There continue to be big differences in health outcomes between groups of people and between countries in the European Union. To address these inequalities and to improve health for all, we need a new narrative on economic and fiscal policy. A process-focused, holistic approach is now needed, one which incorporates social sustainability and health equity. The European Council Conclusions on the Economy of Well-being are a crucial development. The European Semester is an important tool for implementation.

The national, regional, and local health bodies that make up the EuroHealthNet partnership are working to address health inequalities and their root causes. They need structural support and investments through ambitious changes at the European Union level to make real impacts. We recommend the development of a reformed European Semester that implements the Sustainable Development Goals as well as the European Pillar of Social Rights.

The effective and equitable digital transformation of health systems can have many benefits. People who are digitally health literate – those that can gain and use knowledge from electronic sources to solve a health problem – are more able to manage personal health and care issues. Better prevention models can be developed, and healthy behaviours supported.
However, there is a risk that the most vulnerable people are left behind in the transition.
People with lower social and economic status have a higher burden of disease. They also face more barriers to accessing and using information. Ensuring that they benefit from the digital transition requires action within health and other sectors; innovation within states and companies; the development of professionals and services; and wider improvements in education, and social justice and inclusion.
EuroHealthNet’s policy precis examines the issue, the policies influencing them, and what policies and practices will help us make progress.

The number of years spent in formal education is closely related to health outcomes, both amongst individuals and across populations. Equally, health status in early years and later in life affects our ability to participate in education and society. The main factor that determines both health and educational outcomes is socio-economic status. By investing in good quality, accessible education – especially in early years – we can start to break and prevent the cycle of poverty and social exclusion, and its harmful effects on mental and physical health.

This exercise aims to help refocus the EU and support its Member States’ efforts towards “future-proofing our policies”, to promote more effective responses to emerging challenges and opportunities, and to improve linking policies in different areas so they work towards common long-term objectives and re-engage with citizens on Europe’s future.

EuroHealthNet draws attention to the need to provide responses to persisting problems of unsustainable healthcare systems, and undervalued and underfunded public health measures (prevention and health promotion). These problems are going to be aggravated by the heavy impact of the COVID-19 pandemic. The lives of people living in deprivation will bear the heaviest effects. The lessons from COVID-19 also indicate the need to tackle avoidable health inequalities, boost health literacy and embrace more holistic approaches. It is essential that social protection systems are proportionately universal and well-resourced, with equitable employment and income support provided and accessible across borders.

We strongly support a comprehensive, ambitious, and truly transformative transition to European food systems that put people and planetary health, sustainability, and social equity at the centre. In the framework of the European Green Deal, this strategy offers an important opportunity to design and deliver a coherent response to the health, social, and environmental challenges related to unsustainable food production and consumption patterns.

Unhealthy diets – a major contributor to a NCDs pandemic – are already responsible for over 950,000 deaths and 16 million DALYs lost in the EU (the 2017 Global Burden of Disease). Today’s food systems are perpetuating and driving up health inequalities – which is conspicuously missing from this proposed strategic thinking. There is an abundance of evidence to show that sedentary and unhealthy lifestyles of people are heavily influenced by their social, economic, and environmental circumstances and cultural contexts. Therefore, a pivotal role for a modern, fit-for-purpose Farm to Fork^[1] strategy will be in creating food environments where ‘a healthy choice is an easy choice’ for all. EuroHealthNet counsels against disproportionate focus on ‘downstream’, ‘personalised’, or lifestyle-oriented measures (information, education) without real appreciation of the underlying causes of ill-health and disease, the social determinants of health. Those down-stream measures are part of a solution, but not enough to drive the transformative changes needed.

[1] European Council; Council conclusions on food product improvement(2016/C 269/04)

To be successful, however, ambitious commitment must be made to urgently address the large scale of social and economic inequalities in cancer-related health outcomes and in population-wide opportunities for prevention.

Disadvantaged groups in all EU countries and in different regions in Europe are at a higher risk from most of the common cancers due to a combination of higher exposure to risk factors, poorer access to cancer preventive measures and health services in general, and less capacity to deal with the social, employment, and financial consequences of the disease. Further disparities may occur in terms of informal care and peer-support required, return to work arrangements, or need for long-term care.

Europe should also better contribute to more cost-effective approaches to health care delivery while meeting the needs and demands of local populations. Technical and structural support to Member States, regional and local authorities can target better investments in health promotion and preventative measures as part of strengthened primary health care systems.

Finally, EuroHealthNet suggests giving due attention to developments in the field of task-shifting within health systems, which has the potential to contribute to the sustainability of the health workforce and financial sustainability of health systems, and can be a means to improve quality of care as well as its social impact. It can also offer new ways of delivering preventative and health-enabling activities. To this end, however, not only traditional roles of health professionals should be reviewed, but also the role of patients, their communities and healthy populations in their wellbeing co-creation process.

This public consultation was an integral part of the evaluation of ESF. It sought feedback from all stakeholders of the ESF in the EU countries, as well as from the wider public.

EuroHealthNet stressed its concern that, although the European Social Fund has played an important role in fostering employability across the EU, there are persistent disparities within and between countries and regions, and certain groups. High and rising in-work poverty rates are also noted.  This suggests that the EU policy actions on employment and social inclusion need to be reviewed. A siloed focus on fragmented labour market policies and skills development is not enough to stabilise work and life conditions for all. To build a productive and resilient society, capable to adapt and withstand economic fluctuations, the ESF should be rooted in holistic approaches that integrate employment with health and other social inclusion policies, ensuring that no vulnerable groups are left behind. (Un)employment initiatives that reach out towards health and social protection services with an aim to improve health and well-being of people, and give them equal opportunities to contribute to a society life-long are good investments.

EuroHealthNet responded to a consultation for the Horizon Europe framework that focused on questions that had not been addressed in earlier consultations.

In its response, EuroHealthNet welcomes the interconnected character of the Horizon Europe (HE) targeted impacts, which brings more coherence to the overall impact of the programme. Overall priorities related to the ‘European Green Deal’, ‘Economy that works for people’, and ‘Europe fit for the digital age’ can be reached through HE investments. From a public health perspective, environments in which we live determine health and wellbeing, and environmental inequalities are subject to a differential and often unfair distribution in populations. Horizon Europe should be able to provide relevant evidence and ensure that the transition to greater sustainability is feasible for all as well as being socially fair.

The programme concerns both the research and innovation area but also the European socio-economic model at large. Horizon Europe should guarantee that the benefits of furthering evidence and innovation are inclusive and accessible, respond to public needs and advance societal health and wellbeing.

EuroHealthNet welcomed the Draft Opinion as a useful contribution to develop strategic approaches to implementing health promotion within the EU region and strengthening the integration of health promotion within health systems. Recognising that health promotion is an essential strategic approach for addressing health inequalities and wider systemic determinants of physical and mental health is a fundamental message that should underpin further action on transformation of health, care and wider public systems in Europe.

However, we suggest that the Opinion should clarify the responsibilities and accountabilities of the EU and Member States, and to set out potential measures in terms of time frame. EuroHealthNet also suggested to strengthen the opinion as follows:

• Clarify what is meant by health promoting systems.
• Include a stronger focus on digital transformation and digital health.
• Consider the underpinning of macro-economic perspective in achieving health promoting health systems.
• Ensure capacity building in human resources, institutional structures, and processes for health promotion.
• Highlight the importance of sustained multi-level partnerships for health promotion.
• Reinforce leadership and coordination at EU-levels.
• Emphasise the reorientation of a medical model of health and addressing the ‘lifestyle drift’ of health promotion.

In our responses we urged to consider equity and social fairness, as only then innovative health interventions can make a significant contribution to addressing the challenges identified in the proposed initiative. If left unchecked, the transformative potential of digitalisation or innovations in the field of health may remain inaccessible or too costly to benefit all population groups. Better digital health literacy, broader R&I understanding of the structural causes of disease and paths that lead to better health and wellbeing, the continuum of care, and life-course approach may offer a much- needed change of R&I narrative. Preventative, people-centred and integrated care, addressing key determinants of health, should always constitute an integral part of the European Partnership on Innovative Health.

Digital technologies offer new opportunities to strengthen – in a balanced way – the public and private sector, and they are crucial to ensure sustainability, growth and equity in the EU. Digital innovation can bring new opportunities to transform health systems, including new approaches to health protection and promotion, treatments and care, accelerated scientific progress for early diagnosis, and prevention of diseases. Importantly, new digital technologies can contribute to reducing inequalities, by lowering costs, expanding coverage and improving access to and quality of public services, such as health, social protection and education.

While EuroHealthNet supports strategic approaches and forward-thinking set out throughout the accelerator discussion documents, we believe that important equity-related issues should be addressed and further strengthened in the final Global Action Plan for Healthy Lives and Well-Being for All. In our response, we set out how the strategy can better address health inequalities.

EuroHealthNet highlighted the strong links between the environment, health, and inequalities, and urged the Commission to take these links into account in all aspects of the proposed climate law, building environmental policy whilst looking through health and equity lenses. We recommended that the studies and assessments foreseen in the climate law take into account inequalities and the distributional impacts of policies or interventions on people across socio-economic gradients. Whilst recognising that EU Institutions have limited competencies to ensure Member States’ compliance with the law, we also wonder if stronger measures could not be included that lie within the scope of their powers to hold EU Member States accountable. Measures that encourage and enable Member States to monitor implementation as well as effects on health and distributional effects, and benchmarking of Member States performance will in this respect be crucial.

As part of its strategy “Shaping Europe’s Digital Future”, the European Commission has put forward a European Strategy for Data. Seizing the opportunity, EuroHealthNet organised on the 14th of May an online discussion for its members to exchange on their expectations and concerns regarding the use of new digital technologies in public health. The discussion put a particular focus on data and systems and related technologies and their use in tackling the current health emergency as well as other societal challenges. The outcomes were integrated in the final answer to the consultation.

EuroHealthNet is an accredited non-state partner to WHO Europe, confirmed by the WHO Regional Committee in 2018. EuroHealthNet engages with the various WHO Europe offices in Copenhagen, Venice, Bonn and Brussels (Observatory) and we are part of the Advisory Group of the WHO Coalition of Partners (CoP).

In June 2019, WHO Venice held a High-level Conference on Health Equity in Ljubljana, Slovenia, that introduced the first WHO European Health Equity Status Report. It is a milestone report, marking persistent and increasing health inequalities in the WHO European Region. It confirms the importance of finding solutions beyond and outside the healthcare sector. EuroHealthNet President Mojca Gabrijelcic of NIJZ was closely involved in the organisation of the event and participated in a plenary session, while our Director Caroline Costongs took part in several formal and informal sessions and side meetings with Member State representatives, including our Executive Board members Mariana Dyakova of Public Health Wales and Frank Lehmann of BZgA (Germany).

The WHO Bonn office published the second WHO Assessment report on Environmental health inequalities in Europe. The report suggests that environmental risk factors account for at least 15% of mortality in the WHO European Region, equivalent to about 1.4 million deaths per year. It also suggests that environmental interventions are effective but are not reaching the most vulnerable. EuroHealthNet spoke at its launch event and stressed that measures that protect our environment must be equitable and not place a relative higher burden on the most disadvantaged.

In September 2019, during the 69^th WHO Euro Regional Committee Meeting, EuroHealthNet presented two statements:

• On Health Equity:  ‘Accelerating progress towards healthy prosperous lives for all, increasing equity in health and leaving no one behind in the European Region’
• On Health Literacy: ‘Roadmap for implementation of health literacy initiatives through the life course.’

In January 2020, we participated at an expert meeting to help develop the WHO European action plan on health literacy, building on the Roadmap 2019, in Copenhagen, hosted by the Danish Health Authority. The outcomes will be used to draft the vision, actions, expected outcomes and relevant indicators to guide the enhancement of health literacy related actions in the European Region by 2030 and beyond. A draft action plan will now be developed, and a wider consultation will be launched.

On 9 October 2019, the eve of World Mental Health Day, the Alliance organised an event about the future of work and mental health. The seminar addressed how changes in the world of work can impact mental health and well-being of workers, and what can be done to adequately address these changes.

The report briefly summarises the discussions of each panel and highlights the main recommendations that resulted from them.

Read the report.

This group brings together European networks representing social services, education, social housing, and ageing . The Steering Board is specially focused on monitoring of and engagement with plans for InvestEU and in particular its 4th window on social infrastructure investments. On 4 December 2019, the Steering Board and Mr Alfred Sant MEP co-organised the European Parliament event InvestEU and the Economy of Wellbeing: making the most of local know-how. With over 130 participants, the event engaged EU policy makers and investors on concrete steps to ensure that InvestEU brings genuine solutions to high-quality and innovative social, health, education, and housing projects. The major recommendation was to ensure that the Steering Board becomes a formal partner to help InvestEU reach its social impact potential in local communities across Europe. EuroHealthNet presented on the need to invest in health promotion and disease prevention as part of transforming health systems.

EuroHealthNet collaborated as part of the EU4Health Campaign on a job vacancy for the future health Commissioner, and a Guide and Phonebook for newly elected Members of the European Parliament (MEPs) on how they can improve people’s health in Europe.

EuroHealthNet led on the development of a joint contribution towards the Council Conclusions on the Economy of Wellbeing.