The World Health Organization was established in 1948 as the specialized agency of the United Nations responsible for directing and coordinating authority for international health matters and public health. One of WHO's constitutional functions is to provide objective and reliable information and advice in the field of human health. It fulfils this responsibility in part through its publication programmes, seeking to help countries make policies that benefit public health and address their most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme geared to the particular health problems of the countries it serves. The European Region embraces some 880 million people living in an area stretching from the Arctic Ocean in the north and the Mediterranean Sea in the south and from the Atlantic Ocean in the west to the Pacific Ocean in the east. The European programme of WHO supports all countries in the Region in developing and sustaining their own health policies, systems and programmes; preventing and overcoming threats to health; preparing for future health challenges; and advocating and implementing public health activities. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and and adaptation. By helping to promote and protect health and prevent and control disease, WHO's books contribute to achieving the Organization's principal objective, which is the attainment by all people of the highest possible level of health. Ever since the WHO European Region launched its first regional Health for All strategy in 1980, it has committed itself to making periodic policy updates. These updates entail regular monitoring, evaluating, rethinking and revising of how the Region approaches and implements its Health for All policy. On the one hand, the present update is mandatory. The WHO Regional Committee for Europe stipulated the next update of the Region's Health for All policy be submitted in 2005. On the other hand, this obligation is also opportune, or a good occasion to explore how the function of health systems is related to ethics and human rights. Moreover, this update gives us a chance to forge links between established WHO and Health for All concepts and public health policymaking at the beginning of the 21st century. The Tenth Standing Committee of the Regional Committee has been continuously involved in revisiting the European Region's Health for All policy framework. It has provided direction on the concept, process and methodology of the update. It suggested the ethics of the health system be at the heart of this update and endorsed the core values that underpin Health for All and Health21, which is the Health for All policy framework for the WHO European Region, the 1998 update. The Standing Committee also called for the current update to acknowledge changing political and economic circumstances and the growing need to translate values into guidelines and practical tools, despite the high complexity of such an endeavor. And it urged elaboration of the concept of ethical governance as a novel way of linking values to implementation. The Regional Committee discussed this policy update at two sessions, before and during its preparation. At the fifty-third session, Member States agreed the update should ensure continuity with Health21 while reflecting new knowledge and recent developments, and the core of the update should emphasize knowledge-based public health policies and the ethics of health systems. The Regional Committee also approved the methodology and approach to be taken by the Regional Office in preparing the update. Member States were then given a progress report at the fifty-fourth session. The Regional Office has also regarded the present update as an opportunity. It initiated the process early to allow ample collaboration and consultation with Member States. In 2003, when work began, the Regional Office decided it made sense to develop the document along three analytical axes. They comprise the three main pillars of the update, each answering one core question. The European Observatory on Health Systems and Policies Responded to this question by conducting a comprehensive overview of how the Health for All policy has been used in the European Region. To do so, the Observatory initiated two studies in 2003. The first study provides a synopsis of the de facto adoption and use of Health for All concepts in Member States. The second study, still under way at the time of publication of this update, assesses countries' experiences with health target programmes and describes the design and implementation of national health targets. To assist with the policy-making decisions, an international think-tank was assembled, consisting of experts with broad knowledge and experience in formulating, assessing and implementing health policies internationally, nationally and sub-nationally. Putting Health for All into practice offers many challenges. To achieve this goal a review was conducted of available tools that might enable decision-makers to construct national Health for All policies and programmes. A wide range of such tools already exists in many countries. While they have not been explicitly developed to implement or assess values, they can be used to do so. From the tools reviewed, ten main types were chosen to exemplify the possibilities. The selection was based on whether a given type had proven useful at a national level, was holistic and adaptable, had been tested, was undergoing further improvement and was available. The methodology and the suggested tools are presented in this report. In addition, they offer policymakers some guidelines for determining how well their own national health policies promote Health for All. This update of the European Health for All policy framework has been developed to be inspiring rather than prescriptive. It does not provide a model for Member States to adopt or emulate, but merely offers a possible architecture for health policy; that is, one based on a particular vision and values. In developing their own policies, countries are invited to use this framework in whatever way seems most useful, adapting it to their specific health, economic, cultural and historical needs. Ultimately, the true determinant of success is how an individual country approaches such a process, and policymakers must decide for themselves which Health for All elements their national health policy will incorporate. In other words, the present update is meant to be a framework that encourages choice. For example, each country must decide itself whether to allocate specific funds for implementing the Health for All vision. Where financial resources are limited, such allocation might be used as a tool to ensure the Health for All values are respected within the health sector. However, the adoption of such a financial tool must be country-specific, and a recommendation cannot be made at the regional level. Another national choice to make is whether to adopt one single domestic Health for All policy, or to integrate Health for All into every existing national policy that has an impact on health, to ensure that it respects the Health for All values and conforms to the concept of ethical governance. It is important to emphasize the present document is only an update of the European Health for All policy framework, not a new policy. Only seven years have passed since the adoption of Health21. The Standing Committee of the Regional Committee felt that, given the relatively short time that has elapsed, it was premature to develop and propose an entirely new policy for the Region. Certainly, target-setting has been a traditional approach in the European Region's Health for All policy formulation. Recently, however, there has been a consensus that establishing common targets for all countries in the Region can often be artificial, unfair or simply uninspiring. It does not take into account significant differences in Member States' public health and economic development. Nonetheless, setting targets can be an important exercise at national and sometimes sub-national levels. National targets can be an excellent implementation and guidance tool, as well as a means for a country to articulate its degree of ambition. And when all stakeholders are involved, the formulation of national health targets can help ensure their joint ownership of health policy. The recommendations included in this update are not exhaustive, nor do they cover every field of public health. Instead, the focus is on fields and methods that are either new or have evolved significantly since 2000. Even though Health21 was adopted a short time ago, the intervening period has seen many significant changes in the health systems of Member States. Some of the experience and knowledge they have acquired is presented here. In other words, rather than attempting to produce an authoritative document that finalizes the Region's Health for All policy, this update aims to encourage an open-ended Health for All process. The Health for All policy framework can then be continuously enriched by the broad range of Health for All activities that individual countries themselves choose to carry out. Some countries may decide to develop and analyse national case studies. Other Member States may regard this update as an invitation to re-examine and revisit their health policies. Still others might devote special attention to the communications challenge that involves how best to communicate the Health for All values, the concept of health and human rights, and the model of ethical governance to different audiences and stakeholders. There may also be countries that elect to develop concrete benchmarks against which to measure the implementation of Health for All policies. Meanwhile, a given country might focus on the local level because it sees decentralization and the meeting of local health needs as essential in successfully implementing Health for All. In this way, a group of countries could invest effort in developing national and sub-national health targets and linking them to the United National Millennium Development Goals. Most of these ideas were suggested by individual countries during consultation on the present update. They are only a few among many possible national activities and developments that could help give the European Health for All process a new, open-ended dynamic. The process could serve as a forum for exchanging up-to-date health policy information, experiences and ideas. National and sub-national updates could in turn contribute elements and ideas to the continuing evolution of the regional Health for All policy, in a permanent process of renewal and improvement. Such a development would be the best testament to this document's relevance and usefulness. It is also hoped the present update will serve as a valuable tool for promoting the ethical development of health policies. The Health for All movement in the WHO European Region has been marked by continuity, and the present update is the latest step in a cumulative development. Since its adoption in 1998, Health21 has met with wide acceptance throughout the Region. That framework update conveyed a broad vision of public health, underpinned by the core values of the global Health for All movement, and it outlined the general approach and direction individual countries might take. It remains valid, and the present update reaffirms Health21 as the broad policy framework that guides the work of the Regional Office in its support for Member States. In particular, the update addresses Health21's call to "provide up-to-date, evidence-based tools that countries can use to turn policies on Health for All into action." It reiterates the significance of the 21 Health21 targets because "they provide a framework for the Region as a whole, and an inspiration for the construction of targets at the country and local levels." Health21 describes its own set of targets by saying they are not meant to be prescriptive, but together they make up the essence of the regional policy. The present update maintains this flexible approach. In short, the current document amplifies Health21's role as "fundamentally, a charter for social justice, providing a science-based guide to better health development and outlining a process that will lead to progressive improvement in people's health." The present Health for All update is also consistent with other major health policy formulations. For instance, the update has been developed in connection with WHO's Eleventh General Programme of Work, which was carefully prepared and sought, when adopted in 2006, to outline the main directions for the Organization's work through 2015. The two documents share a number of key characteristics, notably a common foundation in core WHO and Health for All values, a reaffirmation of the guiding role these values play in WHO work, a particular focus on the rights and needs of vulnerable populations, and a flexible approach to national circumstances in the implementation of policy. This update is also strongly linked to several of the Regional Office's key policies. In particular, its recognition of the need for a country-specific approach to health and for national interpretation and implementation of Region-wide concepts supports the vision espoused by the Regional Office's Country Strategy, or "Matching services to new needs." The Health for All update and the Country Strategy are also united in their call for developing partnerships outside the health sector. Moreover, in consonance with the next phase of the Country Strategy, which is focused on strengthening health systems, this update places strong emphasis on health systems as the appropriate setting for national Health for All efforts. The update is also consistent with the position taken by the Regional Office on the United Nations MDGs. The values of equity, solidarity and participation at the centre of the Health for All update also lie at the heart of the Regional Office's MDG strategy. These three values are especially significant due to the economic heterogeneity of the Region, in which poverty continues to require a great deal of attention not only in low-and middle-income countries, but also in the richest countries. These values are highlighted by MDG strategy's emphasis on two problems; namely, how to achieve the MDGs in countries where they are unlikely to be met, and how to identify from the national aggregate data in individual countries the vulnerable sub-populations the MDGs are most relevant to and then direct efforts accordingly. The 1946 Constitution of the World Health Organization states "the health of all peoples is fundamental to the attainment of peace and security." The Constitution also recognizes "the enjoyment of the highest attainable standard of health" as a fundamental human right. By the late 1970s, the widespread enjoyment of this right was still far from being achieved, with about one thousand million people in the world living in such poverty that acceptable standards of health were quite impossible. Recognizing the challenge, WHO and its Member States set about creating a special framework to help translate the vision of universal health into a strategy and policy. The process began in 1977 with a call for national governments and WHO to work towards one goal; namely, enabling all the world's citizens to enjoy by 2000 a level of health that would allow them to lead a socially active and economically productive life. This vision and movement have come to be known as Health for All. The Health for All concept was subsequently introduced at the 1978 International Conference on Primary Health Care in Alma-Ata, the former USSR. The Declaration of Alma-Ata states that attaining Health for All as part of overall development starts with primary health care based on "acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost the community and the country can afford." Since then, Member States have been urged to consider the Health for All concept when formulating policies and action plans. It was believed that, by interpreting Health for All in a national social, political and developmental context, each country would be able to contribute to the global aim of Health for All by the year 2000. The call for Health for All was, and fundamentally remains, a call for social justice, equity, and solidarity, and a societal response that strives for unity in diversity. Rather than enshrining a single finite goal, Health for All is instead a process of bringing countries to progressive improvement in the health of all their citizens. Globally, WHO has continued to pursue its own commitment to Health for All by adopting in 1981 the Global Strategy for Health for All by the year 2000 and approving, one year later, a global action plan for implementing the Strategy. In 1980, the Regional Committee for Europe approved a European strategy for attaining Health for All by the year 2000. It decided to monitor the Strategy's implementation every two years, beginning in 1983, and to evaluate its effectiveness every six years, beginning in 1985. Following the initial launch of a European Health for All policy, the Regional Committee asked for the formulation of specific regional targets to assist in implementation of the regional strategy. Such targets were thought necessary in order to motivate and actively involve Member States in committing to Health for All. The first Health for All policy and targets in support of the regional strategy were adopted in 1984. They provided a broad, but precisely drawn vision of health development in the Region. They also outlined a clear ethical framework for policy development. Instead of focusing solely on inputs to health services, which is characteristic of an inward-looking, hospital-oriented health sector, they also emphasized outcomes, encouraging a shift to a health sector that reaches out and is oriented towards primary care. In addition, a list of 65 indicators, linked to the 38 regional targets, was devised to measure progress. In the same year, the Regional Committee also adopted an action plan for implementing the regional strategy. This framework described the roles and actions to be taken by the Member States, the Regional Committee and the Regional Office, respectively. While the plan was again directly linked to the regional targets, it also left room for each country to define its own priorities and strategies. With the adoption of these three documents in 1984, the Regional Committee created a framework for health policies in the Region. At the same time, it also established a mechanism to regularly monitor and evaluate progress towards achieving Health for All in the Region by 2000. As a consequence of this commitment, an update of the regional policy, strategy and targets was made in 1991. Meanwhile, the Regional Committee also assessed progress towards the regional targets every three years. In 1998, a revised European Health for All policy framework, entitled Health21, was adopted. It reflected the extraordinary changes that had occurred in the Region since the previous regional policy, including the addition of 20 new pluralistic societies and their emerging voices, as well as, despite many positive developments, severe economic downturns that had led to major crises in the health sector. Health 21 articulates two primary aims, three basic values and four main strategies. Its 21 targets also provide benchmarks to measure progress in improving and protecting health and in reducing health risks. Health for All is and has always been about values, and the Health for All policy framework links a set of basic values to the development of health policy. Among them, the core Health for All value is equity. In the Health for All context, equity means that everyone has a fair opportunity to attain his or her full health potential. A concern for equity has direct implications for how decision-makers choose their priorities in health policy and for how they decide which public health issues and which population groups merit the most attention. Health policies built on concern for equity will ensure health services are fairly distributed within the population. This could mean priority is given to the poor and other vulnerable and socially marginalized groups. Health systems based on equity contribute to the empowerment and social inclusion of such disadvantaged groups. Health for All also incorporates the closely linked value of solidarity, which is usually interpreted as a society's sense of collective responsibility. In Health for All contexts, solidarity means everyone contributes to the health system according to his or her ability. Solidarity can be seen as a way to ensure equity. A health policy that promotes solidarity is better able to counterbalance the unequal impact of health determinants on access to services and health outcomes. In contrast, a health policy that does not value solidarity will typically privilege those who are already wealthy, more educated and more proactive in taking advantage of health-care entitlements.­ Equity and solidarity are directly linked to a third value that has become increasingly important in the Health for All movement, and that is participation. The active participation of health system stakeholders, including both individuals and organizations, improves the quality of public health decision-making. These three values of equity, solidarity and participation directly affect health-system financing, access to health services, efforts to improve population health and the development of high-quality programmes in the sector. They also affect the dissemination of health information, since the uneven dissemination of information contributes to inequity and, conversely, information-sharing is an important tool in combating it. While there will always be a need to pitch some health communications to the general population, focus on particular, individual lifestyle choices and behaviors should not undermine the importance of public health policies and structural, inter-sector initiatives. Respect for core societal values, or a lack thereof, affects such policies and initiatives as much as it does the population served. In accordance with the Health for All policy framework, a health policy should address more than just patient care. Today, this belief appears to be widespread, especially in countries that have adopted and developed national Health for All policies. Nevertheless, policymakers throughout the European Region often find it difficult to incorporate other elements in their health policies. In several countries, these policies revolve chiefly around health care. Though the Health for All framework recognizes the quality of patient care contributes significantly to a population's health status, it regards care as only one of many factors in health improvement. Other major influences include the variety of social and economic circumstances in which people live and work. There is ample evidence these structural determinants of population health play a key role in this rapidly changing Region. That is why the Health for All framework calls for policymakers to look beyond health care and recommends a better policy balance among all the key factors that contribute to population health. In a Health for All policy, such a balance will be necessarily reflected in the budget allocations. This plan is in tune with some countries' efforts to improve the effectiveness of disease-specific programmes by adopting a more general approach to strengthening their national health systems. In the Health for All vision, health improvement is not the exclusive responsibility of the health sector. There are far too many examples of how other sectors' policies can lead to an increase in poor health that the health sector must address. Such problems can be avoided by involving other sectors in health improvement. Tobacco, alcohol and nutrition are just three examples of issues on which it is advantageous for the health sector to collaborate with other sectors, such as environment, education, agriculture and industry. Working internationally enhances efficiency and provides many additional opportunities for health interventions. For instance, health system development should be placed high on local, regional and national development agendas, rather than confined solely to the health sector as an item of public expenditure. Healthier people have greater human capital, and therefore, the health sector has significant potential to impact the overall development and economic growth of a country. This interaction between health and other sectors is a two-way process. Non-health professionals, such as teachers or economists, can also play an important role in health issues. However, it is important to remember that such professionals are often just the most visible elements of other sectors that impact health, so values such as equity in health need to be linked to the entire structure of each of these sectors. Health systems are societal institutions and, as such, their development needs to be based on and driven by values. For a national health system to be consistent with the Health for All vision and values, it must have several important features. There should be enough functioning health and public health facilities, goods and services to meet the needs of everyone in the country. Programme capacities should be similarly sufficient. The determination of what is necessary for a particular country depends on the national context and level of development. The need for accessibility applies to every element of the health sector, but it is particularly critical for primary care. Access has an economic dimension, which is affordability, a geographical dimension, which is physical accessibility, an ethical and human rights dimension, which is accessibility to all population groups equally, without discrimination, and a communications dimension, or accessibility of information. All health facilities, goods and services, including communication and information, should be culturally appropriate and respectful of cultural differences and traditions. Mechanisms to ensure the continuous improvement and upgrading of health services have become increasingly important to Health for All polices. The benefits of such changes should be evenly distributed among all groups, not just available to those who can pay for them. Quality improvement efforts should focus on how much particular changes can improve health. For instance, adopting procedures that ensure patient safety is one efficient way to boost quality. The benefits of quality improvement include better health, improved relations between the general public and health professionals, and a decrease in costly failures in patient treatment. In Europe, health systems can be described as having three essential goals; namely, health gain, fairness and responsiveness. All three are in harmony with the Health for All concept. Improved health is not only an end in itself, but also a major factor for overall development, which is another reason why health gains should be equally distributed among all population groups. Fairness in financial contributions to health requires there be sufficient funding to enable universal access to health services without forcing individuals or families into poverty. A health system that is driven by Health for All goals should also respond to non-medical expectations of both individuals and society; for instance, by safeguarding patient dignity, confidentiality and autonomy; respecting patient rights; being sensitive to the specific needs and vulnerabilities of all population groups; and promoting social inclusion and poverty reduction. Finally, a health system that respects Health for All is efficient, by producing the best health outcomes from available resources. The way a health system works reflects ethical choices. This plan is true for the four core functions of a health system; namely, provision of services, finances, resource generation, and stewardship and governance. Of these, the biggest challenge to solidarity and equity lies in how a health system is financed. In a system based on the Health for All values, budgets should be drawn up to reflect the relative contributions of the various budget items to health improvement. For example, a policy that favours sophisticated high-technology investments should make sure all population groups benefit. The Health for All concept calls for a broad partnership approach to health. The Regional Office for Europe works with a range of international partners, including the Council of Europe, the World Bank, the European Commission, nongovernmental organizations and private partners. This cooperation helps ensure the support the Regional Office provides to individual countries is consistent with that provided by other public health stakeholders. Such a collaborative approach also makes better health outcomes possible by uniting the forces of disparate partners and setting common agendas, while exploiting each one's specific strengths and capabilities. With regard to the Health for All policy framework, such synergy is essential. The European Region shares certain common societal values, and respect for these values is seen in the policies and actions of all international stakeholders. A good example is the work done within the European Union (EU) system. Through its legal and financial mechanisms, the EU has achieved a great deal in public health throughout the WHO European Region. For instance, not only are environmental standards now enshrined in EU legislation, they are also automatically applied to countries joining the EU and used as reference standards by neighbouring countries. In addition, numerous EU institutions contribute to health-related activities, such as the European development banks and the European Commission with their Public Health, Technical Assistance to the Commonwealth of Independent States and Phare programmes. In general, EU legislation strengthens the cause of health in every policy that affects the social and economic development of its Member States. A common ground of shared values makes international partnerships for health easier to sustain. At present, the Health for All concept and values permeate a variety of the European Region's technical policies; they also characterize the commitments that Member States have made before the Regional Committee. It would be a great step forward for the Region if the major stakeholders in public health were to enshrine in policy the concept of ethical, values-based governance. Of the 52 health policies analysed, 40 policies satisfy all four Health for All criteria that have been discussed. Nine of the qualifying ones exist only as draft health policies, although some Member States that are currently drafting such policies previously had other Health for All policies in place. Among the twelve Member States without qualifying policies, two have International health policy documents that satisfy all the criteria. The Russian Federation provides a unique example. It has issued a number of Health for All policy papers focusing on single sectors, most notably health care delivery.

The World Health Organization was established in 1948 as the apecialized agency of the United Nations responsible for directing and coordinating authority for international health matters and public health. One of WHO's constitutional functions is to provide objective and reliable information and advice in the field of human health. It fulfils this responsibility in part through its publication programmes, seeking to help countries make policies that benefit public health and address their most pressing public health concerns. The WHO Regional Office for Europe is one of six regional offices throughout the world, each with its own programme gearsed to the particular health problems of the countries it serves. The European Region embraces some 880 million people living in an area stretching from the Arctic Ocean in the north and the Mediterranean Sea in the south and from the Atlantic Ocean in the west to the Pacific Ocean in the east. The European programme of WHO supports all countries in the Region in developing and sustaining their own health policies, systems and programmes; preventing and overcoming threats to health; preparing for future health challenges; and advocating and implementing public health activities. To ensure the widest possible availability of authoritative information and guidance on health matters, WHO secures broad international distribution of its publications and encourages their translation and and adaptation. By helping to promote and protect health and prevent and control disease, WHO's books contribute to achieving the Organization's principal objective, which is the attainment by all people of the highest possible level of health. Ever since the WHO European Region launched its first regional Health for All strategy in 1980, it has committed itself to making periodic policy updates. These updates entail regular monitoring, evaluating, rethinking and revising of how the Region approaches and implements its Health for All policy. On the one hand, the present update is mandatory. The WHO Regional Committee for Europe stipulated the next update of the Region's Health for All policy be submitted in 2005. On the other hand, this obligation is also opportune, or a good occasion to explere how the function of health systems is related to ethics and human rights. Moreover, this update gives us a chance to forge links between established WHO and Health for All concepts and public health policymaking at the beginning of the 21st century. The Tenth Standing Committee of the Regional Committee has been continuously involved in revisiting the European Region's Health for All policy framework. It has provided direction on the concept, process and methodology of the update. It suggested the ethics of the health system be at the heart of this update and endorsed the core values that underpin Health for All and Health21, which is the Health for All policy framework for the WHO European Region, the 1998 update. The Standing Committee also called for the current update to acknowledge changing political and economic circumstances and the growing need to transalate values into guidelines and practical tools, despite the high complexity of such an endeavor. And it urged elaboration of the concept of ethical governance as a novel way of linking values to implementation. The Regional Committee discussed this policy update at two sessions, begore and during its preparation. At the fifty-third session, Member States agreed the update should ensure continuity with Health21 while reflecting new knowledge and recent developments, and the core of the update should emphasize knowledge-based public health policies and the ethics of health systems. The Regional Committee also approved the methodology and approach to be taken by the Regional Office in preparing the update. Member States were then given a progress report at the fifty-fourth session. The Regional Office has also regarded the present update as an opportunity. It initiated the process early to allow ample collaboration and consultation with Member States. In 2003, when work began, the Regional Office decided it made sense to develop the document along three analytical axes. Theycomprise the three main pillars of the update, each answering one core question. The European Observatory on Health Systems and Policies Responded to this question by conducting a comprehensive overview of how the Health for All policy has been used in the European Region. To do so, the Observatory initiated two studies in 2003. The first study provides a synopsis of the de facto adoption and use of Health for All concepts in Member States. The second study, still under way at the time of publication of this update, assesses countries' experiences with health target prograammes and describes the desighn and implementation of national health targets. To assist with the policy-making decisions, an international think-tank was assembled, consisting of experts with broad knowledge and experience in formulating, assessing and implementing health policies internationally, nationally and sub-nationally. Putting Health for All into practice offers many challenges. To achive this goal a review was conducted of available tools that might enable decision-makers to construct national Health for All policies and programmes. A wide range of such tools already exists in many countries. While they have not been explicitly developed to implement or assess values, they can be used to do so. From the tools reviewed, ten main types were chosen to exemplify the possibilities. The selection was based on whether a given type had proven useful at a national level, was holistic and adaptable, had been tested, was undergoing further improvement and was available. The methodology and the sugested tools are presented in this report. In addition, they offer policymakers some guidelines for determining how well their own national health policies promote Health for All. This update of the European Health for All policy framework has been developed to be instpiring rather than prescriptive. It does not provide a model for Member States to adopt or emulate, but merely offers a possible architecture for health policy; that is, one based on a particular vision and values. In developing their own policies, countries are invited to use this framework in whatever way seems most useful, adapting it to their specific health, economic, cultural and historical needs. Ultimately, the true determinant of success is how an individual country approaches such a process, and policymakers must decide for themselves which Health for All elements their national health policy will incorporate. In o words, the present update is meant to be a framework that ancourages choice. For example, each country must decide itself whether to allocate specific funds for implementing the Health for All vision. Where financial resources are limited, such allocation might be used as a tool to ensure the Health for All values are respected within the health sector. However, the adoption of such a financial tool must be country-specific, and a recommendation cannot be made at the regional level. Another national choice to make is whether to adopt one single domestic Health for All policy, or to integrate Health for All into every existing national policy that has an impact on health, to ensure that it respects the Health for All values and conforms to the concept of ethical governance. It is important to emphasize the present dorument is only an update of the European Health for All policy framework, not a new policy. Only seven years have passed since the adoption of Health21. The Standing Committee of the Regional Committee felt that, given the relatively short time that has elapsed, it was premature to develop and propose an entirely new policy for the Region. Certainly, tarkeg-setting has been a traditional approach in the European Region's Health for All policy formulation. Recently, however, there has been a consensus that establishing common targets for all countries in the Region can often be artificial, unfir or simply uninspiring. It does not take into account significant differences in Member States' public health and economic development. Nonetheless, setting targets can be an important exercise at national and sometimes sub-national levels. National targets can be an ex