Crisis as a test of commitment to values of equity, solidarity and universal coverage

I am happy to welcome European colleagues here, and to welcome WHO Euro for organizing this important meeting.

We should all recognize that WHO has been fundamental in establishing global norms and standards in the field of health. As such, WHO is a key actor in global health and in supporting national health systems.

Last week I took part in an event here in Oslo where a governmental report on Norwegian initiatives in the field of global health was launched. At this event, my colleague the foreign minister quoted what I had said when I held that position: ”Health is too important to be left to health ministers only.” Today, in my function as a health minister, I recognize the importance of making other decision-makers aware of the health effects of their policies. We must anchor the understanding of health broadly – not as a cost but as an investment!

20 years ago, in 1993, the World Development Report documented an important issue: The link between macroeconomics and health. Its main conclusion was that investing in health benefits the overall economy.

In my time as chief of staff for Director-General Gro Harlem Brundtland in WHO, we saw that WHO had to find out how this link could be documented. We therefore launched the Commission on macroeconomics and health. And the learnings from then are just as valid in the current context: When resources are scarce, it is even more important how they are spent…!

Since 2000, many countries around the world have experienced rapid growth. Interestingly enough evidence is clear that countries which have invested in education and health in general have higher growth rates than those which have not. Health gains started before economic growth. This demonstrates that improved health is not just a consequence of increased wealth, but actually a contributor to such growth. 

Four years ago, WHO Euro Member States met here to discuss what was then a serious finance sector crisis, but which nevertheless was putting state budgets – including health – under pressure.

One conclusion from that meeting was the importance of ensuring universal access to health services – particularly when considering measures to address budget cuts.

Where are we today compared to 2009? Clearly, the economic crisis continues to be a challenge. It is no longer limited to the bank sector, now high proportions of citizens in Europe are suffering from the consequences.

Several countries have experienced long periods of negative growth. State budgets in many countries suffer from reduced income.  Poverty and unemployment – particularly among young people - is at a peak. The social fabric in our societies is under serious pressure.

In the midst of this crisis, which so far has affected certain countries more than others, we all share a challenge in the longer perspective: That of the sustainability of our health systems.

The demographic trends in Europe, with an ageing population, will mean that our health services will have to adjust to new user groups, and likely also will see an increased demand for services, where non-communicable diseases will be even more dominating than today. On top of this, medical innovations allow people to live longer with their disease.

At the same time, a lower proportion of our populations will be in working age and thus contribute financially to health and social services.

In this context, can the financial crisis be used to implement reforms with long-term, stabilizing consequences? Can we find the courage to initiate larger, structural change, now that we have picked the ”low-hanging fruits”?

Despite the diversity of national health systems; European Health systems share a common ideological basis: that of equity, solidarity and universal access. When put under pressure, all health politicians should set those values first when planning for change.

I would like to point to four principles I believe are important when external conditions make changes necessary:

1. Equity: How can we ensure that the changes we introduce do not increase social inequity in health? Solving budget cuts by increasing user payment for all would typically be a challenge for marginalized groups.

2. A well-functioning primary health care with access for all citizens. We know that improving primary health care services is a cost-effective way of providing health care to e.g. chronically ill patients.

3. Prevention and promotion: We must look at how we can address external factors which improve or deteriorate the health of our citizens. We must work actively with colleagues responsible for other policy areas – infrastructure, taxation, education etc. – to ensure that policy changes in their sector may be beneficial to promote health and reduce the incidence of non-communicable disease. This is where health ministers only have limited leverage on their own; they need to apply a cross-sectoral approach and work together with other ministers in achieving their objectives. The current crisis indeed demonstrates the importance of the principle of Health in all policies.

4. Innovation in health: Budget cuts often means cuts in investments. In times of crisis, it may be tough to work strategically in renewing the delivery of health services. In this regard, a crisis can serve as a driver to introduce new technologies, new ways of working, that would otherwise be very difficult to reach political agreement about.

 

In the coming years, crisis or not, all European countries will have to take tough prioritization decisions in order to ensure the long-term sustainability of our health systems. As I see it, these decisions must ensure that public health authorities are responsible for overall prioritization and management of the health sector.

It is my hope that the country studies to be presented here, as well as the subsequent discussions, will enlighten us about effects – positive and negative -  of the changes which have been introduced, and thereby helping us to take better informed decisions when considering similar measures.

I welcome the fact that some of Europe’s best researchers are doing a thorough analysis in this area through these country reports and their follow-up. We need this knowledge base to help us when facing the need for health reforms at national level. 

Can the experiences we gain in this crisis help our societies to face other types of societal crisis, thereby improving our overall preparedness and resilience?