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Letter to EPSCO Council: The need for more effective investments and reforms towards sustainable health and care systems

5 December, 2018

As the December EU Employment, Social Policy, Health & Consumer Affairs Council (EPSCO) meets within the Austrian Presidency this 6-7 December to discuss the European Semester 2019 cycle, EuroHealthNet recommends you to take this important opportunity to act for more effective investments and reforms towards sustainable health and care systems including health promotion, disease prevention, and measures tackling health inequalities. These approaches are also cost-effective, bringing high social return on investment.  A move to a more social European Semester is good for health, good economically, and crucial for reducing health and social inequalities.

As the Annual Growth Survey 2019 (AGS) shows, despite broadly positive economic progress, significant social inequalities persist and, in some cases, have widened in our societies. The economic recovery has not yet reached all people to an equal degree and inequality of opportunities persist.  Poor living and working conditions are linked with poor and unequal health and wellbeing gains. This situation is echoed in recent important reports Health at A Glance 2018 and Inequalities in Access to Healthcare.

Encouraged by progress in applying the principles of the European Pillar of Social Rights and its – now updated – Social Scoreboard, we support the Semester’s potential contribution to monitoring social, health and wellbeing policies. Social inclusion policies and universal timely access to quality affordable health and care services can be further promoted in all Member States. Building resilience and capacities in health and social systems will be vital in 2019 and beyond given the risks indicated in the AGS.

EuroHealthNet reiterates its concern that prioritisation and direct funding for health promotion, disease prevention, and achieving health equity remain insufficient to make the sustainable impacts which you as Ministers have recommended in previous Council Conclusions and are reiterated in the AGS. While average annual total budgets for health promotion across Europe have stalled at 2.5% of total health spending, 70-80% of health-related costs are caused by largely preventable chronic diseases.  The European Commission’s own implementation analysis of the European Semester process shows that the strengthened Structural Reform Programme can help implement sustainable transformations and reorientation which bring multiple co-benefits to States.

We welcome the AGS highlighting that “the experience of civil society organisations plays an important role to ensure that reforms are designed and implemented effectively. Yet the degree of engagement with societal stakeholders varies significantly among member states, with insufficient capacity to actively participate in the policy debate being an issue in some of them”. In EuroHealthNet’s published report of our work with partners in Member States and analysis of the 2018 European Semester cycle, we explain why important voices remain unheard and offer concrete recommendations for using the Semester mechanisms as tools for addressing health equity from a socioeconomic determinants of health perspective. Putting the expertise of public health professionals and authorities central is key to the Semester Process.

This respects your national rights in the organisation and delivery of social and health care, and also enhances the principles of the EU Pillar of Social Rights and the competences of the EU treaties objectives for wellbeing and public health protection across all EU policies. This also prepares for the planned integration of EU health and social programmes within the ESF+ budget provisions of the Multi Annual Financial Framework 2021-27 and helps to prepare towards the new Horizon Europe and Invest EU Programmes.

EuroHealthNet works with partners for sustainable development actions towards the universal SDGs, and urges integration of cross cutting social, economic, and environmental sustainability metrics, indicators and measures in the EU Semester, which are crucial towards achieving social sustainability and wellbeing targets.

I therefore recommend you take concrete steps in the EPSCO Council to put better health for all, social equity and sustainable wellbeing at the core of the policy and implementation measures within the EU Semester in 2019 and beyond.

To make this happen, you can count on our continuous support and collaboration.


Yours faithfully,

Caroline Costongs

Director, EuroHealthNet



EuroHealthNet is the leading Partnership for Health, Equity and Wellbeing in Europe, with key activities in policy, practice as well as research. Its unique focus is on reducing health inequalities through action on the social determinants of health, integrating sustainable development goals, and contributing to the transformation of health systems. Its main members are authorities and statutory bodies responsible for public health, health promotion and disease prevention at national, regional and local level.


EuroHealthNet (2018). EuroHealthNet calls for new and improved approaches to financing for health promotion and health equity. Statement.
Masters, R. et al. (2016). Return on investment of public health interventions: a systematic review. Journal of Epidemiology and Community Health, vol.71(8)
OECD (2018). Health at a Glance: Europe 2018. State of Health in the EU Cycle.
ESPN (2018). Inequalities in access to healthcare. Thematic report.
Health-related Country Specific Recommendations receive the least attention and the lowest level of national implementation among all other areas (see: European Commission Communication on the CSRs 2018
EuroHealthNet (2018). The European Semester 2018 from a health equity perspective here.

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