Forty-eighth Regional Committee for Europe: Copenhagen, 14-18 September 1998: Draft report of the Forty-eighth Regional Committee for Europe

'A ^ IS K ' w o r l d h e a l t h o r g a n i z a t i o n m 1 m 1 9 4 8 R e g i o n a l O f f ic e f o r E u r o p e h j A r \ r \ n C o p e n h a g e n REGIONAL COMMITTEE FOR EUROPE Forty-eighth session, Copenhagen, 1 4 - 1 8 Septem ber 1998 EUR/RC48/14 17 September 1998 10238 ORIGINAL: ENGLISH D r a f t R e p o r t o f t h e F o r t y - e ig h t h S e s s io n o f t h e R e g io n a l C o m m it t e e f o r E u r o p e CONTENTS Paragraphs I. Opening of the session..................................................................................................................... 1-3 1. Election o f officers.................................................................................................................. 4 2. Adoption o f the agenda and programme o f w ork............................................................... 5 II. Review of the work of WHO 1. Statement by the Director-General........................................................................................ 6-30 2. Regional Director’s report on the work of WHO in the European Region in 1996 and 1997...................................................................................................................... 31-67 3. Report of the Standing Committee of the Regional Committee....................................... 68-76 3.1 Semi-permanent membership of the Executive Board........................................... 77-80 3.2 Composition of the Regional Search Group for candidates for the post of Regional Director.......................................................................................................... 81-83 3.3 Amendments to the Rules o f Procedure.................................................................... 84-86 4. Report of the European Environment and Health Committee.......................................... 87-94 5. Collaboration with integrational organizations, intergovernmental organizations, agencies within the United Nations system and nongovernmental organizations in Europe.................................................................................................................................... 95-111 III. The future work o f WHO 1. Matters arising from decisions o f the World Health Assembly and the Executive Board (including the outcome of the work o f the Executive Board Special Group for the Review of the Constitution o f WHO related to regional arrangements)............ 112-117 2. Proposed programme budget 2000-2001 ............................................................................. 118-137 3. The European regional Health for All policy and strategy for the twenty-first century................................................................................................................... 138-148 4. The structure and function of public health in Europe ...................................................... 149-155 5. Proposals for a Committee for a Tobacco-free E urope...................................................... 156-165 6. Appointment o f a Regional Search Group for candidates for the post of Regional Director...................................................................................................................... 166-172 IV. Elections and nominations............................................................................................................... 173 1. Nomination of members of the Executive B oard ................................................................ 174 2. Election o f members o f the Standing Committee of the Regional Committee.............. 175-176 3. Election o f a member o f the Joint Coordinating Board of the Special Programme for Research and Training in Tropical Diseases.................................................................. 177 4. Election of a member o f the Management Advisory Committee o f the Action Programme on Essential Drugs................................................................................. 178 5. Election of members of the Management Advisory Committee o f the Action Programme on Nations for Mental Health.............................................................. 179 V. Other matters 1. Date and place of the forty-ninth and fiftieth sessions....................................................... 180 RESOLUTIONS EUR/RC48/R1 EUR/RC48/R2 EUR/RC48/R3 EUR/RC48/R4 EUR/RC48/R5 EUR/RC48/R6 EUR/RC48/R7 EUR/RC48/R8 EUR/RC48/R9 DECISION EUR/RC48(1) Annex 1 Report o f the Regional Director on the work of WHO in the European Region 1996-1997 Regional Search Group for candidates for the post o f Regional Director Healthy Cities - Strengthening action for health for all at local and city levels in the European Region of WHO Amendments to the Rules o f Procedure of the Regional Committee and the Standing Committee of the Regional Committee Health for All policy framework for the European Region for the 21st century Appointment of a Regional Search Group for candidates for the Post of Regional Director Date and place of regular sessions of the Regional Committee in 1999 and 2000 Report of the Standing Committee of the Regional Committee Proposed programme budget for 2000-2001 Establishment of a Committee for a Tobacco-free Europe Agenda 1. The forty-eighth session of the Regional Committee for Europe was held in Copenhagen from 14 to 18 September 1998. Representatives of 45 countries of the Region took part. Also present were observers from one non-Member State and one member state of the United Nations Economic Commission for Europe (UN/ECE), and representatives of the World Bank, the European Commission, the Council o f Europe and nongovernmental organizations. 2. The inaugural ceremony, together with a ceremony to mark the fiftieth anniversary o f WHO, was held at the University o f Copenhagen on the evening of 14 September 1998, in the presence o f Her Majesty Queen Margrethe II of Denmark. Addresses were delivered by Mr C. Koch, Minister of Health o f Denmark, Dr H. Mahler, WHO Director-General emeritus, Professor I. Dogramaci, President, Bilkent University, Turkey and signatory of the Constitution o f WHO in 1946, Professor L. Kaprio, WHO Regional Director for Europe emeritus, and Dr J. Asvall, WHO Regional Director for Europe. 3. The session was opened on 14 September 1998 by Dr H. Ozsoy, outgoing President. 1. Election of officers 4. The Committee elected the following officers: Mr C. Koch (Denmark) President Professor V. Grabauskas (Lithuania) Executive President Dr D. Hansen-Koenig (Luxembourg) Deputy Executive President Dr B. Dimitrov (Kyrgyzstan) Rapporteur 2. Adoption of the agenda and program m e of w ork (EUR/RC48/1 and /Conf.Doc./l) 5. The Committee adopted the agenda and a programme of work. I. O pen in g o f t h e session II. R e v i e w o f t h e w o r k o f W H O 1. Statem ent by the D irector-G eneral 6. The Director-General said that attending the Regional Committee for Europe represented an opportunity for her to draw inspiration and to seek its guidance and advice. As WHO celebrated its 50th anniversary it could look back on impressive achievements, yet there was still much to do in paving the way towards health for all (HFA) in all Member States. The regional committees were the key to that goal. WHO, though a global organization, was not complete without its regional dimension, and the challenge was to make WHO not seven organizations but one. 7. The European Region had changed dramatically over the past decade, gaining 20 new Member States since the early 1990s. The Fifty-first World Health Assembly had decided to increase allocations to the African and European regions. That was an historic decision, reflecting a need to redistribute resources in a world of growing inequities - between regions, between countries, and often within countries. Today’s Europe combined advanced welfare states and countries with almost no welfare at all. It should never be forgotten that the single biggest threat to health came from poverty: poverty led to ill-health and ill-health bred poverty. Europe had to cope with its own situation, but its richer countries also had a duty not to reduce their development cooperation with countries outside the Region. 8. Most determinants of better health lay outside the health system. They included better education, a cleaner and safer environment, a sustained reduction in poverty and a stop to armed conflict and excessive military expenditure. Military conflict, however, was again taking a heavy toll in Europe, causing some 400 000 deaths in the 1990s, leaving infrastructures destroyed, health stations abandoned and many thousands o f people with mental and physical scars that would haunt populations for generations. Even now people in Kosovo faced a winter that many of them knew they would not survive. Europe’s political bodies had to act swiftly to avoid another human disaster in that region. 9. The health sector was well aware that timely investment in health benefited society as a whole. That message had to be put across to other government sectors and to presidents and prime ministers themselves, so as to convince them that they were also responsible for health. Health could be placed at the centre of the development agenda by gathering evidence, by better advocacy and by reaching decision-makers with a convincing case. That would require new momentum and new methods of work. 10. There was equally a need to reach out to other United Nations agencies, to other key players in health, to the private sector and to civil society. WHO could become a stronger lead agency in health by entering into partnerships with such stakeholders; its projects and workplans would therefore place specific emphasis on those partnerships. The same approach applied to the Organization’s work in Europe. There was already cooperation with the United Nations Children’s Fund (UNICEF), UN/ECE, the United Nations Development Programme (UNDP), the World Bank and the United Nations Population Fund (UNFPA), but the European Union (EU) and WHO could achieve much more together, in particular in giving coordinated advice to the countries in transition, many of them candidates for membership in the EU. WHO’s presence in Brussels would be strengthened to deepen cooperation between WHO and the EU, the Organization on Security and Cooperation in Europe (OSCE), the Council o f Europe and the Organisation for Economic Co-operation and Development (OECD). 1 1. Europe had been at the forefront of the shift in the global burden o f disease from communicable to noncommunicable diseases, but the developing world was moving in the same direction. At the same time, a tide of noncommunicable diseases was flooding countries with little or no experience in facing them. Europe had a great deal of experience to share with other regions, and WHO should be there to facilitate the transfer of that knowledge. 12. In Europe, cardiovascular diseases, cancer and diabetes were the top three health problems, and they had common risk factors - smoking, unhealthy nutrition, lack of physical exercise and heavy drinking. The prospects for an integrated approach to the reduction of these conditions should be good. There was now greater knowledge o f the causes of noncommunicable diseases, but there was a need to improve screening, early detection, diagnosis, acute care and rehabilitation of patients. But above all, there was a need to focus on self-care and the reduction and control of environmental risk factors. Tobacco 13. Smoking was probably the single most important cause o f death in the European Region. Unless decisive action was taken, tobacco would be responsible for 2 million deaths, or 20% of all deaths, by the year 2020. Everyone should speak out loudly: tobacco was a killer! It should not be advertised, subsidized or glamourized. The Tobacco-Free Initiative aimed at galvanizing global support for tobacco control. It was necessary to ensure that WHO’s policy pronouncements were backed by people, money and institutions, not just in Geneva, but also in the regions and within all Member States. 14. The European Region was providing leadership through the Action Plan for a Tobacco-free Europe, and was building partnerships with the European Commission, the World Bank and European nongovernmental organizations (NGOs). Ambitious targets had been set to achieve less than 20% of adult smokers by the year 2015. The decision of the EU to totally ban all forms of tobacco advertising and sponsorship was laudable, and had impressed and surprised people far beyond the boundaries of Europe. Those efforts - in Europe and beyond - would require additional funding in the form of voluntary donations from governments as well as the private sector. The ministerial conference planned for 2001 would provide an opportunity to involve the highest levels of government and opinion-leaders in efforts to build on the present momentum and secure commitment. Communicable diseases 15. Communicable diseases in general had made an alarming comeback in many parts o f the Region and new zoonoses posed an added health hazard. Tuberculosis incidence was rising dramatically. In the 1980s, malaria had not been a disease of public health significance in Europe; currently it was a rising public health problem in the European Region, as were vaccine-preventable diseases, sexually transmitted diseases and HTV/AIDS. There was a need to find new and innovative ways of dealing with them. 16. Important efforts had been made in recent years to reduce communicable diseases through health promotion, disease prevention and surveillance. Great strides had also been made towards poliomyelitis eradication, but the battle had not yet been won. It was most important that Member States made a major effort to ensure the success o f the final and most difficult phase of global eradication. Strong surveillance would be required in all Member States in the effort to stamp out the last pockets of transmission. 17. Concerning HIV/AIDS, Europe was again no exception, although there were great differences between the eastern and western parts o f the Region. WHO had just taken over the chair o f the Joint United Nations Programme on HIV/AIDS (UNAIDS) and would lend its full support to that body’s efforts and give increased attention to the way WHO addressed the HIV epidemic in all areas of its work. Health sector development 18. How could sustainable health systems be built to stand the test o f changing times and economic constraints? How could one ensure access to basic health services in situations where the public finance base was in danger of collapse? Each country had to choose its own way based on its pattern of disease, its institutions, its resources and the needs o f its people. But WHO would always be ready and able to assist and to share with countries the experiences gathered through the different models. 19. A key responsibility for governments should be to secure access to care, and only the public sector could guarantee basic universal rights. Market forces had enormously increased productivity in many sectors of the world economy, and the health sector was also benefiting. But while the private sector and private industry might be good at allocating resources cost-effectively, it would never become the key provider o f primary health care or the guarantor of securing health services for the poor. Nor would it ensure universal access. 20. There was a need to begin a discussion on the norms and standards of a new way of addressing universal coverage. That would be a major issue on the agenda of each country and therefore would be a WHO priority. Everything WHO did should contribute to health sector development, otherwise it should not become involved; the European Region had achieved a lot in that area, but more needed to be done. 21. Universal access to quality services was a bedrock principle. Governments should provide strategic leadership by setting priorities, acknowledging that there were limits to the care they could afford. But setting priorities and defining limits required a knowledge o f which efforts would make the best impact, reach the most people and achieve the most effective results. WHO should be there to advise governments on that process. The recent establishment by the Regional Office of the European Observatory for Health Care Reforms was a timely initiative, providing Member States with a continuous update of the true value of the many reform initiatives in different countries. The WHO reform process 22. WHO was embarking on a process o f change, to secure a better unity o f purpose. The Organization should be very good at what it decided to do - and also ready to say that it could not do everything! It was necessary to say that WHO was one: setting its priorities as one, raising additional resources as one, and speaking out as one. WHO was a small organization if measured against its mandate and against the scores o f unmet needs. WHO was not a deliverer of health services; that was the responsibility of national and regional authorities, NGOs, private providers and communities. It was only through a combined effort that any difference could be made. At WHO headquarters, the programmes had been grouped into nine “clusters” . In the coming months each cluster would streamline its activities in order to optimize what could be achieved across the Organization and in partnership with others. 23. The focus would continue to be on communicable and noncommunicable diseases, but the challenges of a changing world would also be addressed. The Cluster on Social Change and Mental Health would try to meet the health challenges of changing and aging societies, with a particular focus on the unmet needs within the field of mental health. The Cluster on Sustainable Development and Healthy Environments would strive to make the link between a globalized world and the strains on people’s health from poverty and the growing burden on the environment. Nevertheless, it had to be remembered that the work of WHO counted for nothing if it did not have an impact in the countries in terms o f better collaboration, better pooling o f knowledge, better global advocacy for health and better resource mobilization. 24. The Regional Directors were an integral part o f the senior management team of the Organization and closer contact with them would be established and maintained. A major modernization of WHO’s information technology network had begun, which would lead to better communication and to savings by doing away with unnecessary travel. More direct relations would be established with the WHO country representatives or, in the case of the European Region, the liaison officers. The Executive Board would be invited to establish closer contact with the secretariat and to hold more focused debates on the challenges facing WHO. Closer relations would be established with the private sector by inviting industry to round-table discussions and exchange, and the Director- General would meet more regularly with NGOs to define new opportunities of working together. To provide more relevant and tangible results from WHO’s efforts at country level, a task force had been established to make concrete recommendations on how ambitions could be turned into reality. 25. In all the Organization’s work there was a growing need to underpin it with solid facts. A special Cluster had therefore been created called Evidence and Information for Policy. That knowledge base was there for the countries to use and to contribute to. The Organization would report the important facts, and one of the most important was that healthy people helped build healthy economies. 26. Although there were scores of unmet needs, the health sector had a track record of success over the past 40 years and it was the mandate of WHO and its Member States to carry that record forward. Science had provided powerful tools; the need now was for political, financial and ethical commitment. 27. There was much to expect from the European Region. Throughout its long existence, it had often been a pilot region, pioneering new types o f programme such as health promotion, quality of care, health of the elderly and accident prevention and taking new initiatives through collaborative networks such as Healthy Cities and Health Promoting Schools, that had subsequently been adopted by other regions and at global level. The Region faced new and daunting challenges in lifting a part of Europe towards better and more sustainable health for all. At the same time, Europe had to live up to its ideals and continue to lend its support beyond the Region. The Director-General pledged to do everything possible to make WHO a better instrument for turning hopes into realities and making a difference for the health of all people in the new century. 28. All speakers congratulated the Director-General on her recent appointment and on her inspiring address to the Regional Committee. Her vision, leadership skills and long experience in management would undoubtedly stand her in good stead in undertaking the many difficult tasks set out in her comprehensive statement. The representative of Austria, speaking on behalf of the 15 member states o f the European Union, strongly supported the Director-General’s intention to make the Organization more effective, accountable, transparent and receptive to a changing world. Several speakers took up the question of the determinants of health lying in sectors other than health, and underlined the utmost importance of building partnerships at all levels. 29. Replying to two speakers on the question o f closer ties with the EU, the Director-General insisted that only by working with entities such as the EU, where the greatest political and economic power lay, could WHO encourage the global solidarity necessary to build more equitable and therefore healthier societies. The EU was influential far beyond the borders o f its 15 member states. She believed that all UN bodies needed to make use of such political and economic links in order to move ahead with their programmes to make the world a better place. Moreover, the programmes carried out by WHO and the EU in the countries in transition were different, and it was necessary to work together to avoid duplication. More specifically, the planned framework convention on tobacco would need the support of both WHO and the EU if it was to succeed and become the first example o f WHO, in keeping with the mandate in its Constitution, promoting such a convention. 30. The Director-General stressed that the reform process was not yet complete. Tobacco and malaria had been chosen as Cabinet projects because they were good examples of noncommunicable and communicable diseases, respectively, and as a means o f mobilizing partnerships, but the project managers had not yet been selected. She confirmed, however, that the projects would not duplicate the normal work o f the Organization in those areas. Similarly, she agreed with one delegation that it would be timely to revive the task force on health and development, but a decision would have to await the finalization of the clusters. 2. Regional D irector’s report on the work o f W HO in the European Region in 1996 and 1997 (EUR/RC48/2, /Conf.Doc./2 and /Inf.D oc./l) Socioeconomic developments 31. Presenting his report, the Regional Director noted that the socioeconomic developments in the Region continued to show a rather mixed picture: in western Europe there had been reasonable growth o f some 2.5-3% of GNP per year, but unfortunately only a very slight improvement in the major social problem o f unemployment. In countries of central and eastern Europe (CCEE) and the Baltic States, with the exception of Albania, Bulgaria and Romania, the initial fall at the beginning of the 1990s had been replaced by growth o f 4-5% of GNP per year. The newly independent states (NIS), on the other hand, had experienced declines in GNP per inhabitant o f 50% or more in the 1990s. Armed conflicts 32. During the 1990s, a large number of armed conflicts had occurred in the Region. Most had subsided, although a new war had broken out in the Kosovo province of Serbia. The Regional Office for Europe (EURO) had strengthened its presence in Kosovo, Podgorica (Montenegro) and Tirana (Albania), to give more coordinated support to refugees. Infectious diseases 33. The coordinated campaign against diphtheria organized by the Regional Office had prevented the development of a large epidemic, avoiding more than 600 000 cases and 15 000 deaths. The MECACAR Plus campaign, organized in cooperation with W HO’s Eastern Mediterranean Region, had halted the transmission o f poliomyelitis in 50 out o f 51 countries. However, transmission was continuing in Turkey, with five cases to date in 1998. 34. There had been a dramatic fall in the number o f AIDS cases in western Europe, but unfortunately HIV infection rates were rising sharply in many eastern European countries, mainly due to intravenous drug use. The dramatic increase in sexually transmitted diseases, including syphilis, was very alarming and there was a real danger that that epidemic would merge with the spread of HIV infection, in particular among prostitutes. In order to strengthen its action against those diseases, the Regional Office had established an international task force, funded by the United Kingdom, the United States and the Soros Foundation in cooperation with UNAIDS. 35. Tuberculosis prevalence was also rising sharply, with the substantial drug resistance - both in western Europe and in the more eastern part o f the Region - giving grounds for particular concern. The Regional Office, in close cooperation with WHO headquarters, was therefore strongly promoting the DOTS (Directly Observed Treatment, Short-course) strategy. 36. Malaria was back with a vengeance in the south-eastern part of the Region and was spreading to other countries. The Regional Office had started a new programme with a long-term approach to controlling malaria. 37. The Interagency Immunization Coordinating Committee (IICC) had been a particularly important element in helping to combat the onslaught of infectious diseases, and a new Department for Infectious Diseases had been established at the Regional Office. Health policy development 38. Considerable efforts had gone into updating the European policy for Health For All (HFA), and important discussions had taken place with the Belgian Government on the establishment o f a health policy centre in Brussels. 39. Building on the success of the 1996 Ljubljana Conference on European Health Care Reforms, the Regional Office had decided to create a permanent mechanism (the European Observatory on Health Care Systems) to monitor, analyse and evaluate reform initiatives in all Member States and disseminate relevant experience from other regions. Family and child health 40. To promote the ideas of family health, the Charter for General Practice/Family Medicine in Europe had been disseminated throughout the Region, while in the area o f health services and health personnel development, very promising discussions were being held with the Catalonia region in Spain regarding the establishment of a new EURO project centre for a five-year period. 41. The Family and Reproductive Health programme had expanded rapidly during the biennium. The CARAK project for the Central Asian Republics, Azerbaijan and Kazakhstan, being implemented in cooperation with UNFPA, the World Bank, the Italian Government, the International Planned Parenthood Federation (IPPF), and UNICEF, showed that the training o f health professionals and more cost-effective interventions could reduce maternal and infant mortality. 42. A new Child Health and Development programme had started in 1997, in line with W HO’s “Safe Motherhood Initiative”. The programme was promoting a holistic approach using evidence-based care and cost-effective interventions for pregnancy, birth, neonatal care and breastfeeding. The OBSQID project for continuous quality development in perinatal care had helped to establish pan- European indicators and variables on perinatal outcomes. A new service on the Internet offered on-line information on some 13 million deliveries in 42 Member States. 43. WHO and UNICEF had also initiated a programme on Integrated Management of Childhood Illness (IMCI), designed to demonstrate how to provide basic care for the most common childhood illnesses, as well as to take preventive measures and improve family and community practices. Finally, a new programme element was being initiated in the area of child abuse and neglect, developing a European network to combat those emerging causes of psychosocial and physical ill health in children. 44. Work done by WHO and its collaborating centres had shown that therapeutic patient education could be a very important factor in improving health outcomes and quality o f life for people with chronic disease, as well as in reducing health care expenditure. An important development during the previous 12 months had been the production o f the first WHO guidelines on that issue. Lifestyles and health 45. In the European Region, the decision by the EU Health Council to ban the advertisement and sponsorship of tobacco products in EU countries would have a major impact over the coming years, not only on the 15 EU member states but also, indirectly, on other countries in the Region. 46. Work continued to promote the implementation of the second five-year European Alcohol Action Plan and to follow up the 1995 Paris Conference on Health, Society and Alcohol. In the area of illicit drugs, initiatives had concentrated on preventing HIV infection in intravenous drug users, where the rapid spread of drug use in the NIS was a major cause of concern. Environment and health 47. The Second European Conference on Environment and Health (Helsinki, 1994) had had a major impact on developments in the countries o f the Region: almost all countries had either finalized or were drawing up national environment and health action plans (NEHAPs), as joint efforts between health, environment and other ministries. As a result the next major European Conference on Environment and Health, scheduled to be held in London in 1999, would start with close to 100% follow-up of the recommendations made in Helsinki. The clear benefits of intersectoral collaboration on the environment and health offered a useful model for work in the area of lifestyles and health. 48. In addition to their core activities, the Rome division o f the European Centre for Environment and Health had been working on the water and health protocol that would be presented to the London Conference, the Bilthoven (Netherlands) division had been updating the global WHO document Air quality guidelines and the Nancy (France) division had advised on public health engineering projects in a number o f CCEE/NIS. In spite of the excellent work done by the latter and the “clean bill o f health” which it had received from an external evaluation organized jointly by EURO and France, the French Government had recently decided to withdraw its support. The activities it had been carrying out would in 1999 be transferred to other divisions. Health information and communication 49. One particularly important development had been the establishment of a European public health information network for eastern Europe (EUPHIN-EAST), designed to interconnect with a similar network being developed by and for the 15 EU countries. 50. Good progress had been made in implementing EURO’s communication strategy. That had involved training staff, issuing a new newsletter (Health catalyst), and carrying out regional and country-based activities in partnership with Worldwide Television News, the BBC World Service and the International Press Institute. The WHO European Health Communications Network had been launched in 1997 to provide mechanisms for sharing experience and resources and helping countries, particularly CCEE and NIS, to develop their health and environment communication capacities. Research coordination 51. Due to the budgetary crisis, EURO had put the work of the European Advisory Committee on Health Research (EACHR) “on the back burner” during 1995 and 1996. The EACHR had recently been reconvened and had warmly endorsed the new HFA policy, noting in particular that the role and importance of research was well reflected in that document. The time had come to again strengthen the activities of the EACHR in the Region. EUROHEALTH programme 52. During the past year all Liaison Officers had been appointed as National Professional Officers, which meant that they were full-time WHO staff and more respected by their colleagues in the UN system. A project to establish a school o f public health in Kazakhstan had been successfully undertaken, and the school had started its activities. An interesting pilot project on primary health care had been launched in the Aral Sea area o f Uzbekistan, in order to see what practical help could be given to the populations living in the terrible conditions created by the environmental disasters in that region. In the Barents Region, at the opposite end o f the NIS, EURO had recently proposed to the Barents Council a similar concept o f strengthening primary health care approaches that also included environmental components. 53. Finally, a very important area of assistance to EUROHEALTH countries had been that o f health care reform, with activities channelled partly through bilateral country projects, partly through the collaborative networks o f central Asian republics (CARNET) and central and eastern European countries (MIDNET and EASTNET). Cooperation with other partners 54. Collaborative networks were a strategic tool for linking intercountry and country programmes in a cost-effective way. EURO had such networks in four areas: the first, involving health professionals, aimed to ensure that the 1.5 million physicians, the 5 million nurses and the many other health professionals in the Region were knowledgeable about and supportive of HFA developments. The European Forum of Medical Associations and WHO (EFMA) included 58 associations in 46 Member States; in addition to annual meetings of the Forum, it also had very active task forces on smoking and quality of care. The European Forum of National Nursing and Midwifery Associations and WHO had grown rapidly during the past twelve months and currently comprised 51 associations in 43 Member States, operating task forces on quality o f care, tobacco and primary health care. The European Forum of Pharmacists and Pharmacy Owners and WHO (EuroPharm) was also expanding, with a current membership o f 39 associations in 31 countries and task forces on patient information and smoking cessation projects. A new Health Promoting Universities network was also under development. 55. The second category was related to settings. The Health Promoting Schools network had grown to cover 38 Member States, with 500 schools in WHO’s inner network and an additional 5000 schools in the affiliated national networks. The Health Promoting Hospitals network reached 500 hospitals through 27 national networks in 18 countries. There was also strong interest in the most recent development, the Health in Prisons network, which brought together ministries of health and justice in 14 Member States. The Healthy Cities network was present in 22 Member States, comprising 39 “WHO cities” and 26 national networks reaching out to over 700 further cities. A major conference for that network had taken place in Athens in June, revealing the vital role that the Healthy Cities movement was playing in mobilizing many new partners for HFA-oriented action in local communities throughout the Region. 56. Other networks had been set up to tackle specific health problems. The Office had a long-standing tradition of fostering collaboration among countries interested in establishing countrywide integrated noncommunicable disease intervention (CINDI) strategies at the community level, by applying existing knowledge initially through demonstration projects and, subsequently, countrywide. The C1ND1 project was accordingly active in 23 Member States and 96 areas, while the St Vincent programme on diabetes management had expanded to cover virtually all Member States. 57. Lastly, subregional geographic networks such as the above-mentioned CARNET, EASTNET, MIDNET and SOUTHNET (the latter for southern European countries) were major vehicles for channelling EURO’s HFA strategies to groups o f similar countries in the Region; all had been very active during the previous twelve months. 58. In conclusion, the Regional Director noted a palpable feeling of optimism that the important decisions which the recent World Health Assembly had taken - to appoint a new Director-General, to adopt a new HFA policy, and to introduce a new budget allocation system - would rapidly bring the global level of the Organization back to its former leadership position and thus strengthen the image o f WHO as a whole. 59. In the ensuing discussion, many delegates expressed their appreciation o f the support they received from WHO and in particular of the work o f the Regional Office for Europe, in collaboration with countries and other international partners. On the other hand, they were deeply concerned about the growing and inexcusable health divide, both between different parts of the Region and between different socioeconomic groups within countries. One important way o f reducing inequities was to set appropriate targets. Much greater attention needed to be paid to social development and people’s health and welfare. The EUROHEALTH programme had to remain a key tool for bridging the gap between eastern and western Europe. Additional financial resources for the European Region should be directed towards reducing the east-west gap and benefiting the most disadvantaged population groups. Healthy public policy should be emphasized over the coming years, with continuing attention paid to tobacco. 60. Increasing concern was expressed about the danger o f emerging and re-emerging communicable diseases. A conference on the topic of multiple-resistant organisms, which had taken place in Copenhagen the week before, had resulted in practical suggestions about how to reduce the risk of antibiotic and antimicrobial resistance. The creation of a new Department o f Infectious Diseases at EURO was warmly welcomed. 61. Many delegates stressed the importance o f ethics in health, especially in relation to medical technology, gene therapy and reproductive health. Those issues should be resolved with human dignity and respect for the individual. Ethical considerations should run through all programmes. 62. In view of the continuing negative health effects o f the Chernobyl disaster, one speaker suggested that consideration could be given to holding a special conference, to lay the foundation for subsequent practical action to tackle that problem. 63. It was noted that all countries faced urgent problems with regard to health policy, including the need to elaborate strategies based on sound information. It was also noted that the centre for analysis of health policy, to be set up in Brussels, would adopt an intersectoral approach, and that the Treaty of Amsterdam introduced new opportunities for joint work with the European Commission. 64. One delegate emphasized the importance of the Athens Declaration for Healthy Cities, which had been signed by representatives o f 110 European cities and which stressed the role that cities and local governments could play in promoting health and sustainable development. In reply, the Project Manager, Healthy Cities noted that the Athens Conference had marked 10 years o f action in Europe and launched a strategy to take the movement into the next century. 65. In an invited statement, Sir Donald Acheson stressed the remarkable scope of the action taken by the Regional Office, an achievement that was even more noteworthy given the contraction of resources and staff. While good progress had been made on some communicable diseases, tackling the problems arising from chronic diseases due to socioeconomic factors was a slower process. In view of the clear evidence for deplorable and striking inequalities in health within the Region, he strongly urged that efforts should be concentrated on attaining HFA target 1, equity, noting that that was an area where more could be achieved with less. 66. Responding to issues raised by delegates, the Regional Director confirmed that poverty and ethics were extremely important strands both of the new HFA policy and of all the Office’s programmes. He again emphasized the importance of the EUROHEALTH programme. He agreed that antimicrobial resistance was a very important issue: following the Copenhagen meeting, every country should review its policy on restricting the use of aminoglucosides. Much could be done through clear policies and clinical guidelines. Failure to act would be expensive in terms o f human lives lost and the resources required by health care systems. The Office had increased the regular budget allocation for infectious disease control and was receiving extensive support from WHO headquarters and various countries. In conclusion, he noted that the question of genetics figured prominently in the new HFA policy. 67. The Committee adopted resolutions EUR/RC48/R1 and EUR/RC48/R3. 3. Report o f the Standing Committee o f the Regional Comm ittee (EUR/RC48/3, /3 Add 1, /Conf.Doc./3, /Conf.Doc./4 and /Conf.Doc./8) 68. The Chairman of the SCRC paid tribute to the members of the Standing Committee and the Regional Office secretariat for their contribution to ensuring that the SCRC had functioned effectively during the year. A total o f five meetings had been held. The SCRC’s activities were as set out in document EUR/RC48/3, supplemented by the report of its meeting at the Regional Office on 12 September 1998 contained in document EUR/RC48/3 Add.l. 69. The SCRC’s activities could be grouped together in four categories. Under the first (dealing with the current biennium), it had reviewed action taken by the secretariat following the forty-seventh session of the Regional Committee, considered the report of the external evaluation of the Office’s NEHAP programme and selected the external evaluators for the Communicable Diseases programme in 1999. It had recommended to the Regional Committee that the evaluation o f the EUROHEALTH programme should be postponed to 2000 rather than carried out in 1999. It had considered the external review of the Office’s Administration and Executive Management departments, and commissioned a survey by the secretariat o f WHO collaborating centres in the Region. Finally, the SCRC had played a valuable role in ensuring that in future objective criteria were used in allocating the Organization’s regular budget to its regions. 70. For the following biennium (the second category o f the SCRC’s activities), it had reviewed the proposed programme budget for the European Region for 2000-2001, including the increased allocation to the Region of approximately US $2.2 million. In that respect, it had recommended to the Regional Committee that the additional funds should be distributed evenly among the six countries that fell within the World Bank’s definition of “low-income”. The SCRC had endorsed a revised draft o f the Third Action Plan for a Tobacco-free Europe 1997-2001 and reviewed a proposal that a Committee for a Tobacco-free Europe should be convened by the Regional Director. It had also reviewed a draft paper on the development o f public health in Europe. 71. So far as the medium term was concerned (the third category of work), the SCRC had provided guidance and feedback throughout the year on the development o f the new European HFA policy and strategy. While acknowledging that final adjustments were still required, the SCRC at its most recent meeting had wholeheartedly endorsed both documents and recommended that every effort should be made to issue them as soon as possible after the forty-eighth session o f the Regional Committee. 72. Under procedural and other matters (the fourth category), the SCRC had reviewed the situation concerning the semi-permanent members o f the Executive Board and had favoured an arrangement whereby those members would serve for three years out o f nine rather than the present three years out of four. The SCRC had also discussed nominations for membership o f the Executive Board and other committees; reviewed its own role during sessions o f the Regional Committee; examined its Rules of Procedure concerning the replacement o f its members; reviewed the provisional agenda and draft resolutions for the forty-eighth session of the Regional Committee; and considered the process of selecting members of the Regional Search Group for candidates for the post o f Regional Director. 73. In addition, the President o f the EUR Staff Association had addressed the SCRC at its third session. The SCRC had paid tribute to the loyalty and effectiveness o f the staff and had acknowledged the very large amount o f work they were doing in the face of declining resources and increasing demands. 74. In the ensuing discussion, delegates commended the SCRC on the work it had done during the year and on the quality o f the reports. In relation to the survey of WHO collaborating centres, several speakers pointed out that the status of collaborating centres had declined over the years: they were no longer used as centres o f excellence but had been designated in greater numbers to carry out the work of WHO. In reply to questions on the use that would be made o f the information obtained from the survey, whether the work of the centres would be evaluated, and what would be done to improve the system, the Regional Director said that the Director-General had placed a temporary moratorium on the establishment o f new centres with the intention of creating fewer, more active ones. There was also a task force at the Regional Office looking into the matter. A printout of the full list o f collaborating centres would be made available to Member States. 75. With regard to the new European HFA policy, one concern was that too little attention was paid to the importance o f healthy eating, while other lifestyle factors were comprehensively addressed. One participant pointed out that the new policy could not be ratified by governments and that individual countries should be left to decide how they should make use of the policy. On the question of the increased regional budget allocation, it was recognized that this was the first stage in a process that would span five biennia. With the limited funds available it was reasonable to select for support those countries that would show the most progress in, for example, control of infectious diseases. 76. The Committee adopted resolution EUR/RC48/R8. 3.1 Semi-permanent membership o f the Executive Board 77. On the question of semi-permanent members o f the Executive Board, some speakers felt that the compromise put forward by the SCRC was acceptable as a first step but that a more permanent solution should be striven for, whereby all countries would have an equal opportunity to put forward candidates for membership of the Board. Others, however, thought the present system should be maintained. They pointed out that the measures proposed would have wide repercussions and that before any decision was taken they should be discussed with other WHO regions and other international organizations. One delegate suggested that, for this very reason, the Executive Board should be asked to set up a working group to explore the subject at global level. 78. Given that delegates had expressed various points of view on the question o f the semi-permanent members of the Executive Board, the Regional Committee set up a subcommittee to reach consensus on the approach to be taken. 79. Professor T. Zeltner, speaking subsequently on behalf o f the subcommittee, stated that the subcommittee had agreed on the following points: • there was a need for change; • more time was needed in order to find a solution acceptable to all Member States, and the duration o f the present session of the Regional Committee was not sufficient for such a solution to be identified; • there were different views among the members o f the subcommittee about whether the question o f semi-permanent representation should be dealt with in a regional or a global context; • a similar question would be discussed at the Fifty-second World Health Assembly in the context of the amendment of Article 25 o f the Constitution; • the SCRC should continue its work on the matter following discussion by and decisions of the Fifty-second World Health Assembly, take into account the various solutions already proposed, and invite other interested Member States to participate in the discussion; and • the Regional Committee should consider the issue again at its forty-ninth session, preferably before it took up the question o f nominations for membership o f the Executive Board, at which time it should discuss a new agreement and its implementation. 80. The Regional Committee endorsed the points made by the subcommittee. 3.2 Composition o f the Regional Search Group fo r candidates fo r the post o f Regional Director 81. There was some support expressed for the SCRC’s proposal to formalize the practice for selecting members of the Regional Search Group (RSG). Several speakers, however, felt the need for more transparency in the process by allowing all delegations to the Regional Committee the right to propose members. 82. Some speakers felt that if delegations were to propose the names o f candidates for membership of the RSG, they should be accompanied by some form of curriculum vitae. Others expressed the view that the link between the officers of the Regional Committee and/or the SCRC and the RSG should not be too close, and that it should not be a prerequisite that candidates be members of delegations. It was pointed out, however, that the RSG members should be people known to the Committee as being impartial in their views and able to carry out the work o f the RSG. It was therefore agreed that delegations would propose candidates in writing to the secretariat. 83. The Committee adopted resolution EUR/RC48/R2. 3.3 Amendments to the Rules o f Procedure 84. Following several suggestions for amendments to the draft resolution contained in document EUR/RC48/Conf.Doc./4, the Committee set up a small drafting group to reach a consensus on the wording. 85. Some delegations considered that the draft resolution as reworded by the drafting group did not adequately reflect the rather widespread concern over the Rules o f Procedure o f the SCRC. It was therefore proposed to add a new operative paragraph requesting the SCRC to examine its Rules during the coming year and to present any suggested changes to the Regional Committee at its forty-ninth session. 86. The Committee adopted resolution EUR/RC48/R4. 4. Report o f the European Environm ent and Health Com m ittee (EUR/RC48/4) 87. Sir Kenneth Caiman, Chairman o f the European Environment and Health Committee (EEHC) outlined the two main issues taken up in the annual report: the Third European Conference on Environment and Health (London, June 1999) and NEHAPs; and the end of the EEHC’s current remit and any follow-on action that might be required. The London Conference would be an important event, bringing together 100 ministers from across Europe to address a broad range of priority issues agreed on in consultation with Member States. Thirty-one countries had finalized their NEHAPs and eleven countries were in the process of developing them. That meant that 82% of Member States had realized the vision set out four years previously in Helsinki. 88. The focus of the London Conference would be on implementation and partnerships; that represented a natural progression from the conferences held in Frankfurt (1989) and Helsinki (1994), which had concentrated on policy formulation and planning, respectively. The conference format, while still at the planning stage, would include, alongside ministerial sessions, a major forum to involve nongovernmental organizations, industry, professionals and local authorities. 89. Several key documents were currently being prepared for the Conference: they included a protocol on water and health, a landmark development from a meeting hosted by the Hungarian government in February 1998 and which would be the first legally binding document produced by WHO jointly with the United Nations Economic Commission for Europe; a charter on transport, environment and health, in whose preparation Austria was taking the lead role; and a ministerial declaration which would set out strategic vision and describe WHO’s role in maximizing the health sector contribution to sustainable development. 90. In summary, the forthcoming London Conference had enormous potential for exerting a positive impact on the health of the people of Europe. An action plan must be a key outcome o f the event. Member States would have an opportunity to shape the final programme for the London Conference and to influence the contents o f each of the documents through their participation in a meeting to be held in Bled (Slovenia) from 14 to 16 February 1999. 91. The EEHC had almost completed its five-year programme of work. A final meeting o f the Committee would take place in November 1998. A report on its achievements and an assessment of what coordination would be needed in future and how that might be secured would be presented at the London Conference. In conclusion, he stressed the importance o f the work already done by the EEHC, for example on NEHAPs, and the need to continue with an agenda on environment and health into the following century. 92. Participants expressed their broad appreciation of the EEHC and its Chairman’s report. Several speakers emphasized the importance o f the NEHAP process as a means of facilitating effective intersectoral collaboration. The benefits of developing a NEHAP, it was suggested, were not confined to environmental health but had a much wider impact on a country’s policy agenda. Particular emphasis was placed on the importance of collaboration with local authorities and the need for countries to move from a solely national focus to a more local one, drawing up and carrying out local environment and health action plans. 93. Concern was expressed about the effects o f political conflicts and other disasters on the environment in some European countries. It was pointed out that it could take up to 20 years to create a whole new infrastructure, with negative consequences for the population in the meantime. WHO could play an important monitoring role in that regard. 94. The London Conference was perceived by many as promising to be a landmark event, and the particular emphasis on implementation was broadly welcomed. There was general agreement about the importance of the work that had been done by the EEHC, in particular in its coordinating role and in raising awareness about the environment and health agenda. It was not clear how that work would continue to be done in the absence o f such a committee but, in any case an appropriate mechanism would need to be put in place to ensure that the work which would inevitably result from the London Conference was managed appropriately. 5. Collaboration with integrational organizations, intergovernm ental organizations, agencies within the United Nations system and nongovernm ental organizations in Europe (EUR/RC48/7) 95. The Regional Adviser, Coordination and Humanitarian Assistance noted that increasing interest in public health policy within the EU had drawn the Regional Office into a closer collaborative relationship with the European Commission, particularly on public health aspects o f the process of accession by new member countries. The Commission had agreed to prepare a working paper on “Health-related requirements and strategy for enlargement” in collaboration with WHO and the World Bank, and WHO had contributed information on health developments in accession countries over the previous few years. The Commission had also been made aware of the Office’s programmes, databases and documentation that were helping the accession countries to bring their legislation and infrastructures into line with EU requirements. 96. Other collaborative activities with the European Commission included work on national drug policies under the EU PHARE programme; the ongoing process o f reform o f health services and health care financing mechanisms; the reorientation o f occupational health to conform with EU directives; and the strengthening of reproductive health. Cooperation had also taken place in areas such as public health nursing, health care reform projects in CCEE and NIS, drug regulation, and environmental issues. The European Commission participated in the European Environment and Health Committee, placing particular emphasis on the development and implementation of NEHAPs in EU member countries, as well as on the NEHAP Task Force whose work was especially geared towards assisting countries with the accession process. 97. Collaboration between the Regional Office and the Council o f Europe was expanding. The Council had urged Member States to participate actively in the process o f consultation on the revision of the European HFA policy. The Regional Office had been represented on two occasions at meetings of the Council’s European Health Committee (CDSP) and had played an active role in preparatory' meetings of the Committee o f Senior Officials for the sixth Conference o f European Health Ministers. A joint WHO/Council of Europe publication had recently been issued on the principles o f HIV prevention among drug users. 98. The Regional Office was actively supporting the reform process within the United Nations system. One practical example o f that was the Office’s recent involvement in the United Nations Development Assistance Framework (UNDAF) exercise in Romania and Turkey. 99. Collaborative activities with the World Bank were continuing. One initiative, the European Observatory on Health Care Reforms, would allow for the collection and analysis of existing information and research evidence on health care systems and reforms and would make that knowledge widely accessible throughout the European Region. Other main partners in that project included the Government of Norway, the European Investment Bank, the London School of Economics and Political Science and the London School of Hygiene and Tropical Medicine. 100. It was confirmed that the Regional Office needed to work more openly and intensively with NGOs. The Pan-American Health Organization had assisted the Office by providing its regional policy paper to the EURO Task Force on External Relations that had been set up. 101. The Office’s role as overall health coordinator (both for bodies in the United Nations system and for NGOs) in disaster and emergency situations as they related to public health in the Region had been considerably strengthened, and field offices were located in Albania, Bosnia and Herzegovina, the Federal Republic of Yugoslavia and Tajikistan. Collaboration with other agencies was ongoing in parts o f Central Asia, Albania, NIS and the Caucasus. Successful partnerships had also been established between the Office and various professional organizations, trade unions and NGOs for the planning and implementation of activities at local level. 102. The Regional Adviser was commended for his comprehensive and succinct report on W HO’s collaborative efforts over the previous year. None the less, several delegates were o f the view that they fell far short of what was required to ensure a coordinated approach to health policy development and implementation across Europe. Even greater efforts were required if unnecessary duplication o f work was to be minimized and the scarce resources available were to be used to best effect. 103. It was recognized, however, that improving collaboration between the Council o f Europe, the European Commission and WHO was not solely the responsibility o f the respective organizations. Member States also had a crucial role to play in forging links through their membership of those bodies’ various committees and task forces. Political will was considered to be of paramount importance in ensuring that all three organizations worked together effectively. To that end, it was suggested by one Member State that the time was ripe to develop a well thought-through political strategy for achieving the desired goal. 104. Several Member States referred to the recent speeches made by W HO’s new Director-General in which she expressed her strong commitment to collaborative working with a range o f agencies, including the European Commission. It was generally felt that, given the new leadership and direction coming from WHO headquarters together with the structural arrangements currently being put in place, the collaboration long called for by the Regional Committee might soon be realized. The European Observatory on Health Care Reforms and the proposed European Centre for Health Policy Analysis in Brussels would provide fresh impetus for collaborative efforts and had the potential to become sources of shared data for the Council of Europe, the European Commission and WHO. 105. Reference was also made to the need for closer cooperation between United Nations agencies at country level and the possibility of all UN staff operating from the same premises. Examples o f closer working relationships between such staff at country level were provided by the Regional Director, who also pointed out the importance of WHO staff being in close proximity to ministries o f health. 106. The representative o f the Council o f Europe informed the Committee of the Council’s vigilance over the ethical and social concerns that had been troubling European countries over the past decade. Those concerns had been translated into action in the Council’s work programme in areas such as bioethics, equitable access to health care and quality o f care development. 107. The work of WHO, the Council of Europe and the European Commission in the area o f health was based on the same concept - protecting health - and followed the same orientations, thus opening up the possibility o f a common European health policy shared by all the Member States of those organizations. However, one question was whether a single European health policy founded on human rights should be the aim, or whether different policies promoted by different organizations (i.e. one for member countries and another for non-members) would be acceptable in terms of preserving human dignity and rights. In the wake o f the Regional Committee’s endorsement of the Health21 policy framework, “rapprochement” could be revived and would offer an assurance of coherent policies in Member States and satisfactory service to the people. The new HFA document could be a meaningful and credible reference point for that rapprochement. 108. The European Commission representative noted that the Commission’s interest in health as an activity area dated from before 1993. The Maastricht Treaty had introduced its new competence in public health, while the new Amsterdam Treaty had further strengthened it. Several examples were cited of public health activities undertaken by the Commission. The key issue now was for the Commission to make an effective contribution to the development and implementation o f health policy. Public health policy was inextricably linked to policy on the development of health systems: public health aimed to maintain and improve the health of entire populations or subgroups, and public health policy would thus deal with the cost-effectiveness of health systems themselves and how well specific health interventions worked in prevention and treatment. 109. A European Union policy on public health would require cooperation with third countries and international organizations. WHO was identified as one major partner, primarily in relation to candidate countries for accession to the Union. Other areas of joint activity with WHO included health information, health service reform projects, environment and health, and pharmaceuticals. 110. On behalf of the EU member states, the representative of the Commission welcomed the appointment o f Dr Brundtland as the new Director-General o f WHO and expressed the conviction that, under her leadership, there would be even closer cooperation between WHO and the Commission. 111. Statements were delivered by representatives of the following nongovernmental organizations: the European Council for the Blind, the International Association of Medical Laboratory Technologists, the International Confederation of Midwives, the International Council o f Women, the Medical Women’s International Association, the World Organization of Family Doctors, and the European Forum of Medical Associations and WHO. In addition, written statements were submitted by the European Chiropractors Union, the International Association of Agricultural Medicine and Rural Health, Rotary International, the World Federation of Occupational Therapists, the World Veterinary Association, and the European Forum of National Nursing and Midwifery Associations and WHO. III. THE FUTURE WORK OF W HO 1. M atters arising from decisions o f the W orld Health Assem bly and the Executive Board (including the outcom e o f the work o f the Executive Board Special Group for the Review o f the Constitution o f W HO related to regional arrangem ents) (EUR/RC48/5) 112. The Executive President, on behalf of the members o f the Regional Committee, thanked Professor Z. Reiner for his sustained and concentrated efforts on behalf o f the European Region in the deliberations on regional arrangements in the Executive Board and its special group. 113. The Regional Director introduced document EUR/RC48/5, which was in two parts. Part I provided an overview of the Health Assembly and Executive Board discussions o f interest to the Member States, and Part II contained comments on the decisions and resolutions relevant to the regional programme. The most important items contained in Part I were: - the work done on regular budget allocations to regions by the Executive Board’s special group; the recommendation by the special group that Article 2 o f the Constitution should be revised; the recommendation by the special group that the term of office of regional directors should be five years, renewable once; the adoption o f a resolution by the Health Assembly that the number o f seats on the Executive Board should be increased to 34, giving the European Region one more seat; the decision by the Health Assembly that members o f the Executive Board should be designated as government representatives technically qualified in the field o f health; the adoption o f a resolution by the Health Assembly ensuring that documents were dispatched and made available on the Internet not less than 30 days before the opening o f the Health Assembly; and the lengthy discussions in the Executive Board and the Health Assembly on the revised drug strategy. 114. With regard to the fourth point, he emphasized that the amendment to the Constitution would not come into force until ratified by the majority o f Member States. Members o f the Regional Committee were therefore urged to ensure that their governments ratified the amendment as soon as possible and to use their influence to persuade Member States o f other regions to do so. On the penultimate point, he noted that the European Region had followed suit and had managed to dispatch almost all Regional Committee documents six weeks before the current session and simultaneously place them on the Internet. 115. Replying to a query as to why document EUR/RC48/5 mentioned that the transfer o f the additional budgetary allocation to the Region would be spread over three rather than five biennia, the Regional Director explained that resolution W HA51.31 provided that regions should not lose more than 3% of their allocation per year. In the case o f two regions, however, the transfer o f allocations according to that provision would take five biennia. 116. Turning to the revised drug strategy, the Executive President said that, in accordance with decision EB 102(14), regional committees were being requested to select two Member States to participate in a subgroup of the Executive Board, of which one Member State should be currently entitled to designate a person to serve on the Board. The subgroup would meet in Geneva in October 1998 to finalize the resolution on the revised strategy. The SCRC had felt it preferable that the countries selected should represent the east and west of the Region, and therefore proposed Poland and Switzerland. The Committee endorsed the SCRC’s proposal. 117. The SCRC had also recommended to the Regional Committee, based on an assessment of replies from five Member States, that Article 2 o f the Constitution should be worded in as simple and general manner as possible. The consensus in the Committee was that the SCRC’s recommendation was too vague. It was generally felt that the text should be sufficiently detailed, while using inclusive terminology to avoid the need for frequent revision. One delegation suggested that a special group of the Board should be set up to reconsider the question in a more comprehensive manner and give a fuller explanation of the proposed changes. That would not be a problem, since the matter was not of high priority. The Committee agreed with those views and asked for them to be transmitted to the Executive Board. 2. Proposed program me budget 2000-2001 (EUR/RC48/8, /8 A d d .l and /Conf.Doc./5) 1 18. The Executive Management Coordinator explained that, largely as a result of resolution EUR/RC47/R9 adopted the previous year, the structure of the proposed programme budget had been changed. It was now based on the structure of WHO’s Ninth General Programme of Work while highlighting the regional HFA targets and priorities. That structure had been chosen to ensure the greatest possible comparability and compatibility between the regional and global programme budgets. 119. The proposed programme budget was a zero-growth budget. Its preparation had been influenced by three main factors: the new regional HFA policy, the reform processes taking place within WHO and the United Nations system as a whole, and the new Director-General’s vision o f W HO’s priorities. All of those factors had introduced an element o f uncertainty into the preparation. With that in mind, a process had been undertaken involving evaluation of the programme budget for 1996-1997, operational planning for 1998-1999 followed by strategic planning and other meetings and discussions, and review by the SCRC. Since the SCRC had already endorsed the draft programme budget before the World Health Assembly passed resolution W HA51.31 increasing the regular budget allocation to the European Region, it was considered appropriate to seek the Committee’s specific guidance on the use of those funds by means of document EUR/RC48/8 Add. 1. 120. Document EUR/RC48/8 was in two parts. Part 1, the Regional Director’s introduction, showed that priorities identified by the Regional Committee had been borne in mind, and that an attempt had been made to align them with those identified by the Executive Board at its 101st session in January 1998. Part 2 dealt with the six appropriation sections, which corresponded to those o f the Global Programme of Work and were indicated by one digit. Under each of those headings could be found a text stating the rationale of the proposed action. Each appropriation section contained a number o f major programmes, indicated by two digits, making a total of 19 such programmes. Each major programme included a proposed table o f resources showing the distribution of funds between the intercountry, country and regional activities, and between regular budget funds and those from other sources. The table also showed expenditure in 1996-1997, the approved budget for 1998-1999 and the strategic budget for 2000-2001. Embedded in those major programmes could be found four new interdepartmental projects on primary health care, a healthy start to life, health and work, and urban health. Finally, each major programme contained a number o f specific programmes, indicated by three digits, with targets, products and projections. The tables presenting the budgetary allocation for major and specific programmes showed, for the first time, not only the allocations to the intercountry and country programmes but also staff costs, thus increasing both the information value and the transparency of the programme budget. 121. There had been a substantial increase in the funds allocated to the priority areas identified by the Executive Board in resolution EB99.R13. As to the Health Assembly’s request for efficiency savings (resolution WHA50.26), the Office had made savings o f 3.2% on administrative costs, which had been used to strengthen capacity in six technical areas. 122. Through resolution WHA51.31, the regular budget o f the European Region had been increased by some US $10-11 million over three biennia, the first instalment o f which, US $2.2 million, would be received in the biennium 2000-2001. Since the funds were to be used for country support, the EUROHEALTH programme was considered the natural vehicle for their distribution. 123. In selecting the countries that would benefit most from the funds, three alternatives were proposed. Alternative A would comprise those six countries in the Region that qualified as “low-income” countries according to the World Bank’s definition. Alternative B comprised those six countries plus eight others that satisfied the criteria for a WHO country office other than a liaison office. Alternative C consisted of the 26 EUROHEALTH countries plus Turkey. 124. Three options were put forward for allocating funds to the beneficiary countries. Criterion 1 consisted of an even allocation, and was considered most appropriate for Alternative A. Criterion 2 consisted of a preferential allocation, with the countries most in need receiving a multiple o f that of the others; that was considered most suitable for Alternative B. Criterion 3, considered most suitable for Alternative C, would make use o f preferential allocation according to the criteria set out in resolution W HA51.31. As to the use to be made of the funds, it was proposed to abide by the agreed EUROHEALTH priorities for 1995-2000, though the order o f priority might differ for individual countries. 125. It was also considered that some o f the additional allocation should be used for a common purpose. The provision of WHO country offices had been considered, but they would be impossibly expensive to maintain - some US $500 000 each - even in the six countries listed in Alternative A. It was therefore proposed to use only about US $0.2 million to strengthen the capacity for programme development and cooperation in countries. 126. The SCRC, at its most recent meeting, had recommended Alternative A and Criterion 1, to be administered according to EUROHEALTH priorities with appropriate flexibility in tackling national priorities. The SCRC had considered that that formula gave the maximum benefit in terms of equity, solidarity and value for money. It would also be relatively easy to demonstrate the impact of the use o f the funds. The Regional Office intended to evaluate that impact at the end o f the biennium, with a view to determining the use o f the additional allocation in the future. 127. The Regional Director, replying to a previous question on the impact on the regional programme budget o f the recent restructuring at WHO headquarters, stated that the new global budget would be completed by the end o f October 1998, and he had appointed two focal points to explore with headquarters how the regional programme budget would fit into the new structure. He also suggested that the SCRC might wish to examine the regional response to the Director-General’s new priorities, especially in the three areas of tobacco, malaria and the evidence base. So far there had been no request from headquarters that the regional programme budget be modified in any way. 128. The Regional Committee recognized that the global programme budget would not be finalized until after the fifty-second Health Assembly in May 1999, and that the relative emphasis on different programmes in the regional budget might need to be shifted as a consequence. It agreed that the Executive President and Deputy Executive President could endorse any major changes on its behalf. 129. In the ensuing discussion, speakers expressed their general satisfaction with the new format o f the budget document, its links to the regional HFA targets, its compatibility with the global programme budget and its clarity and transparency. The document clearly identified the relative priorities given to the various programme areas. One speaker questioned the low estimates o f voluntary contributions for the biennium 2000-2001 compared with 1998-1999 and asked for trends in budgetary allocations to be shown in percentages rather than actual figures. 130. With regard to the increased allocation, speakers overwhelmingly supported alternative A together with criterion 1, stressing that since the funds in question were only the first tranche it was important to gain the maximum impact from them. Some felt that communicable diseases and the continuing effects o f the Chernobyl disaster were particularly important areas to deal with. In that connection the Regional Director mentioned that the Regional Office had a thyroid project run by the Rome division of its European Centre for Environment and Health. It had been difficult to ensure the required voluntary donations for that particular project; thus, perhaps a foundation for the purpose could be set up. That possibility would be discussed with the countries affected. 131. Several speakers advocated the use of objective criteria, not only for allocating the additional regional budget but indeed for the budget as a whole. One delegate noted that the country allocations in the European Region were proportionately far less than in other regions. Another regretted that his country’s current allocation would not continue in the following biennium. 132. One speaker called for the endorsement o f a model o f budgetary allocation based on resolution WHA51.31, instead of the application of one designed by the Regional Office. In reply, however, the Executive Management Coordinator noted the drawbacks in one of the components of the model advocated by that resolution, namely the immunization coverage rate. It was also pointed out that the SCRC and the secretariat had discussed the use of objective criteria, and it was planned to apply such criteria to all country allocations in future. 133. One speaker expressed concern over the general structure o f the programme budget. In 1998-1999 some 90% of the budget had been allocated to intercountry and regional programmes, leaving only 10% for country work. In reply, the Regional Director pointed out that the bulk o f the Office’s work was in fact practical cooperation with countries, although for the purposes o f budget presentation it figured as intercountry or regional activities. As a result, the nominal country allocations appeared quite small, but in reality far more than 10% of the budget was spent on direct cooperation with countries. He suggested that the SCRC might wish to take up the whole question of how to present a true picture o f country support in the programme budget document, and to report to the Regional Committee at its forty-ninth session. 134. When reviewing the proposed programme budget chapter by chapter, one speaker emphasized the importance of avoiding duplication with the European Commission and queried the level of extrabudgetary funds foreseen for programme 2.4. Another welcomed the increased attention paid to general practice and nursing in Chapter 3, but wished to see more western European countries involved. 135. On Chapter 4, one country acknowledged the benefits of the European Action Plan on Alcohol and offered to host a second ministerial conference on the subject in 2000, an offer which the secretariat acknowledged with gratitude. In that context another country noted that more emphasis should be placed on demand reduction and prevention, rather than on tackling the harm caused by alcohol. One delegate called for the budgetary allocation for activities on aging to be increased in the following biennium, in view o f demographic trends in Europe. Approval was expressed for the interdepartmental project on a healthy start in life. The cut in the allocation for nutrition was questioned, in view of the undoubted importance of that area, which included food safety and security. It was surprising that there was no reference to the WHO task force on sexually transmitted diseases (STDs) in eastern Europe, nor was there a target on them in programme 4.1.1. 136. On the question o f targets, one speaker pointed out that they had to be realistic - as stated in the proposed programme budget, it was unlikely that the target on measles, for example, in programme 5.1 would be reached. Another delegate emphasized the connection between tuberculosis and HIV infection, and urged that the problem (particularly in eastern Europe) should be tackled more vigorously. The noncommunicable diseases covered by programme 5.3.1 were very diverse and probably necessitated differentiated approaches in the form of direct intervention and lifestyle-based prevention. Several speakers pointed to the need to include activities against hepatitis, influenza and Creuzfeldt-Jakob disease. 137. The Committee adopted resolution EUR/RC48/R9. 3. The European regional Health for All policy and strategy for the twenty-first century (EUR/RC48/9, /10 and /Conf.Doc./6) 138. The Regional Adviser, Health Economics, introducing the new Health for All (HFA) policy for the European Region, Health21, noted that the documents were the outcome of widespread consultation with Member States and organizations. He acknowledged the close involvement and support of the SCRC in their preparation. 139. Two documents had been produced for consideration by the Regional Committee: the full policy document was designed for use by public health experts, while the introduction document was aimed at top-level decision-makers. The number o f targets had been reduced from 26 to 21. There was a sharper focus on equity through solidarity, on the determinants o f health and on accountability for health outcomes. Emphasis was placed on achieving better health for people and strengthening multisectoral approaches. The documents gave prominence to management by outcomes at the population, family and clinical levels and to settings-based partnerships for planning and action. 140. For the way ahead, the most important part was the plan of action. The new HFA policy should become the established health policy in Europe, through close cooperation with countries in their policy development. The policy should be adapted for specific audiences. The evidence base for action should be strengthened, with the support of the EACHR to help mobilize the scientific community. 141. Delegates commended the Regional Office on the preparation o f both documents. They welcomed the fact that the underlying values were clearly set out, and that emphasis was placed on the socioeconomic determinants of health and multisectoral responses to them. One speaker described the documents as one o f the best public health references available in Europe and beyond. They were regarded as user-friendly and, since they defined basic values and strategies for action, usable by health policy-makers at all levels. They clearly reflected the health landscape across the Region and could serve as a tool for all integrational organizations in Europe. One delegate proposed a health summit to support implementation o f the HFA policy. Another commented that the suggestion to regard the long document as the policy, as proposed by the SCRC, was not what the Regional Committee had thought at the time o f its previous session. 142. While recognizing that the documents still required further modification (and agreeing to provide comments in writing), representatives stressed the need to have the two documents published and disseminated as soon as possible. A number o f topics were identified as requiring strengthening, including ethics and genetics, the health o f refugees and migrant groups, women’s health, nutrition (in particular obesity) and disability. 143. The reduction in the number of targets was welcomed, and some speakers advocated a further reduction. The rights and responsibilities o f Member States to develop and implement their own health policy should be acknowledged and respected, with the HFA policy serving as a guide that could be adapted for country-based implementation. One delegate noted that some targets were not strictly quantifiable and wondered whether they should have been included. 144. Delegates were keenly aware of their own responsibility for implementing the policy at country, regional and local levels. Strategies, targets and timetables for implementation at those levels would need to be devised. All sectors that had an influence on health and the public would need to be informed and convinced. WHO and the Member States would have to cooperate closely on implementation of the policy. Where international conventions could have an effect in parallel with national efforts, their use should be explored. 145. Many speakers expressed concern at the number o f proposed indicators and considered that a working group should be convened to review the number and content o f indicators and report back to the Regional Committee in 1999. Such work must not, however, preclude the early publication and dissemination o f the two documents. There was a need to coordinate the information needs of different bodies. 146. In reply, the Regional Adviser, Health Economics warmly thanked the delegates for their positive comments and looked forward to receiving written suggestions for strengthening the texts. He pointed out that the number of 21 targets was a compromise - it would be difficult to reduce that number still further. He welcomed the recommendations for revision, including greater attention to the topics of nutrition, obesity, women’s health, immigration, refugees, disability, and ethics and genetics. He agreed that the formulation o f the HFA targets should not undermine national ones. 147. Summing up, the Regional Director stressed that the targets were set for the Region as a whole. They were meant to serve as an inspiration for the countries, not as a straitjacket. They should be a blend o f today’s realities and tomorrow’s dreams, and a mixture o f concrete technical targets and policy targets. In conclusion, he noted that the indicators related to the HFA policy were useful to many organizations. They would be elaborated at a meeting scheduled to be held in Rome in October 1998, jointly with the European Commission and the ECE. A final list would be submitted for adoption by the Regional Committee at its forty-ninth session. 148. The Committee adopted resolution EUR/RC48/R5. 149. The Project Manager, Healthy Cities introduced the working document by describing it as an important WHO initiative for raising awareness and as a catalyst for countries to develop tools and guidelines on public health. The timing was right, especially in the light of the new HFA policy framework endorsed by the Regional Committee earlier in the week. No country could say that it was backing the HFA policy without making a parallel commitment to develop public health. A proper public health infrastructure, with adequate processes in place, was a prerequisite for making the new HFA a reality. 150. A distinction should be made between traditional and new public health, the former often restricted to public health medicine and the latter - the HFA approach - focusing on a broader concept which aimed to respond to the needs o f whole populations, through intersectorality. Public health was no longer the domain of medicine alone but involved many other professionals and a whole range of new actors, sectors and approaches. Modem public health needed autonomy within the health sector and actors who had the right to speak out on public health issues, if they were to be true advocates for the people. Those actors needed to be full partners in negotiating resource allocation, prioritization and targeting, and not confined to dealing with traditional technical issues. While scientific skills were important, they were not enough to tackle inequities and health determinants nor to manage the implementation of public health action. Advocacy and leadership skills were essential. Schools of public health needed to review their curricula in line with modem public health thinking. 151. There was a huge variation in the development of public health across Europe. With the exponential growth in the knowledge base about the social determinants o f health, all countries should review their approaches and invest much more in public health than was currently the case. 152. In the ensuring discussion, all speakers agreed that it was timely and relevant to place the issue of public health on the agenda of the Regional Committee and that the document was an important first step in the process o f developing a European regional framework. Public health needs were different in different countries, and all countries were at different stages of development. While approaches like multisectorality, multidisciplinarity and partnership were important and must be emphasized, the complexity o f moving from the concept to the reality should not be underestimated, especially when a larger range o f actors and sectors was involved. 153. It was generally agreed that there was a need to improve the training of all health professionals and others involved in the new public health agenda. Caution should be exercised in focusing too much on individual disciplines, and there should be greater movement towards integrated approaches at local, national and regional levels. All professionals should have epidemiology, economics and evaluation skills included in their basic training. That was considered to apply particularly to general 4. T he s tru c tu re and function o f public health in E urope (EU R/R C 48/13 and /Conf.D oc./9) practitioners. However, education alone would not deliver the agenda - a cultural shift was needed at all levels, including universities, the hospital sector and, more importantly, within the professions. 154. The Regional Committee acknowledged that public health was a highly topical issue which needed to be strengthened through milestone events. It welcomed WHO’s efforts in raising awareness and its willingness to provide the tools and know-how to lead the way on the new public health agenda. A pragmatic approach was endorsed. The forthcoming seminar to be held in Antalya (Turkey) could provide a useful opportunity for brainstorming on a possible WHO conference on public health, perhaps in 2000. It was agreed that the document presented to the Regional Committee was an important reference point, as was the European Commission’s forthcoming framework on public health. 155. Several delegations, though praising many aspects of the paper, felt that it did not sufficiently address a number o f important aspects such as issues at national and subnational levels, the education of health personnel and those in other sectors, etc. The Committee therefore felt that it was too early to adopt a definitive resolution on the subject and referred the question back to the SCRC for further study. 5. Proposals for a Comm ittee for a Tobacco-free Europe (EUR/RC48/11 R ev .l) 156. The Regional Adviser, Tobacco or Health informed the Committee that since the Action Plan for a Tobacco-free Europe had been discussed the previous year, the Office had undertaken a number of key activities. Those included tobacco policy missions, together with colleagues from WHO headquarters, to countries in the eastern part of the Region, the development of action plans for tobacco-free cities and regions, and the establishment o f a partnership with the International Press Institute. 157. Because o f the time lag between smoking and smoking-related deaths, the main determinant of tobacco-related deaths in the Region over the next twenty-five years would be the number o f the existing 180 million smokers who could quit smoking. The July 1998 directive of the European Council to ban the advertising and sponsorship of tobacco products would have an impact far beyond the borders of the European Union. In particular, accession countries would have to amend their tobacco advertising and sponsorship legislation. When health gains in the health care sector were considered, cessation interventions were highly cost-effective. The Office had been working closely with the European fora of medical, nursing and pharmaceutical associations to ensure that training and implementation programmes for smoking cessation were widely disseminated. 158. Describing the proposals for a Committee for a Tobacco-free Europe (CTE), he noted that the European Commission and a number o f European nongovernmental organizations had indicated their willingness to join the Committee. The CTE could also comprise up to four authoritative individuals representing the advertising, media, legal and scientific fields, as well as one observer from the SCRC. 159. Delegates thanked the Regional Adviser for his presentation, welcomed the establishment of the CTE and offered it their support. They emphasized that the time was ripe for action on tobacco and that the CTE, whilst being evidence-based, should concentrate on big issues and not on details. Those who were not yet converted to the tobacco or health issue needed to be addressed. 160. The need for the CTE to communicate a health message was pointed out, and prominent figures should be sought to do that. One delegate, commenting that the structure o f the CTE might well reflect that aim, questioned the need for technical personnel to be members o f the CTE, and indeed for the Regional Office both to be a member o f the CTE and to act as its secretariat. 161. Another representative drew attention to the proposed International Framework Convention on Tobacco and stressed the importance of Member States supporting that initiative. One speaker, while recognizing the need to reduce health problems and institute effective measures against tobacco, mentioned that innovative ways had to be found to take into account the needs of tobacco- growing countries. Another delegate wondered whether the idea o f the CTE should not be taken up at a global level, rather than a European one. Lastly, one speaker pointed out that tobacco issues needed to be integrated into a broad health promotion framework, and that unpredicted and unpredictable ways should be sought to take action against tobacco. 162. In reply, the Regional Adviser thanked delegates for their helpful and supportive comments. The European Region had a wealth and depth o f experience of action against tobacco, and Member States were to be thanked for their assistance in implementing the Action Plan for a Tobacco-free Europe. Health21 provided a framework for ensuring that tobacco control activities were incorporated into a broad health promotion approach. It was important not to alienate smokers, but rather to provide assistance to the large majority o f smokers who wanted to quit smoking. While many tobacco-growing countries had implemented effective tobacco control measures, there was a need for innovative approaches that took account o f their interests and the specific features of the tobacco trade. Although it was important for the CTE to communicate a health message, that should be underpinned by a strong technical base. One example of an unpredictable opportunity that had been taken was the support which Miss Sweden had given WHO the previous year in bringing the issue o f tobacco more strongly to the public’s attention. 163. The Regional Director, commenting on the structure of the CTE, noted that having a member from the Regional Office on the CTE was similar to the principle adopted in the European Environment and Health Committee, an arrangement which had strengthened the support given by the Organization. The name of WHO would be safeguarded, and the chairperson o f the CTE would be approved by all the member organizations. 164. The Director-General considered that the CTE would prove to be a model development at regional level and recommended that it should work closely with the Organization’s global Tobacco-Free Initiative. 165. The Regional Committee decided to endorse the proposals outlined in document EUR/RC48/11 Rev.l setting up a Committee for a Tobacco-free Europe and asked the Regional Director to implement those proposals. 6 . Appointm ent o f a Regional Search Group for candidates for the post o f Regional Director (EUR/RC48/12 and Conf.Doc./lO) 166. The Executive President stated that proposals had been received for a range of excellent candidates. Twenty-one delegations had submitted twelve names for consideration. The criteria which he and the Deputy Executive President had endeavoured to apply to the best o f their ability included the following: the people recommended for membership should be active and known within the Organization but not too closely linked to it, and they should be respected and trusted by their peers and the Member States. In addition, a broad geographical spread was considered to be important. 167. The following people had been identified as meeting those criteria and were therefore proposed as constituting the Regional Search Group: Members: Dr M. di Gennaro (Italy) D rJ. Eskola (Finland) Dr M. Saveliev (Russian Federation) Alternates: Dr J. Goicoechea (Andorra) Mr V. Jaksons (Latvia) Dr G. Liebeswar (Austria) 168. There was general support for the appointments proposed, and all nominees were believed to meet the criteria as agreed. Some delegates, however, expressed concern regarding the initial selection process and believed that the approach adopted appeared to lack transparency. There had been no apparent change to the list presented on the first day o f the session, despite the fact that delegations had responded to a request for further proposals. 169. One speaker requested that the list o f names submitted by the Member States should be shared with the Regional Committee. That request was complied with. There was also a request for clarification concerning alternates, in particular with regard to the procedure to be adopted for filling a vacancy on the RSG should one arise. In the course of the lengthy discussion which ensued, Legal Counsel advised the Regional Committee that its Rules of Procedure (as amended by resolution EUR/RC48/R2 adopted the previous day) had been scrupulously followed. 170. None the less, there was still a degree of discomfort among some Member States regarding the process followed. Ultimately, however, the Committee agreed to proceed in line with the mechanism already laid down but to request the SCRC to make a thorough review the Rules of Procedure and propose any amendments required to the Regional Committee at its forty-ninth session. 171. On the question o f the procedure for appointing members from among the alternates selected, the Regional Committee agreed that any vacancy which arose should be filled by drawing lots and asked for the draft resolution to be amended accordingly. The Committee further decided that alternates should be fully involved in the work of the RSG and attend all its meetings, although without the right to vote. 172. The Committee adopted resolution EUR/RC48/R6. IV . E l e c t i o n s a n d n o m i n a t i o n s 173. The Committee met in private to consider the nomination of members of the Executive Board and to elect members of the SCRC, the Joint Coordinating Board of the Special Programme for Research and Training in Tropical Diseases, the Management Advisory Committee of the Action Programme on Essential Drugs and the Management Advisory Committee o f the Action Programme on Nations for Mental Health. 1. Nomination o f m embers o f the Executive Board (EUR/RC48/6 and 16 Add.2) 174. Consensus was reached on which countries were to nominate members o f the Executive Board at the Fifty-second World Health Assembly in May 1999. 2. Election o f members o f the Standing Comm ittee o f the Regional Committee (EUR/RC48/6 and /6 Add.2) 175. Even though the seat o f Bosnia and Herzegovina had been declared vacant in accordance with Rule 2.2 of the SCRC’s Rules of Procedure, the Regional Committee, after due consideration o f the circumstances, considered that the membership of Bosnia and Herzegovina should continue until the end o f its term o f office in September 1999. 176. The Committee decided to select the Czech Republic (Dr L. Romanovska), Ireland (Dr J. Kiely) and Spain (Dr I. de la Mata) for membership o f the SCRC for a three-year term of office (from September 1998 to September 2001). 3. Election o f a m em ber o f the Joint Coordinating Board o f the Special Program m e for Research and Training in Tropical Diseases (EUR/RC48/6) 177. In accordance with the Memorandum of Understanding on the Special Programme for Research and Training in Tropical Diseases, the Committee decided to select Israel (Dr M. Ephros) for membership of the Joint Coordinating Board for a three-year period from 1 January 1999. 4. Election o f a m em ber o f the M anagem ent Advisory Com m ittee o f the Action Program m e on Essential Drugs (EUR/RC48/6) 178. The Committee decided to select Turkey (Dr S. Oksiiz) for membership o f the Management Advisory Committee of the Action Programme on Essential Drugs for a three-year period from 1 January 1999. 5. Election o f m embers o f the M anagem ent Advisory Com m ittee o f the Action Program m e on Nations for M ental Health (EUR/RC48/6 and /6 A d d .l) 179. The Committee decided to select Germany (Dr H. Salize) and the Netherlands (Dr D. Kaasjager) for membership of the Management Advisory Committee of the Action Programme on Nations for Mental Health for a three-year period from 1 January 1999. V . O t h e r m a t t e r s 1. Date and place o f the forty-ninth and fiftieth sessions (EUR/RC48/Conf.Doc./7) 180. The Committee adopted resolution EUR/RC48/R7, confirming that its forty-ninth session would be held from 13 to 17 September 1999 in Florence, Italy and deciding that its fiftieth session would be held at the Regional Office for Europe in Copenhagen from 11 to 15 September 2000. The delegation of Spain confirmed its invitation to the Regional Committee to hold its fifty-first session in Madrid.