Statement by Dr Hans Henri P. Kluge, WHO Regional Director for Europe
Guten morgen, good morning to all of you,
For well over a century, Europe has grappled with multiple, momentous crises. But in recent years, the frequency of crises has been increasing – including those linked to climate change and emerging infectious diseases, with ever faster spread in our interconnected world.
The extreme heat and wildfires that have devastated many parts of Europe this summer are just one example.
The ongoing COVID-19 pandemic, with – so far – some 250 million confirmed cases and with over 2 million recorded deaths in Europe and central Asia, is another crisis that has put health higher on the political and development agenda, but whose lessons many countries may not yet have fully absorbed.
Then, we have the current monkeypox public health emergency of international concern, as well as the recent re-emergence of vaccine-derived polio in our region.
And, not least, a devastating war in Ukraine, which unfortunately shows no signals of de-escalation, and is compounded by horrific attacks on health facilities and providers – also triggering a mental health crisis of immense proportions.
These are all obvious examples that contribute to what the European Health Forum Gastein has termed a “permacrisis”.
But I would like to broaden and expand the definition of permacrisis beyond climate change, infectious diseases and war.
There are other long-running crises that are relatively silent – often going unnoticed – yet compromising the health of millions and burdening our health systems region wide.
I’m referring here to noncommunicable diseases – including cancer, heart disease, alcohol- and tobacco-related disease, and the epidemic of obesity.
No doubt COVID-19 is the most visible pandemic in our lifetime, but it is not the deadliest. It is not the most preventable. That distinction goes to the pandemic of cardiovascular diseases. During COVID-19, 5 times more people have died at a younger average age due to heart attacks and strokes, than from COVID-19 at its worst.
The 3 main drivers – which are preventable – of strokes and heart attacks are tobacco use, hypertension and air pollution.
The only thing which kills more people in our region than tobacco is hypertension: 2.4 million people a year, or 1 out of 4 deaths in our region.
Of course, we know that hypertension is also linked with obesity. One out of every four children in primary school in our region is living with overweight or obesity.
That’s why we were very inspired by the announcement at the Regional Committee in Tel Aviv 2 weeks ago by the First Lady of Croatia, who is establishing the WHO Pan-European Summit of First Ladies and First Gentlemen to tackle childhood obesity, with the first summit happening next year in Croatia.
Obviously, hypertension is also linked to alcohol consumption. Our region is home to the heaviest drinkers in the world. One out of every three deaths among young people is linked to alcohol.
There is no safe level of drinking; there is enough evidence on that. And the regional framework to tackle alcohol use was adopted for the first time at our Regional Committee in Tel Aviv.
The third big driver of strokes and heart attacks is air pollution. In our region alone, air pollution kills 550 000 people a year, half due to cardiovascular diseases.
I came back last week from Kazakhstan, where I attended the meeting of the ministers of health of the Commonwealth of Independent States in Turkestan, and it reminded me of the old foes that have disappeared from the political agenda: namely, HIV/AIDS.
According to UNAIDS, eastern Europe and central Asia, together with Latin America, the Middle East and North Africa, are the regions where HIV infections are still on the rise; but it’s very politically comfortable not to have it on the agenda anymore. Because what is needed are greater efforts to reach key populations, which include men having sex with men, transgender people, people who inject drugs, sex workers and the sexual partners of people in those groups. We urgently need strong political commitment and financing to strengthen HIV services. We know that in a number of countries, up to 50% of HIV testing services were closed during the COVID-19 pandemic.
So yes, we’re in a permacrisis that stretches well beyond the pandemic, climate change and war. This is our new normal. And our new normal demands a dual-track response.
What does this mean?
On one hand, we must urgently prepare for health emergencies like pandemics, climate-related crises and conflicts. On the other hand, we must urgently strengthen our current health systems and essential services to address the permacrisis of noncommunicable diseases and HIV. One cannot be sacrificed for the other. It requires investment in the health workforce and mental health.
This dual-track approach should guide WHO/Europe and the work we do to support our countries, and the European Union.
These challenges are daunting. But that does not mean we should surrender.
We can – and should – tackle the permacrisis in its entirety together, in practical ways that benefit all.
I wish all of us peace and strong health.*
*This story was updated to correct a mistake. An earlier version wrongly claimed that the European and African regions were the only two WHO regions seeing a rise in HIV infections.