Europe & Central Asia are in a ‘permacrisis’ that stretches beyond the pandemic, climate change and war

Statement by WHO Regional Director for Europe, Dr Hans Henri P. Kluge
Gastein, Austria, 27 September 2022
For well over a century, Europe has grappled with multiple, momentous crises. But in recent years, the frequency of crises is increasing – including those linked to climate change and emerging infectious diseases, with ever faster spread in our interconnected world.
The extreme heat and wildfires that have devastated many parts of Europe this summer are just one example.
The ongoing COVID-19 pandemic, with – so far – some 250 million confirmed cases and with over two million recorded deaths in Europe and Central Asia, is another crisis that has put health higher on the political and development agenda, but whose lessons many countries may not yet have fully absorbed.
Then, we have the current monkeypox public health emergency of international concern, as well as the recent re-emergence of vaccine-derived polio in our region.
And, not least, a devastating war in Ukraine, which unfortunately shows no signals of de-escalation, and is compounded by horrific attacks on health facilities and providers -also triggering a mental health crisis of immense proportions.
These are all obvious examples that contribute to what the European Health Forum Gastein has termed a ‘permacrisis.’
But I would like to broaden and expand the definition of ‘permacrisis’ beyond climate change, infectious diseases and war.
There are other long-running crises that are relatively silent – often going unnoticed – yet compromising the health of millions and burdening our health systems regionwide.
I’m referring here to non-communicable diseases -including cancer, heart disease, alcohol- and tobacco-related disease, and the epidemic of obesity.
No doubt COVID-19 is the most visible pandemic in our lifetime, but it is not the deadliest. It is not the most preventable. That distinction goes to the pandemic of cardiovascular diseases. During COVID-19, five times more people have died at a younger average age due to heart attacks and strokes, than COVID -19 at its worst.
The three main drivers – which are preventable – of strokes and heart attacks are tobacco use, hypertension and air pollution.
The only thing which kills more people in our Region than tobacco is hypertension: 2.4 million people a year, or 1 out of 4 deaths in our Region.
Of course, we know that hypertension is also linked with obesity. One out of every four children in primary school in our Region is living with overweight or obesity.
That’s why we were very inspired by the announcement at the Regional Committee in Tel Aviv 2 weeks ago by the First Lady of Croatia who is establishing the first WHO Pan-European Summit of First Ladies and First Gentlemen to tackle childhood obesity, with the first summit happening next year in Croatia.
Obviously, hypertension is also linked to alcohol consumption. Our Region is home to the heaviest drinkers in the world. One out of every three deaths among young people is linked to alcohol.
There is no safe level of drinking, there is enough evidence on that. And the regional framework to tackle alcohol use was adopted for the first time at our Regional Committee in Tel Aviv.
The third big driver of strokes and heart attacks is air pollution. In our Region alone, air pollution kills 550 000 people a year, half due to cardiovascular diseases.
I came back last week from Kazakhstan, where I attended the meeting of the ministers of health of the Commonwealth of Independent States (CIS) in Turkestan, and it reminded me of the old foes that have disappeared from the political agenda: namely, HIV/AIDS.
Our Region together with the African Region are the only WHO regions where HIV is still on the rise. But its very politically comfortable not to have it on the agenda anymore. Because what needs to be done is greater efforts to reach key populations, which include men having sex with men, transgender people, sex workers and the sexual partners in those groups. We urgently need strong political commitment and financing to strengthen HIV services. We know that in a number of countries, up to 50% of HIV testing services were closed during the COVID-19 pandemic.
So yes, we’re in a permacrisis that stretches well beyond the pandemic, climate change and war. This is our new normal. And our new normal demands a dual track response.
What does this mean?
On one hand, we must urgently prepare for health emergencies like pandemics, climate-related crises, conflicts. On the other hand, we must urgently strengthen our current health systems and essential services to address the permacrisis of noncommunicable diseases and HIV.  One cannot be sacrificed for the other. It requires investment in health workforce and mental health.
This dual track approach should guide WHO/Europe and the work we do to support our countries, including the EU.
These challenges are daunting. But that does not mean we should surrender.
We can – and should – tackle the ‘permacrisis’ in its entirety together, in practical ways that benefit all.
I wish all of us peace and strong health.
This statement was delivered to the press at the European Health Forum Gastein in Austria on 27 September 2022.

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