Promoting health and wellbeing, preventing disease and reducing health inequalities require universal and quality services. The pandemic has highlighted that people with pre-existing chronic diseases (often associated with lower socio-economic backgrounds) were more likely to suffer severe health consequences or die from COVID-19. Many of these chronic diseases are preventable through health promoting services. This guide aims to provide inspiration for how these can be defined, designed and attract investments.
Defining health promotion and health promoting services
Health promotion is the process of enabling people to increase control over and to improve their health. It represents a comprehensive social and political process, which includes actions for improving the skills and ability of individuals to increase control over the determinants of health, and actions towards changing social, environmental and economic conditions to address their impact on public and individual health.
Health promoting services include organized efforts to strengthen the skills and capabilities of individuals, as well as efforts to change social, environmental and economic conditions to alleviate their impact on public and individual health
Health promotion is a major contributor at municipal, regional, and national level to shaping policies, actions and services which address health and social inequities through action on the social determinants of health. The social determinants of health (SDOH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.
In order to “build back better” after the pandemic it is important to adopt broad-based measures to improve overall population health within a ‘healthy public policy’ or a ‘health in all policies’ framework. This would foreground the health impact of each sector and would ensure that steps are taken to minimise adverse effects and promote positive health benefits for all. As the iceberg-illustration indicates, it is action on the social determinants of health that is crucial if we are to improve health and wellbeing for all in our societies and improve resilience towards future crisis
Why does health promotion matter?
In the EU in 2016, two thirds of early deaths of people under 75 were avoidable 1EuroStat (2019). For people under 75, two deaths out of three in the EU could have been avoided Eurostat News Releases. That is 1.2 million out of 1.7 million deaths. Of those, 741,000 deaths could have been avoided through effective public health and primary prevention interventions, and 422,000 deaths through timely and effective health care interventions. The picture is not uniform across Europe. The highest shares of avoidable deaths were registered in Romania with 80.1 percent, followed by Lithuania, Hungary, Latvia and Croatia, whose percentages were in the high 70s. France had the fewest avoidable deaths (60.6 percent), followed by the Netherlands, Poland, Bulgaria and Italy. This was due to public health interventions to prevent heart and lung disease and stroke, which accounted for most avoidable deaths.
The continued pervasiveness of health inequalities across and within European countries, and amplified through the COVID-19 pandemic, means that new approaches are needed. Restrictions on public health budgets require creative and novel ways of financing and delivering services that promote and protect health and wellbeing. Even though large recovery funds and funds for crisis preparedness were made available in 2020, health promoting budgets face continual financial uncertainty. Throughout Europe, approximately only 3% of health system expenditure is assigned to public health, health promotion and disease prevention. By comparison, around two thirds is spent on curative and rehabilitative care, with the remainder on medical goods and governance.
Meanwhile, long-term care costs continue to grow. All health and social systems seek new ways to meet needs sustainably and often cite prevention as being a better investment than cures. Such restrictions on public health budgets demand creative and novel ways of financing and delivering services to promote and protect health and wellbeing.
Knowing that health promotion budgets are among the most vulnerable areas of health system spending – often cut when resources are constrained – a range of actions are available. This information guide presents a series of options that planners and policymakers can utilise to tackle some of these resource challenges, improve health and wellbeing, and address the persistence and prevalence of health inequalities ,which are among the most important challenges for governments to tackle 2Marmot, M., Allen, J., Bell, R., Bloomer, E., & Goldblatt, P. (2012). WHO European review of social determinants of health and the health divide. The lancet, 380(9846), 1011-1029..
Europe is facing a large gap between the needs of people and the actual budgets that are mobilised for social infrastructure (i.e. social services, education, health services and housing), which are key social determinants of health. Public investments are 20% lower than a decade ago, meaning that services such as education, health and social protection have reduced standards. Demand is growing, from ageing and demographically changing populations with related chronic disease needs; from consumer and provider pressures in rapidly developing technological media; and from factors around sustainable development, including major climate change and migration challenges. It is estimated that this investment gap in social infrastructure alone is 150 billion euros per year for the next ten years. 3Fransen, L., Del Bufalo, G., & Reviglio, E. (2018). Boosting investment in social infrastructure in Europe. rapport de la task-force de haut niveau sur les infrastructures sociales en Europe) discussion paper (74)
It is clear that current investment policies and practices are often unsustainable and result in high human, social, economic and environmental costs. Instead of seeing health as a cost, we need to find pathways and resources which will persuade relevant policymakers, planners, and politicians – and the public – to understand health as an investment asset and a common good that needs to be preserved.