Focusing on a healthier Europe

Re-elected as the World Health Organisation's director for Europe in September, Marc Danzon speaks to Daniela Xuereb about the state of Europe's health.

In February you start your second term in office as WHO director for Europe. What is your five-year health plan for Europe?

This will be my last term as WHO's director for Europe. I intend to do my utmost to work on the programme I launched during my election campaign - a programme on which I consider myself to have been re-elected.

I made a very clear statement about my priorities, the first being to help member states strengthen their health systems.

From what we see at the moment, health systems need to be strengthened in order to face and adapt to any form of crisis. We need to look at this issue from all aspects including working on better communication, the number of beds, training of staff and more. Together with strengthening the health systems, the quality of services and the safety of patients are also key issues.

Better quality results in a direct benefit for the patient. We also need to ensure that the system provides the best possible and most efficient services - that does not automatically mean an increase in costs.

Health systems in the different regions are undergoing a very important reform. Due to this we need to facilitate the exchange of information and learn from past experiences. In order to do so we are helping different regions in reforming their health systems.

There is also a strong movement in Europe which deals with patients' safety and quality of services. The WHO wants to strengthen health systems in all its member states taking specific action in different countries. Malta, for example, has already developed a very interesting health quality system.

What about other priorities?

Tackling obesity, which is caused by a bad diet and the lack of physical exercise, is definitely a priority.

This problem also exists in Malta. We need to be careful with our children, they are eating too much and not doing enough exercise... because parents still insist on driving them to school.

This is a global issue where we need to make progress, particularly in Europe because of the burden of disease caused by obesity.

Yet another problem is that some fast food chains are resisting change and in some instances so are clients resisting change - one example is that some fast food outlets are losing clients when offering more salads and less fries.

The European Ministerial Conference on Mental Health takes place in Finland this month. How do you view the mental health status in Europe?

Mental health is in fact another of my priorities and that is why we are holding this conference on mental health in Helsinki.

If I just mention adolescent mental health, in Europe the situation is very worrying - especially when one looks at the increased suicide rate of young people; this is a big problem. Depression is also increasing world-wide.

The major problem is the taboo surrounding depression and suicide. In our society nothing is shocking anymore except mental health. We are not helping this problem by reacting this way.

We want people to be aware that there are dangerous trends in adolescence - the suicide rates are alarming.

There is a problem with the way society is handling mental health and this is why we are holding this conference in Helsinki - we want to increase mental health awareness among societies.

I've read that at least one person in every family is likely to suffer from some form of mental health problem. Is that correct?

Yes, you are not exaggerating. I would say it is seldom that a person goes through life without suffering a problem. Furthermore one in three people in our society will suffer from depression.

We must remember that even the very strong people can be depressed... everybody and anybody can or will be affected.

The reality is that when someone suffers from a cardiovascular disease, society respects that illness but when someone suffers a depression, the situation is completely different.

How fast is HIV/AIDS spreading across Europe?

Very fast and every country should be concerned - even Malta where there are not so many cases.

The ingredients for AIDS are drug addiction and prostitution - of course there are countries where this factor is less worrying and in others it is exploding.

This is a big issue and we need to succeed because public health systems would suffer in credibility if we do not. Money is not the problem because there is a lot of money allocated for the help and prevention of HIV/AIDS but it is the services we offer that we need to organise.

The WHO has recently launched a "3 by 5" initiative. This global target is to get three million people living with HIV/AIDS in developing and middle income countries on antiretroviral treatment (ART) by the end of 2005. It is a step towards the goal of providing universal access of HIV/AIDS prevention and treatment services for all who need them, as a human right.

What about other priorities?

Tobacco and alcohol remain an ongoing priority. Others include the environment, poverty and tuberculosis.

I must say that we have been very pleased to see that Malta was the second country in the world (after Norway) to ratify the Framework Convention on Tobacco Control. Malta ratified it on September 24, 2003.

Not many people are aware of this positive factor; it's a pity - there was not enough publicity about this.

For the first time, the government of Malta has put the Department for the Elderly under the auspices of the Ministry of Health. Would you consider this to be a positive factor?

Yes. In fact I myself am pushing to have a proper programme for the elderly. Why? Because it is a growing pleasure to have elderly persons in our society.

It is also a success of society, the health systems and its services that we are able to have an increasing number of elderly persons.

Elderly people are living longer in good health but need special medical services. It is certainly good for Malta to have a visible programme on the elderly.

Personally I am begging the WHO to have a bigger budget for the care of the elderly so that I can help countries further develop their health systems for the elderly. Every year I claim to be ashamed at not doing enough in this area. In my opinion it is very positive to see that Malta has a specific high-level politician responsible among other things for the care of the elderly.

There is a social, societal and medical aspect to the care of the elderly and that is how it should be.

What about the health service in Malta?

Malta cannot have a good health system without the necessary financing.

I know people have questioned the expenses currently being incurred for your health system. Of course, one can raise questions over the costs but there is definitely no miraculous solution - the fact is that there will not be a good health system if there is not enough investment.

From the WHO's point of view there is always room for better efficiency and one can always seek that but a good health system cannot exist without the adequate financing.

Cutting too many costs is also not advisable because when you decrease too much, problems arise and consequently people start blaming the system. This is why it is very important to keep a normal and sustained level of financing.

While the WHO has often congratulated Malta for its health system, it also states that, like in other countries, there is room for improvement. Malta needs to develop its health system further and focus on ensuring a better quality of health services. Furthermore, Malta needs to analyse the potential of future difficulties which could emerge.

Ms Xuereb forms part of the private secretariat of the Parliamentary Secretary in the Ministry of Health, the Elderly and Community Care.