The EU Semester undervalues health promotion and investment in health across the life course in its recommendations to countries

Ministers for employment, social affairs and health gather on 18-19 June to discuss the next steps in the European Semester process. They will discuss the social and employment aspects of the Country-Specific Recommendations (CSRs) (1), including those related to health. Outcomes of the discussions will feed into the CSRs, due to be endorsed by the European Council at its meeting on 25-26 June.

EuroHealthNet is highly concerned about the reduced focus on health promotion and integrated services that prevent and tackle the underlying causes of poor health, as part of health system reform recommendations. For pensions, efforts need to be stepped up to improve health equity across the life course, particularly in countries where the differences between retirement ages and lower healthy life expectancy are pronounced. The EU Semester also lacks recommendations on adequate investment in children and families, as services and support need to be both universal and responsive to need in order to achieve health equity.

Following the release of the recommendations in May, EuroHealthNet analysed all the CSRs (2), looking at three issues: 1) recommendations to increase retirement ages, 2) recommendations aimed at children and families, and 3) recommendations concerning health.

The analysis finds that:

  • Simple calls to increase SR ‘in line with life expectancy’ need to be considered in the light of HLY. Only 6 of the 13 countries receiving CSRs to increase pension/retirement age can expect people to work longer without facing long-term activity limitations; of these, only 4 would be able to do so for both sexes. While activity limitations do not necessarily mean people cannot continue working, they do suggest that adaptations and efforts are needed to keep workers in the labour market. Lower socio-economic status (SES) groups have much lower HLY than higher SES groups, so increasing statutory retirement ages without sensitivity to poor health status is likely to affect already disadvantaged people disproportionally.
  • For child and family CSRs, too little emphasis is placed on early investment in early child development or on encouraging early intervention. Just three countries received a CSR on early intervention in 2015. This is extremely worrying, given that early intervention is widely considered one of the most effective means of preventing health and social problems later on.
  • CSRs related to health are characterised by a contradiction: they focus on cost-effectiveness, performance and the efficient use of resources while failing to mention health promotion and disease prevention, the importance of mental health or the need to address health inequalities. Yet cost-effectiveness and efficient use of resources is not possible without focusing on these latter issues. (3)

 “Our analysis clearly shows that the EU Semester undervalues the crucial role of health promotion and health investment throughout the life course. Heads of state and governments have time to reconsider the design of CSRs so that reforms are implemented that not only benefit health and wellbeing for all European citizens, but contribute to long-term economic recovery at the same time”, states Caroline Costongs, EuroHealthNet Managing Director.


Notes to editors:

  1. Ministers will hold a policy debate on the employment and social policy measures contained in the Country-Specific Recommendations. These recommendations offer tailored advice on actions that each EU country should take to meet commonly agreed objectives.
  2. The document is available here
  3. To access directly the document, click here
  4. A recent paper by DG Economic and Financial Affairs (ECFIN) notes “it is universally acknowledged that lifestyle factors, such as tobacco smoking, obesity, wrong diet and lack of physical activity have a significant impact on health outcomes, increasing demand for health services. Major chronic diseases can often be prevented through lifestyle changes. Prevention policies may lead to a longer period of life without diseases and reduce costs. However, the health benefits of prevention may also increase the overall life span in such a way that especially older people can live longer but with chronic diseases… moving resources from treatment to prevention of cardiovascular diseases or diabetes will increase the cost-effectiveness of spending, while relying on treatment alone will be suboptimal”. Available here.

For more information, contact EuroHealthNet Policy & Research Senior Co-ordinator Linden Farrer.