Invest4Health: Mobilising novel finance models for health promotion and disease prevention

The Invest4Health project (2023-2026), funded by Horizon Europe, aims to revolutionize public health financing by identifying and incentivizing new finance and business models for health promotion and disease prevention, under the concept of ‘Smart Capacitating Investment’. The project will develop and test models, alternative governance mechanisms and tools, and methods to facilitate the use of Smart Capacitating Investment for health promotion and disease prevention. These include cost-effective strategies that span multiple sectors to share risks, pool assets, and analyse return on investment to ensure efficient utilisation of all available resources.


At present, healthcare budgets across Europe are overwhelmingly spent on treatment of disease, with an average of only 3% spent on health promotion and disease prevention. 1[i] European Commission (2018) State of the Health in the EU, Companion Report. Yet a growing burden of preventable diseases and widening health inequalities across Europe illustrate that present approaches to financing are unsustainable and not fit for purpose. The fiscal space for governments to invest in health has also been shrinking; even pre-pandemic, public investment in social infrastructure (e.g., health, education, affordable housing) was 20% lower than before the 2008 financial crisis.22018 – Fransen L, del Bufalo G and Reviglio E. Boosting investment in Social Infrastructure in Europe: Report of the High-Level Task Force on Investing in social infrastructure in Europe. European Economy Discussion Paper 074, Luxembourg. Note: SHCN team members were part of the Task Force Secretariat, coordinated both expert working groups and J Lane was  a member of the HLTF 3[iii] EIB (2017) Investment Report 2017-2018, November, EIB: Luxembourg

What is ‘Smart Capacitating Investment?’

The term Smart Capacitating Investment (SCI) was first used by the High-Level Task Force for Social Infrastructure Investment initiated by the European Long-Term Investors Association (ELTI), which explored ways to enhance public and private investments in social infrastructure (Fransen et al 2018).


Smart Capacitating Investment makes the most of existing resources (including financial and non-financial assets) and builds partnerships between different sectors (e.g., public, private, voluntary, or housing, health, environment) to make investments that generate sustained returns and localised benefits to improve health and wellbeing, thereby making health systems more sustainable.


During the Invest4Health project, the concept of Smart Capacitating Investment will be further defined, and ‘SCI-compatible’ business and finance models will be identified and promoted.

Invest4Health promotes the use of new models and mindsets to achieve sustainable return on investment from health promotion and disease prevention. The consortium, led by Region Skåne in Sweden, combines interdisciplinary expertise with four real-world pilot sites (or ‘testbeds’) to develop new financing models, foster practical implementation and ensure community involvement. The project is exploring various mechanisms for delivering health promotion and disease prevention, including public, private (for-profit, not-for-profit), and ethical, equitable Public-Private Partnerships. The project also includes a focus on primary, secondary, and tertiary levels of prevention (figure 1), as well as interventions focused on key determinants of health (e.g., housing, education, transport, and environment). These models will be evaluated and validated, thereby offering decision-makers and policymakers resources and tools to prioritise and for health promotion and disease prevention at all levels.


The goal is to deliver tangible results through validated models and tools, encouraging decision-makers to prioritize risk-sharing and resource pooling for health initiatives. The project also emphasizes citizen science, a digital collaborative space for decision-making, and the social franchising approach to ensure the active involvement of communities in promoting health and preventing diseases.

Structure of the Invest4Health Project

The Invest4Health project has three main work streams:

  • Developing functional prototype models of the ‘Smart Capacitating Investment’ concept under pinning the project
  • Iterative testing of ‘SCI’ in real world environments representing both Beveridge (tax-based) and Bismarck (insurance-based) financing systems
  • Preparing a social franchising package for large-scale demonstration of SCI compatible models.

A cross-cutting emphasis is placed on ensuring citizen involvement in planning and investment decisions for interventions and services.

EuroHealthNet is responsible for the project’s Operational readiness & capacity building activities. The tasks serve as a bridge between the theoretical elements that the project is researching and the iterative testing that occurs while testing SCI models and governance mechanisms in the four pilot sites.

Invest4Health pilot sites

Location of Invest4Health Test Beds

Invest4Health includes four “test beds”, or pilot sites, where SCI-compatible business and finance models will be tested in alignment with health promotion and disease prevention interventions selected by the test beds.


The test beds are located in Germany (North Rhine Westphalia), Spain (Galicia), Sweden (Skåne), and Wales (Hywel Dda). These four initial regions represent a range of health systems, including universal single-payer (Galicia), universal multi-payer (North Rhine Westphalia), universal and decentralised (Skåne), and universal single-payer (Wales). The four test-beds will also work on a range of health promotion intervention areas which cover the lifecourse (Table 1). Testing in the policy labs will be informed by the theoretical and research driven knowledge base being developed (Work Packages 2-4). Feedback from citizens and local communities will also be gathered to iteratively inform development and piloting of new tools and models.



Table 1: Selected health promoting interventions and target populations of each Invest4Health test bed
North Rhine Westphalia (DE) Working-age population Supporting health in the home office environment through bundled tools (e.g., ergonomics, digital resources)
Galicia (ES) Ageing and rurally isolated population Supporting healthy and active ageing through the improved use of existing digital tools
Skåne (SE) Children and young people in municipalities across Skåne Expanding the use of ‘Getting it Right for Every Child’ (GRIFEC) and other similar interventions to improve holistic child and adolescent wellbeing.
Hywel Dda (UK) Socially vulnerable populations (e.g., those in need of complex interventions) Using a new government social prescribing initiative to enhance the use of social prescribing across West Wales

Sustainability of project outcomes through social franchising

As the test sites and theoretical knowledge come together, the framework of what could be transferred and replicated in other settings will become clearer. At the mid-point of the project, an open call will be launched to attract a second tranche of regions to run simulation exercises with SCI models. This will also inform what will eventually become the basis of the core Invest4Health model, which project partners aim to promote through social franchising.4 The goal will be to replicate the impact of Invest4Health in different locations while maintaining a consistent standard. The approach will not be on financial profit from the model, but rather maximising social benefits to ‘franchisees.’ Through its social franchise model, Invest4Health would provide peer support and development to networks of local stakeholders (in various municipalities or regions) who have agreed or will agree to deliver equitable health promotion and disease prevention services under the ‘Invest4Health’ label. By combining mobilization efforts and market-based approaches, Invest4Health works to ensure the replication of its proven models and interventions while allowing for local flexibility in implementation, creating value where it is most needed.


Health promotion and disease prevention are an investment and they benefit from being designed and financed within an investment paradigm. Invest4Health helps to reimagine investment in and delivery of equitable health promotion and disease prevention. Smart Capacitating Investment can support the paradigm shift from health ‘cure’ systems to health ‘care’ systems, making them more resilient to future shocks, more health-promoting, more interdisciplinary, and more equitable.

What is 'Social Franchising?'

Social franchising is a relatively new approach which applies commercial franchising methods to achieve social goals. Rather than pursuing the franchise model for profit, the purpose is to create social benefits.


Social franchising is an increasingly popular approach to achieve scale through replication and to ensure the sustainability and transmission of good practices. The ‘franchisors’ who own the franchise are able to train the new ‘franchisees’ who are building up local versions of the practice or approach and help maintain quality and ensure a consistent standard.

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