Who is responsible for improving health and wellbeing?

The State of Health in the EU 2021 Report is out, published by the European Commission jointly with the OECD and the European Observatory on Health Systems and Policies. It consists of 29 Country Health Profiles and a Companion Report which sets out specific health system challenges.

It comes as no surprise that most of the analysis focuses on COVID-19. The analysis looks at the direct and indirect consequences of the pandemic and its containment measures. For almost two years now, COVID-19 has dominated the news with statistics on infection rates, vaccination rates, and mortality. The report states that we have seen nearly 800000 deaths due to COVID-19 in the EU/EEA area. An estimated 49000 health professionals have lost their lives due to COVID-19 in the WHO Euro region. In countries like Germany, 70% of people with low education were at risk of developing severe COVID-19 compared to 41% of those with a higher education. These figures convey the harsh reality of a pandemic that unsettled the world and hit us hard.

The hidden harms of the pandemic

Behind these cold statistics, lies a wider experience of suffering, vulnerability, and psycho-social distress caused by the pandemic. The indirect health damage of COVID-19, for example in terms of increased anxiety and depression, are considerable. In Belgium, nearly 40% of young people aged 18-29 reported symptoms of depression in March 2021[1].

A lot of this suffering however is invisible, stigmatised, and difficult to capture in traditional statistics. This is about the consequences of economic insecurity and the changing world of work, digital exclusion, postponed treatment, and related anxieties. It concerns people with disabilities, children’s hampered education and social activities, limited access to physical activity or culture and arts, young people’s social development and happiness, older people’s loneliness and so much more. Some of these issues are touched upon in the articles of this Magazine.


Who is taking the responsibility to act on improving health and wellbeing? Often health-related problems lie at the interface of policy sectors such as health, education, employment, culture, social sector.

Take mental health for example. Some mental health problems require medical and pharmaceutical treatment, but many can be treated in ways that involve psychological support, behavioural, or social interventions. The same goes for health inequalities, which is more a social rather than a health concern – as its causes (and solutions) lay predominantly in the social domain.

These broader health and wellbeing challenges are recognised by the health sector. But the sector is mostly concerned about its preparedness for health emergencies, health care capacities, and workforce – as also demonstrated by the EU State of Health in the EU 2021 Report. They are not able to provide appropriate responses to the wider impacts on health and wellbeing, nor do they have the capacity to help prevent (new) health problems from emerging.

The health sector is under-resourced on many fronts. This is particularly the case with its capacity to act on the determinants of health, dealing with chronic diseases, with the psycho-social consequences of our inequitable and unsustainable societies, and with environmental concerns. This is reflected in how the COVID-19 crisis is handled at national and EU levels. The ‘European Health Union’ takes a predominantly bio-medical approach. Equally, the EU ‘Recovery and Resilience Facility’ (RRF) does not place sufficient emphasis on strengthening public health and wellbeing, as recently indicated in EuroHealthNet’s RRF analysis. So whose responsibility is it?

Health at the Crosspoint

Health and wellbeing result from the actions of a wide range of sectors and how they interact. We need a more comprehensive, societal level approach to address the wide scope of health-related issues and the more invisible suffering that we face. This is embodied in the concepts of Economy of Wellbeing. It makes health and wellbeing outcomes not just the responsibility of the health sector, but of the highest levels of government, such as the Prime Minister (as in the case of New Zealand) or at EC (Vice-) Presidential level. This will allow a coordinated, cross-sector approach with dedicated wellbeing budgets across sectors, action plans and performance monitoring.

The Geneva Charter for Wellbeing, an outcome of the 10 Global Conference on Health Promotion for Equity, Wellbeing and Sustainable Development, can be helpful to move us in that direction, under the stewardship of WHO.  It is the responsibility of all of us to work together to turn this vision into a reality. Again, the many articles of this edition of the EuroHealthNet Magazine reflect this broad vision. They demonstrate the vital contributions that different professionals can make, from local to global levels.

The 18th Edition of EuroHealthNet magazine

Each year, we publish one themed issue of the magazine and one ‘open’ edition. This, as you will see, is our open edition for 2021. The diversity of the topics covered here is a reflection of the diversity of public health today.

Climate change

We begin this edition in Glasgow, Scotland where global leaders came together last month for climate change negotiations – COP26. We look at what happened there, and what it means for public health.

Health Inequalities

We then travel to Wales, where the Welsh Health Equity Status Report initiative (WHESRi), established by Public Health Wales and the WHO Collaborating Centre (CC) on Investment for Health and Well-being has published ‘Placing health equity at the heart of the COVID-19 sustainable response and recovery: Building prosperous lives for all in Wales’. They explain their work and a new report.

From the Centre for Global Health Inequalities Research, we hear about the threat of infectious disease to the lives of children in low- and middle-income countries. As the pandemic threatens the global progress towards the Sustainable Development Goals, what can be done to ensure a fair and healthy start in life?

Again in Wales, we look at a new report, funded by Public Health Wales, showing how vulnerability emerged during the Coronavirus pandemic. It examines the role of the voluntary and community sector (VCS), and the factors that made the sector able to respond quickly to needs. How can public health practitioners and policymakers harness their value in future crises?

Living and working

The links between art, culture, and public health is an exciting field ripe for exploration. Art has a role in helping us understand and express the human experience, and culture binds and brings us together. Can art and culture then help us to manage the collective trauma created by the pandemic? This article explains some of the new and exciting developments in Italy.

The links between employment and health are at the core of the EuroHealthNet partnership. It is always encouraging to see partners pushing boundaries in workplace health promotion. Our colleagues in Austria are at the forefront of this work. In this edition, we hear about inclusivity in health promotion. People with disabilities are often excluded from workplace health promotion – how can we do better? Read on to discover.

The place for patients in public health

Looking at the patient-side of public health, and the connection between public health issues and the physical symptoms people live with, we have two interesting articles in this edition. Firstly, we look at oral health and public health. Periodontitis is one of the world’s most prevalent health conditions and disproportionately affects lower-income groups. It’s preventable and treatable through community-level interventions. Colleagues from the Egas Moniz Higher Education Cooperative explain the issue, and what we can do to move forward.

Finally, we look at health data. Better use of health data can empower patients to maximise their health outcomes and accelerate research, argues Professor Dipak Kalra. He stresses one key element: education, education, education. We must improve patients’ health literacy and health data literacy if we want to make progress in this area.

[1] State of Health in the EU Report (2021)

Caroline Costongs
Director at EuroHealthNet | + posts

Caroline Costongs is Director of EuroHealthNet and expert in public health and health promotion. Caroline leads a multi-disciplinary team working on European and (sub)national policy, advocacy, research and capacity building addressing health inequalities. Caroline is active in various EU and WHO fora, Advisory Boards and various EU projects, and is a member of the ICC – International Council for the European Public Health Conference.

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