97.-156 p.

4. Report on the state of health care in Europe. Public health action to improve the health of children and populations. – WHO Regional Office for Europe. 2005.

5. Health 21: a policy framework for achieving health for all in the WHO European Region. European series on achieving health for all No. 6. - Copenhagen, 1999. - 310 p.

6. Macroeconomics and health: investing in health for economic development. Report of the Commission on Macroeconomics and Health. - WHO. Geneva, 2001.

7. Policy framework for achieving health for all in the WHO European Region. Update 2005 - European Health for All Series, no.

A certain historical logic emerged in health care reforms, and their most important stages were 1918, 1948, 1978 and 2000.

Proclamation in 1918 Soviet Russia the people's right to health care and the assignment of state responsibility for ensuring it to the world's first Ministry of Health. 1948 marked by nationalization medical institutions and the creation of a national (public) health service in the UK. Established within the UN, the Economic and Social Council (ECOSOC), the World Health Organization (WHO) and the Children's Fund (UNICEF) in 1978.

In 1973, WHO introduced the idea of ​​primary health care as the area of ​​first contact between the individual (family, community) and national health systems.” The concept was

discussed at International conference WHO and UNICEF in Almaty (6-12 September 1978) with the participation of delegations from 134 countries and representatives of 67 international organizations. As a result, the Alma-Ata Declaration and 22 recommendations were adopted. The Declaration declared that the most important task of governments, international organizations and the entire world community is for all peoples of the world to achieve by the year 2000 a level of health that will allow them to lead socially and economically productive lives. And the main tool for this is the development of national health care systems, the main function of which is primary health care. These provisions were expanded in more detail in the recommendations.

The conclusions and decisions of the Alma-Ata Conference were confirmed by the World Health Assembly, and then General Assembly UN in 1979, as well as in other international and interstate decisions and declarations.

1.6.1. "Health for all in the 21st century"

In 2000, the world community puts forward new tasks: 1) sustainable development of society in harmony with nature, 2) formation of a humanistic paradigm, 3) protection and provision of human rights and peoples throughout the world, 4) achievement of “Health for all” in the 21st century.

WHO has formulated within the framework of the program “Health for all in the 21st century” 10 global challenges:

1. Strengthening health equity.

2. Improved opportunities for survival and quality of life.

3. Reversing global trends in the five major pandemics (infectious diseases, injuries and violence, non-communicable diseases, alcoholism and drug addiction, tobacco smoking).

4. Complete or partial elimination of certain diseases (poliomyelitis, etc.).

5. Improved access to water, sanitation, food and housing.

6. Promote healthy and discourage unhealthy lifestyles.

7. Improving access to comprehensive, quality health care.

8. Support for health research.

9. Implementation of global and national health information and epidemiological surveillance systems.

10. Development, implementation and monitoring of policies to achieve “Health for All” in countries.

1.6.2. European strategy for achieving health for all - Health 21

A response to the demands of the 21st century, formulated in the World Health Declaration, is the adoption of a new European strategy to achieve health for all - “Health-21”. 21 goals were set for the 21st century, which affect various areas of people’s lives:

A. Principles and approaches:

1. Solidarity of the EU Member States in the interests of health.

2. Equality of different groups within countries in health care.

B. Focus on the entire population and major hazards:

3. Healthy start in life.

4. Youth health.

5. Maintaining health in old age.

6. Improved mental health.

7. Reducing the prevalence of infectious diseases.

8. Reducing the prevalence of non-communicable diseases.

9. Reduce injuries from acts of violence and accidents.

B. Prevention and healthy lifestyle:

10. Healthy and safe physical environment.

11. Healthier lifestyle.

12. Reduce the harm caused by alcohol, addictive drugs and tobacco.

13. Conditions for a healthy environment.

14. Multisectoral commitment to health.

D. Change in orientation - focus on final result:

15. Healthcare integration.

16. Governance issues and quality assurance in health care.

D. Resources:

17. Health services financing and resource allocation.

18. Development of human resources for health care.

19. Scientific research and health information.

20 Mobilizing partners for health.

21. Policy and strategy to achieve health for all.

The key goal of Health21 in the European Region is for all people to achieve their full “health potential”.

The key goal can be achieved by:

1) Ensuring equality in matters of protection through solidarity of action;

2) Strengthening and protecting people's health throughout their lives;

3) Reduce the prevalence and suffering caused by major diseases, injuries and disabilities.

Thus, the Health for All policy is based on three

fundamental values ​​that are its ethical basis. This:

1. Recognition of health as the most important human right.

2. Equity in matters of health and its protection and effective solidarity of countries and population groups within countries in these matters.

3. Participation in health care activities and responsible attitude in it of all layers and sectors of society.

In Russia, in accordance with the WHO strategy, the objectives of the national strategy “Health for all Russians” are defined, which can be divided into three categories:

1) the first category includes two objectives that address the fundamental orientation of the policy of achieving health for all, namely: achieving justice and equity in health issues and improving health and quality of life;

3) the third category includes tasks that address specific health problems: cancer and cardiovascular diseases, other chronic diseases, infectious diseases, accidents, mental health problems and suicide.