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

9 June, 2020

Brussels, 9th June 2020

Dear Ministers of Health and Social Policy,

Dear Health and Social Policy Attaches,

The need for more effective investments and reforms towards sustainable health and care systems


In light of the EPSCO meeting today, with this letter EuroHealthNet aims to provide you with further evidence-based information that supports for more ambitious and effective investments and reforms towards sustainable and needs-driven health and care systems. This includes health promotion, disease prevention, and measures tackling health inequalities. Enhancing wellbeing at work and supporting decent working conditions, including addressing in-work poverty and work-life balance are part of the solution. Within this critical moment for each of our countries, there are opportunities. You can help to create more sustainable health systems. You can make sure the recovery from the pandemic and its economic consequences is rapid, efficient, and inclusive by aligning measures towards common goals of sustainability and fairness. These opportunities should not be missed.

The pandemic has revealed profound systematic inequalities in health. This can be seen in exposure to infections, death rates, and co-morbidity with chronic diseases which are highly concentrated among the socially and medically vulnerable populations. Europe is bracing for another long-term, deep recession. We have still not recovered from effects of the 2008 crisis, which led to a substantial increase in chronic diseases and a widening health gap. These are linked to the underlying structural determinants of ill-health; poor living and working conditions lead to poor and unequal health and wellbeing gains. This is echoed in recent important reports such at EC/OECD Health at A Glance (2018), and the WHO European Health Equity Status Report (2019).

We have all the tools and knowledge of what works to protect people�s health and wellbeing from likely devastating consequences of economic hardship. Austerity in health and social sector spending must be avoided.

With regards to the new impetus given to health(care) in the amended proposal for the EU long-term budget (Multiannual Financial Framework 2021-2027) – while a creation of a stand-alone new and much resourced EU4Health Programme is a welcome move – EuroHealthNet calls for strong synergies and complementarity between health and social policies to be ensured in all its legislative provisions. Despite “health” being taken out of the European Social Fund Plus, we urge you to ensure that social determinants of health and “health in all policies” principles prevail. We just cannot afford to address health or social issues in a disconnected manner. EuroHealthNet restates its long-standing call to urgently reinforce and review the value of primary health care and community health workers, to effectively resource preventative measures, and to build resilient and health-promoting places and communities, in an integrated and people-centred manner. These approaches are cost-effective, bringing high social return on investment.

The European Commission’s own estimates show that public spending needs for re-orienting EU health systems is “likely to exceed” 70 billion, or around 0.6% of EU GDP, though with large variations across countries.” While in the last decade average annual total budgets for health promotion and disease prevention across Europe have stalled at 2.5% of total health spending, 70-80% of health-related costs are caused by largely preventable chronic diseases. This is where the funds should be more effective and efficient.

In addition, health inequalities reduce economic and social productivity and lead to higher healthcare and welfare costs, estimated at 980 billion per year, or 9.4% of EU GDP. A 50% reduction in gaps in life expectancy would provide monetised benefits to countries ranging from 0.3% to 4.3% of GDP. The latest report from WHO Europe also makes a case for accelerated investments in policy areas that affect health equity beyond health services – income security and social protection, living conditions, social and human capital, and employment and working conditions. Importantly and encouragingly, these gains can be achieved “within the lifetime of a single government”. 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 and maintain the gains achieved in the current post COVID-19 context.

A move to a more socially just recovery from the pandemic and building resilience against the economic recession is good for health and the economy.  It has public support, and remains crucial for reducing health and social inequalities. We welcome an increasingly more social European Semester as a potential public health “game changer” for steering national reforms in a direction of greater sustainability and equity. This respects your national rights in the organisation and delivery of social and health care and the competences of the EU treaties objectives for wellbeing and public health protection across all EU policies. This work should be guided by the European Pillar of Social Rights and its imminent Action Plan. Only then can conditions for new European political priorities – green and digital transition ambitions – be realised.

We 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 amended MFF and EU recovery plans. We strongly suggest you take advantage of the European Semester 2020 cycle which for the first time ever saw health-Country Specific Recommendations issued to all EU Member States.

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.


See also:


  • Masters, R. et al. (2016). Return on investment of public health interventions: a systematic review. Journal of Epidemiology and Community Health, vol.71(8)
  • Mackenbach JP, Meerding WJ, Kunst AE. Economic costs of health inequalities in the European Union. Journal of Epidemiology & Community Health 2011; 65:412-419.
  • ibid
  • ibid
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