Editorial By Caroline Costongs
For those of us working on health promotion and health inequalities, these are important times. On the one hand we are seeing increasing interest in our field due to a growing concern about chronic diseases, and pressing problems related to ageing, inequalities, and the sustainability of health systems. On the other hand, we are experiencing declining public budgets to tackle these problems at EU, national, and local levels. Health promotion and disease prevention can make crucial and cost-effective contributions, however, they remain consistently low in Member States’ and the European Commission’s financial priorities. In fact, in one of the proposed scenarios for a future Europe, health policy and parts of social policy would even be removed. The EU is challenged by the mantra “do more with less”; it hardly refers to health in its financial plans for the future.
One bright light on the horizon is the European Commission’s recently published ‘Social Package’ with proposals on the European Pillar of Social Rights, which is essential reading for all of us. This initiative aims to improve economic resilience whilst supporting fair and well-functioning labour markets and welfare systems. At present, the pillar is a set of principles and recommendations, and a number of flanking and monitoring measures. One of the 20 principles includes the right to health and access to affordable health care, including health promotion and disease prevention. Later this year the European Institutions may issue a joint proclamation in favour of this initiative, potentially easing its way into law.
However, we are still far away from that possibility and our immediate questions concern the realities and implementation of these 20 Social Pillar principles. Many of the articles in this edition of the EuroHealthNet magazine already showcase a diverse range of actions on health and the social determinants of health that are being undertaken or explored in line with these principles.
The HiNews project for example is examining why inequalities in health and chronic diseases vary across welfare states. It has found that risky behaviour does not alone explain differences in health outcomes for different groups, and that there is wide variation in access to health and patterns of health inequalities.
In many countries, we note rising levels of childhood obesity as well as concerns about malnutrition. The DIATROFI programme in Greece is responding to that by indiscriminately delivering nutritionally balanced meals to participating schools in disadvantaged areas, whilst promoting healthy nutrition to children and their families with a variety of measures throughout the school year.
The article on ageing underlines the importance of older people staying active and engaged. In the Baltic Sea region the ‘Let’s be active’ initiative examined how seniors feel about volunteering and hobbies, and used this knowledge to develop new activities which are now helping many citizens and communities.
The life expectancy of Spanish people is one of the highest in the world, but healthy life expectancy lags far behind. The Strategy on Health Promotion and Prevention (SHPP) takes a life course approach and aims to encourage healthy lifestyles and environments. It has identified local implementation as a key to its success, alongside educational and health care interventions.
This local and community aspect is echoed in the grassroots-led ‘health movement’ growing in the Netherlands. This comprehensive ‘National Prevention Programme’, stimulated by authorities but driven by citizens, emphasises health promotion at home, school, and work. Municipalities, schools, businesses, local governments, and institutions are taking steps towards healthier lifestyles including better nutrition and more physical activity.
From Sweden, we learn about the national mental health strategy 2016-2020. Whilst many Swedes report good physical health, they also report rising mental health and related somatic problems- rates, notably amongst 13 and 15 year old girls. They stress the importance of good data to improving prevention measures, and collaboration between stakeholders.
Finally, we have an article examining how health promotion and protection measures can be introduced in the absence of legislation. The Healthy Stadia Network and UEFA developed new ways of communicating and reinforcing a smoke-free policy, without legal recourse. With 20 million people attending football matches each week, the ideas and knowledge gained could be used more widely to protect many more citizens from the dangers of tobacco.
While these great initiatives for a healthier Europe are being developed and implemented, battles will need to be fought to ensure appropriate and sustained levels of investment in health promotion and prevention at EU and (sub) national levels. The added value for EU support for health promotion is obvious to us, but will need to be made clear to those decision makers participating in the reflections and debates on our future financial frameworks, and in competition with emerging topics such as migration, security, and climate change. EuroHealthNet is prepared for this dialogue and ready to contribute.
I hope you enjoy this edition of the magazine. As always, we welcome your feedback. In addition to the articles here, please find below some suggestions for further reading, including the future scenarios for Europe and its financing.
- White Paper on the Future of Europe
- Reflection paper on the social dimension of Europe (26 April 2017)
- Reflection paper the future of EU finances (28 June 2017)
In addition, EuroHealthNet has published a number of documents on the social pillar: