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Value of health – Too often ignored and forgotten by EU policy-makers?

Annika Hedberg

Date: 29/09/2014

Whether on national or European level, policy-makers tend to under-value health, healthy society, and healthy citizens in policy-making. As the European Commission continue to ponder how questions related to health should be reflected in EU policy-making and what role it should take, there are three issues to keep in mind: 1) there is a need to recognise health as a value, 2) health should be considered across policies, 3) the EU has the tools to promote a healthier European society.

Health as wealth

Healthier people are an asset for society and economy. They require less support from public budgets and healthcare systems, and they create a healthier, more productive society and labour force that can contribute to the economy for longer. There should be no question about it: Europe’s interest is to ensure that the value of health is recognised and supported across policies.

The economic impact of health improvement is felt also elsewhere. The health sector is a significant provider of employment. As an important user of new solutions ranging from medicines to medical devices, it encourages development, deployment and competition between new innovative solutions. Promoting health, preventing diseases and treating patients is a growing business, with a great potential in and outside the EU.

Delivering health requires understanding determinants for health

At the same time, new thinking is required on how to deliver health and make it the asset it could be. It is good to keep in mind that people’s health and well-being are affected by various factors, including life-style, genetic make-up, age, gender and population sub-group, level of education, environment from safe water to good working conditions, and access to health and other services that prevent and treat illnesses. Thus, there are also different ways to deliver health, and whilst health policy and provision of healthcare are Member States’ responsibility, the EU is not without a role.

Ensuring health in all policies…

As health is influenced by various factors from environment to urban planning, the EU must put greater emphasis on a cross-sectoral policy approach to health. In accordance with the Lisbon Treaty, the EU must ensure that policies that can influence Europeans' health – including agricultural, transport, industrial, employment, environmental, taxation and regional development policies – promote health and healthier lifestyles. For example, transport, climate and industrial policies can advance healthier environments by encouraging a decrease in vehicle emissions. Moreover, financial instruments, including Structural Funds, European Agricultural Fund for Rural Development and EU-funded research should contribute to creating healthier European societies.

Bringing health in all policies requires also calculating and communicating the impacts on health in economic terms. As a result, the value of health would be easier to recognise and take into account in policy-making. Communicating the positive health impacts of EU policies could also help to bridge the gap between Brussels and European citizens. Make it personal and people become interested.

Unfortunately, the proposal for the new European Commission does not foresee a Vice-President, who could help to mainstream the value of health across EU policies. Thus, in the new set-up, it is important that the Vice-President for Jobs, Growth, Investment and Competitiveness, will help to ensure that health as an asset for society and economy is recognised and supported across policies.

… while protecting health and patients’ safety

It is important that internal checks and balances are created, which can be used to ensure that public health concerns will not be undermined by efforts to boost industrial competitiveness. The decision to move the files for medical devices, pharmaceuticals and European Medicines Agency from the Directorate-General for Health and Consumers to the Directorate-General for Internal Market, Industry, Entrepreneurship and SMEs, has provoked strong reactions from the European health community. Many fear these changes could lead to situations where the voice and needs of patients will be undermined if in conflict with industrial interests. There are also concerns about a negative impact on transparency of clinical trials. It is in the EU’s interest to ensure that Commissioners for Health & Food Safety and Internal Market, Industry, Entrepreneurship and SMEs will cooperate and work closely together on health-related dossiers, and that policies on pharmaceuticals and health technologies will promote and protect health and patients’ safety.

… and empowering people to take a stronger role in health decisions

The ongoing efforts to empower European citizens, to allow and encourage them to become more involved and take a stronger role in promoting and improving their own health must continue. Health-related EU policies or new solutions for markets should be developed with and for consumers and patients. Seeing patients and consumers as partners in health is also good for business.

Using the European Semester to make European health systems better

The new Health Commissioner will be responsible for public health, health systems, health strategy, and health technology assessment (HTAs), and one of the most important supportive tools is the European Semester process. The healthcare sector accounts for around 10% of EU member states' GDP. In most countries, close to 80% of healthcare spending is public-sector-funded, and it is among the largest and fastest growing areas of expenditure. As the European Semester reviews and helps to coordinate Member States' macro-economic, budgetary and structural reform policies, it is understandable why building efficient health systems is considered an integral part of economic recovery.

EU healthcare systems are under enormous pressure to demonstrate their value and cost-effectiveness, to improve people's health while contributing to economic recovery. The sector suffers from growing demand and increasing cost pressures. There are significant inefficiencies imbedded in healthcare systems: a lack of continuation of care, failure to computerise information and analysis, investment in technologies and solutions that are not cost-effective, over-prescription of drugs that do not work or which lead to further complications, and focusing on treating the sick rather than paying more attention to promoting health and preventing diseases. While the healthcare systems differ and it is reasonable that the final decisions on needed measures are taken at national and local level, the EU can play an important role in encouraging needed reforms and cooperation between Member States and regions.

As a part of the European Semester process, the EU provides the Member States annually with country-specific recommendations, including on improving health systems. The recommendations should guide Member States to carry out reforms, which can improve people's health outcomes and ensure the sustainability of the sector in long-term. There should be a stronger emphasis on encouraging a more thorough understanding of the cost-effective drivers for health, the relationship between inputs and outputs in a healthcare system, and which measures provide the best return on investment – that is, health, wealth and well-being – in the short, medium and long term. Arguably most EU countries could improve health outcomes with their current budgets if there were more focus on measuring outputs and maximising health gains. Having a more standardised approach would allow comparisons and benchmarking of the performance of national healthcare systems. The objective should be to benchmark EU’s healthcare systems and use that to compare good practices within similar systems.

… and discovering the potential with HTAs

Health technology assessments (HTAs) are used across EU Member States to assess the medical, social, economic, and ethical impacts – thus the value – of new solutions including pharmaceuticals, medical devices, and prevention methods. While HTAs can be used to assess cost-effectiveness of health solutions, they could also provide a tool for understanding health outcomes and thus assessing health systems. As the EU continues to encourage Member State cooperation on HTAs, including in exchanging information and developing methodologies, there is a great potential in making HTA an important tool for decision-making and a promoter for better European health systems.

The EU has the tools to make health the basis for a wealthy Europe – if it so wishes. However, this requires recognising that health matters for individuals, society and economy, and ensuring that health considerations become an integral part of EU policy-making.

Annika Hedberg is a Senior Policy Analyst at the European Policy Centre (EPC).
Disclaimer: The views expressed in this Commentary are the sole responsibility of the author.

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