 The floor is yours we tell you. Thank you very much Monsieur de Montréal Let me start with a question. What is the real purpose of health care? What are health systems supposed to deliver to the people using them and? These questions might be less obvious than you initially think And they have everything to do with the topic that we are talking about today mental health And I'm coming from an international organization the OECD the organization of economic cooperation and development And I am there working in the health division and our slogan is just something you see on the wall when you enter the OECD is better policies for better lives so we do a lot in all areas of health and health care and And Sometime ago I said to your colleague of mine. I know why are we so often talking about? mental health as a separate topic but we never talk about somatic health and maybe This is because we unconsciously assume that when talking about health somatic health is Sort of the default that is to say is there something wrong physically? It's crystal clear to most people that we are talking about a health problem with mental health problems This is sometimes less obvious in so in general like you mentioned in your introduction We could say that it's it's usually neglected and also highly underestimated also in terms of economic figures we have found that across the OECD, which is Definitely not the whole world, but it's 37 member countries About 50% of the population will encounter some mental health issue somewhere in life The costs of mental health problems add up to about 3.5 to 4% of GDP across the OECD, so we're talking about a huge and massive problem here and Maybe we are thinking too much in a dichotomy here mental and somatic elements of health because these two are strongly Interconnected, but this mental aspect may not always receive the attention it deserves in health policy Now back to our question. What is exactly what health systems systems should produce and How do we know that our health systems are actually doing a good job? now the performance measurement of health systems has a relatively short history Which goes back to the 20th century and in the 20th century we would say the outcomes of health systems life expectancy and curing diseases because when we live long and free of diseases we are healthy, right? And this may have made a lot of sense in the 20th century and Where this was the dominant idea of a health care, which was quite episodic the curative approach So something is wrong patient goes to the doctor Dr. Felix is the problem But that's not For a more important part of health care is not no longer the reality we living today Populations in most countries have changed dramatically over the past decades. We all have aging populations and This goes hand-in-hand with the continuous increase of chronic conditions and There are morning session Alexander the gmail's already mentioned that that this is a massive problem and in the age group of 65 years and older for instance, we see that across the OCD about six out of ten people Live with two or more chronic conditions So I know that the overall Prevalence is actually quite higher. We talk about multi morbidity here in the overall population. This is about one-third and Yes, we need to work on prevention. There's a lot that we can do But a major part of this population, they are never going to be cured They are live living with these conditions and they rely on health care to manage their conditions and to provide Regular continuous care prescribed medication provide lifestyle counseling, etc the purpose of health systems is not so much curing these diseases and and Lengthing life. It's mainly about quality of life it's supporting people in what really matters to them and This is something that cannot be measured simply in clinical outcome measures You can only get these information by asking patients about the outcomes and experience with care So when it comes to mental health, we should not just think about Disorders or mental diseases. I mean, this is certainly important But also we should think about the overall quality of life in general Now this may sound a bit abstract, but we are talking about a straightforward things here our people Able to do their work. Can they engage in social activities or are they hampered in doing this by pain by concerns by fatigue Limitations in their mobility sleeping problems. These are all things that people with conditions Are struggling with and that we can measure But it's really what about what matters to people and health systems should help people Realizing their own goals and help help living meaningful Good quality lives and for some of us. This may be a life full of ambition for others It's have reached a stage in their life Where we're talking about being able to be with your grandchildren to walk your dog, etc Now at OECD, we are we are proud to have the biggest Database with health care related data in the world We have massive amounts of data Because health systems are collecting these data prescriptions admissions mortality morbidity costs etc But little of these data. I mean, this is all important It's useful information for health policy, but such data Are using not reflecting the essential questions Do health system deliver what people need do health systems enable people to leave this meaningful to live this meaningful life Such information is still extremely scars know that this is Just not just my personal mission to get more of this information as OECD We talk all the but with with our governments with member states and in the 2017 We had our health ministerial meeting that we do once about every five years and during this meeting the health ministers across the OECD agreed that a New generation of health reforms was needed if we need to make this move towards what we called People-centered health systems systems that are organized around the needs of patients and ask patients How they feel about the outcomes of their care? And now I know that that I mean, it's difficult to disagree with that It's you might say it's it's maybe easy to reach a political momentum for that because how can you be against it? You know health systems that serve patients The issue here is how are we going to to walk the talk? How are we going from the narrative to action and the first logical step is to quote Juliet said to actually this morning data data data We need to start measuring internationally and systematically patients reported indicators let's start taking patients seriously and Take what they report on their outcome seriously and a major misconception here I think is that we are talking about soft data It's not soft data. It's we're talking about really well validated instrument There's a lot of scientific rigor and a lot of academic work has been done on how you can measure such outcomes but it is currently a situation of Either these tools are not being used or it's a situation of many flowers blooming So there are a lot that's being measured, but it's difficult to compare. It's difficult to To internationally learn from each other because everybody is doing it slightly differently Now Let's end with the good news that countries across the OECD have joined forces to start developing Implementing international standards for this under the flag of what we call Paris the patient reported indicator surveys initiative And in the past we have you you may have heard about Successful programs international programs that we had like for instance PISA in education Where there we have developed an international standard to compare the performance of students All over the world and this has been a real game-changer in the world of education. This has All right also Encouraged countries to reform their educational system and we hope that Paris Will be the PISA for health care So we are currently friends of working on the international survey of people with chronic conditions who are managing primary care setting this is the the most rapidly growing group of health care users across the OECD and How well these people are served The care that they receive It's mainly a black box and what we are going to do is You're going to open this black this black box and the information coming from Paris will help policymakers to identify Best practices and will also facilitate international learning in this area I just to end with a few take-home messages Just like we have been comparing life expectancy costs morbidity and So what internationally we should also learn from each other by observing to what extent our health systems are Successful in meeting the needs of patients. There's a lot room to improve and to learn from each other We can only do this by taking this information seriously think of it as soft data. It's just Essential data. It's about the very essence of health care and just like we develop international standards for all these other measures We must develop such standard for patient reported measures Lastly mental health is something that I think deserve more attention in health policy We should not only pay attention to it when we are talking about psychiatric psychiatric labels But but somatic and mental health are closely Interconnected and we should ask people about it and should it should be in the center of healthcare in general Back to you, Mr. Chair Thank you very much for your presentation. Let me ask you one simple question because the whole conference is about global governance that is issues of Well, the political Consequences of Interdependence so my question is in your judgment. What is the global governance dimension of health care at the global level? Well, you know, this is actually a topic that is really on top of the international agenda at this moment As you as you may know also on the level of European Commission because if there is one thing that this pandemic has told us that Health care and health policy is much more an international issue than we may often think and We have and this is also How I see the role of international organization. We have 37 member states and in all these member states These countries are struggling with the same issues. They see the same demographic epidemiologic Changes and are struggling with the same the same challenges and I think I like to to think about this in terms of How I call it international learning. There's a lot to to learn from each other and To to identify best practices Internationally because we what we definitely know that some health systems Cross-world are performing much better than others and they're they're huge opportunity to to exchange and to learn lessons from that Thank you. Well, there is a question. I'm going to ask you, but the other two speakers as well, you know Mental health mental diseases are usually classified as non-communicable Diseases, but this is the way they are classified usually and as An amateur if I may say so, I wonder if it is true Is it not true that the mental disease will maybe Communicable diseases which would of course increase the international dimension What do you think Miguel? Yeah, well spoken. It's definitely a non-communicable disease. We can we can easily agree on that Yes, but I think I get I get your points this division between communicable This is a very rough. I mean, it's only two groups. I think there is definitely Something more in that because it's not at probably there is a similarity here with other non-communicable diseases What we call lifestyle diseases that there are certain Societal developments going on that definitely affects mental health of populations and Well, we're living in strange times these days with the COVID-19 pandemic and senior introduction It's a very good example Where we all I mean we all in the same boat We are in this pandemic together and you see that the impact also on the mental health of populations is Is huge? It's it's it's a big issue Thank you very much. So now let me move to professor Roberto Burriotti