Tessa Richards: WHO in Tallinn

Tessa RichardsStart with Handel’s Alleluia chorus, include a fireworks display, lay on a dinner hosted by government, during which the director general of the WHO makes a cabaret style eulogy. Add addresses from global health gurus, contributions from European health ministers, a scattering of parallel sessions and you have the making of a notable conference. And so it proved to be. For the 500 ministers, policy makers and observers who met at last weeks WHO European Ministerial Conference on Health Systems in Tallinn their sense of achievement as they signed up to a new pan European health charter was tangible.

Ministers don’t rush to commit themselves to health charters and inevitably the term “landmark” was bandied about. Reaching agreement on the values and goals of Europe’s health systems had not been easy, said Dr Fiona Adshead, deputy CMO for the UK Department of Health, and chair of the charter drafting group. It had taken two years of painstaking discussion and negotiation between member states, she said, and up to the last minute there were haggles over individual words.

What the legacy of the charter will be 30 years on is anyone’s guess. It takes more than a charter to achieve change in health systems. Look at this year’s soul searching about the failure to realise the global vision of comprehensive primary health care, as set out in the 1978 Alma Ata declaration.

Will Tallinn’s belief that investment in health systems pays economic dividends have become an accepted fiscal truth by 2038? Will our health systems be hugely more efficient and accountable than they are today? Health inequalities markedly reduced? Time will tell, but for now the charter has certainly put the spotlight on Estonia.

Since gaining independence, economic growth in the country has outstripped the EU average (Estonia, Health system review Health Systems in Transition, Vol 10 ,No 1, 2008; European Observatory on Heath Systems and Policies) A hospital dominated Soviet style health system has been replaced by one orientated towards primary care . But challenges remain. A man in Estonia is still (on average) likely to die 15 years earlier than his counterpart in Germany, said Jarno Habicht, head of the WHO country office in Estonia. Premature death rates due to poor life styles are high, “out- of –pocket”” health expenditure a crippling burden for some, a shortage of health professionals is causing concern, and the country is struggling to find effective incentives for hospitals and clinicians to improve their performance.

Sitting in “the Gods” in Tallinn’s splendid state concert hall, listening to health and finance ministers from Turkmenistan to Iceland talking about the success and failures of their health systems was illuminating. The style varied but the experiences struck common chords. The start warning, from Uwe Reinhardt, Professor of Economics at Princeton Univeristy, not to emulate the US in any way was refreshingly honest.

Back in London and Lord Darzi ‘s report on the NHS is being debated and it’s good to see the recommendation that the UK should systematically compare quality of care with other EU countries. Mutual learning in Europe make sense, but with caveats. One of the messages from Tallinn was we need more and better comparative health indicators. Another that health reforms must be informed not only by evidence but sound local knowledge- adaptation not adoption should be the role.- ministers please note