Ministers and high-level officials from WHO/Europe’s 11 smallest countries – Andorra, Cyprus, Estonia, Iceland, Latvia, Luxembourg, Malta, Monaco, Montenegro, San Marino and Slovenia – have adopted a landmark statement committing governments to stronger actions to improve people’s health in their respective countries.
The Luxembourg Statement, adopted at the 9th High-level Meeting of WHO/Europe’s Small Countries Initiative (SCI), crafts a way forward specifically on access to medicines, mental health, digital tools for health, the health and care workforce, and the prevention and control of noncommunicable diseases.
Co-hosted by WHO/Europe and Luxembourg on 10–12 May, this year’s ministerial event marked 10 years since the creation of the SCI. It saw 4 WHO regions represented, thanks to the observer-status participation of Barbados, Bhutan, North Macedonia, the Republic of Moldova and the Seychelles.
“It is a privilege for us at the WHO Regional Office for Europe to be able to convene all of you at this forum, so that we can find common solutions to shared challenges. Your unique perspectives and innovative solutions are always an inspiration,” said WHO Regional Director for Europe Dr Hans Henri P. Kluge in his opening address.
“Your countries may be small, but thanks to your unique qualities – your proximity to your citizens and your agile institutions that are a crucible for innovation – you can implement change fast. Your ambitions and achievements are big, a shining light for all to see.”
Signed by Dr Kluge and Luxembourg’s Deputy Prime Minister and Minister of Health Paulette Lenert, the Luxembourg Statement includes the commitments of the SCI moving forward. It highlights the health issues that have become particularly relevant in the Region’s smallest countries (those with a population of 2 million and less).
Tackling the key health challenges affecting small countries
Small countries face a wide range of health challenges, some of which are unique to their small size. These include inadequate access to affordable medicines, including novel high-cost medicines, and shortages of essential medicines. WHO/Europe, together with SCI member countries, is calling for stronger and better financial protection for people trying to access the medicines they need. The 11 countries have committed to supporting WHO/Europe’s newly launched Access to Novel Medicines Platform, established after the successful Oslo Medicines Initiative.
All countries in the WHO European Region have also recognized that the crisis affecting health workers is no longer a looming threat – it is here and now. For the Region’s smallest countries, the health workforce crisis is particularly dire.
Challenges in the training, education and retention of health workers in small countries mean that collaboration, with WHO support, will be key moving forward. WHO/Europe’s draft framework for action, expected to be adopted at the upcoming 73rd session of the WHO Regional Committee for Europe in Astana, Kazakhstan, will be an important step towards improving the working conditions of millions of health workers across the Region.
WHO will also support small countries to strengthen the capacity of health policy-makers by organizing a specific session for small countries as part of its executive course on health workforce leadership and management.
In addition, as shown by the COVID-19 pandemic, mental health needs to be front and centre in health systems. In small countries, like elsewhere, mental health challenges can be exacerbated by stigma and poor access to chronically underfunded services. Communities may also be unprepared to provide comprehensive responses to people’s needs.
The SCI presents opportunities to strengthen cooperation with and among multidisciplinary peer-support groups and to engage in networks offered by the Pan-European Mental Health Coalition, now in its third year of operation.
Finally, the evolving digital landscape means that both small and large countries will need to keep up with the latest developments and leverage them for health services, while making sure that no one – neither patients nor health workers – are left behind in this progress. Equity and digital literacy can become a reality when countries implement digital inclusion plans and policies to ensure that everyone has access to digital technologies, while safeguarding people’s privacy.
An ambitious network, extending far beyond the WHO European Region
The 9th High-level Meeting of the SCI was a special occasion, gathering more than 80 delegates from 16 countries and marking the first phase of implementation of the “Roadmap towards better health in small countries in the WHO European Region, 2022–2025”, endorsed at the 8th High-level Meeting last year.
The attendance of new observer-status countries from 4 different WHO regions, stretching across continents and time zones, means that the SCI is addressing issues that small countries can relate to, regardless of location.
Dr Bettina Menne, Coordinator of the SCI, pointed out the importance of 2-day event for participating countries: “We met to discuss how to invest in health by working more closely together, sharing lessons learned, monitoring progress, and advocating for the needs of small countries at the regional and international levels.”
Housed at the WHO European Office for Investment for Health and Development in Venice, Italy, the initiative was launched in 2013 and now counts 11 countries with a total population of nearly 9 million people.