EuroHealthNet has recently published an information guide on Financing Health Promoting Services. The guide aims to demonstrate how to make transitions from spending on curative approaches to investing in preventative approaches for better health and wellbeing. It explores how resources and capacities can be mobilised to help finance these transitions and contribute to an ‘economy of wellbeing’.
By Andrew Barnfield
Europe is facing a well-documented investment crisis in social infrastructure for health, education, and social services, which directly affects the health and wellbeing of all citizens. Since the 2008 financial crisis, public investment in social infrastructure has reduced dramatically, remaining 20% lower than a decade ago. It is estimated that the investment gap in social infrastructure in the EU is more than €150 billion per year[i]. In addition, health promoting budgets face continual financial uncertainty. Throughout Europe approximately only 3% of health system expenditure is assigned to public health, health promotion and disease prevention[ii]. By comparison around two-thirds is spent on curative and rehabilitative care, with the remainder for medical goods and governance.
Health promoting services are a vital and valuable societal service[iii]. Equitable and sustainable public health is crucial for society’s economic development and social sustainability. Rising inequalities, the ageing of society and related chronic disease burdens, along with climate change and migration challenges are increasing demand for services. Long-term care costs continue to grow. Preventative measures, delivered through health promoting services, require durable and dedicated funding. Current investment strategies and public funding are not suitable, are unsustainable, and produce unfair social, economic, and environmental costs.
All health and social systems seek new ways to meet needs sustainably and often cite prevention as being a better investment than cures. Innovative multi-sector solutions are required to make the most suitable and equitable use of public funds and to maximise the added value of private investments. It is crucial to invest in the types of social infrastructure and health promoting services which best respond to the needs and expectations of people, especially for those who are most disadvantaged. Long-term solutions and alternative financial instruments must be considered and developed to fill existing gaps in investment. Connections between different fields must be made urgently if the benefits for health, wellbeing, sustainable development, equity and safety are to be usable, useful and used.
It is crucial to invest in the types of social infrastructure and health promoting services which best respond to the needs and expectations of people, especially for those who are most disadvantaged.
EuroHealthNet’s information guide on health promotion services (developed with support from WHO Europe and the WHO Coalition of partners) aims to build the capacity of the public health and wider social policy community in EU Member States to access new funds such as the increased investment fund ‘InvestEU’. It explores how we can increase funds through smarter taxation, boost investments and innovative thinking, and recognise health as an asset. It provides examples through a range of cross-sectoral case studies. The guide also presents a set of public health-focused investment criteria for potential investors or financial managers.
Financing public services is an inherently ethical decision[iv]. However, we must stress that this guide is in no way supportive of the implementation of charges or increases in charges for users of any public service. Nor is it a call for the easy to reach or easy to fund programmes to be sold off for quick financial profit. Rather, with this guide[v] we are making a call to place an ethical framework at the centre of decisions made to improve health promoting services and the health of all people. What do we mean by this? We mean that an ethical perspective involves taking into account societal, environmental, universality, and transparency factors as well as financial returns. Financial returns must not take supremacy. At the centre of health promoting services are people. For all these services, the number one priority must be to improve the health and wellbeing of all people, no matter their background, circumstance, or their ability to pay.
An ethical perspective involves taking into account societal, environmental, universality, and transparency factors as well as financial returns.
The continued pervasiveness of health inequalities across and within European countries means that new approaches are needed. Restrictions on public health budgets require creative and novel ways of financing and delivering services that promote and protect health and wellbeing. To meet these needs, policymakers and planners across departments require the tools to identify new funding opportunities and the techniques to put them into practice. Investing in well-planned, equitable, and evidence-based health promoting services has multiple benefits. This includes strengthening local communities, ensuring quality health and social services, encouraging environmental sustainability, and fostering economic activity.
Knowing that health promotion budgets are among the most vulnerable areas of health system spending – often cut when resources are constrained – a range of actions are available. Our new information guide presents a series of options that planners and policymakers can utilise to tackle some of these resource challenges, improve health and wellbeing, and address the persistence and prevalence of health inequalities which are among the most important challenges for governments to tackle.[vi].
Addressing the social determinants of health is beneficial for all in our society. This guide offers a source of inspiration for funding for services that reduce social isolation, address psychosocial problems at work, decrease consumption of health damaging products, and prevent ill-health before it starts.
The guide explores how we can increase funds through smarter taxation, boost investments and innovative thinking, and recognise health as an asset. It provides examples through a range of cross-sectoral case studies. The guide also presents a set of public health-focused investment criteria for potential investors or financial managers. The criteria aim to bridge the gap between public health, wellbeing and financial investment. The guide which has been developed in collaboration with WHO Regional Office for Europe and the WHO Coalition of Partners will be supplemented by an interactive online tool that will be launched in January 2020.