Seventy-second Regional Committee for Europe: Tel Aviv, 12–14 September 2022: implementation of resolution EUR/RCSS/R1

Regional Committee for Europe 72nd session Tel Aviv, Israel, 12–14 September 2022 EUR/RC72/20 Provisional agenda item 17 1 September 2022 | 220666 ORIGINAL: ENGLISH Implementation of resolution EUR/RCSS/R1 At a special session of the Regional Committee that was convened on 10 May 2022 at the request of 43 Member States of the WHO European Region in line with Rule 5 of the Rules of Procedure of the Regional Committee for Europe, to consider the health situation in Ukraine and the wider consequences of the ongoing war on health matters in the Region and beyond, resolution EUR/RCSS/R1 was adopted. At the third regular session of the Twenty-ninth Standing Committee of the Regional Committee for Europe (SCRC), which was open to all Member States in the WHO European Region, the WHO Regional Director for Europe briefed the SCRC on implementation of the resolution. This document provides a further update on actions taken by the Regional Director and the WHO Regional Office for Europe to implement the above-mentioned resolution. The Regional Committee is invited to consider the status of implementation and provide guidance. EUR/RC72/20 page 2 Contents Introduction ............................................................................................................................................. 3 Update on implementation (September 2022) ....................................................................................... 3 Annex: Overview of the WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office)............................................................................................... 7 Financial overview .............................................................................................................................. 8 EUR/RC72/20 page 3 INTRODUCTION 1. On 10 May 2022, at the formal request of 43 Member States of the WHO European Region, a special session of the WHO Regional Committee for Europe was convened under Rule 5 of the Rules of Procedure of the Regional Committee for Europe, to consider the health situation in Ukraine and the wider consequences of the ongoing war on health matters in the Region and beyond. 2. At its special session, the Regional Committee adopted resolution EUR/RCSS/R1. The resolution included three action items for the WHO Regional Director for Europe. 3. Paragraph 4 of the resolution requests the Regional Director to “explore options, in consultation with Member States of the WHO Regional Committee for Europe, to safeguard the technical cooperation and assistance provided by the WHO European Office for the Prevention and Control of Noncommunicable Diseases, including the possible relocation of the aforementioned office to an area outside of the Russian Federation”. 4. Paragraph 5 of the resolution calls upon the Regional Director “to consider temporarily suspending all regional meetings in the Russian Federation, including technical meetings and meetings of experts, as well as conferences and seminars whose composition is set by the WHO Regional Office for Europe”. 5. Paragraph 6 invites “the Regional Director to transmit the resolution to the Director-General with the request that: (a) it be brought to the attention of the World Health Assembly; (b) an assessment of the health emergency situation in Ukraine and of consequential international health risks, […], as well as proposed responses thereto is provided to the Seventy-fifth World Health Assembly, in a dedicated report during its consideration of WHO’s work in health emergencies; and (c) the Director-General coordinates with relevant partners, including the International Atomic Energy Agency (IAEA), the Food and Agriculture Organization of the United Nations (FAO) and the United Nations High Commissioner for Refugees (UNHCR), as well as others, as appropriate.” 6. At the third regular session of the Twenty-ninth Standing Committee of the Regional Committee for Europe (SCRC), held in Copenhagen, Denmark on 7–8 June 2022, the Regional Director provided an update on the implementation of the resolution. That meeting was open to all Member States in the European Region. 7. This document presents a further update on actions taken by the Regional Director and the WHO Regional Office for Europe (WHO/Europe). UPDATE ON IMPLEMENTATION (SEPTEMBER 2022) 8. Pursuant to Paragraph 6, the resolution was transmitted to the Director-General immediately after the closure of the Regional Committee’s special session, and was brought to the attention of the Seventy- fifth World Health Assembly. The health emergency in Ukraine was also reported on by WHO/Europe and discussed by the Health Assembly. 9. That report (document A75/47) highlighted the wide-ranging impact on WHO/Europe’s operations. It covered the negative impact of the war on civilian populations and health systems in Ukraine, shortages of supplies, delays in sharing data and reporting, and challenges to technical support to Ukraine and neighbouring countries. The report mentioned the cancellation, postponement or relocation of international meetings. It also noted that a significant number of Member States have ceased engagement in existing partnerships and networks with the Russian Federation and Belarus. EUR/RC72/20 page 4 10. On Thursday, 26 May 2022, the Seventy-fifth World Health Assembly adopted a resolution condemning “in the strongest terms the Russian Federation’s military aggression against Ukraine”. Eighty- eight Member States voted in favour of the resolution, entitled Health emergency in Ukraine and refugee- receiving and -hosting countries, stemming from the Russian Federation’s aggression. Twelve countries voted against the resolution, 53 abstained and 30 were absent. 11. Concerning Paragraph 4 of the resolution, the Regional Director immediately made interim arrangements and adopted new modalities to safeguard the technical cooperation and assistance provided by the WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office) to tackle noncommunicable diseases in the Region. 12. Maintaining and accelerating efforts in that regard is critical, since NCDs are the cause of 90% of premature mortality, and a heavy burden of ill health in the Region. The huge economic cost of NCDs for the Region is well documented. The high prevalence of NCDs, as well as high levels of risk factors, including overweight, obesity, smoking and alcohol use, increased the COVID-19 death toll in Europe, while the pandemic, in turn, exacerbated the burden of NCDs. There is clear evidence that a post-COVID increase in NCD mortality and morbidity can be expected, particularly for more vulnerable groups, leaving European populations even more exposed to future pandemics. There remains, therefore, a great need to accelerate action to improve the coverage and quality of implementation of evidence-based interventions for NCD prevention and care. Innovative tactics and transformative ideas are also needed to move from knowledge to action. 13. The NCD Office represents a strategic investment by WHO/Europe to tackle NCDs. It supports all 53 Member States across the technical areas of NCD surveillance, NCD investment cases and support in development of national multisectoral plans, NCD prevention, and risk factor (tobacco, alcohol, nutrition/obesity, and physical inactivity) reduction. The NCD Office also hosts networks of Member States, including: the WHO Action Network on Salt Reduction in the Population in the European Region; WHO European Action Network on Reducing Marketing Pressure on Children; Health-enhancing Physical Activity Focal Point Network, Health-enhancing Physical Activity (HEPA) Europe (Physical Activity Researchers Network); and Commonwealth of Independent States Alcohol Policy Network. For detailed information about the NCD Office, see Annex. 14. As requested in Paragraph 4 of the resolution, to safeguard the work of the NCD Office, which relies heavily on voluntary contributions from the Russian Federation, WHO/Europe is now applying subregional approaches and bilateral direct country support to each Member State to deliver technical cooperation and assistance. No regional meetings or consultations have been held in the Russian Federation. Online events are organized when regional-level consultations are required and to launch new regional-level technical products. Despite these circumstances, the NCD Office has maintained its delivery of technical cooperation and support to Member States, thereby safeguarding the objectives and commitments of WHO/Europe and the European Programme of Work, 2020–2025 – “United Action for Better Health”, with regard to NCD prevention and control. 15. Activities conducted since the adoption of the resolution on 10 May 2022 include the following: • Subregional policy dialogues on obesity/childhood obesity management: Subregional policy dialogues on obesity were launched for the Western Balkans and central Asia. In the Western Balkans, a policy dialogue was held in Skopje, North Macedonia, with attendees from Albania, Bosnia and Herzegovina, Montenegro, North Macedonia and Serbia. In central Asia, a policy dialogue was held in Bishkek, Kyrgyzstan, with participants from Armenia, Azerbaijan, Kazakhstan, Turkmenistan and Uzbekistan. During the dialogues, participants discussed best buys in obesity prevention, identifying priority areas of intervention and informing action to tackle obesity. The discussions were followed by a childhood obesity treatment training course for capacity-building for health care professionals in both subregions. • The WHO Childhood Obesity Surveillance Initiative (COSI): Continuous technical support has been provided to COSI countries for Round 6 data collection, including Austria, Azerbaijan, EUR/RC72/20 page 5 Bulgaria, Croatia, Cyprus, Czechia, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Kazakhstan (subnational only), Kyrgyzstan, Lithuania, Malta, Montenegro, Poland, Portugal, Romania, Republic of North Macedonia, Russian Federation, Slovenia, Spain, Türkiye, Ukraine and Uzbekistan. • Alcohol control policies: A health tax capacity-building workshop and technical expert meeting was held in Bishkek, Kyrgyzstan, to provide key information on health taxes, present existing evidence, increase awareness and knowledge of health tax design and implementation, and create a platform to share international experiences and best practices by inviting experts from different countries. An online meeting of civil society representatives involved in reducing harm from alcohol discussed and agreed action-focused WHO/Europe support to Member States and the role of civil society in implementing, monitoring and protecting SAFER alcohol policies. A forum of young people for a SAFER WHO European Region free from harm due to alcohol brought together young people and civil society representatives to share perspectives on alcohol policies and discuss the challenges in implementing them effectively, including overcoming industry opposition. • Tobacco control: A joint WHO and European Union (EU) technical workshop was conducted in Copenhagen, Denmark, to discuss challenges and regulatory needs for novel and emerging nicotine and tobacco products in EU Member States. The main focus was providing direct country support through a high-level mission (to Kazakhstan) and targeted technical support to strengthen tobacco legislation (in Armenia, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Serbia and Ukraine), to develop comprehensive tobacco control programmes (in Turkmenistan), to strengthen the capacities of enforcement agencies (in Ukraine), and to improve tobacco cessation services (in Montenegro, Kazakhstan and Poland). • Physical activity: A meeting of the EU Physical Activity Focal Points Network provided information about potential mechanisms to support the monitoring and promotion of health- enhancing physical activity policies in the EU. A publication on the socioeconomic costs of physical inactivity in the 27 EU Member States, Kazakhstan, the Russian Federation and Türkiye has been prepared. • Innovative technical products: A misinformation toolkit, mapping the current landscape of health misinformation – the problems, actors and potential solutions – with NCDs at the centre, has been developed, to be launched in October 2022. An innovative mobile application artificial intelligence tool (KidAd) has also been developed to assist in monitoring the digital marketing of unhealthy food and beverages. 16. As of 27 August 2022, the NCD Office had reached 70% of its annual financial implementation for activities. 17. To continue the technical work delivered by the NCD Office, and considering different dimensions of disruption caused by the war in Ukraine, including the logistical challenges, costs and limited air travel options, financial transaction challenges and importantly, duty of care towards staff, the Regional Director will request his international staff from the NCD Office to work remotely from the WHO/Europe main office in Copenhagen. The existing/current remote modality of work for the NCD Office international staff (working from their home locations) has proven successful in safeguarding delivery over the past months and will now be further enhanced by having them together, as a unit, in Copenhagen. Discussions are ongoing with the Russian Federation regarding this step, and its sustainability. Recognizing that the Russian Federation finances the work of the NCD Office in Moscow (see figures in the Annex), a working group has been established at the main office to maintain regular interaction with the Ministry of Health of the Russian Federation. 18. Having staff members temporarily working as a unit from Copenhagen, in a hybrid fashion, with travel to Moscow on a regular basis to coordinate NCD activities and engage in technical work with the WHO Country Office in the Russian Federation, will help to ensure full continuity of technical assistance to Member States and development of normative guidance. EUR/RC72/20 page 6 19. Paragraph 5 of the resolution called upon the Regional Director to consider suspending all regional meetings in the Russian Federation, including technical meetings and meetings of experts, as well as conferences and seminars, the composition of which is determined by WHO/Europe. 20. No such meetings have been held in the Russian Federation since 10 May 2022. 21. The measures outlined in this document were taken by the Regional Director in response to resolution EUR/RCSS/R1 to safeguard technical cooperation on NCDs and ensure the continuation and stability of the NCD Office. Any decisions regarding the long-term future of the NCD Office will need to be made by the Regional Committee. In the meantime, the NCD Office has continued to successfully implement technical activities. 22. A further update on implementation of resolution EUR/RCSS/R1 will be delivered at the second session of the Thirtieth Standing Committee of the Regional Committee in December 2022, which for that occasion will be made open to all Member States from the Region. EUR/RC72/20 page 7 Annex: Overview of the WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office) 1. WHO European Office for the Prevention and Control of Noncommunicable Diseases (NCD Office) or Geographically Dispersed Office (GDO) was established by the WHO Regional Committee for Europe at its 62nd session on 13 September 2012 by decision EUR/RC62(2). The decision provided the WHO Secretariat with the mandate to establish a GDO in the area of noncommunicable diseases, hosted by the Russian Federation. 2. The agreement that was signed in 2014 between the World Health Organization (WHO), through its Regional Office for Europe (WHO/Europe), and the Ministry of Health of the Russian Federation, relates to a financial contribution from the Russian Federation to WHO to finance the operations of a specialized WHO NCD Office based in Moscow, Russian Federation. 3. The NCD Office was established in 2014 and has since provided specialized support for the 53 Member States in the WHO European Region for the prevention and control of NCDs. In 2019, the NCD Office was awarded the Director-General’s Award for Excellence (2018–2019). In 2019, in recognition of its success, the Russian Federation agreed to continue supporting the office for further five years, into 2024. 4. The NCD Office is funded in large part by a grant from the Government of the Russian Federation. In 2014, the Russian Federation provided around US$ 22 million (2014–2018), and in 2019, this funding was increased to US$ 26.7 million (2019–2024). 5. In 2019, as part of the renewal, US$ 26.7 million granted from the Russian Federation for the work of the NCD Office is being spent on work occurring exclusively within the WHO European Region. WHO/Europe also receives funding from additional donors, including Member States, the EU, World Bank and global philanthropic organizations, such as RESOLVE to Save Lives. In future, it is hoped that the NCD Office funding will increase and that its funding sources can be diversified. Most additional grants provide funding earmarked for activities, while core technical staff costs for NCD-related activities are funded by the grant from the Russian Federation, thereby providing stability for the technical programmes. 6. The NCD Office provides support to Member States across the technical areas of NCD surveillance, governance, NCD prevention, risk factor reduction and NCD management. In the area of NCD surveillance it leads several important studies: STEPs; the WHO European Childhood Obesity Surveillance Initiative (the largest childhood obesity surveillance in the world, with more than a million children measured); the FEEDcities project, the WHO NCD Country Capacity Survey; and alcohol, health and policy surveillance, among others). With regard to governance, the NCD Office collaborates with regional economic organizations, such as the Eurasian Economic Union and the EU, to work across national borders and to address the determinants of health. It supports the development of investment cases, national multisectoral action plans, policy impact case studies, financing of NCD programmes and advancing innovation in the areas of NCD prevention and control, both for the community at large and for people living in detention. In NCD risk factor reduction, the NCD Office supports implementation of the WHO “best buys” for NCD prevention and control. It promotes interventions to reduce tobacco use, alcohol consumption, unhealthy diets and physical inactivity, through regulation and policy change, alongside traditional and innovative efforts to change behaviour (behavioural and cultural insights for health). The NCD Office has prepared implementation manuals and technical packages to support mobilization of good practices (including the country package for salt reduction, NCD data modelling tools, the CLICK digital marketing monitoring tool, alcohol policy impact assessment models, and health taxation guidance). The NCD Office has also supported the development of national policies and action plans, and the preparation of intersectoral policy dialogues. Furthermore, it provides training for governments on monitoring and implementing NCD policies. In the area of NCD management, the NCD Office is providing funds for work implemented by the Division of Country Health Programmes based in Copenhagen. It also supports capacity-building: it organizes training for stakeholders involved in NCDs, implementation of WHO EUR/RC72/20 page 8 surveillance initiatives and provides capacity-building activities to support Member States to translate data into policy action. 7. The NCD Office is an integral part of WHO/Europe, under the Division of Country Health Programmes. The activities and products of the NCD Office reflect Member States’ requests for support and recognize the need for health systems and policies to be more responsive to the NCD burden in the Region. The work of the NCD Office is driven by the strategic objectives of reducing the burden, improving equity and increasing participatory governance of health, as defined by the European Programme of Work, 2020– 2025 – “United Action for Better Health” (EPW). The EPW aligns the work of WHO/Europe with the Triple Billion targets of the Thirteenth General Programme of Work, while supporting countries in their commitments to implement the 2030 Agenda for Sustainable Development and the Global Action Plan for Healthy Lives and Well-being for All. Financial overview EUR/RC72/20 page 9 = = =