November 2013

Sustainable Health Systems for Inclusive Growth in Europe:
Session V Overview

A conference organised by the Lithuanian Presidency of the Council of the European Union, Vilnius, 19-20 November 2013.

Closing Plenary: Sustainable health systems for the future

Surveying the fallout from austerity-era cuts and contemplating the rising tide of demand from an ageing population, it may be hard to feel optimistic about the prospects for Europe’s health systems. But there is much to build on to ensure health systems are sustainable for the future, as will be brought to the fore and discussed in the closing plenary.

However great the challenges, the means are at hand – in the form of new technologies, in social innovation, process improvements, modernising structures, workforce training, a pre-emptive approach to chronic disease, better public health, a whole-of-government approach, refining governance, and human energy and ideas – to make health systems sustainable for the future and maintain Europe’s commitment to universal care.

The imperative to learn from the impact of budget cuts and inform a programme of targeted investments and sensitive reforms, with the aim of creating sustainable health care systems, is central maintaining European values, but also has a resonance for the rest of the world, as Vytenis Povilas Andriukaitis, Minister of Health of the Republic of Lithuania, highlights in his interview.

In taking Sustainable Health Systems as the theme of the conference, the Lithuanian Health Ministry is building on other meetings that have taken place during the Presidency. Across the course of its Presidency of the European Union, Lithuania has marshalled the disparate strands that must be brought together as the basis of an agenda for change. This final session will synthesise these discussions into a practical brief for the European Health Council meeting in December.

The Tallinn Charter

Most recently, the World Health Organisation Regional Office for Europe convened a meeting to discuss how to strengthen health systems on 17 – 18 October in Tallinn, Estonia, to mark the fifth anniversary of the signature of the Tallinn Charter.

The Charter, ‘Health Systems for Health and Wealth’ signalled a shared recognition of the need of each Member State to improve the performance of their health systems. The signatories pledged to “invest in health systems and foster investments across sectors that influence health, using evidence of the links between socioeconomic development and health.”

The fact that the Charter was signed in rosier economic climes amplifies, rather than reduces, its relevance. Such investment is more essential than ever.

As one illustration of this need, the huge increase in unemployment in Europe is known to be increasing ill health. In addition to reinforcing the core statement of the Charter, that “it is unacceptable that people become impoverished because of poor health” it is now – sadly – necessary to transpose the statement to read, “it is unacceptable that people become unhealthy because of poverty.”

Europe’s shockingly high level of youth unemployment is particularly disturbing in this respect, as Michael Marmot, the world’s leading expert and pioneer in exposing the social determinants of health highlighted in his latest report, published last week. ⁽¹⁾

Youth unemployment in Europe is a “public health time bomb waiting to explode,” Marmot said. The poverty that comes from unemployment is closely linked to poor diets and smoking, leading to longer-term health problems, with poor health among 16 – 24 year-olds storing up problems for the future.

Economic problems are a reason for action, not inaction

The review of inequities in health between and within countries overseen by Marmot, was commissioned by the WHO Regional Office for Europe to support the development of the new European policy framework for health and well-being, Health 2020. Its findings underline the relevance of the Tallinn Charter and the need to keep pushing on with work to strengthen and make health systems sustainable, taking Health 2020 as the guide.

Health systems rank amongst the largest, most geographically dispersed and most complex – for which read difficult to manage and control – organisations in any country. Amongst the themes highlighted in Tallinn earlier this month was the importance of improving governance and transparency, so that reforms of these unwieldy organisations can be tracked and the relevant parties held to account.

This is crucial to the object of building sustainable health systems, because without such oversight it will not be possible to check the progress of reform. A summary of the other conclusions of the Tallinn meeting and also of an earlier meeting, ‘Health in times of global economic crisis: implications for the WHO European Region’, held on 17-18 April 2013 in Oslo, Norway, appears alongside this overview.

Good governance

The requirement for good governance, accountability and transparency was one also one of the main themes of the concluding session of the European Health Forum in Gastein, Austria at the beginning of October.

Similarly, the European Public Health Alliance conference in September, also an official event of the Lithuanian Presidency, underlined how shrinking health budgets have accentuated the need for reform, and called on governments to address the root causes of health inequality, “through political commitment, good governance and inclusive growth”.

Also feeding into the closing plenary are, the conclusions of the Informal Council of the Ministers of Health of the EU Member States, held on 8-9 July in Vilnius; the European Commission summary of reflection process which took place in September; and the reflections of the Council High level working group and Public health working group.

Despite the impact of the financial crisis, Europe still has some of the best healthcare systems the world has ever seen. But they now need some care of their own. It is a complex and multifaceted task, but in putting the spotlight on the need to create sustainable health systems, the Lithuanian Presidency has provided a single, tangible objective, to which everyone from policy makers to patients, health care professionals to politicians, citizens and industry, can contribute and aspire.

⁽¹⁾ WHO Regional Office for Europe: Review of social determinants and the health divide in the WHO European Region: final report. Review chair Michael Marmot; Report prepared by University College London Institute of Health Equity