COVID-19 vaccination roll-outs in eleven small countries within the WHO European region; Lessons learned.

The development and administration of COVID-19 vaccines has been an essential element in controlling the COVID-19 pandemic. However, countries worldwide have faced challenges in planning and implementing vaccination strategies. The aim of the current paper is to describe the situation faced by small countries in the WHO European Region in implementing their national vaccination strategies during the first stages of the planned roll-out (up to May 2021). This paper uses information from the WHO Small Countries Initiative (SCI), which includes a network of 11 countries with populations of ≤ 2 million (Andorra, Cyprus, Estonia, Iceland, Latvia, Luxembourg, Malta, Monaco, Montenegro, San Marino, and Slovenia). The SCI countries faced many challenges including: a lack of appropriate vaccination centers, adequate workforce, and registration/booking systems to cope with the unprecedented vaccine storage and administration demands; difficulties for high-risk groups (e.g., older individuals and those with health problems or cognitive impairment) to access vaccination sites or use digital registration/booking systems; vaccine wastage due to canceled appointments; and inequalities in vaccine uptake. Innovative programmatic interventions were implemented to facilitate the vaccination uptake of the populations such as: the creation of non-medical vaccination sites and mobile vaccination units; on-site vaccination of people in long-term residential facilities and long-term medical wards; diversifying health workforce like redeployment of healthcare professionals and use of medical students and retired medical professionals; campaigns with clear information to the general public (in multiple languages where necessary) both offline and online; use of digital registration/booking systems and alternative (non-digital) registration/booking systems for relevant individuals; and administration of excess vaccine doses to non-priority groups to avoid wastage.

Estonia advances on SDG achievement by tackling high alcohol consumption through a multi-pronged approach.

Estonia has implemented a comprehensive, multipronged approach to the reduction of alcohol consumption in the population, comprising a series of successful policy responses. The Estonian alcohol strategy (2014) builds on the Global strategy to reduce the harmful use of alcohol and the European action plan to reduce the harmful use of alcohol 2012-2010. It aims to decrease the overall yearly consumption of alcohol among the adult population to less than 8 litres of absolute alcohol per capita. Gathering support across society from a range of stakeholders, including policy-makers, researchers, parents and advocates, has been one of the key elements in the implementation of the policy. High-level political commitment and strategic timing of efforts have maintained the issue of alcohol control on the political agenda and in the public's mind.

Montenegro makes important strides towards achievement of the SDGs.

In 2018, Montenegro took an important step towards ratification of the Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes. A multisectoral national consultation provided a forum where national stakeholders could assist in related decision-making. The Protocol is the first and only multilateral legal agreement linking sustainable water management and the prevention, control and reduction of water-related diseases in the pan-European region. It was adopted in 1999 at the Third Ministerial Conference on Environment and Health in London and entered into force in 2005 as legally binding for the ratifying countries. To date, 26 countries have ratified it, covering about 60% of the population of the pan-European region. Montenegro is on the way to becoming the next country to ratify it and has used it as an instrument to strengthen national action towards progressively reaching regional and global WASH-related commitments, specifically in relation to SDG 3 (good health and well-being), SDG 6 (clean water and sanitation) and the Ostrava Declaration on Environment and Health (2017).

Participatory approaches to reaching the Sustainable Development Goals: Luxembourg: east healthily, move more

The first National Health Conference, “Vers un plan national santé”, was held in Luxembourg in November 2005. This event resulted in the development of a 10-year interministerial strategy on promoting healthy nutrition and physical activity with a focus on children and adolescents, entitled “Gesond iessen, méi beweegen” (“Eat healthily, move more”; GIMB) (2006–2016). An interdisciplinary body, comprising representatives of the Ministry of Health, the Ministry of Sports, the Ministry of Education, Childhood and Youth, and the Ministry of Family, Integration and the Greater Region, was established to coordinate implementation of the action plan and evaluate the results. The Ministry of Health coordinated the group. The aim of GIMB 2006–2016 was to increase awareness among the general population and provide information about the importance of healthy lifestyles to physical, mental and social health, promote balanced nutrition, and increase the quantity and quality of physical activity in the population, with a focus on children and adolescents. GIMB 2006–2016 serves as an example of a whole-of-government, whole-of-society approach to achieving SDG 2 (zero hunger), SDG 3 (good health and well-being), SDG 10 (reduce inequalities) and the goal of the WHO “Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being” of leaving no one behind. In 2018, the strategy was renewed in the form of the GIMB national framework for 2018–2025.

Participatory approaches to reaching the Sustainable Development Goals: San Marino: promoting healthy lifestyles through schools and family

In San Marino, the intersectoral approach to improving population health is a long-standing tradition. Several intersectoral projects have been under way for some time with a focus on the achievement of the Sustainable Development Goals (SDGs). In 2013, the Health and school working group was established to promote a systematic approach to health education. The aim is to create a school system in which everyone involved works together to provide students with a safe and healthy environment and positive experiences, and to promote a more sustainable and fairer lifestyle. Such an environment, involving both families and communities, is needed in tackling the burden of noncommunicable and chronic diseases and their risk factors. The adoption of the 2030 Agenda in 2015 gave San Marino the impetus to create the Intersectoral working group on implementation of the SDGs. Comprising representatives of all government departments, this working group is tasked with preparing the voluntary national review for submission to the High Level Political Forum in 2019. San Marino has also set up a strategic platform entitled “Produce health and development” to promote intersectoral policies and multi-partner cooperation, and provide leadership of the World Health Organization (WHO) Small Countries Initiative in conjunction with the WHO European Centre for Investment for Health and Development of the WHO Regional Office for Europe. The action reported in this briefing is directly linked to SDG 3 (good health and well-being), targets 3.4 and 3.5, and SDG 4 (quality education), target 4.7, and the strategic directions of the WHO European “Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being”.

Participatory approaches to reaching the Sustainable Development Goals: Malta: leaving no one behind: participatory development of policy on health services for transgender people

In 2018, Malta took concrete steps in the development of health services for transgender people. A high level of political commitment, the strong leadership of the Minister of Health and the adoption of a human rights-based, gender-responsive approach were important factors in the design and planning of these services, which led to the opening of the Gender Wellbeing Clinic in November 2018. The Clinic provides gender-affirmative health care services, tailored to the needs of the users by a multidisciplinary team, including an array of psychosocial and medical professionals. Malta’s health services policy for transgender people addresses Sustainable Development Goal (SDG) 3 (good health and well-being) and SDG 10 (reduced inequalities).

Participatory approaches to reaching the Sustainable Development Goals: Cyprus: leaving no one behind: Cyprus puts universal health coverage in place

Until recently, there was no universal health system in Cyprus. Health care was provided by two uncoordinated subsystems, which led to inefficiencies. While around 75% of the population was entitled to health care in public facilities, financed by general taxation, many still opted for private health care and paid out of pocket. As a result, the rate of out-of-pocket expenditure in Cyprus is among the highest in the European Union (EU), exceeding 45% of total health spending, compared to an EU28 average of 22% in 2016. Furthermore, the dual system had no links between public and private providers to ensure the continuity of care. This briefing addresses SDG 3 (good health and well-being), target 3.8 (achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all) and SDG 10 (reduced inequalities). It also addresses strategic direction 5 of the WHO “Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020” due to its focus on strengthening health systems for universal health coverage.

Participatory approaches to reaching the Sustainable Development Goals: Slovenia: integrating population and individual services to reduce health inequalities at the community level through health-promotion centres

In 2002, health-promotion centres (HPCs) were created in all 61 primary health care (PHC) centres across Slovenia. Their major role was to provide lifestyle interventions against the key risk factors for noncommunicable diseases through a combination of population- and individual-based approaches. These centres integrated activities, which had previously been dispersed among the PHC centres, including community nursing. To better focus on vulnerable groups, between 2013 and 2016, HPCs piloted a new approach to integrating the different services, targeting vulnerable groups at the community level. This entailed their reaching out to and involving key stakeholders with an impact on community health to ensure that vulnerable groups were not left behind. Partnerships were created with different stakeholders, including social services and nongovernmental organizations. This resulted in the adoption of local health-promotion strategies and action plans aimed at addressing the needs of the different population groups by identifying and reducing health inequalities. Slovenia’s experience shows how they are working towards reaching SDGs 3 and 10 in order to achieve good health and well-being and leave no one behind.

Participatory approaches to reaching the Sustainable Development Goals: Estonia: a multipronged alcohol policy involving all levels of society

Estonia has implemented a comprehensive, multipronged approach to the reduction of alcohol consumption in the population, comprising a series of successful policy responses. The Estonian alcohol strategy, adopted in 2014, builds on the “Global strategy to reduce the harmful use of alcohol” and the “European action plan to reduce the harmful use of alcohol 2012–2010”. It aims to decrease the overall yearly consumption of alcohol among the adult population to less than 8 litres of absolute alcohol per capita. Gathering support across society from a range of stakeholders, including policy-makers, researchers, parents and advocates, has been one of the key elements in the implementation of the policy.

Participatory approaches to reaching the Sustainable Development Goals: Montenegro: working towards SDG 6 and ratification of the Protocol on Water and Health

In 2018, Montenegro took an important step towards ratification of the “Protocol on Water and Health to the 1992 Convention on the Protection and Use of Transboundary Watercourses and International Lakes” (hereafter, “the Protocol”). A multisectoral national consultation was held with the overall aim of facilitating the process towards Montenegro’s accession to the Protocol. This provided a forum where national stakeholders could assist in related decision-making. The consultation was triggered by the “Iceland Statement. Ensuring safe and climate-resilient water and sanitation” (2018), according to which the small countries committed to acceding to the Protocol by 2022. The Protocol is the first and only multilateral legal agreement linking sustainable water management and the prevention, control and reduction of water-related diseases in the pan-European region. It was adopted in 1999 at the Third Ministerial Conference on Environment and Health in London and entered into force in 2005, becoming legally binding for the ratifying countries. To date, 26 countries have ratified it, covering about 60% of the population of the pan-European region. The United Nations Economic Commission for Europe and the WHO Regional Office for Europe provide the joint secretariat of the Protocol. Montenegro is on the way to becoming the next country to ratify it. The Protocol is recognized as an instrument for use in strengthening national action towards progressively reaching regional and global WASH-related commitments, specifically in relation to SDG 3 (good health and well-being) and SDG 6 (clean water and sanitation) and the “Ostrava Declaration on Environment and Health” (2017). It stipulates the importance of formulating national priority targets and implementation plans, while promoting a whole-of-government approach to and coordinated intersectoral action in doing so.

Participatory approaches to reaching the Sustainable Development Goals: Latvia: involving the general public in the SDG review process

In the 1990s, soon after the country became independent, Latvia decided to launch an initial environmental policy with the aim of balancing economic and social processes related to environmental needs. In 2002, Latvia enacted its strategy for sustainable development based on the Latvian National Report “Rio + 10” to the World Summit on Sustainable Development in Johannesburg. In 2006, following a review of the European Union’s Sustainable Development Strategy, Latvia began a participatory sustainable-development planning process in which citizens were encouraged to express their vision of Latvia in 2030 as regards all dimensions of sustainability. This resulted in Parliament’s approval of the Sustainable Development Strategy of Latvia until 2030 (Latvia 2030) in 2010. Because of the extensive involvement of the public in discussions about the country’s future, Latvia 2030 is sometimes referred to as a “social contract”. The Government’s planning system places achieving Latvia 2030 as the overarching goal of the seven-year mid-term national development plans. The current National Development Plan of Latvia for 2014–2020 ensures a hierarchy of performance indicators that are operationalized in sectoral or multisectoral policy documents down to the activity level. While Latvia mainstreams targets for implementing the 17 SDGs in its policy, this briefing focuses specifically on SDG 16 (promote peaceful and inclusive societies for sustainable development, provide access to justice for all and build effective, accountable and inclusive institutions at all levels) with a focus on participation. It showcases the participatory process put in place in government planning, and the contribution of public participation to the SDG review process.

Participatory approaches to reaching the Sustainable Development Goals: Iceland: youth, health-promoting communities and partnerships

Iceland is taking active steps towards achieving the Sustainable Development Goals (SDGs) through a whole-of-government approach. These include creating health-promoting communities (HPCs) and involving youth. All of the strategic directions of the WHO “Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being” are being taken into account, specifically with respect to: advancing government and leadership, and assisting local communities in the creation of supportive environments and conditions that promote healthy behaviour and the health and well-being of all inhabitants, with sustainability as one of the guiding principles; establishing healthy places, settings and resilient communities within the Icelandic HPC programme (within the context of the Icelandic Youth Council; young people are the main stakeholders of SDG-related activities). These two approaches show how the Government of Iceland is encouraging participation in the implementation of activities aimed at achieving SDGs 3 and 17 and the overall goal of leaving no one behind. With respect to the HPC programme, the Directorate of Health approached the Interministerial working group on SDGs set up by the Government, suggesting that the HPCs work towards connecting the SDG-related activities taking place at the local level with those at the government level.

Participatory approaches to reaching the Sustainable Development Goals: Andorra: national strategy on nutrition, sport and health: engaging the general public

In 2016, Andorra carried out its second national nutrition survey to evaluate the impact of a decade of action to promote healthy eating habits and regular physical activity in the population. This action was linked to implementation of the National strategy on nutrition, sport and health. The survey assessed food consumption, physical activity and other health-related habits, as well as anthropometric trends in the adult population. Comparing the results of the second national nutrition survey with those of the first survey has provided information that will be useful in reviewing and updating health-promotion policies and programmes related to healthy lifestyles in Andorra, as well as in decision-making in this area. Andorra’s efforts in the area of nutrition span across several United Nations Sustainable Development Goals (SDGs): SDG 2 (zero hunger), specifically targets 2.1, 2.2, and 2.4 to ensure access for all people to sufficient food, end all forms of malnutrition, and implement resilient agriculture practices that help to maintain ecosystems, respectively; SDG 3 (good heath and well-being), specifically targets 3.4 and 3.5 related to premature mortality from noncommunicable diseases and the prevention and treatment of harmful use of alcohol; SDG 4 (quality education), specifically target 4.7 on education for sustainable lifestyles; and SDG 10 (reduced inequalities). They also address several of the interdependent strategic directions of the WHO Roadmap to implement the 2030 Agenda for Sustainable Development, building on Health 2020, the European policy for health and well-being, namely, preventing disease and addressing health determinants by promoting multi- and intersectoral policies throughout the life-course, and establishing healthy places, settings and resilient communities.

Разработка национальных планов действий в области транспорта, охраны здоровья и окружающей среды: пошаговое пособие для лиц, формирующих политику и осуществляющих планирование

Национальный план действий в области транспорта, охраны здоровья и окружающей среды (НПДТОСОЗ) является ключевым механизмом для развития экологически устойчивого и здорового транспорта в стране. В нем представлен всеобъемлющий межотраслевой метод планирования и осуществления действий в области транспорта, окружающей среды и здоровья на национальном уровне. НПДТОСОЗ также стимулирует работу по всем секторам и действия, которые могут способствовать сокращению неравенств в отношении здоровья, внося вклад в достижение целей таких важнейших европейских мер политики и стратегий, как: Здоровье-2020, основы Европейской политики в поддержку здоровья и благополучия; Пармская декларация по окружающей среде и охране здоровья 2010 г.; План действий по реализации Европейской стратегии по профилактике и борьбе с неинфекционными заболеваниями, 2012–2016 гг. Данное пособие предназначено для помощи в разработке НПДТОСОЗ в странах. В нем предлагаются четыре этапа: планирование, разработка, реализация и оценка. В пособии не представлены конкретные рекомендации по организации процесса выработки общих стратегий и мер политики в отношении экологически устойчивого и здорового транспорта, то есть того процесса, который обычно предшествует разработке НПДТОСОЗ. Пособие содержит практические рекомендации по каждому из четырех этапов (и шаги в рамках каждого этапа) НПДТОСОЗ, а также представляет примеры эффективной практики из стран Европейского региона.

Developing national action plans on transport, health and environment: a step-by-step manual for policy-makers and planners

A national transport, health and environment action plan (NTHEAP) is a key tool and mechanism for developing sustainable and healthy transport in a country. NTHEAPs provide a comprehensive and intersectoral way of planning and implementing transport, environment and health action at the national level. They also call for working across sectors, and action can result in reducing health inequalities, thus contributing to Health 2020, the European policy for health and well-being; the Parma Declaration on Environment and Health; and the action plan for implementation of the European Strategy for the Prevention and Control of Noncommunicable Diseases 2012–2016. This manual was developed to guide NTHEAP development at the country level. It proposes four phases: planning, development, implementation and evaluation. It does not provide specifics on how to establish the general policies or strategies on sustainable and healthy transport, an activity that usually precedes the development of action plans. The manual provides practical advice for each of the phases and steps and highlights good practices from the European Region.

Élaboration de plans nationaux d’action pour les transports, la santé et l’environnement : manuel pas à pas destiné aux décideurs et planificateurs

Un plan national d’action pour les transports, la santé et l’environnement est un moyen essentiel de mettre en place des transports viables et sains dans un pays. Il permet de planifier et de mettre en œuvre, de manière globale et intersectorielle, des mesures relatives aux transports, à l’environnement et à la santé au niveau national. Il appelle également à agir dans tous les secteurs, action qui peut, en réduisant les inégalités de santé, contribuer à la réalisation de Santé 2020, la politique européenne de santé et de bien-être ; de la Déclaration de Parme sur l’environnement et la santé ; et du Plan d’action pour la mise en œuvre de la Stratégie européenne contre les maladies non transmissibles (prévention et lutte) 2012-2016. Le présent manuel a été conçu pour aider à élaborer un tel plan au niveau d’un pays. Il propose quatre phases: planification, élaboration, mise en œuvre et évaluation. Il ne donne pas de détails sur la façon d’établir les politiques ou stratégies générales requises pour assurer des transports viables et sains, activité qui précède habituellement l’élaboration de plans d’action. Il donne, en revanche, des conseils concrets pour chacune des phases et étapes, mettant en lumière les bonnes pratiques de la Région européenne.

Improving children's health and the environment: examples from the WHO European Region

Since the Fourth Ministerial Conference on Environment and Health (Budapest, 2004), the children’s health andenvironment programme of the WHO Regional Office for Europe has been collecting case studies on actions toimprove children’s health and environment. The aim of this exercise was to document experiences in implementingmeasures to address the risk factors covered by the Children’s Environment and Health Action Plan for Europe.These descriptions are intended to serve as examples for future implementation of national children’s environmentand health action plans. This collection of case studies describes initiatives, with the intention of encouragingcountries to share their experiences, focusing on the process of implementing each action, including challengesand lessons learned. Thirty-three case studies from the WHO European Region were selected for inclusion. Thisreport describes them and presents the results of their analysis.

Workgroup report: developing environmental health indicators for European children: World Health Organization Working Group.

A working group coordinated by the World Health Organization developed a set of indicators to protect children's health from environmental risks and to support current and future European policy needs. On the basis of identified policy needs, the group developed a core set of 29 indicators for implementation plus an extended set of eight additional indicators for future development, focusing on exposure, health effects, and action. As far as possible, the indicators were designed to use existing information and are flexible enough to be developed further to meet the needs of policy makers and changing health priorities. These indicators cover most of the priority topic areas specified in the Children's Environment and Health Action Plan for Europe (CEHAPE) as adopted in the Fourth Ministerial Conference on Health and Environment in 2004, and will be used to monitor the implementation of CEHAPE. This effort can be viewed as an integral part of the Global Initiative on Children's Environmental Health Indicators, launched at the World Summit on Sustainable Development in 2002.

Children's environmental health in Central Asia and the Middle east.

Children in Central Asia and the Middle East bear disproportionate environmental threats to health, of which the most widespread and serious result from poverty, malnutrition, lack of access to safe drinking water and food, and exposures to toxic chemicals. Their psychological health is threatened in several parts of this region by internal wars and strife. Many, or even most, children are regularly exposed to environmental tobacco smoke. In many of these countries, children constitute very high percentages of the population. Because children constitute the future, it is critical that these threats to their health be addressed and reduced to the greatest extent possible through both provision of safe and adequate drinking water and nutrition and reduction of exposures to environmental contaminants.