Europe faces an enormous – and growing – investment gap in social services, including social housing, education and health. It is essential for health promotion providers to begin exploring the opportunities offered by complementary and innovative funding mechanisms. Social investment offers an opportunity to both private and institutional investors, who are likely to be more involved in social investment and services in Europe in the coming decades due to public investment constraints, government investments, and policies to encourage private sector participation. The devastating impact of COVID-19 on health inequalities demonstrates a clear need to ensure not only investments in crisis preparedness, but also to involve investors in building wider social infrastructures to improve resilience of communities.
Investing in health promoting services
Health promoting service providers would benefit from being proactive in seeking innovative financing opportunities and knowledgeable of financial language, measures, and instruments.
There are benefits to thinking beyond health sector budgets alone to realise systemic change and make substantive progress. This requires smarter thinking about the ways in which cross-sectoral relationships and services can be leveraged to reduce expenditure and improve the quality of service provision. Working with other sectors, including housing, education, and long-term care, can result in a better continuity of care for the community and bring about co-benefits such as improvement in the underlying social determinants of health, ultimately leading to the prevention of illness and reduction of health inequalities.
One way of increasing funding for actions that benefit health is by working outside the health sector and to form cross-sectoral alliances. Health and other social sectors share common goals, benefits, and economic gains from taking a health equity perspective to their work. For example, cross-sector benefits include school health-programmes that cover school-performance, mental health, and health literacy and are inclusive of families and the community. To provide shared funding, sectors can take a joint budgeting approach, including mutually determined targets and outcomes, as well as the breakdown of roles and responsibilities for the delivery of pre-agreed services.
It is important to also encourage investing in infrastructures, as part of a broader shift across sectors that recognises the need for integrated, community-based health and social care and services.
- 'Hard' social infrastructure may include building health centres, good quality social housing, sustainable transport infrastructure, playgrounds or green spaces.
- 'Soft' social infrastructure investments include staff skill development, community programmes, welfare advice services, prevention and early interventions, and person-centred approaches.
While this increased collaboration is welcome, we must acknowledge that these investments carry certain risks for both investors and recipients of investments. For investors this includes political and regulatory exposure; governments can amend the standards of service expected from privatised facilities, the length of their leases or concessions, or the level of risk-weighted returns on capital outlays. For recipients this includes badly drawn contracts, negative impact on staffing, limitations in provisions, and cherry picking of services, which could exacerbate health inequalities. We do not advocate for the privatisation of any service, programme, or facility. However, policymakers must be aware of the possibilities and potential pitfalls from increased investment opportunities.
Investments in both hard and soft social infrastructure- simultaneously - are important for supporting sustainable and effective health promoting services. What we need to see is investments like the programme below from Germany where investments in 'softer' skills are seen as a crucial aspect to improve health and the rehabilitation of workers.