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Open Letter: National Recovery and Resilience Plans to support sustainable and fair health and social care systems

20 January, 2021

In January 2021, EuroHealthNet sent an open letter to heads of permanent representatives of Member States to the European Union. While welcoming a bottom-up approach in drafting the National Recovery and Resilience plans, EuroHealthNet, in an open letter, asked the representations of the Member States in Brussels to reiterate to their national counterparts the importance of addressing the following four matters:

Please find the letter below.


Your Excellency,

I write to you regarding the new Recovery and Resilience Facility (RRF) on behalf of the public and statutory bodies responsible for public health which make up the EuroHealthNet partnership. The Facility offers a much-needed window of opportunity for more effective investments and reforms towards sustainable and fairer health and care systems.

This is a critical moment for all of us in Europe. The RRF is a vital instrument for equitable health and the wellbeing of people and the planet for the years to come. This week, important discussions on the implementation of the National Recovery Plans take place both within the Economic and Finance Council and the European Council.

While welcoming a bottom-up approach in drafting the National Recovery and Resilience plans, EuroHealthNet asks the representations of the Member States in Brussels to reiterate to their national counterparts the importance of addressing the following four matters:

  1. Prioritise and enable direct funding for health promotion and disease prevention to avoid similar and new health crises in the future. In the last decade, average total annual budgets for health promotion and disease prevention across Europe have stalled at about 3% of total health spending, however 70-80% of health-related costs have been generated by largely preventable chronic and non-communicable diseases. By tackling major risk factors, this disease burden can be reduced. This is where the funds should be more effective and efficient. The systematic underfunding and under-appreciation of public health-promoting and preventative systems – and the associated workforce – need to be addressed in the national Recovery and Resilience plans.
  1. Make achieving health equity and leaving nobody behind central to – and one of the key outcomes of – the National Recovery and Resilience Plan. Make periodical reviews of associated targets mandatory. 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, as much emerging evidence confirms. Europe is bracing for another long-term, deep recession very likely to lead to a substantial increase in chronic diseases and a widening health and wellbeing gap. This is echoed in recent important reports such as EC/OECD Health at A Glance (2020), and the WHO European Health Equity Status Report (2019).  The national RPP should respond to the principles of the European Pillar of Social Rights and take forward the imminent action plan.
  1. Ensure the implementation of the legal requirement by EU Member States’ official structures in charge of the drafting of the National Recovery and Resilience Plans to “set out the expected contribution to gender equality and equal opportunities for all as well as a summary of the conducted consultation process with relevant national stakeholders”. Members and partners of EuroHealthNet, the national institutes of public health, play a key role in advising governments on measures to mitigate the pandemic and tackle COVID-19. To build resilience to future crises, national institutes and regional health actors need to be included in discussions about the recovery and in shaping the National Recovery Plans.
  1. Build up and strengthen positive synergies between health, wellbeing, and our economies. This pandemic has taught us how much our economies depend on healthy and socially cohesive populations. Health and social equity are fundamental assets that cannot be ignored in the design, funding and implementation of the future plans. With its Conclusions on the Economy of Wellbeing, the European Council called for Member States and the European Commission to “include an economy of wellbeing perspective horizontally in national and Union policies and to put people and their wellbeing at the centre of policy design.” The RRF and the National Recovery and Resilience Plans should not be an exception.

EuroHealthNet has provided the European Commission and Member States with a health impact assessment of the pandemic and analysis of how the European Semester can play a useful role in steering national reforms in a direction of greater sustainability and equity.  This can be done while respecting national rights in the organisation and delivery of social and health care and within the competences of the EU treaties objectives for wellbeing and public health protection across all EU policies.

A socially and environmentally just recovery from the pandemic, and increased resilience against the coming recession is good for health and the economy. You can make sure the recovery is rapid, efficient, and inclusive by aligning measures towards common goals of sustainability and fairness. These opportunities should not be missed.

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.

Caroline Costongs
+ 32 2 235 03 XX
146 Rue Royale
1000, Brussels, Belgium
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Follow us on Twitter: @EuroHealthNet or @CaroCostongs


  1. Video conference of the members of the European Council, 21 January 2021
  2. EuroHealthNet. EuroHealthNet calls for new and improved approaches to financing for health promotion and health equity. Statement, 2018 
  3. WHO Regional Office for Europe. Action Plan for the Prevention and Control of Noncommunicable Diseases in the WHO European Region 2016-2025.
  4. Masters, R. et al. (2016). Return on investment of public health interventions: a systematic review. Journal of Epidemiology and Community Health, vol.71(8) 
  5. CHAIN – Center for Global Health and Inequalities. The COVID-19 pandemic and inequalities: we are not in it all together. Factsheet 2020. 
  6. EuroHealthNet. Health inequalities in Europe. Factsheet. 2019.
  7. EC/OECD. Health at a Glance: Europe 2020. State of health in the EU cycle.
  8. WHO Regional Office for Europe. Healthy, prosperous lives for all: the European Health Equity Status Report. 2019.
  9. Council of the EU. Proposal for a Regulation of the European Parliament and of the Council establishing a Recovery and Resilience Facility – Confirmation of the final compromise text with a view to agreement. 21 December 2020. 
  10. Council Conclusions on the Economy of Wellbeing, October 2019.
  11. EuroHealthNet. Recovering from the COVID-19 pandemic and ensuring health equity – The role of the European Semester.
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