There is a lot that the new EU4Health programme can do to enable to scale up health promotion and disease prevention in sustainable ways.
Ms Costongs focused on three areas:
- Helping authorities and MS to make the transition from unsustainable care systems to more health promoting health systems through use of new models
- Continuing the valuable exchange of promising practices in critical areas for health and health inequalities.
- Strengthening the capacity of health systems to engage with other sectors and stakeholders
1. Help Member States to explore how to move from health care systems to health promoting system through new models that put more emphasis on:
- Primary/community care, where public health, health promotion and disease prevention are integrated. In Slovenia, they have a network of 60 health promotion offices, which are one-Stop Shops for personalised support.
- Digital innovations, which help GPs to develop more holistic and personalised prevention plans with patients, and link them up to other services.
This can also involve prescription of non-medical treatments, like exercise, or nutrition, programmes to combat loneliness, employment support, develop skills etc. Portugal for example is working on social prescribing.
- Models that transform how we finance health systems – design instruments to fund prevention and calculate the savings made to health care and other costs. Financing for ‘health’, rather than ‘sickness’. In the Netherlands health insurers pay individuals for taking part in evidence-based, lifestyle interventions (GLI) taking socio-economic contexts into account.
2. The EU4Health programme should continue the valuable exchange of promising practices in critical areas for health and health inequalities. it should support the transfer of elements of these approaches to other parts of Europe to instigate discussion and system change.
- In the area of child health. Health problems accumulate over the life course, and action in early years provide a great return on investments. This means exchanges on quality early childhood programmes and parenting courses, on free, nutritious school meals, and on physical activity and mental well-being programmes in schools. The EU4Health Programme should align its work with the EU Child Guarantee which is being launched today.
- In the area of health literacy and digital health literacy; ensure that vulnerable people can access and use digital tools to make their experiences and voices better heard.
- In the area of Mental health It is also crucial to ensure more transnational exchange and learning.
3. Strengthen the capacity of health systems to engage with other actors at all levels (HiAPP), address ways our societies are structures, dealing with strong market forces that impact our health.
- It is vital to link up with strategies that combat the climate crisis. We need to improve air quality, access to green spaces, invest in affordable quality and healthy housing, cycling, walking, public transport, address food deserts. All this has a huge impact on health and disease.
- Health authorities can exchange learning on how to use municipalities as innovators. Health as a driving force for change at the local level, with a specific focus on deprived areas. In Finland they have local wellbeing strategies which are embedded into national and regional plans.
- The EU4Health programme should give health authorities better insight into the levers the European Commission has to address the commercial determinants of health, and encourage cooperation: this includes market regulation, measures around alcohol, tobacco, food and food labelling – but also the European Semester process to steer health reforms to health promoting health systems, and linking it to the European Pillar of Social Rights to address the social determinants of health.
We need many more resources to promote and cultivate the talent that is needed to design, implement, and evaluate effective policies, programmes and initiatives and to strengthen the capacities of health professionals in these areas.
EuroHealthNet, as the partnership of public health authorities is keen to support such measures to move to more health promoting systems, exchange good practice and strengthen capacities to engage with other sectors.
- There is evidence that more health spending doesn’t automatically lead to better health outcomes. Only if we target inequalities in health and inequitable access to health services, will we be able to have significant health impact. And also only if we achieve this paradigm change: one that moves away from cure and care systems and put more emphasis on promoting health, prevent and that ‘heal and deal’ with disease.
- EC and MS must invest in the collection of better comparable data on health inequalities as well as on NCDs (diabetes, mental health etc) at national, regional and local level, and their cost to societies, to understand the problem and be able to gather the evidence on the effectiveness of measures taken.
- In our experience EU funds are extremely useful for cross country learning and reduce inequalities in capacity between countries and regions. This can include learning about useful structures (e.g., Health Inequality units at cabinet level or within Health Ministries) as well as tools (HIA, HEA, strategies like joint budgeting, communication tools, evidence).
- The EU4Health Programme should facilitate exchanges on ‘systems and processes’ and move away from just looking at ‘outcomes and impacts’. Tackling health inequalities and chronic diseases cannot be solved with easy and quick solutions, and impacts are really difficult to assess in particular in short time frames.
- Some of the mechanisms in the past did not work, because they were too top-down. For example, The current Joint Action funding mechanism only allows participation of Ministries of Health and delegated bodies. Other stakeholders, experts or civil society, who would bring value, cannot participate. The new funding mechanisms need to support movements for change, involve citizens, co-produce solutions and facilitate working across countries at sub-national levels too.