Forty-ninth Regional Committee for Europe: Florence, 13 - 17 September 1999: draft report of the fifty-ninth session of the regional committee for Europe

WORLD HEALTH ORGANIZATION R e g i o n a l O f f ic e f o r E u r o p e C o p e n h a g e n REGIONAL COMMITTEE FOR EUROPE F o r ty -n in th se ss io n , F lo re n c e , 13 – 17 S e p te m b e r 1 9 9 9 EUR/RC49/13 16 September 1999 11799 ORIGINAL: ENGLISH D r a f t R e p o r t o f t h e F o r t y -n i n t h S e s s i o 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 CO N TENTS P a ragraph s I. Introduction 1. Opening o f the sess io n ...................................................................................................................... 1-3 2. Election o f officers ............................................................................................................................. 4 3. Adoption o f the agenda and programme o f w ork..................................................................... 5 II. Review o f the work o f WHO 1. Statement by the Director-General................................................................................................ 6 -15 2. Statement by the Regional D irecto r.............................................................................................. 16-31 3. Report o f the Standing Committee o f the Regional C o m m it tee .......................................... 32-33 3.1 Semi-permanent membership o f the Executive B o a rd .............................................. 34-35 3.2 Amendments to the Rules o f Procedure.......................................................................... 36-38 4. Collaboration with other agencies within the United Nations system and with integrational, intergovernmental and nongovernmental organizations in Europe....... 39—48 III. The future work o f WHO 1. Matters arising out o f decisions o f the World Health Assembly and the Executive B o a rd ............................................................................................................... 49-55 2. HEALTH21: the health for all policy framework for the W HO European Region 2.1 EU R O ’s response to WHO reform and HEALTH21.................................................... 56-59 2 .2 Prom otion o f HEALTU21.................................................................................................................. 6 0 - 6 5 2.3 Indicators for HEALTI121 and monitoring o f progress towards health for a l l ..... 6 6 - 7 2 3. Public health structure and function in E u ro p e ......................................................................... 73-81 4. European Alcohol Action Plan - assessment o f Phases I and II (1992-1999) and adoption o f Phase III (2000-2005)..................................................................................... 82-94 5. Country strategy 5.1 Description o f country work in the programme b u d g e t .............................................. 9 5 -97 5.2 Principles and criteria for determining country allocations ...................................... 98-105 6. Environment and health..................................................................................................................... 106-118 7. Strengthening public health action in natural disasters and internatinal cooperation on emergency preparedness and briefing on W H O 's work in Kosovo and Turkey.... 119-126 IV. Elections and nom inations ......................................................................................................................... 127 1. Nomination o f a candidate for the post o f Regional D irec to r ............................................... 128-129 2. Nomination o f members o f the Executive B o a rd ...................................................................... 130 3. Election o f members o f the Standing Committee o f the Regional C o m m it tee ............... 131-132 4. Election o f members o f the European Environment and Health C o m m it tee ................... 133 5. Election o f a m ember o f the Policy and Coordination Committee o f the Special Programme on Research, Development and Research Training in Human R eproduc tion ...................................................................................................................... 134 6. Election o f a member o f the Management Advisory Committee o f the Action Programme on Essential D ru g s ..................................................................................... 135 V. Other matters 1. Tribute to Dr Leo K a p r io ................................................................................................................. 136 2. Date and place o f the fiftieth and fifty-first sessions................................................................ 137 R E SO L U T IO N S EUR/RC49/R1 Amendments to the Rules o f Procedure o f the Regional Committee and the Standing Committee o f the Regional Committee EUR/RC49/R2 Nomination o f the Regional Director EUR/RC49/R3 Expression o f appreciation to Dr Jo Eirik Asvall EUR/RC49/R4 Environment and health EUR/RC49/R5 Strategic planning for work with countries and distribution o f country allocations in the European Region EUR/RC49/R6 Necessary public health action on natural disasters and em ergencies and international cooperation for emergency preparedness EUR/RC49/R7 Date and place o f regular sessions o f the Regional Committee in 2000 and 2001 EUR/RC49/R8 European Alcohol Action Plan - Third phase EUR/RC49/R9 Upgrading the role o f public health in the European Region EUR/RC49/R10 Health for All indicators for monitoring and evaluation o f HEALTH21 EUR/RC49/R11 Report o f the Standing Committee o f the Regional Committee Annex 1 Agenda 1. O pening o f the session The forty-ninth session o f the Regional Committee for Europe was held in Florence from 13 to 17 September 1999. Representatives o f 50 countries o f the Region took part. A lso present were observers from one non-Member State and two member states o f the United Nations Economic Commission for Europe, and representatives o f the World Bank, the United Nations Population Fund, the Council o f Europe, the European Commission and nongovernmental organizations. The inaugural ceremony was held at the Palazzo Vecchio on the evening o f 13 September 1999. Addresses were delivered by Mr Leonardo Domenici, Mayor o f Florence; Dr Rosy Bindi, Minister o f Health o f Italy; Mr Vannino Chiti, President o f the Region o f Tuscany; Dr Gro Harlem Brundtland, Director-General o f WHO; and Dr Jo Asvall, WHO Regional Director for Europe. The first working session o f the Committee was opened on 13 September 1999 by Mr Carsten Koch, outgoing President. 2. Election o f officers The Committee elected the following officers: Dr Rosy Bindi (Italy) President Dr Danielle Hansen-Koenig (Luxembourg) Executive President Dr Jeremy Metters (United Kingdom) Deputy Executive President Mrs Miloslava Kollarova (Slovakia) Rapporteur 3. Adoption o f the agenda and program m e o f w ork (EUR/RC49/1 R ev .l and /C on f.D oc./l) The Committee adopted the agenda and a programme o f work, with the addition o f one item on strengthening public health action in natural disasters and international cooperation on emergency preparedness. I. I n t r o d u c t i o n II. R e v i e w o f t h e w o r k o f WHO 1. Statem ent by the Director-G eneral The Director-General outlined four global strategic directions for WHO on the eve o f the new millennium. The first was to reduce the burden o f disease, especially on poor and marginalized people. While noncommunicable diseases were an increasing problem, infectious diseases remained a huge threat to all Member States. WHO’s efforts in developing joint strategic frameworks for the prevention and management o f communicable diseases had begun to pay off; the aggressive approach to combating diphtheria in endemic areas had saved thousands o f lives; and concerted efforts, including the building o f effective alliances, had resulted in the world now being on the threshold o f eradicating poliom yelitis. There was a need to roll back malaria, and that could be done if everyone joined forces and worked towards better interventions and new preventive measures and treatments, as well as more sharply focused health services. The battle against AIDS was formidable, but it had W HO’s total commitment. The need to assure blood safety was perceived as the key to success and would be the theme o f World Health Day in 2000. Tuberculosis was also a major global threat to health, particularly in eastern Europe and central Asia, and WHO would redouble its efforts to bring together new partners in the WHO Stop TB coalition. The Organization needed the total commitment o f its Member States to achieve 100% coverage with the “directly observed treatment, short-course" (DOTS) approach by the year 2005. On a broader front, agreement had been reached on establishing a Global Alliance for Vaccines and Immunizations, which would be led by WHO for the following two years. The second strategic direction was to counter potential threats to health that resulted from economic crises, unhealthy environments and risky behaviour. There was a need for political will to position public health centre stage and to strengthen public health infrastructures, but it was also important to realize more clearly that areas outside the health sector had a major impact on health. The Third Ministerial Conference on Environment and Health, held in London in June, had been a classic example o f effective intersectoral working and demonstrated that nations could reach legally binding agreements that straddled both health and other sectors. Similarly, an intersectoral approach was needed to tackle unhealthy behaviour such as smoking and to protect young people from the violation o f their rights by the aggressive and intrusive marketing o f the tobacco industry. The third strategic direction concerned health systems. Countries were looking to WHO to help them redesign their health care systems so that they could better respond to present and future needs. There was a need to develop a process o f priority-setting which was evidenced-based, ethically grounded and socially acceptable. Health care systems should make improvement o f health status and reduction o f health inequalities their defining goals, and they must protect people from financial loss due to health care costs. A growing body o f evidence suggested that a pre­ payment mechanism was an efficient as well as equitable way o f doing that. Such was the importance o f that issue that the whole o f the W orld health rep o rt in 2000 would be devoted to it. The fourth direction concerned the development agenda. Health was the key to human development and progress, and there was evidence that improved health conditions could break the vicious circle o f poverty. WHO had recently convened a meeting o f leading donors to engage in a dialogue about how health could be a more powerful tool for poverty reduction and growth acceleration. To further explore that crucial area, the Director-General had decided to establish a commission on macro­ economics and health. 11. In conclusion, the Director-General emphasized the need for WHO to redefine its role as the lead technical agency on health, as well as to identify where its comparative advantage lay and to agree which functions it was best equipped to perform. WHO needed to position itself strategically and map out where it could have the greatest impact. To that end. she had already taken steps to secure the cost-efficiencies mandated by the World Health Assembly, and she asked for Member States’ cooperation as she sought to free up funding for priority areas. 12. All speakers congratulated the Director General on the results she had achieved in such a short space o f time: she had created a more transparent, accountable and efficient organization. Representatives expressed their ongoing commitment to WHO and its ideals, and to the four strategic directions as set out by the Director-General. 13. One representative raised the issue o f the conflict in East Timor and the need for WHO to offer humanitarian assistance as a matter o f urgency. Another expressed the thanks o f his people and government for the assistance provided by WHO, the Member States in the European Region and the international community during the recent earthquake in Turkey and appealed for continued support as the country embarked on a reconstruction programme. Other speakers raised concerns related to past disasters in their countries and called for sustained support from WHO. 14. Several speakers made reference to the need for global and inter-regional approaches in all WHO activities and congratulated the Director-General on the efforts she had made in that regard, while one representative asked for mechanisms to be developed within WHO to draw on the expertise o f countries o f central and eastern Europe (CCEE) and newly independent states (N1S) to assist other countries at earlier stages o f their development, in particular with regard to reforming their health care systems. 15. In reply, the Director-General said WHO was ready to offer humanitarian assistance and to use the experience gained elsewhere to help East Timor. It was also important to work with nongovernmental organizations (NGOs) to ensure a coordinated effort. Lastly, she confirmed that subjects such as the elderly and the mentally ill, while they had not been covered in her address, were indeed important issues for WHO and had been implicit in her references to equity and to appropriate and accessible health care services which met peoples' needs. Two major WHO meetings on mental health would take place later in the year. The area o f food safety, too, was one where WHO had an important role to play in ensuring that standards were set and adhered to. 2. Statem ent by the Regional D irector (E U R /R C 49/Inf.D oc./l) 16. The Regional Director began by drawing attention to the very serious crises which had occurred in the Region in the previous 12 months, including armed conflicts such as the war in Kosovo, guerrilla fighting in Kyrgyzstan and Dagestan (Russian Federation), and the earthquake in Turkey. WHO had sought to meet all those challenges in the best possible way, such as mounting a major humanitarian assistance programme with some 60 staff and seconding a staff member to be the Health Commissioner attached to the United Nations Mission in Kosovo (UNM IK), participating in United Nations assessment missions, giving advice on resource mobilization, providing supplies and opening a WHO office. 17. On a more positive note, the endorsement o f the updated health policy framework for Europe - HEALTH21 - had given a boost to health policy development in Europe. HEALTH21 had been translated into 12 European languages, in addition to the four official working languages o f the Region, and many countries either had updated or were in the process o f updating their national policies. The new European Centre for Health Policy had been established in Brussels and aimed to give strong support with health impact assessment. 18. In the area o f disease control, Europe was on the verge o f eradicating poliom yelitis, since the last reported case in the Region had been eight months previously. The DOTS strategy to control tuberculosis was being taken up by western and eastern European countries, and the diphtheria epidemic could be regarded as conquered. Unfortunately, malaria had returned to Europe and greater efforts needed to be made, especially in the southern and eastern parts o f the Region. 19. While the number o f AIDS cases now seemed to be declining in the Region as a whole, there was an epidemic o f HIV infection in the NIS; a lot o f work therefore remained to be done, and WHO had set up a new task force to help coordinate activities on sexually transmitted diseases. Infectious disease surveillance had been improved with the introduction o f a new computerized information system; there was good collaboration with the European Commission. 20. With regard to noncommunicable diseases, the Regional Office continued to promote the St Vincent movement on diabetes, while the mental health programme had been re-established, currently focusing on depression and suicides and on assistance to war-torn countries. The health promotion programme continued its “Verona initiative’' and was in the process o f opening a new European centre in Venice. The new Committee for a Tobacco-free Europe had held its first meeting in Copenhagen in June, and the Regional Office was planning to lead the preparation o f two protocols for the Global Framework Convention, on the marketing o f tobacco products and on treatment for tobacco dependence. A new regional food and nutrition action plan was being prepared for adoption at the fiftieth session o f the Regional Committee for Europe; this would also be an input to a major conference on nutrition and health organized by France in Paris in December 2000, within its remit o f presidency o f the European Union. Preparations were also under way for a European conference on young people and alcohol, to be hosted by the Swedish Government and held in December 2000. The Regional Director drew attention to the important work done in the field o f environment and health: the London Conference had given a strong impetus and it had decided that a fourth ministerial conference would be held in Hungary in 2004. The environment and health programme had also shown itself capable o f major resource mobilization as, in addition to the department in Copenhagen, there were divisions in Bilthoven and Rome, with a further one agreed in Bonn, as well as seven project centres. In November 1998 WHO had celebrated the 20th anniversary o f the Alma-Ata Declaration, endorsing the continued importance o f primary health care to overall health development. Inspired by the HEALTH21 policy framework, activities on the concepts o f the family health nurse and family health physician were ongoing and pilot sites were being sought. Intensive preparations were also being made for the Second European Conference on Nursing (Munich, June 2000). The European Observatory on Health Care Systems, a joint venture between the Regional Office for Europe, the World Bank, the European Investment Bank, the governments o f Norway and Spain and some distinguished academic centres, had been official inaugurated in February 1999. The Observatory would provide important evidence-based knowledge about health care systems and contribute to WHO’s global efforts on systemic evidence for policy. The four WHO health care reform networks in Europe had continued their successful work, while important country projects in Kyrgyzstan, Tajikistan and Turkmenistan had provided intensified support to those countries’ health care systems and to health reforms in general. A new European centre for integrated health care services and human resources had recently been opened in Barcelona. The Regional O ffice’s partnerships for health, in the form o f collaboration with the European Commission, the Council o f Europe and NGOs, had developed strongly during the previous 12 months. Its collaborative networks (such as Healthy Cities, Health Promoting Schools and Health in Prisons) had also broadened their scope. The newest network (the European Health Communication Network) aimed to promote awareness o f the importance o f communication as a determinant o f health. Considerable emphasis had been placed on organizational development o f the Regional O ffice in the first part o f the year, when the Director-General had urged all regional offices to undertake an internal review to ascertain whether their structure, management and administration needed revision. A EURO Reform Task Force had been established and submitted its report in June. Evaluation o f its proposals and review o f staff comments were ongoing. Finally, the Regional Director presented statistical information on how the regional organization had changed in the ten years from 1989 to 1999. The number o f Member States had increased from 32 to 51, office locations from 3 to 43, voluntary donations from US $5.3 million to US 540.8 million, and regional staff from 300 to 573 people, while posts funded from the regular budget had fallen from 245 to 177. 27. Many delegations expressed their satisfaction with the work o f WHO and with the excellent leadership o f the Regional Director. His work would have a permanent positive impact on the health o f European people. He had always believed in the future o f the European office, even at times when many forces had been against it; he had led the Office into a well balanced decentralization process and set up networks in an innovative and progressive way; and he had led the fight against new emerging communicable diseases such as diphtheria, HIV/AIDS and poliomyelitis in a very effective way. A number o f representatives proposed that Dr Asvall should be given the title o f Regional Director emeritus, while one university had decided to award him a gold medal. 28. Several speakers emphasized the importance o f WHO’s country work and welcomed the gradual increase in country funds, as well as the better reporting o f W HO’s country work through the new activity management system. It was also emphasized that closer collaboration between other regional offices such as that for Africa could be one way to make the work more efficient. The opening o f new WHO centres was greeted with satisfaction as an innovative way o f improving the Organization’s country presence and making better use o f scarce resources. One representative proposed that meetings involving other ministries could be organized by WHO. 29. Delegations emphasized many areas o f WHO’s work which deserved more attention: health should be given a more prominent place in the new peace movement in the Balkans; the Chernobyl catastrophe should not be forgotten; the health o f women and children would need continued emphasis; environmental health in central Asia deserved more attention; and alcohol policies needed strengthening. Several delegations reported on positive developments in their countries, such as intensified action on immunization, strengthened training in public health, better coordination between donors, and health-for-all policy developments. 30. In reply, the Regional Director thanked all the speakers for their kind words and said that he was very grateful for the years he had worked for WHO and for the satisfaction and joy they had brought him. W HO’s decentralized centres were o f paramount importance for its work: the Health Policy Centre in Brussels, the new Barcelona centre and the forthcoming centres in Venice and Bonn would be very important additions to the O ffice’s capacity. The European Observatory on Health Care Systems had a vital role to play in studying evidence-based health care reforms, disseminating that information to Member States and acting as a pilot project for other regions and WHO headquarters. 31. He welcomed the delegates' interest in the new country cooperation strategy', and the idea o f organizing a “summit” involving other ministries, not only ministries o f health. The impact o f health on overall economic development was a new concept that needed more elaboration and would provide a strong argument for investment in health; the new Venice centre would be an asset in that regard. Several speakers had mentioned the importance o f work against infectious diseases as a core function o f WHO, and he confirmed that the strengthening o f public health management in general would indeed need stronger WHO involvement. The imbalance between eastern and western Europe, as well as inequities within countries, would continue to be one o f the major challenges facing WHO. 3. R eport o f the Standing C om m ittee o f the R egional C om m ittee (E U R /R C 49/2, /2 A d d .l, /2 Add.2, /C onf.D oc72, /C onf.D oc./3 and /Inf.D oc./3) 32. The Chairperson o f the Standing Committee o f the Regional Committee (SCRC) briefly outlined the work o f the Standing Committee over the previous year. A total o f six meetings had been held. In the light o f comments made at the forty-eighth session o f the Regional Committee, her introduction addressed only those aspects o f the SCRC’s work that would not be covered under other items on the agenda. They included the Director-General's “cabinet projects", proposals for taking forward a programme on aging and the programme on nutrition, external evaluation o f the programme on communicable diseases, and the expected outcome o f evaluation o f the EUROHEALTH programme. The SCRC was congratulated from the floor on its work over the previous year and on the quality and conciseness o f its report. 33. The Committee adopted resolution EUR/RC49/R11. 3.1 Sem i-perm anent m em bership o f the E xecutive B oard 34. The previous year the Regional Committee had requested the SCRC to continue work on the question o f semi-permanent membership o f the Executive Board, and the Standing Committee had therefore decided to hold an ad hoc meeting on 15 and 16 July 1999, to which all Member States had been invited to send representatives. Although consensus had not been reached, a compromise had been recommended that provided a reasonable balance between the need to see some meaningful change immediately, while allowing sufficient time to work out a better arrangement for the future. 35. The Regional Committee endorsed the SCRC’s recommendation, as set out in document EUR/RC49/2 A dd.l, namely: - to retain the present practice o f agreeing each year in a private meeting o f the Regional Committee which countries will submit their candidatures for the Executive Board to the subsequent World Health Assembly; — to introduce a new system in 2003 whereby agreement on candidates will be guided by objective criteria relative to geographical distribution and other elements, in line with the principles o f solidarity and transparency adopted in HEALTH21; to this end the SCRC will present proposals for consideration by the Regional Committee at its fifty-first session in 2001; - to adopt as an interim arrangement for the current three semi-permanent members o f the Executive Board a proposal whereby the Regional Committee at its fiftieth session agrees to the United Kingdom for membership o f the Board (from May 2001); at its fifty-first session agrees to the Russian Federation (from May 2002); and at its fifty-second session agrees to France (from May 2003). 3.2 A m endm ents to the R ules o f P rocedu re 36. The Vice-Chairman o f the SCRC presented to the Regional Committee a review o f the work done on proposed revisions to the Rules o f Procedure o f the Regional Committee and the SCRC. Those revisions were set out in Annex 2 to document EUR/RC49/2. He described the background, procedures and timetable for the SCRC’s work and the main areas where changes to the Rules were proposed. The latter comprised: election to and membership o f the SCRC; the work programme o f the SCRC; identification and election o f members o f the Regional Search Group; election o f representatives to other bodies; election o f the Deputy Executive President o f the Regional Committee; and consistency in the use o f terms and descriptions. 37. One representative, speaking on behalf o f a group o f countries, commended the SCRC on its work and considered that the proposals went some way to towards meeting the concerns expressed by the Regional Committee at its previous session. However, the SCRC could have attempted to bring the rules more into line with the principles governing the Rules o f Procedure o f the Health Assembly and the Executive Board, particularly concerning the election o f the officers o f the SCRC and the Regional Committee. While it was felt that the rules would need to be further refined in the future, the group o f countries concerned nevertheless supported the proposed amendments and the draft resolution. In response, the Executive President suggested that the SCRC might subsequently wish to look again at the points raised. 38. The Committee adopted resolution EUR/RC49/RI. 4. Collaboration with other agencies within the United Nations system and with integrational, intergovernm ental and nongovernm ental organizations in E urope (EU R /R C 49/6 and /Inf.D oc./2) 39. The Regional Adviser, Partnerships in Health and Emergency Assistance said that the Regional Office, through the HEALTH21 policy framework, was striving to establish a sense o f shared vision with its major partners. The Director-General had held discussions with the European Commission (EC) concerning strategic collaboration, and the Regional Office had been involved in issues such as the future o f public health policy within the European Union (EU), health information systems, health promoting schools, the Commission's membership o f the European Environment and Health Committee, and humanitarian assistance work. The European Health Committee o f the Council o f Europe (CE) had recently placed emphasis on intensified collaboration between CE, EC and WHO. 40. In the context o f United Nations reform, the Regional Office had supported the role o f United Nations resident coordinators, had endorsed the concept o f an integrated United Nations presence, and had participated in the United Nations Development Assistance Framework (UN DAF) exercises. The O ffice’s programmes on sexually transmitted diseases and HIV/AIDS cooperated closely with UNAIDS and its other co-sponsors, and a publication on preventing HIV infection among drug users was being sponsored and distributed by CE. The United Nations Economic Commission for Europe (ECE) and the Regional Office would share the secretariat functions for implementing the Protocol on Water and Health signed by 35 Member States at the Third Ministerial Conference on Environment and Health. The Office continued to collaborate with the United Nations Environment Programme (UNEP) Global Resources Information Database office in Norway, and considerable efforts continued to be made in strengthening collaboration with the World Bank. 41. WHO’s function as the overall health coordinator in disaster and emergency situations continued to benefit enormously from the existence o f field offices in Albania, Bosnia and Herzegovina and the Federal Republic o f Yugoslavia. Common systems o f epidemiological surveillance had been introduced in Albania and the former Yugoslav Republic o f Macedonia, and the Regional Office had coordinated mental health programmes, mainly in refugee camps, in those countries. W HO’s presence in Pristina (K osovo) had been re-established and considerably strengthened. In Tajikistan, an operational contract had been signed with the European Community Humanitarian Office (ECHO) on health care reform, managing supplies o f essential drugs and coordination o f humanitarian medical assistance. 42. The annual meeting o f the European Forum o f Medical Associations and WHO, held in Israel in March had addressed a number o f important issues, while membership o f the European Forum o f Nursing and Midwifery Associations and WHO had grown considerably, and the Forum had held its third meeting in March. The theme o f the seventh annual meeting o f the EuroPharm Forum in November 1998 had been pharmaceutical services. In addition, there had been active collaboration between the Regional Office and foundations, NGOs and the private sector. 43. Speakers expressed their general approval o f the Regional O ffice’s policy on collaboration with other partners: it was certainly one o f the most important aspects o f W HO’s European programme. Nevertheless, there was still room for considerable improvement, particularly in coordinating country work to avoid overlap and duplication o f effort and to make optimum use o f available resources. It was also very important for WHO to maintain and strengthen its role as the lead agency in health in Europe. 44. Replying to specific points, the Regional Adviser emphasized the extraordinary importance o f W HO’s relationship with the EU and trusted that the anticipated exchange o f letters would take place very soon. The Regional Office intended to raise the present project-based collaboration with the EU to one based on policy, and also to involve the CE in a tripartite relationship. He recognized that there remained problems in the area o f drug donations, and that greater efforts must be made to ensure the timely provision o f safe and effective drugs. Lastly, he confirmed that WHO was committed to playing a full part in the current process o f United Nations reform. 45. The representative o f the World Bank outlined its strategic priorities in health, nutrition and population, areas in which it enjoyed a close working relationship with the Regional Office. In particular, it was involved in the challenges that had arisen in the Region as a result o f economic and political transition, conflicts and natural disasters. The Bank was pleased to support WHO in its fight against tobacco, notably through the recent publication o f its report entitled C urbing the epidem ic, and also by assisting individual countries in the Region with econometric modelling to demonstrate the effects o f tobacco control policies. At the global level, the challenges for both WHO and the Bank were increasing: more attention needed to be paid to the structural and social aspects o f development, and to extending links with other sectors to focus efforts on health improvement. 46. The representative o f the European Commission said that 1999 had been a momentous year. Following the entry into force o f the Amsterdam Treaty in March, the entire college o f commissioners had resigned, bringing to a halt the development o f future health policy and collaboration with other organizations active in the health field, including WHO. Recent events involving contamination o f foodstufU had convinced the Commission o f the need to give priority to food safety, an area in which it looked forward to collaborating with WHO, the Codex Alimentarius Commission and the World Trade Organization. It would also concentrate efforts in the areas o f health information and increased capacity to respond to emergencies. The future enlargement o f the EU, and a restructured Commission that included a commissioner responsible for health, would hopefully provide the opportunity for greater progress in the health field. 47. I he representative o f the Council o f Furope said the Council recognized that social cohesion was one o f the priorities in a wider Furope. Since WHO stressed the link between health and social welfare, it was therefore clear that the Council had a role to play in the area o f health. The Council had taken a series o f measures to bring its work more into line with its specific vocation and to respond better to the needs o f its changing membership. The health department was orienting its activities towards promoting social cohesion from a health care perspective: equity in access, patient participation and empowerment, safe and good quality health care, and the combating o f all kinds o f discrimination. A cooperative programme with the countries o f south-eastern Europe was being built on those principles. Since the Council recognized WHO as the lead agency in health matters in Europe, it was planning that programme in close cooperation with WHO to ensure there was no duplication. 48. Statements were delivered by representatives o f the following NGOs: the European Society o f General Practice/Family Medicine, the International Confederation o f M idwives, the World Confederation for Physical Therapy, the World Federation o f Chiropractice, the World Federation o f Neurology and the World Federation o f Occupational Therapists; and by the representative o f the European Forum o f Medical Associations and WHO. In addition, written statements were submitted by the Liaison Office o f the United Nations Population Fund (UNFPA), the World Veterinary Association, the World Confederation for Physical Therapy, and the European Forum o f Nursing and Midwifery Associations and WHO. I I I . TH E FUTURE WORK OF W H O 1. M atters arising out o f decisions o f the W orld Health A ssem bly and the E xecutive Board (EUR /RC 49/4) 49. The Regional Director introduced document EUR/RC49/4, which was in two parts. Part I provided an overview o f the Health Assembly and Executive Board discussions o f interest to the Member States, while Part II contained comments by the Regional Director on the resolutions adopted at the Fifty-second World Health Assembly that were relevant to the regional programme. Referring to Part I, he noted that the Board had endorsed the Director-General’s “one WHO” concept; several steps had already been taken, and others were to follow. It had also decided that the entire WHO budget, including regional components, should in future be based on the new cluster structure. 50. The lack o f any compensation for cost increases in the global budget would be taken into account in the O ffice’s operational planning for 2000/2001, with the highest priority being given to the technical and country programmes. The Office would bid for a share o f the US $15 million that had been earmarked for high-priority programmes, but it was not guaranteed any o f those funds since they would be distributed according to need. 51. Moves towards a framework convention on tobacco control were especially welcome, and the Committee for a Tobacco-free Europe would support development work on the convention in the European Region. As to the eradication o f poliomyelitis, that should be achieved in the Region by 2003 if the current rate o f progress continued. 52. Noting that the Fifty-second World Health Assembly had decided that no amendments to the Constitution were necessary at the present time, the Regional Director referred to the adoption o f a resolution by the Fifty-first Health Assem bly raising the number o f seats on the Executive Board from 32 to 34, thus giving one more seat each to the European and South-East Asia Regions. He reminded the Committee that the amendment to the Constitution would not com e into force until a majority o f Member States (128) had ratified it. Thus far, only 55, including 13 from the European Region, had done so. He urged those countries that had not yet ratified the amendment to do so. 53. Finally, on the question o f the use o f languages in the Secretariat and for WHO publications, the situation regarding the needs o f NIS for documentation in Russian was a particularly important challenge for the European Region. 54. The Executive President, referring to the introduction o f round table discussions at the Health Assembly, invited Member States to submit suggestions for topics that might be taken up under similar arrangements at future sessions o f the Regional Committee. 55. One representative, noting that her country would host a WHO expert meeting in 2000 on the regulation o f tobacco products, called for global and regional work on the framework convention to be designed in a complementary way that would enhance national efforts. 2. HEALTH21: the health for all policy fram ew ork for the W H O European Region (EU R /R C 49/7, /7 A d d .l, / l l , /12 and /C onf.D oc./4) 2.1 E U R O s response to W HO reform a n d HEALTH21 56. The Director, Programme Management, introducing document EUR/RC49/12, reminded the Committee that both the reform process initiated by the Director-General and HEALTH21 conveyed the same message - that health lay at the heart o f human development. During the previous 7 -8 months, the Regional Office had responded to both developments, beginning with a series o f workshops and discussions to ensure that all staff understood HEALTH21 and to decide how the O ffice’s work should be planned in the medium term. A task force had also been set up to look at ways o f responding to the reforms at WHO headquarters. The challenge was to put into practice the policy directions thus established, by providing the necessary mechanisms, skills, knowledge and capacity in the Regional Office. 57. Professor Ay§e Akin expressed her appreciation, on behalf o f the SCRC, for the work currently being done to develop a strategic plan for the Office for the following five years. The SCRC welcomed the fact that the Regional Office was working to a common agenda with WHO headquarters. It would discuss the report o f the regional reform task force at its meeting in December 1999 and would report back to the Regional Committee at its fiftieth session. Several representatives welcomed the fact that the Regional Office was undertaking the necessary preparatory work for the inevitable changes that would arise out o f the Director-General s reform programme. Appreciation was also expressed for the efforts being made by the O ffice to position itself better to assist countries as they implemented the new policy framework. One delegation stated that the joint planning between WHO headquarters and the Regional Office created an ideal opportunity for clarifying their respective roles. That would be all the more necessary in order to make more effective use o f limited resources, as the Organization’s regular budget was unlikely to increase. 2.2 Prom otion o f HEALTH21 The Regional Adviser, Communication and Public Affairs pointed out that HEALTH21 was the common property o f all Member States, which could be used to compare performance, promote equity and, not least, improve and save lives. It was vital that the HEALTH21 “brand” should be instantly recognizable. The Office would be happy to support Member States in translating and disseminating the text o f HEALTH21 and in engaging all audiences and obtaining the necessary political commitment. WHO’s European Health Communication Network would be available to Member States for organizing training in mass media advocacy o f HEALTH21. Professor Ay§e Akin said the SCRC considered that the overall aim was to secure Member States’ acceptance o f HEALTH21. The selling points to be emphasized would depend on the chosen target audiences, the prime target being policy-makers at national level. Securing endorsement at the highest political level would make it easier for the health ministry to convince other ministries that healthy public policy was in their interests. Health professionals should feel a sense o f ownership o f the policy framework, which should become part o f the curricula o f medical schools, universities and schools o f public health. In reaching out to the general public, the SCRC had recognized the importance o f using a variety o f approaches. It had emphasized the crucial role o f the media and commended the Secretariat on the efforts made to set up a health communication network and organize advocacy training courses. Some members o f the SCRC had considered that the workshop-based approach used at the Regional Office might usefully be followed at country level. A “millennium event” to publicize the policy framework had been suggested. Finally, the SCRC thought it would be advisable to have a mechanism for monitoring and following up what was being done in countries. Several speakers gave examples o f how their countries were using HEALTM21 to develop their own country-specific policies and commended W H O on producing an excellent document. There was widespread acknowledgement o f the need for all European countries to work together, to promote solidarity and tackle the issue o f inequities. HEALTH21 was considered to be one o f the best examples o f visionary leadership in public health ever produced by the Office, although one speaker felt that some o f the concepts introduced in the document needed to be further developed so that they were more meaningful to Member States, especially at the operational level. 1 he policy framework provided Member States with a clear challenge, as well as with the opportunity to improve the health status o f their populations. 64. One speaker suggested that an event should be organized at the beginning o f the new millennium to ensure that the new policy received maximum publicity. There was also a need to ensure that all sectors, and not just the health sector, were aware o f its existence. 65. The representative o f the European Commission also welcomed the document and said that it would make a very valuable contribution to the Com m ission’s work. 2.3 In d ica tors f o r HEALTH21 a n d m onitoring o fp r o g r e s s to w a rd s health f o r a ll 66. The Regional Adviser, Epidemiology, Statistics and Health Information outlined the process and timetable for development o f the HEALTH21 indicators and the main issues on which comments had been sought from the Member States. To date, replies had been received from 25 countries, the vast majority o f which agreed that the proposed list o f indicators was sufficient and/or adequate. The number o f “generic” HFA indicators had been reduced from 112 in 1991 to 59, by dropping some and redefining or regrouping others. 67. One o f the main principles o f reporting to the Regional Office was that countries were only asked to provide data that were not already available from existing international sources. All data collected were fed back to Member States through the HFA database. Statistical highlights documents were now available for all EU member states and provided comparative trends, thus enabling countries to see where they stood in relation to others. 68. Professor Ay§e Akin reported that the SCRC favoured a three-yearly monitoring exercise. It was also broadly in favour o f the indicator set, although it believed there might be a need to further consider socioeconom ic and gender factors, for example. The SCRC also believed that it was important for WHO to coordinate its efforts with other United Nations agencies, as well as with the European Commission. 69. Several speakers thanked the Secretariat for its work in drawing up the set o f indicators, and in general felt that the indicators selected and their reduced number were an improvement. It was acknowledged that it was not easy to choose indicators that met the requirements o f both adequate coverage and manageability, and which reflected the ability o f Member States to provide the required data. One delegation felt that continuity between the previous set o f indicators and the new ones was not optimal. 70. There was strong support for coordinating the activities o f all the agencies involved in monitoring health, in order to avoid unnecessary duplication and ensure international comparability. One speaker identified a need to do further work on the current indicator set, in order to ensure the availability and comparability o f data. Such work would include the harmonization o f definitions, as well as basic aspects such as data collection and processing. His country offered to host a meeting o f a group o f experts to study the comments received by WHO, follow ing consultation on the current set o f indicators. The outcome o f that work could then be presented to the Regional Committee at its fiftieth session. That proposal was strongly supported by several other delegations. 71. The representative o f the European Commission agreed that progress had been made in selecting the new set o f indicators and drew attention to the cooperation in that field between the Commission, the Regional Office and OECD. 72. The Committee adopted resolution EUR/RC49/R10. 3. Public health structure and function in Europe (E U R /R C 49/10 and /C onf.D oc./6) 73. In his introduction, the Regional Adviser, Urban Health Policies said that the decision by the Regional Committee at its forty-eighth session to request the Secretariat to further develop the paper had been a good one. That development had coincided with an intensive analysis by the Regional Office o f the policy and strategic implications o f HEALTH21. The current document was therefore a radically revised one which covered not only the strategic aspects o f promoting public health in the European Region but also its research, education and training implications. 74. The recent developments and changes in the Region clearly called for increasing reliance on public health, while its organization and the position o f public health practitioners in many Member States remained weak. In many countries, the practice o f public health still reflected the era when its main contributions were to health protection and disease prevention only, rather than to also include health promotion and population-based public health programmes. 75. For public health to achieve its rightful position as a key instrument for implementing HEALTH21, its evidence base had to be strengthened. That called for increased emphasis on research and solid education and training programmes. Those programmes were needed not only for public health specialists but also for other actors, who included all health care providers and health service managers, many technical specialists (such as economists, engineers and epidem iologists) and a number other public health workers, stakeholders and representatives o f all sectors. They all needed evidence and decision-making and analytical tools on which to base their actions. It was also necessary to bridge the artificial divide between public health and clinical medicine. 76. In concluding, the Regional Adviser stressed that the main issues for public health practitioners were autonomy (not in the sense o f pursuing their own agenda but o f being able to inform decision­ makers and the public freely about the state o f public health), authority, accountability, resource base and professional standing. WHO could help them by advocating for and advising on public health and creating partnerships at all levels. 77. All speakers thanked the Secretariat for a greatly improved document. Different challenges - such as genetically manipulated food, the strength o f the tobacco industry and other interest groups that advocated unhealthy lifestyle choices, etc. - showed the importance o f having strong, evidence- based public health. The implementation o f HEALTH21 would depend on a strong and appropriate public health function in Member States. Given the importance o f the issue, it would need to be reviewed and monitored periodically. It would also merit a major meeting or conference to look at the roles o f the different public health actors. Greece kindly offered to host such a meeting. 78. Some speakers found the document still perhaps too ambitious in scope. One felt that it lacked a clear focus and that its title should be changed to better reflect the need to strengthen public health. Another speaker highlighted the importance o f rapid interventions and field epidem iology, two methods the document did not cover. A third felt that subnational entities needed a broader definition o f their potential actors, in order to avoid too much reliance on action at the central level. 79. While the work which WHO was undertaking and the directions proposed in the document were complementary to the public health framework o f the European Union’s Amsterdam Treaty, care should be taken to coordinate the efforts o f the two bodies. A common understanding and framework would be particularly important for countries currently undergoing rapid political, social and economic changes. While public health would enable them to counteract the negative aspects o f such changes (such as an increase in mortality), there was a tendency to look at short­ term solutions. If the general public were informed about the principles o f public health, there would be increasing pressure also on politicians to heed those principles and to look for sustainable, long-term solutions. That would also strengthen the intersectoral approach to public health. 80. Many speakers stressed the need to strengthen the research base in public health. One way o f reaching that goal would be for WHO to encourage the establishment o f schools o f public health. WHO should also work on developing a European core curriculum for training in public health, where a balance would have to be struck between the need to train public health field workers and researchers based in academia. Although many determinants o f health were outside the scope o f health care, a common curriculum, strong schools o f public health and a solid research base would ensure that the health sector would keep its rightful role as the leader and coordinator in public health. 81. The C om m ittee adopted reso lu tion EU R /R C 49/R 9. 4. European Alcohol Action Plan - assessm ent o f Phases I and II (1992—1999) and adoption o f Phase III (2000-2005) (EU R /R C 49/9 and /C onf.D oc./5) 82. The Regional Adviser, Psychoactive Drugs informed the Committee o f the positive developments following the adoption o f the European Alcohol Action Plan in 1992. One notable achievement was the first European Ministerial Conference on Alcohol (Paris, December 1995), at which the European Charter on Alcohol had been endorsed. 83. The recent exercise undertaken by the Regional O ffice to evaluate the Action Plan suggested that alcohol was currently a prominent issue in many countries. Nonetheless, it was difficult to make an accurate assessment o f the impact o f the Plan, given the complexity o f the issue and the many variables that needed to be taken into account. The short time scale further compounded the difficulty. It was clear, however, that the increasing trend towards free market econom ies ran counter to a number o f the proposals in the current Action Plan, so it was important that WHO together with its Member States continued their efforts to combat the problem. 84. To that end, the Regional Office had prepared a proposal for extending the Action Plan to cover the period from 2000 to 2005. The third phase o f the Plan took account o f the wide diversity o f circumstances across the Region and offered a range o f programmes which Member States could tailor to meet their own needs. One item within the Plan which appeared to cause concern related to the role o f the industiy in the promotion o f alcohol beverages. Given the highly competitive environment within which it operated, the industry would find it difficult to achieve self-regulation. The growing internationalization o f trade made it necessary for Member States to consider reaching an international consensus on the control measures to be taken in that regard. 85. As recommended by the SCRC, a meeting had been organized between WHO and representatives o f the Amsterdam Group o f companies in the alcohol industry, to explore mutual concerns. The Group had made a number o f suggestions, including the need for WHO to place more emphasis on the benefits o f alcohol; to raise awareness o f drink-driving legislation, rather than to advocate a high level o f legislative enforcement: and to promote responsibility among consumers. It was felt that some o f those suggestions could be taken up, but caution needed to be exercised in respect o f the benefits o f alcohol, as the evidence was not conclusive. 86. As a final point, the issue o f the reported increase in the use o f alcohol by young people was brought to the attention o f the Committee. Such was the importance o f that growing problem that it would be the theme for the next ministerial conference on alcohol, which Sweden had generously offered to host in December 2000. 87. A number o f representatives reported that their countries had followed the guidance given by the Regional Office and developed national policies and action plans. Some had also established high- level committees or steering groups. There was strong agreement that the misuse o f alcohol caused a huge burden o f disease in many countries and needed to be tackled in a systematic way. One speaker, however, expressed concern that alcohol was being dealt with in isolation from other issues o f substance abuse, and also suggested that prevention was only one component: the treatment o f those suffering the effects o f alcohol misuse was also a key task in all Member States. 88. The proposal to extend the Action Plan for a further five years was welcomed, as was the fact that it took account o f the diversity o f the European Region. There was agreement that such an approach allowed country-specific action plans to be developed which took account o f different cultural, social, econom ic and legal contexts. 89. Involving local communities in the development o f policy was also considered important, to foster a sense o f ownership. In implementing the Action Plan, WHO was encouraged to work at subregional level, as well as with other interested organizations such as the International Labour Organization (1LO). That approach would ensure that efforts were maximized and duplication minimized. 90. Several speakers suggested that there was a need to develop indicators and measuring tools to ensure that the best possible information was available throughout the Region. It was further suggested that the expert group proposed by one Member State to explore the wider issue o f the HFA indicators should also include alcohol as an important area for further work. 91. One speaker strongly endorsed the SCRC’s proposal that the Action Plan should include the objective o f achieving a Europe-wide ban on alcohol advertising at sporting events and on advertisements aimed especially at young people. 92. Several speakers expressed particular concern about the increasing problem o f young people’s drinking, and there was widespread support for the conference being organized on that question. 93. In reply, the Regional Adviser said he was extremely pleased with the support expressed for the Action Plan and grateful for a substantial financial contribution from one Member State. It was clear that countries had great expectations o f the Plan, which in many cases was already reflected in national alcohol policies. The need to monitor progress had been noted, and the Regional Office was in the process o f creating a stronger database with more refined indicators. He supported the suggestion that an expert group should be formed to identify appropriate indicators. It was clear that alcohol policies needed popular support if they were to succeed, and the second European conference on alcohol planned for December 2000 would provide a forum for building that support. It was intended that the conference would involve significant partners, such as the World Bank, the European Commission, the Council o f Europe, United Nations Children s Fund (UNICEF) and ILO. 94. The Committee adopted resolution EUR/RC49/R8. 5. Country strategy (EU R/R C 49/8 and /C onf.D oc78) 5.1 Description o f country work in the programme budget 95. The Director, Country Health Development outlined the work done as a follow-up to the discussions at the forty-eighth session. In view o f the forthcoming evaluation o f the country health programme, the SCRC had advised that a full discussion o f EURO’s country strategy should be deferred to the fiftieth session o f the Regional Committee. The Regional Committee was therefore asked to review only some strategic issues for the country' programme, including the proposed formula for allocation o f the country budget and the current level o f support being provided to countries by WHO. 96. The Regional Office had had a strong commitment to country work over many years. There was, however, a need to develop more strategic and country-sensitive approaches, as well as to strengthen WHO’s presence in countries. While the strategy should embrace all 51 Member States in the European Region, the ideal o f providing intensified support to countries most in need remained valid. Partnerships and integrated approaches would be the guiding principles, with multi-agency and multisectoral working given greater prominence. N ew emphasis would be placed on helping countries develop health policies and action plans. A subregional office structure would be explored with a view to maximizing available resources. The current liaison office function would be strengthened, and full benefit would be derived from W HO’s technical programmes, collaborating centres and networks. A team approach calling on a range o f WHO staff and national counterparts would be used to support the planning process. 97. From the considerable amount o f analysis done during the previous year, it was estimated that some 50% o f all WHO’s activities in the European Region were in fact country work. 5.2 Principles and criteria for determining country allocations 98. In the allocation for 2000-2001 endorsed by the Regional Committee in September 1998, the first increase o f EURO’s funding resulting from the new WHA policy o f interregional transfers (i.e. US $2 million out o f US $2.2 million) had been divided equally among the six “low-incom e” countries. The Vice-Chairperson o f the SCRC presented the model which the Standing Committee advocated for allocating future country programme budgets. Applying the principles underlying that model would have the following results: — the six countries with an increased allocation in 2000—2001 would keep their allocation during the subsequent biennia, until the final stage was reached (i.e. 2010); the additional US $2 million expected to be received in 2002-2003 would be distributed to the 22 other countries that were eligible to receive a country allocation, by applying a factor derived from the United Nations Development Programme’s Human Developm ent Index (HDI) and adding the resulting sum to their allocation in the previous biennium; - that process would then be repeated in each biennium up to 2008-2009; as o f 2010-2011 the HDI formula only would be the basis for allocating country funds. 99. Delegates appreciated the explanations given and commended the Director, Country Health Development and the EUROHEALTH team, including the liaison officers, on the huge contribution they had made to assisting countries in transition. There was agreement in principle with the new thrust being proposed for WHO’s future work with countries. Two speakers raised the issue o f the timing o f presentation o f the strategy, in view o f the forthcoming evaluation o f the EUROHEALTH programme. One representative expressed dissatisfaction with the way in which the Regional O ffice’s overall presence in countries was classified. Some concern was also expressed about the proposed subregional approach: it was felt that it might be overly bureaucratic and wasteful o f resources. 100. There was broad endorsement o f the new allocation formula. However, in view o f the formula’s dependence on accurate data, some countries were fearful that they might be adversely affected if their data were deficient. Several representatives suggested that the funds available, however they were allocated, were insufficient given the state o f transition o f many NIS and CCEE. 101. There was general support for bringing the status o f WHO liaison officers into line with that o f United Nations Representatives in countries, for making more use o f national staff in preference to international consultants, and for strengthening partnerships between other United Nations agencies and WHO. One speaker suggested that the sharing o f resources should also be considered. 102. In reply, the Director, Country Health Development thanked representatives for their support and encouragement for the work o f the Department. She was very pleased that countries were in favour o f the approach being proposed towards a new country strategy, and with the strong endorsement o f the new budget allocation model. 103. The Regional Office was introducing a new and improved planning and evaluation system and ensuring closer integration o f all WHO activities in countries. The subregional approach would be used where it added value and would not detract from the work with individual countries. She supported the views expressed about developing the capacity o f national staff, with international staff being used only when the expertise required was not available locally. She endorsed the importance o f liaison officers for the work in countries and agreed that their position should be enhanced. 104. She accepted the inadequacy o f the classification system used to portray W HO's total country involvement but advised that this was a matter for headquarters to rectify, and the Executive President proposed that the latter should be asked to review that question. 105. The Committee adopted resolution EUR/RC49/R5. 6. E nvironm ent and health (EU R/RC 49/3 and /C onf.D oc./10) 106. The Director, Environment and Health was pleased to inform the Regional Committee that the Third European Ministerial Conference on Environment and Health, held in London in June, had attracted 1146 participants from 54 countries, including 73 ministers. Two previous conferences, in Frankfurt in 1989 and Helsinki in 1994, had concentrated on policy formulation and planning, respectively, while the theme o f the London Conference had been “Action in partnership”. In application o f that theme, a large number o f countries and NGOs had participated in a very constructive way in preparation o f the Conference and development o f conference documents. 7 he Director saw a clear need for the process to continue and expressed gratitude to the Government o f Hungary for offering to host the next ministerial conference in Budapest in 2004. 107. The Water Protocol that had been adopted in London and signed by 35 countries was a milestone in the work o f WHO, since it was the Organization's first legally binding document. It was open for signature at the United Nations Secretariat in New York until June 2000. Another major outcome o f the Conference, the Charter on Transport, Environment and Health, challenged ministers o f health to focus on prevention. The Director was happy to note that many countries were keen to implement the actions set out in the Charter, and the first meeting o f the steering group would take place in Rome in October. 108. The strategy o f the Environment and Health Department covered all the items on the agenda o f the London Conference, together with a number o f topics that had not been specifically discussed there. Some o f the programmes in that strategy were ready for implementation, even on a global scale, while others were initiatives in new areas. 109. The new European Environment and Health Committee (EEHC), with its broadened mandate and membership, was an extremely important forum for promoting the implementation o f decisions taken by ministers in London and for coordinating the necessary actions. The Director also acknowledged with appreciation the work performed by the “old” EEHC, and in particular its role as the steering committee for the London Conference. I 10. With regard to organization o f the future work o f the Department, the Director noted that its staff were dispersed over most o f Europe, although the majority were located in Copenhagen and in the Rome and Bilthoven divisions o f the European Centre for Environment and Health (ECEH). The Centre would be further expanded through the establishment o f a new division in Bonn, funded by the Government o f Germany, with effect from 2001. Finally, the Director mentioned with appreciation the work done in subregional groups o f countries and the interest expressed by many countries in hosting centres that would support the Department. 111. The Deputy Executive President recalled that, at its most recent meeting, the SCRC had emphasized the need for the initiatives already taken to be pursued and for sufficient funds to be raised to enable the new EEHC to carry out its important activities. The SCRC had also welcomed NGO participation in the work o f the EEHC. 1 12. In the ensuing discussion, a number o f speakers noted that their countries had already offered to pilot implementation o f the Water Protocol. It was emphasized, however, that the Water Protocol would not enter into force until a minimum o f 16 countries had ratified it. The process o f ratification should therefore be started immediately in all countries, so that it could enter into force as soon as possible. It was also underlined that adoption o f the Transport Charter was the start o f a process o f carrying forward the actions decided on and investigating the need to develop the Charter into a legally binding instrument, i.e. a convention on transport, environment and health. The decision to hold the first meeting o f the steering group in the near future was accordingly welcomed. 113. Many countries appreciated the fact that the development o f national environment and health action plans (NEHAPs) had facilitated cooperation between sectors that had not previously worked together. In addition, many o f the candidate countries for membership o f the EU saw the development and implementation o f NEHAPs as a useful tool in the accession process. The work in subregional groups was commended, and offers were made to establish centres for supporting NEHAP implementation. 1 14. The new initiatives taken up on the London Conference agenda and in the strategy document were welcomed. In particular, some countries saw the question o f children, the environment and health as a decisive issue for the health o f future generations, and it was therefore proposed to convene a meeting in 2002 to discuss that important matter in greater detail. 115. Many countries commended the EEHC on its role as steering committee o f the London Conference and for having established a forum for partnerships between sectors that had so far not cooperated sufficiently closely. The new membership, which would also include representatives o f NGOs and the private sector, and the broadened mandate o f the EEHC were welcomed. 116. The important role o f the ECEH and the generous offer made by the German Government were appreciated by many representatives. However, the dispersed location o f the Environment and Health Department and the numerous programmes to be implemented called for careful coordination and priority-setting, as well as for a sound funding basis. 117. The Legal Counsel informed the Regional Committee that the work on the Water Protocol had emphasized a need for the World Health Assem bly to discuss whether authority to adopt conventions on regional issues should be delegated to regional committees. That issue would be put on the agenda o f the next Health Assembly. 118. The Committee adopted resolution EUR/RC49/R4. 7. Strengthening public health action in natural disasters and international cooperation on em ergency preparedness (EU R /R C 49/C onf.D oc./6) and briefing on W H O ’s w ork in K osovo and Turkey (EU R /R C 49/Inf.D oc./5 and /Inf.Doc./6) 1 19. The Committee was briefed on W HO’s work in Kosovo after the United Nations had assumed responsibility for the government o f that area, whose population was currently estimated to be 1.6 to 1.8 million people. Under the terms o f United Nations Resolution 1244, the United Nations Mission in Kosovo (UNM IK) has been established to provide an interim government. A WHO staff member had been appointed to the post o f Health Commissioner in charge o f the health component o f UNM IK’s civil administration. WHO was currently deploying 25 international and 38 national staff in both the humanitarian and UNMIK dimensions o f its work. To support that work, funds o f around US $10.8 million had been raised. 120. The main problems in Kosovo included an underdeveloped primary health care system, a top-heavy hospital system, and the need to upgrade the training o f health personnel (including physicians and nurses) to overcome the gaps in their knowledge that had arisen during the eight years o f unrest and hostilities. The first tasks o f the Health Commissioner had been to pay the salaries o f about 11 000 health workers, to establish policy guidelines for the health sector, to draft a health care budget for Kosovo, to put the public health service on its feet again, to set up international hospital management teams in secondary-level health care establishments, to confiscate unsafe drugs and to re-establish immunization. 121. Briefing on WHO’s work in the earthquake catastrophe in Turkey in August 1999 was also provided to the Committee. Quite a large area in the north-west o f the country, inhabited by approximately 20 million people, had been affected. More than 15 000 people had been killed, 24 000 injuries had been reported and more than 300 000 people had been left homeless. W HO’s reaction had been immediate. Surgical and orthopaedic kits had been sent to the earthquake area, WHO had participated in a United Nations assessment mission and the Director, Programme Management had gone to Turkey to assist the Ministry o f Health. A dozen European countries had sent rescue teams and emergency assistance to Turkey, all o f which had been gratefully received. 122. Several delegations expressed their solidarity and deepest sympathy with Turkey, in view o f the fact that the natural disaster had affected so many people. Sending emergency support to Turkey was the least that they could have done. Neighbouring countries underlined the importance o f better emergency preparedness. There was a need for more concerted action to address not only immediate requirements (in the form o f rescue operations and treatment o f the injured) but also the longer-term psychological consequences for victims. An early warning system was essential, as were an international roster o f experts and guidelines on how to address emergencies more efficiently. One speaker referred to the recent update o f guidelines issued by WHO headquarters, but it was acknowledged that guidelines alone would not be sufficient, as there was no standard pattern in a catastrophe. A plea was made that the Regional Director should raise the issue o f emergency preparedness at the global level in the next World Health Assembly. 123. One representative expressed deep concern at the effects o f the current conflict on the people o f East Timor, proposed that urgent humanitarian assistance should be provided by European Member States o f WHO and tabled a draft resolution to that effect for consideration and adoption. 124. Another representative, speaking on behalf o f the 15 Member States o f the European Union, expressed the deep sympathy and concern o f the European Union for the refugees and internally displaced people o f East Timor who were being denied access to food, water and basic health care. The European Union was fully committed to providing humanitarian assistance to the population o f East Timor as soon as possible, a response that was echoed by another speaker. 125. In view o f the support offered by the European Union, the draft resolution on East Timor was withdrawn. 126. The Committee adopted resolution EUR/RC49/R6, on necessary public health action on natural disasters and emergency and international cooperation for emergency preparedness. IV . E l e c t i o n s a n d n o m i n a t i o n s 127. The Committee met in private to nominate a candidate for the post o f WHO Regional Director for Europe, to consider the nomination o f members o f the Executive Board and to elect members o f the SCRC, the European Environment and Health Committee, the Policy and Coordination Committee o f the Special Programme o f Research, Development and Research Training in Human Reproduction, and the Management Advisory Committee o f the Action Programme on Essential Drugs. 1. Nom ination o f a candidate for the post o f R egional D irector (E U R /R C 49/C onf.D oc79) 128. The Committee considered the item in a private meeting and, by resolution EUR/RC49/R2, requested the Director-General to propose to the Executive Board the appointment o f Dr Marc Danzon from 1 February 2000. 129. In acknowledgement o f Dr Jo A svall's many years o f service with the World Health Organization, and in particular his 15 years as Regional Director for Europe, the Committee adopted resolution EUR/RC49/R3, declaring Dr Asvall Regional Director emeritus. 2. N om ination o f m em bers o f the Executive Board (EU R /R C 49/5) 130. The Regional Committee elected Italy, Lithuania and Sweden to put forward their candidatures to the World Health Assembly in May 2000 for subsequent election to the Executive Board. 3. Election o f m em bers o f the Standing C om m ittee o f the Regional C om m ittee (EUR/RC 49/5) 131. The Regional Committee elected Poland (Dr Jacek Piatkiewicz), Romania (Dr Anca Dumitrescu) and the Russian Federation (Dr Nikolaj Fetisov) for membership o f the SCRC for a three-year term o f office from September 1999 to September 2002. 132. In view o f the election o f Dr Jeremy Metters as Deputy Executive President o f the Regional Committee (and hence Chairperson o f the SCRC), and in accordance with Rule 2.9 o f the Rules o f Procedure o f the SCRC, it was agreed that Turkey (Professor Ay§e Akin) would take over the United Kingdom's vacant seat for the one remaining year o f the term o f office. 4. Election o f m em bers o f the European Environm ent and H ealth C om m ittee (EU R/R C 49/5 A dd .l and /5 A dd .l C orr.l) 133. The Regional Committee selected Hungary (Dr Alan Pinter), Ireland (Mr Tom Mooney), Turkey (Professor Cagatay Giiler) and the United Kingdom (Dr Liam Donaldson) for membership o f the European Environment and Health Committee for a two-year period from September 1999 to September 2001. 5. Election o f a m em ber o f the Policy and Coordination C om m ittee o f the Special Program m e on Research, D evelopm ent and Research T raining in H um an Reproduction (EUR/RC 49/5) 134. The Regional Committee elected Uzbekistan (Dr Dilbar Makhudova) for membership o f the Policy and Coordination Committee o f the Special Programme on Research, Development and Research Training in Human Reproduction for a three-year period from 1 January 2000. 6. Election o f a m em ber o f the M anagem ent A dvisory C om m ittee o f the Action Program m e on Essential Drugs (EU R /R C 49/5) 135. The Regional Committee elected Spain (Dr Alfonso Rodriguez-Alvarez) for membership o f the Management Advisory Committee o f the Action Programme on Essential Drugs for a three-year period from 1 January 2000. V . O t h e r m a t t e r s 1. T ribute to Dr Leo K aprio 136. The Committee observed one minute’s silence in honour o f Dr Leo Kaprio, who had served as WHO Regional Director for Europe for 18 years until 1985 and who had subsequently been declared Regional Director emeritus. 2. Date and place o f the fiftieth and fifty-first sessions (E U R /R C 49/C onf.D oc./7 and EU R /R C 49/Inf.D oc./4) 137. The Committee adopted resolution EUR/RC49/R7, confirming that its fiftieth session would be held at the Regional Office for Europe in Copenhagen from 11 to 15 September 2000 and deciding that its fifty-first session would be held in Spain from 10 to 14 September 2001, at the kind invitation o f the Government o f Spain.