Some reflections on recent work around investing in health
If you’ve ever been a patient yourself, you know first-hand how much we take our health for granted. And how when illness hits, it provides a stark wake-up-call to just how much we depend on our physical and mental health. Without good health and well-being, it can become impossible to perform the simplest daily tasks, let alone working full-time. Missing days from work or turning up to work and not being able to concentrate or having to stay home to care for a loved one, all demonstrate the virtuous circle of how good health is linked directly to productive societies (and fulfilled individuals) and therefore healthy economies. Hence the call for health to be unquestionably considered as an investment[1] rather than a cost for governments and society.
“Resilience. Sustainability. Preparedness.”
You no doubt also heard these buzz words repeated again and again in the aftershock of COVID-19 among speeches and declarations promising to boost our health systems to be better prepared for future health shocks and pandemics. Alongside the need to desperately expand and support the health workforce, it is well-understood that strengthening the foundational health of society can allow us to better confront the challenge of any future health crises. Maximise health. Minimise harm. This was tragically demonstrated in the statistics showcasing how people living with chronic diseases such as diabetes or obesity had higher risk of mortality from COVID-19. There is also a dire need to reduce health inequalities between and within countries across the globe.
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As election time is imminent, we need to ensure that the calls for health system reorganisation, transformation, modernisation (you get the picture) are not prematurely fading from the political forefront. Government budgets are being squeezed and health budgets even more so, as understandable competing priorities intensify (the green transition, defence policies, cost-of-living crises etc.). Government health expenditure is returning to pre-COVID 2019 levels. But increasing investment in health cannot be deferred. And we know that, for example:
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In order to bring the next wave of health gains and success stories from investing in innovation to reality, we need to broaden the perspective on (smart) health spending[7],[8] and avoid creeping short-term cost-cutting measures. Focusing efforts towards prevention, health promotion, and optimal disease management of chronic diseases can have a profound impact (hence the UN Sustainable Development Goal 3.4 calling for a reduction of premature deaths from chronic diseases by 1/3 by 2030). 90% of deaths in the WHO Europe Region are from NCDs[9], which are also responsible for the largest share of health spending. Improved health promotion and disease prevention can reduce the prevalence of NCDs by as much as 70%. Yet only around 3% of total health spending in the EU is targeted towards health promotion and disease prevention[10].
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The European Commission’s approach to addressing the challenge of NCDs has largely focused on important actions such as sharing of best practices and addressing social determinants of health. For example, the “Healthier Together NCDs initiative[11]”, the “Joint Action on Prevention of CVD and Diabetes[12]” (JACARDI), or the “Joint Action Prevent Non-Communicable Diseases and Cancer[13]” (JA PreventNCD) centering around primary prevention and health promotion (think tobacco control, alcohol reduction and healthy lifestyles). This focus is essential but it is not the full picture. It is critical to also consider actions to improve the lives of those already living with NCDs. Powering up chronic disease management[14] in Europe entails including also secondary and tertiary prevention, improving detection and diagnosis, or optimising treatment pathways and adherence to clinical guidelines. These can all pave the way for increased quality of life, avoided costly complications and hospitalisations down the line, and building a healthier and more resilient society (and economy).
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Ok, so you may say that’s all well and good and of course we all want to improve collective health, but even with the best intentions – money doesn’t grow on trees! This is the tricky part. Asides calling for investing in health remaining an essential priority, the OECD has laid out four possibilities for improving health system financing[15]: i) increase government spending and allocate part of these additional funds to health; ii) increase the allocation to health within existing government budgets; iii) reassess the boundaries between public and private spending; iv) find efficiency gains. However, most of these options can be challenging in the EU-context. The OECD also highlights the critical need for good budgeting practices in the medium and long-term to “facilitate better decisions on whether, when and by how much public funding for health can increase, as well as identifying efficiency gains and where priorities can be shifted”. In line with this, recommendations in a report produced by Vintura [16] for improving pharmaceutical affordability include: i) long-term horizon scanning of net costs and multi-year budgeting ii) including the societal value perspective in Health Technology Assessment iii) innovative reimbursement agreements and iv) integrated budgeting. It is clear a longer-term and cross-budget perspective is needed, involving all ministries and levels of government.
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There are still miles to go to reach better health outcomes for all, across the entire patient care pathway. Risk factors such as high blood pressure, cholesterol, blood glucose or BMI and air pollution, smoking and kidney dysfunction are still topping the charts in terms of global mortality and burden of disease (and growing)[17]. Investing in health is just the first cog needed to turn to put the wheels in motion for reaching long-term population resilience. With an ageing population demographic and an era of permacrisis[18] looming, there is no time to lose.
[4] Solomon et al. Diabetes Care 2017; 40: 412-418
[5] Stone, M. A.,et al., (2013). Quality of care of people with type 2 diabetes in eight European countries: findings from the Guideline Adherence to Enhance Care (GUIDANCE) study. Diabetes care, 36(9), 2628–2638. https://doi.org/10.2337/dc12-1759
[17] Vaduganathan M, Mensah G, Turco J, et al., The Global Burden of Cardiovascular Diseases and Risk; J Am Coll Cardiol., Dec. 2022
Executive and Corporate Management. HealthCare & Life Sciences' management. Public Affairs, Government Affairs, Policy, Market Access, Communication
6 个月Congratulations on the wonderful article. Based on facts and raising very pertinent questions about the future of health systems and, ultimately, about our (citizens) health in the future, because we are all potential users of health systems, with greater or lesser differentiation. Regarding the allocation of funds, why not think about a system in which gains in national productivity (GDP per capita) can generate a health extra-budget? Or something that links lower levels of work absenteeism (or even presenteeism) to people who are better treated and have a greater positive impact on the economy, generating a financial "premium" that would benefit health? And why not aim for minimum levels of 5% of the health budget for primary disease prevention and health promotion?
Sounds like an insightful journey at EFPIA. What were the most eye-opening learnings from your time there? Sophie Millar
HR Executive & BDE(Client Manager) | Driving Talent Acquisition & Strategic Partnerships in Staffing HR/BDA |MBA HR | B.com| HR Operations & Recruitment | Client handling | Employee engagement | Motivational Speaker
6 个月It sounds like you've had quite the journey at EFPIA! Reflecting on learnings is always valuable ?? #InvestInHealth #HealthSystemsSustainability ??
IT Manager | Dedicated to Bringing People Together | Building Lasting Relationships with Clients and Candidates
6 个月Sounds like an insightful and rewarding experience! ?? Sophie Millar