SHF2025｜Hans Kluge

Shaping the Future of Digital Health Transformation in the European Region

Hans Kluge

WHO Regional Director for Europe

I would like, first and foremost, to congratulate everyone on the 20th anniversary of the Shanghai Forum and the 120th anniversary of Fudan University. It is a great honor for me to be at this very prestigious forum, advocating for health as the voice of health.

On behalf of WHO, I have just started my second mandate as the WHO Regional Director for Europe and Central Asia, with the support of 50 member states. This gives me a very strong mandate to be here on a personal invitation to China by the Director of the National Health Commission. We had a very long discussion yesterday to strengthen the collaboration between China and Europe. 

At the moment, China's global health leadership and its place in health diplomacy are at unprecedented heights. If back at home, people ask me why I'm coming here for strengthening this collaboration, I would like to use a beautiful Chinese quote: Zhòng rén shí chái huǒ yàn gāo (众人拾柴火焰高). Many people gather firewood, and the flames burn high. We need trusted partners in these turbulent times.

I will swiftly take you through some of the characteristics of the health systems in the WHO European Region. It is the region with the largest number of member states—53 from low-, middle-, to high-income countries. What do we think we're good at, and what do we have to improve? And most importantly, I’ll give some views on opportunities for collaboration.

The region hosts nearly 1 billion people across 50 member states. There are some strong indicators. But when I gave a presentation at Peking University yesterday, the facilitator said, We thought everything was going wonderfully in the European Region, but after your presentation, we realized that we do face some huge challenges. It's true that universal health coverage is quite high in the region, but I would like to highlight some challenges that are similar in this country.

First and foremost, it's the aging of the population. For the first time in history, the European Region has more people aged 65 and over than young people under the age of 15. And we have a drastic decline in fertility. This is not just a health issue; it's what I call a megatrend.

A second megatrend is climate change. I always say the climate crisis is a health crisis. Every year, we have about 163,000 people dying unnecessarily due to heat, and this number is only going to increase. Every year, we have 550,000 people dying from bad quality of the air.

The third megatrend is what I call the silent pandemic of chronic diseases and mental health. Nine out of ten people in our region are passing away due to what we call chronic diseases—cardiovascular disease, stroke, chronic respiratory disease, cancer, and diabetes. The good news is that the majority of these diseases are preventable, either by early and aggressive treatment, such as for hypertension. The majority of people in this room with hypertension don't even know they have high blood pressure. There are such cheap and effective treatments available.

There are four major risk factors to be tackled: tobacco, alcohol, lack of physical activity, and unhealthy diets—all things that are under our control. The biggest crisis in our health systems in the European Region that every single minister is talking about, is the health workforce. There is no health without the health workforce, which has been our heroes during the pandemic. We face a paradox in Europe: in absolute numbers, we have never had so many doctors and nurses in history. But due to the aging of the population and what we call multi-morbidity—meaning that most of our patients have four or five diseases at the same time—we are always in shortage. We will never be able to produce enough doctors and nurses to meet our needs, which comes to my next point: we need digital health applications. We need artificial intelligence. And after just two days in this country, it is very clear that our region is lagging behind in a big way. I always start with the positive. So, we did a survey in our region. The good news is that there is a strong awareness in the region to leverage AI and digital health for better care and decision-making. Seven out of ten countries view AI as highly relevant for improving health outcomes and patient care. Nine out of ten countries have interconnected electronic health record systems, enabling seamless data sharing. A good example is the electronic health record system in Austria. Over the years, it has expanded beyond hospital services to include the private sector, pharmacies, and e-health applications. Ongoing technical improvements and wider service integration have increased its usage.

Now, what can we improve? First and foremost, the current legislation. There are significant legal uncertainty surrounding artificial intelligence. Nearly half of our member states claim that legal uncertainty is a major barrier. We are also champions in regulation, but you can regulate so much that you suffocate innovation. So we need to rebalance between innovation and regulation. We are also falling short when it comes to evaluating the impact of digital health interventions. Less than two in ten countries, conduct such evaluations. So we are shooting over bullets in the dark. Without that data, it's difficult to know what works and what doesn't work. 

Let's look at some positive projects ongoing in our region. Norway, daily health users showed lower mortality rates and required fewer home care services. From 2018 to 2021, the Norwegian ministry of health found that patients with chronic diseases benefited from digital remote services. They felt safer, more secure, and better equipped to manage their own conditions. The key finding here was that daily health users really improved their health. And the family doctors had interdisciplinary meetings focused on selfcare. I am a medical doctor, too. My father, too. He used to say the best doctor is the one who has been sick a lot him or herself, when you have to go through the system. If you get a diagnosis of cancer, this is a huge shock. Whole your world, the world of a family gets upside down. You need to be navigated through the system.

Next, from Portugal: previously fragmented coronary disease management in Coimbra in Portugal caused delays, inconsistent care, high clinical error risks, and was very expensive to the system. Diabetes management there now aims to eliminate avoidable blindness, amputations of the feet, and reduce hospital admissions by 50%. This is all possible. But what we need to do in Europe is to move from projects to national scale-up. And if you look at the size of a city in China—it's amazing. We have a lot to learn.

Next one: the United Kingdom. The National Health Service (NHS) invested £113 million to test AI tools aimed at improving patient care. The NHS in the UK is the crown jewel of society, but it is under huge pressure. One of the key projects funded was Brain Omni 360 on stroke, an AI imaging software which was designed to support treatment decisions. In a trial across 37 hospitals. Stroke treatments using AI increased by over 280%. Today, Brain Omni 360 is used in every single stroke ward in the NHS.

Next one: Big data. To address today's and tomorrow's threats, we must be proactive, predictive, and person-centered. And that starts with strong primary health care. Digital health is no longer a luxury; it is the backbone of resilient primary health care. Countries like the United Kingdom, Spain, and Israel are leading with population health management. They go beyond tracking; they predict risk. This is where we have to come to use digital health and AI to move from treating an already sick person to predicting who will need a kidney transplant if you have diabetes in 10 to 15 years. And that's a very powerful argument for the ministry of finance, because it's a huge cost-saving. So data must serve the people. With the right digital foundations, primary health care becomes stronger, faster, and fairer. Our hospitals are overloaded. For the first time in history, ambulances have to wait in emergency care. The only way forward is to shift care out of the hospitals, bring it closer to where people are living—to their communities and their homes. 

Now is the fifth case study. I myself went to the emergency room in Västerbotten, in northern Sweden, also a vast country. It's an area as large as Switzerland with one person living per square kilometer. It's very inaccessible. Sweden has established what we call cottage hospitals, often the only access points, using telemedicine to deliver quality care 24/7. A trauma patient from a car accident was brought into the emergency room when I was there. This whole emergency ward is run by nurses because there are no doctors. The only doctor you see on the screen through video connection is sitting in Stockholm, 1,000 kilometers away. At the core is trust. Nurses are empowered to assess and make critical decisions. In too many countries in our region, there is still too much conservatism in the minds of doctors. “I'm a doctor, a nurse cannot do this.” I feel very empowered to talk about this because I have a lot of experience. My father was a chief doctor, and my mother was a chief nurse. I still don't know who was the boss. Basically, you need both of them, but nurses and midwives can do so much more. We have to entrust them. Actually, this whole thing is not about digitalization. It's about putting people first, building professional respect, teamwork, and shared responsibility. There is a deficit of trust now in society, in the public sector or among neighbors. We have to rebuild this trust. The best way to do this is to reassure people. We face a tremendous mental health crisis in Europe. 28% of our girls of 15 years old say they feel lonely most of the time or the whole time. The same mental health also exists in the aging population, as people live longer and their partners pass away maybe 15 years before the other partner. They may also divorce at a later stage. I always say, loneliness is a killer. The answer doesn't have to cost a lot of money. The answer is what I call social connectivity, social cohesion, and relations. It’s very important.

The next case is from Spain in the Basque Country. It offers a compelling illustration of how a digital health ecosystem can work for people, especially those with many diseases at the same time. Again, these tools are not just technological solutions; they are enablers of empowerment to support patients and caregivers. More and more, we ourselves will have to take care of our health and only go to the doctor when it's really necessary. What I appreciated here is that it reduced the tremendous administrative burden. I started my career as a general practitioner, a family doctor. I saw through the years that the time I had to spend on my screen increased, which decreased the time I could look into the eyes of my patients and have this person-to-person contact. Digital tools and AI don't take away the human contact. In these disturbing times, it becomes more and more important. We cannot afford to lose that personal touch.

The final case study is from Sweden again. Through AI transcripts of client meetings, instead of looking at the screen and typing, we can save up to 60% of the time, and improve the interaction with people and social connectivity. Five years ago, at the start of my first mandate, I made digital health a flagship initiative, and we have come some way. In 2022, WHO Europe and its member states adopted the first regional digital health action plan until 2030. I call it a compass—a compass to advance digital health solutions. One of the things we did together with Dr. Gauden Galea was to bring together the private and public sectors. In Europe, we have an enormous amount of private sector innovation hubs. They have so much money, but they have no clue about what we call the public health pain points. We brought the 50 member states together in the same room, telling them what the big issues are. There is a genuine willingness for public-private collaboration. WHO is not against the private sector; we are embracing it, but only if we agree on the foundation of values: universality, equity, and always focusing on the most vulnerable in society. The Sustainable Development Goals are all about reaching the unreached and leaving no one behind.

There's a lot of work ahead. What we'll do now is developing a regional roadmap on artificial Intelligence, continue to build capacity in the member states, because our member states are overloaded by marketing companies, selling their products, which sometimes are very expensive and don't work. And then the country is losing their resources. We have to build capacity first and foremost, to help countries to look for the right solution and do a lot of capacity building. 

Transformation is possible, implemental, sustainable and replicable. One of the visits yesterday in Beijing was at the Chinese Academy of ICT and it was mind blowing what was being presented. And we were very proud that it has the first WHO collaborative center in the whole west pacific region on digital health.

Regarding the opportunities for collaboration with China, the good thing is that we don't start from scratch. Last year in Europe, we welcomed a Chinese delegation to our office in Almaty. It's a center of action for primary health care. We exchanged views on artificial intelligence and primary health care. The delegates witnessed firsthand how Kazakhstan applies community-based primary health care. Recently, we also had a delegation of experts from Nantong and Beijing to explore long-term care financing, a priority for the National Health Commission. They met with Dutch and German experts. This is the UN and WHO's convening power to bring people together.

On the collaboration, we need to tackle the global health challenges. China has become now the number one supporter of WHO. I want to thank the Chinese government. I want to thank President Xi for putting health very high. Internationally, we saw that health may not be everything, but without health, there is nothing. A healthy person wants everything, especially money, a sick person only wants one thing, that's to be healthy.

I want to thank also the Director of the National Health Commission for receiving me so well to the country. We have a very concrete action plan on moving forward hand in hand. It's a win-win situation. China is giving WHO access to one of the world's largest population (1.4 billion), access to rich, technological and scientific advancements and very specific expertise, for example, in traditional medicine, where we in Europe only are starting, frankly speaking. And vice versa, WHO is giving a huge platform to China to scale up digital health innovations and evaluate those. We believe that joining hands together is necessary for a better future. “Xie shou gong ying, gong chuang wei lai (携手共赢，共创未来)”. Thank you!