Healthy Europe”, October 2018, Is a One-Off Publication for the European Health Forum Gastein in 2018

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CURRENT INFORMATION ON PUBLIC HEALTH AND HEALTH PROMOTION

heaeuropelthy EUROPEAN HEALTH FORUM GASTEIN 2018

Health and Sustainable Development

BOLD POLITICAL CHOICES FOR AGENDA 2030

Health Innovation A success inequalities for all story No one should be New incentive systems Tobacco-free left behind are necessary investments

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PUBLISHING DETAILS

Disclosure in accordance with §25 of CONTENTS the Austrian Media Act (MedG)

Media owner and publisher: teamword, Dietmar Schobel, Meidlinger Hauptstr. 3/5-7, 1120 Vienna, Austria TOBACCO-FREE INVESTMENTS Concept: Many pension funds invest in the tobacco industry. Dorli Kahr-Gottlieb (EHFG), 9 Australian cancer specialist Bronwyn King is successfully Thomas Panayotopoulos (EHFG), fighting to change this. Dietmar Schobel (teamword)

Editorial office: Dietmar Schobel, Meidlinger Hauptstr. 3/5-7, 1120 Vienna, Austria, www.teamword.at, [email protected], Tel.: +43 1 909 33 46 (office) or +43 664 360 17 82 (mobile)

Translation/Proofreading: Rosemary Bridger-Lippe

Graphic design: Gottfried Halmschlager

Photos: Fotolia, private

Cover photo: Fotolia – loreanto

Printing: contrastwerkstatt - Fotolia.com Photo: Ferdinand Berger & Sohnë Ges.m.b.H.

Publication frequency: “Healthy Europe”, October 2018, is a one-off publication for the European Health Forum Gastein in 2018. Published and produced in Vienna, Austria

Publisher’s post office: 1120 Vienna, tomhanisch - Fotolia.com Photo: Austria

PEOPLE AND The European Health Herwig Ostermann, Editorial policy: POLICIES Forum Gastein is Managing Director of This edition of the magazine “Healthy Europe” Europe’s leading Gesundheit Österreich was made possible by collaboration between Clemens Martin discussion platform for GmbH, in an interview the European Health Forum Gastein (EHFG), health policies, with a on how evidence can be Gesundheit Österreich GmbH and the Main Auer, President of history that spans used smartly. Association of Austrian Social Security the European 20 years. 7 Institutions. It is a platform for public health Health Forum Gastein and health promotion in Europe, presenting (EHFG) explains in 5 people and conveying content from the worlds an interview why Data protection as an of politics and science, as well as practical health policy-makers Three profiles: Jennifer added value issues. must develop Dixon, Zsuzsanna Jakab, 8 a louder voice. Ilona Kickbusch 4 6

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EDITORIAL Dear Readers, 10 ustainable development and health are the main S topics of the European Health Forum Gastein (EHFG) in 2018, and are likewise the

focus of this issue of the maga- EHFG Photo: zine “Healthy Europe”, which has been published on the occasion of the EHFG for the first time. These two topics can be regarded as two sides of the same coin, such is the strength of the connections between them. They are also the subject of our title story on pages 10 and 11 on the significance of the health sector in the 17 Sustainable Development Goals for 2030 set out by the United Nations.

These Goals are no less than a to-do list for people and the planet in order to avoid leaving the coming generations with a situation that is worse than when we inherited it. Health is a crucial factor here. As one of the UN Sustainable Development Goals itself, health also interacts with many of the other specified Goals; it carries them and ensures that they can be fulfilled. In an interview on page 4, President of the EHFG Clemens Martin Auer explains why bold choices are required of health policy-makers in order to implement the 2030 Agenda in practice at 17 Goals European and national levels. Sustainability also means looking ahead to the for a future and planning over the long term. What “ this means for the health systems as a whole, Photo: Fotolia.com - contrastwerkstatt - Fotolia.com Photo: how innovations can improve sustainability, and future worth the role played by digitisation here, are all topics covered by other articles in this issue. Herwig Ostermann, Managing Director of living Gesundheit Österreich GmbH, explains in an interview on page 7 how scientific evidence can be used smartly. On page 9 we describe how The Sustainable Development Goals set out by the United Nations Australian doctor Bronwyn King has succeeded are a to-do list for people and the planet.” in persuading finance managers against investments in the tobacco industry. Last but not least, we address the frequently tense relationship between economic and health interests in a further article in this edition of the KNOWLEDGE accessible to all citizens The health systems across magazine “Healthy Europe”, which was made of the European Union. Europe are facing similar possible by collaboration between the European According to experts, 14 challenges owing to Health Forum Gastein (EHFG), Gesundheit economic growth demographic change and Österreich GmbH and the Main Association of theoretically leads to Differences in health increasing expenditure. Austrian Social Security Institutions. better health among the outcomes are 18 I wish you enjoyable reading and interesting population. Not everyone considerable between and within European days at EHFG 2018, benefits in the same way, Dorli Kahr-Gottlieb, countries, regarding both however. EHFG Secretary General 12 communicable and non-communicable Medical innovations diseases. should be easily 16

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PEOPLE & POLICIES Health policy-makers must develop a louder voice

Clemens Martin Auer, President of the European Health Forum Gastein (EHFG) on the relationships between health and other social areas, and on alternatives to disruptive policies.

HEALTHY EUROPE especially in the health sector? economy, yet it is endangered by the The main topic of the European It is well known that the health sector is populist policies that we are currently Health Forum Gastein in 2018 is expensive and on average represents experiencing in many places, where the “Health and Sustainable 10 per cent of the gross national product main interest is in securing borders and Development – Bold political in European countries. This means that it preventing migration. In contrast, the United choices for Agenda 2030”. is always under observation, as far as both Nations 2030 Agenda is oriented on What were the reasons economic and financial policies are long-term goals and includes each and for choosing this motto? concerned. In Europe we largely manage every single person. Clemens Martin Auer: Globalisation of to contain cost increases. Nevertheless, we the economy and strengthening the com- naturally have to carry on doing our HEALTHY EUROPE petitive position have been the determining homework, optimise processes and create What role does health play in narrative for the past ten, fifteen years. This transparency. Social and health policies connection with the Sustainable has pushed economic constraints even further should not just be focussed on increases Development Goals? into the spotlight in the political debate. By in benefit and efficiency, though. It is a Good health is one of the 17 Sustainable contrast, the 17 Sustainable Development matter of recognising that there are many Development Goals. Sub-goals include Goals set out by the United Nations for the external processes beyond pure healthcare reducing the number of communicable years leading up to 2030 are socially oriented. that can have a negative effect on the diseases and the number of premature We chose them as the main topic in order health of a population, such as certain deaths due to non-communicable diseases. to be part of this different narrative. We market mechanisms. Comprehensive healthcare is also pursued, would do well to implement them into social which includes making innovations and health policies at a European and HEALTHY EUROPE accessible to all people both rapidly and national level as quickly as possible, and to What issues are at the heart of this? equally. The programme for this year’s adopt them in our daily activities. The relationship between social cohesion, European Health Forum Gastein includes structures for efficient and comprehensive discussions on how this can be achieved. HEALTHY EUROPE healthcare, and a prosperous market We will also focus on possible ways to Isn’t there currently a constant economy in Europe is crucial. Social cohesion strengthen the connections between the demand to reduce expenditure is the prerequisite for a functioning finance market and the health sector. After all, investment in health is investment in the future. “Investment in health is HEALTHY EUROPE There is a need for “bold political investment in the future.” choices” as well – as expressed by CLEMENS MARTIN AUER, PRESIDENT OF THE the conference motto. How can EUROPEAN HEALTH FORUM GASTEIN these choices be identified? To begin with, health policy-makers across

Photo: Harald Minich/HBF the whole of Europe must develop a louder

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PEOPLE & POLICIES

voice and speak out in favour of HEALTHY EUROPE well-functioning health systems. If health What can participants expect from policy-makers don’t dare to put their foot the European Health Forum Gastein down from time to time, they won’t be in 2018? heard. A specific example would be to The European Health Forum Gastein is a demand that processed foods are produced marketplace for ideas where freedom of in accordance with findings from nutritional thought is encouraged. The aim is for par- science. It is incomprehensible why far too ticipants to be full of positive stimulus when much salt, far too much sugar and far too they return to their working environment. Dorli Kahr-Gottlieb much fat is still being used. We have known The event should also act as a wake-up call “The EHFG is Europe’s for a long time that this has a direct for greater socio-political commitment, and leading discussion platform for health negative effect on the health of the inject a good dose of boldness that is nec- policies.”

population. essary for this. Photo: EHFG

WHERE NEW CHALLENGES AND OPPORTUNITIES ARE FIRST DISCUSSED

At the European Health Forum Gastein major topics for health policy-making are examined in result-oriented discussions and within a manageable framework. With a history that spans 20 years.

The medical doctor and former Member together discussing the major topics for countries and Brussels to support of the Austrian Parliament Günther Leiner health policy-making and gain fresh decision-making for health,” emphasises describes his motivation for setting up the insight in a comparatively small and Dorli Kahr-Gottlieb. European Health Forum Gastein (EHFG) in manageable setting,” explains 1998 as follows: “The primary goal has Dorli Kahr-Gottlieb, Secretary General of The “Young Gasteiners” bring always been to develop workable policy the EHFG since 2012. She adds: “Where new momentum recommendations.” The conference aims else do you have the opportunity to meet The contents are not limited to the health to advance discussions on health policies leading representatives from the sector, though. It is rather the in Europe and bring together the players European Union on a walk through the interaction between health and other from four areas, the four pillars of the village and exchange views with them?” societal areas that is continually the EHFG: these are decision-makers from the The formats at the conference also focus of discussions at the EHFG. The public sector, representatives from the ensure lively interaction. Instead of long innovative strength of the event aims to private sector and civil society, and also lectures and panel discussions, the be boosted not least by the initiative researchers and scholars. programme is filled with kick-off “Young Forum Gastein”, which was In its first year, 220 high-level speeches, animated debates, and established in 2007 and invites health representatives from these four spheres of working in small groups as in world experts below the age of 35 who have activity accepted the invitation to visit the cafés, for example. already gained some experience in their alpine valley near Salzburg. Since 2003 The content of the yearly event is professions. Every year around the number of participants has averaged prepared by the public health experts of 70 “Young Gasteiners” take part in the 500 to 600 people annually. According to the EHFG team together with partners event as scholarship holders and play an the organiser, this number is intended to from the four pillars and a committee of active role in the programme and in past- be kept at roughly the same level in order renowned experts. It is an important event publications. This has enabled a to preserve the added value of the Forum: objective for the programme to focus on separate, creative network that is the unique opportunities for open the latest and most intriguing issues in recognised throughout the European discussions and networking. the health sector, and for Gastein to host health community to develop over the discussions on current challenges and past years. “This initiative adds signifi- Fresh insight far away from opportunities. “In Gastein the topics that cant momentum towards maintaining the everyday working life concern the health sector in Europe position of the European Health Forum “Far away from everyday working life in should be discussed, developed further, Gastein as Europe’s leading discussion Brussels and other major European cities, and pooled. Ideally, the results should platform for health policies in the future we offer the opportunity to spend time then be taken back to the European as well,” says Dorli Kahr-Gottlieb.

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PEOPLE & POLICIES

JENNIFER DIXON, CHIEF EXECUTIVE OF “I thought to myself, surely THE HEALTH FOUNDATION there is more to it than this?”

“By age eleven my family had healthcare reform by doing a PhD moved house six times due to in the subject and joining the my father changing jobs,” ex- independent foundation The plains Jennifer Dixon. This may King’s Fund in the mid-1990s. be the reason why – at the age Soon after she became policy ad- of 18 – she chose a stable pro- visor to the chief executive of the fession instead of pursuing her National Health Service for two artistic inclinations. She trained years. In 2008 she joined another in medicine and subsequently independent research foundation, worked for five years as a paedi- The Nuffield Trust as chief exec- atrician in London, often for 90 utive. Since 2013 Jennifer Dixon Photo: The Health Foundation

Photo: Kickbusch Health Consult hours per week. “Then I thought has been chief executive of The daughters aged 16 and 12, and to myself, surely there is more to Health Foundation, the UK’s sec- tries to stay healthy by running “The health of the it than this?” Jennifer Dixon re- ond largest Foundation devoted three times a week and swim- population is influenced calls. In 1989 she began studying to health, after the Wellcome ming. Every year she also pro- by all social sectors.” public health in England and was Trust. The Foundation carries out duces several oil paintings. “One awarded a Harkness fellowship and commissions research, gives goal is to paint something I’m ILONA KICKBUSCH, to study in the US. She soon re- grants to improve health care, happy with, and the icing on the GLOBAL HEALTH EXPERT alised her interests lay more with and funds several national and cake would be to feature in the ‘the role of the state’ than with international fellowship pro- Royal Academy of Arts ‘Summer medicine. So she developed her grammes to develop leaders. Jen- Exhibition’ in London,” says Jen- lona Kickbusch was born in Munich in 1948 interest in policy analysis and nifer Dixon is married with two nifer Dixon. and grew up partly in the Federal Republic of IGermany and partly in South India. She now lives with her partner in Switzerland; her son “The 17 Goals for Sustainable Julian is 35 years of age. Ilona Kickbusch studied Development create unique sociology and political sciences at the University momentum for public health.” of Konstanz, and between 1981 and 1998 she worked for the World Health Organization (WHO) ZSUZSANNA JAKAB, in various positions, most recently as Director of WHO REGIONAL DIRECTOR FOR EUROPE the Division of Health Promotion, Education and Communication in Geneva. During her many Relations in 1989. Jakab held in 29 country offices and six years of work for the World Health Organization management positions at the scientific “Centres of Excel- Photo: WHO/Franz Henriksen she has helped to shape European and WHO Regional Office for lence”. “As WHO Regional international health policies. In 1998 Ilona “The 17 Goals for Sustainable Europe in Copenhagen until Office we strive to maintain Kickbusch was appointed professor at Yale Development by 2030 from in 2002 she was appointed good relationships with the University, where she taught Global Health until the United Nations create Secretary of State at the Member States and to support 2004. As CEO of Kickbusch Health Consult since unique momentum for public Hungarian Ministry of Health, the national governments in 2004, she advises national governments and health,” says the Director of Social and Family Affairs. In their efforts to perform their international organisations, and is Director of the the World Health Organiza- 2005 she became Director of responsibilities,” says Jakab. Global Health Centre at the Graduate Institute tion’s Regional Office for the European Centre for Dis- And how does she take care of International and Development Studies in Europe, Zsuzsanna Jakab (67). ease Prevention and Control of her own health, as an Geneva. What is the significance of the 17 Goals Jakab comes from Budapest in Stockholm and was elected expert? “I watch what I eat, set out by the United Nations for sustainable and studied political sciences WHO Regional Director for do exercises in the morning, development in the health sector? “Good health there from 1969. From 1975 Europe in 2010 and nominat- and I like to go swimming,” is one of the 17 Goals, and the well-being of the onwards she was employed ed for a second term of office the WHO Regional Director population is influenced by all social sectors. in various positions at the in 2014. As Regional Director explains. She continues: “I Taking a sustainable approach to development Hungarian Ministry of Health she is responsible for 300 also try to maintain a balance there will therefore also benefit the health sector,” and Social Welfare and be- employees at the WHO office between work and leisure, Ilona Kickbusch explains. came Director-General of the in the Danish capital, and also and I spend as much time as Department for International for about another 300 people possible with my family.”

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PEOPLE & POLICIES Using evidence smartly

Herwig Ostermann, Managing Director of Gesundheit Österreich GmbH, in an interview on the criteria for determining evidence and how policy-makers, health experts and patients should use it.

HEALTHY EUROPE What is “evidence”, and how can it be used smartly? “Evidence and subjective Herwig Ostermann: In the field of medicine, evidence means providing systematic proof practical knowledge complement of the therapies and other interventions that one another.” are effective – and those that are not. Over HERWIG OSTERMANN, MANAGING DIRECTOR OF the past decades we have experienced a GESUNDHEIT ÖSTERREICH GMBH transformation in which evidence has been increasing in significance in all health professions and also shaping and professionalising everyday working lives. arises as to the extent to which the findings already been provided by health services However, this does not mean that the sub- from the “ideal-typical” study population research and for evidence-based tobacco jective practical knowledge of experts has can then be transferred to real contexts. In prevention, for example. become less valid, but rather that both areas technical terms, the internal validity of such complement each other. And it is ultimately studies may be high, but not necessarily the HEALTHY EUROPE about applying the existing evidence smartly external validity. Who in particular are the people in each specific, individual case. This means who should ultimately use the using well-founded findings to weigh up the HEALTHY EUROPE existing evidence smartly? opportunities and risks of a treatment together Can evidence be generated for The prerequisites are adequate forms of with the patients, taking the best possible non-medicinal therapies as well, or knowledge communication, and in medicine decision which is also the decision that most for measures to improve the health they are encountered primarily via guidelines probably brings the greatest benefit and of a population? from expert associations. It is an established hopefully causes no harm. Interventions such as surgical procedures and and proven procedure. On the other hand, physiotherapy treatments cannot be as easily evidence should above all serve as a basis HEALTHY EUROPE standardised according to comparable criteria for policy-makers to take decisions. It is the What questions can be examined in as medicinal therapies. They are also dependent responsibility of the scientific community to scientific research to produce evidence on the skill of each expert, on the participation prepare the facts with corresponding clarity and in what cases is this not possible? of the patient, and on the context in general. and precision, and to illustrate potential The larger the context, the more difficult it Nevertheless, it is possible to obtain a good action wherever they do not allow unam- can be to generate evidence. The clearer comparison of the effectiveness of operations biguous conclusions. If this is explicitly and more definable the phenomenon to be as distinct from conservative treatments, for commissioned, evidence-based support for examined, the greater the chances of success. example. As far as the health of a population decision-making can be submitted. In the With medicinal therapies the highest degree is concerned, it is becoming increasingly difficult end, however, we must also accept that of evidence is still achieved in double-blind, to obtain evidence that meets the aforemen- whether and how these recommendations randomised controlled studies. This means tioned standards: it is a matter of documenting are implemented is ultimately dependent on that sufficiently large numbers of patients and evaluating the interventions as precisely the decision-makers and the overall political are assigned randomly to a test or control as possible. This enables fact-based, interests. In certain cases, the concerns of group. This is the best way to compare and well-founded knowledge to be gathered to the health sector are in competition with document the efficacy of a drug over a certain establish why a certain measure works in a other social areas such as the labour market

Photo: GÖG/Sebastian Freiler period of time. However, the question always certain context – or not. Such knowledge has or the economy.

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PEOPLE & POLICIES Data protection as an added value

Photo: EDPS Photo: Ma ̈ hr Consulting Personal health data is highly sensitive Leonardo Cervera Navas: Wolfgang Mähr: “Data protection should not “Data will be the raw information. The right to protect it may sometimes be be considered an obstacle, material of the next but an added value.” economic cycle.” perceived as an obstacle to the justified interests in new research findings, though. Text: Dietmar Schobel

can be regarded as the year in which the 1981 internet was born. In the approx. 35 years since then, the digitisation of information, i.e. its depiction in binary numbers, has influenced the economy, politics and society so rapidly and so intensively that it shapes everyday life for each and every one of us. Still, in-depth discussions are a relatively recent occurrence with respect to the personal data left behind by us almost every time we use computers, tablet PCs and smartphones online.

An extensive public debate on how this can be Photo: Fotolia.com - natali_mis protected is ongoing, which applies to personal data in general and also specifically to to the use of his or her personal health data. In group in question could be determined more information on health. the healthcare sector, however, other legal basis precisely based on criteria such as age, gender The General Data Protection Regulation (GDPR), than consent is available in the GDPR, allowing and weight, thus allowing personalised medicine. which came into effect at the end of May, is the processing of such sensitive data in particular “The prerequisite of this, however, would be regarded by many experts and citizens as the when necessary for reasons of public interest in the standardised recording of health data in first important step in the right direction towards the areas of public health, such as for public healthcare institutions ranging from doctor’s the protection of privacy. Others see the new health surveillance activities and epidemiological surgeries and chemists to hospitals. In the rules as too restrictive, for example when it studies, or when necessary for scientific research. majority of countries in the European Union, we comes to evaluating health data for research. Moreover, the processing of anonymised data, are still very far from being able to do this,” “Data protection should not be considered an which no longer singles out a person, is also says the pharmaceuticals expert, who also points obstacle, but instead an added value in order allowed. A working group at the European out that Europe on the whole has a lot of to improve the usage of health data, while Medicines Agency is currently examining how catching-up to do as far as digitisation is keeping it safe and respecting the ethical health data in clinical reports can be best concerned: “After all, data will be the raw dimension,” says Leonardo Cervera Navas, Di- anonymised. This technical anonymisation group material of the next economic cycle.” rector at the European Data Protection Supervisor consists of representatives from the private and Leonardo Cervera Navas also emphasises that (EDPS), which operates for the European Union, public sector. The EDPS is contributing to and the use of health data can bring advantages in an interview with “Healthy Europe” (the full closely following the work of this group. and new treatment options for patients: interview with Leonardo Cervera Navas can be “Nevertheless, we still have to examine the eth- accessed at www.ehfg.org/blog/2018/09/16/ Data as a “raw material” ical issues resulting from this.” These issues will data-protection/. Pharma expert Wolfgang Mähr is convinced that be the focus of the International Data the large volume of data made available to us Protection and Privacy Commissioners Confer- Lawfulness of data processing via digitisation could bring many advantages, ence in Brussels on 22–24 October. Its title: According to the GDPR and ethical principles, particularly in the health sector. For example, “Debating Ethics: Dignity and Respect in Data each person should give his or her explicit consent the medicine with the best effect for the patient Driven Life”.

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PEOPLE & POLICIES Using evidence smartly

Herwig Ostermann, Managing Director of Gesundheit Österreich GmbH, in an interview on the criteria for determining evidence and how policy-makers, health experts and patients should use it.

Photo: GÖG/Sebastian Freiler period of time. However, the question always certain context – or not. Such knowledge has or the economy.

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KNOWLEDGE 17 Goals for a future worth living The 17 Sustainable Development Goals set out by the United Nations are a to-do list for people and the planet. Good health is one of the Goals and it interacts with all of the others.

hree years ago, on 25 September 2015, all the United Nations representatives stood T up from their seats at the General Assembly and applauded wildly. The resolution on the 2030 Agenda for Sustainable Development had been adopted unanimously by all 193 Member States of the United Nations. It was truly a cause for celebration.

“This universal agenda is for every single person Photo: WHO Photo: BMASGK Photo: UN Photo/Mark Garten around the world, and no one should be left Ilona Kickbusch: Beate Hartinger-Klein: Ban Ki-moon: “This universal behind,” explained the then Secretary-General “All the Goals interact “Health is a cross-cutting agenda is for every single person of the United Nations Ban Ki-moon. The Agenda with each other.” issue.” around the world, and no one describes 17 specific Sustainable Development should be left behind.” Goals (SDGs) that aim to end poverty, protect the planet and enable prosperity for all by the www.un.org/sustainabledevelopment/health, “Climate Action”, for example. “All the Goals year 2030. These 17 Goals are intended to be include, for example: interact with each other. The Goal that possibly implemented at national level by the Member has the most significance for sustainable States using plans and strategies. Sub-goals have • By 2030, reduce the global maternal mor- development of the planet is Goal Twelve, which also been formulated for each of the Goals, and tality ratio to less than 70 per 100,000 live aims to achieve ‘Responsible Consumption And the Member States report back voluntarily on the births Production’,” says Ilona Kickbusch. progress made on the journey towards achieving • By 2030, end the epidemics of AIDS, tuber- “In accordance with the approach taken by the each Goal. An annual report summarises this in culosis, malaria and neglected tropical diseases ‘Health in All Policies’ concept, health is a an overview, while examining several of the Goals and combat hepatitis, water-borne diseases cross-cutting issue,” emphasises the Federal more closely each time. and other communicable diseases Minister of Labour, Social Affairs, Health and • By 2030, reduce by one third premature Consumer Protection in Austria, Beate Hartinger- A strategy for every single state mortality from non-communicable diseases Klein. This therefore concerns not only the De- The SDGs build on the MDGs, the Millennium through prevention and treatment and pro- partment of Health, but many other areas of so- Development Goals of the United Nations that mote mental health and well-being ciety as well. For instance, production and trade, set targets between 2000 and 2015 and in many • Achieve universal health coverage, includ- social services and education, and also working cases were particularly aimed at underdeveloped ing financial risk protection, access to quality conditions, have a strong influence on health. regions. “In contrast, the Sustainable Development essential health-care services and access to This is reflected in the Sustainable Development Goals were understood right from the outset as safe, effective, quality and affordable essential Goals as well, which must be implemented at a a strategy for every single state in the world. This medicines and vaccines for all. national level using appropriate measures. “One comprehensive approach is especially important specific example is increasing people’s awareness because the political and economic activities of The Goals influence each other of the connections between their consumer the rich states greatly influence the poor countries The focus of the Sustainable Development Goals, behaviour, their health, and environmental issues,” of the world,” stresses global health expert Ilona however, is that all 17 fields of action are inter- says Beate Hartinger-Klein: “And we need to Kickbusch. connected. The World Health Organization (WHO) begin with children and young people. Workshop Goal 3 reads “Ensure healthy lives and promote therefore points out that health can be influenced formats to generate conscious consumption such well-being for all at all ages”. The sub-goals in by all other 16 Goals, among them “Quality as the ‘COCO lab’ at Vienna’s Economic Museum the area of health, described in greater detail at Education”, “Clean Water and Sanitation” and show how this can be achieved.”

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INTERVIEW

UNIQUE MOMENTUM FOR PUBLIC HEALTH

Zsuzsanna Jakab, WHO Regional Director for Europe, on the importance of the 17 Sustainable Development Goals for the health sector and why we are currently living at the expense of the present and future generations.

HEALTHY EUROPE Can you explain the importance of the 17 Sustainable Development Goals of the United Nations for the health sector? Photo: WHO Europe Zsuzsanna Jakab: The adoption of the 2030 Agenda and the universal commitment to the Sustainable Development Goals (SDGs) create unique momentum for public health. The implementation of the SDGs will contribute to the full realisation of human rights and fundamental freedoms for all, including the right of everyone to the highest attainable Zsuzsanna Jakab: standard of physical and mental health. “Health is an Also, the adoption of the 2030 Agenda overarching goal.” has clearly shown that the vision of the international community is converging, and that there are growing signs of Health is an overarching goal. Without large. If everyone on the planet had the solidarity in the world. We have unprece- health we cannot achieve the SDGs, and same ecological footprint as the average dented political determination to strengthen to achieve health we need to accomplish resident of the European Union, we would health systems towards universal health all of the SDGs. The SDGs have strong need approximately 2.6 Earths to support coverage, strengthen primary healthcare, interconnections that extend to all sectors. our demands on nature. We are living not combat major diseases and address the If properly implemented, actions to only at the expense of future generations, multiple determinants of health through achieve the SDGs should span many but also at the expense of the present the achievement of all SDGs. spheres of governance (such as legal, generation. institutional, technical and fiscal realms) HEALTHY EUROPE and many sectors (such as those focussed HEALTHY EUROPE How can the health sector on agriculture, transport, energy, justice, The SDGs are not legally binding. contribute to reaching all the welfare, education, security, industry and What importance do they have in SDGs together? housing). Ultimately, this will improve practice in terms of national Obviously, its main contribution is the people’s living conditions; increase policy-making? implementation of SDG 3, the “health capacity; improve social, environmental The fact that the 2030 Agenda is goal”, which is the most powerful tool and financial protection; create a greener universal, for high- and low-income for operationalising health in all policies. society; and increase security at all levels. countries alike, provides an unprecedented This is underpinned by universal health opportunity for global governance. coverage, which is the flagship of the HEALTHY EUROPE Although it is not legally binding, we see new global vision for the WHO that was Sustainability means not living at more and more countries, international approved by Member States at the World the expense of future generations. Is players and stakeholders engaged in Health Assembly in May this year. But this currently the case – in Europe implementing and contributing to the health targets are not limited to SDG 3 – and globally? 2030 Agenda and achieving the SDGs. almost all of the other 16 goals are direct- Let me clarify: sustainability means not We can see this commitment in, for ly related to health or contribute to health living at the expense of future or present example, the annual reporting of more indirectly. generations. How societies live, consume than 100 countries worldwide and 36 and produce continues to be disconnected countries in the Region at the United HEALTHY EUROPE from natural environments as a result of Nations High-level Political Forum on The health sector is connected to all long-standing patterns and practices in Sustainable Development. other societal sectors. Should health policies, institutions, technologies and The full interview with Zsuzsanna Jakab therefore be an overarching goal in lifestyles. Despite improvements in the last can be accessed at www.ehfg.org/blog/ the context of the SDGs? decades, Europe’s ecological footprint is 2018/09/16/unique-momentum/

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KNOWLEDGE How the economy affects our health According to experts, economic growth theoretically leads to better health among the population. Not everyone benefits in the same way, however, and industrial production is frequently also linked to environmental damage. Text: Dietmar Schobel

“Policies are merely the degree of freedom per- be accessed at www.ehfg.org/blog/2018/ mitted by the economy,” the German political 09/16/data-protection/. satirist, actor and author Dieter Hildebrandt In a current OECD working paper on the topic of (1927–2013) once said. The extent to which this “Inclusive growth and health”, it is established applies is dependent on the creative drive and that not all groups of the population benefit in courage of the decision-makers. However, it is the same way from the nations’ current growth in indisputable that our modern, highly specialised economic power and health. “Despite overall gains economy that is based on the division of labour in the health of the population, large inequalities shapes all our lives to a large extent. We all need in health still persist in most OECD countries. These goods, services and work for our families and health inequalities seem to have been persistent Mark Pearson: “Economic Hans Kluge: “We know growth has a fundamentally that even in richer countries, ourselves. But what effect does this have on our over time, and are particularly large in Central and positive influence on the the amount spent on public health? Eastern Europe,” write the authors Chris James, health of the population.” health is far lower than it “Economic growth has a fundamentally positive Marion Devaux and Franco Sassi. ought to be.” influence on the health of the population. I know of no country where the two are not connected. Reduce side effects DATA & FACTS However, this connection is more pronounced in A further important aspect is that the way in developing countries than in the rich states,” which working conditions are designed, as well The gains in life expectancy that were says Mark Pearson, Deputy Director of as pollution of the air, water and soil due to the achieved in recent years can be traced back Employment, Labour and Social Affairs of the production and consumption of goods, can have both to factors within the health Organisation for Economic Co-operation and a negative effect on health either directly or system but also to those outside the health Development (OECD), to which 36 Member States indirectly. “However, this does not mean that it system, according to the OECD working paper on “Inclusive growth and health”. worldwide belong. is a reason to restrict economic growth. Instead, For instance, a 10 per cent increase in we should reduce undesirable side effects as best health spending is associated with a gain Better health due to economic growth possible,” states Mark Pearson. “The awareness of 3.5 months of life expectancy from 1995 “Numerous studies have evidenced that people that this is absolutely necessary already exists, to 2015, on average across 35 OECD who are employed and earn more are generally especially in many emerging and developing countries. The same rate of improvement in healthier,” comments Hans Kluge, Director of countries.” healthier lifestyles is associated with a gain the Division of Health Systems and Public Health The same holds true for the importance of the of 2.6 months of life expectancy (fewer at the World Health Organization Regional Office health system overall, says the OECD smokers with 1.6 months, and decreased for Europe, who has observed favourable effects representative. “I do not believe that there are alcohol use with 1.0 month). Wider social of economic growth at an individual level. It is many finance ministers around the world who determinants also matter. A 10 per cent not quite as clear on a macro-economic level, only see the health sector as a cost factor. increase in income is associated with a however. For instance, states with a higher Nowadays, it is generally clear that the health of gain of 2.2 months of life expectancy, and gross domestic product are in principle capable the population has value in itself and is a a 10 per cent increase in education with of investing more in the social network and prerequisite for prosperous economies,” says 3.2 months. healthcare. “But we know that even in richer Mark Pearson: “Slowly but surely, over the past Source: Chris James, Marion Devaux and Franco Sassi: countries, the amount spent on public health is decades the attitude of decision-makers around Inclusive Growth and Health, OECD Health Working Paper far lower than it ought to be,” remarks Hans the world with respect to this issue has been No. 103, 15 December 2017

Kluge (the full interview with Hans Kluge can changing.” Photo: WHO Europe, OECD

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ADVERTISEMENT FEATURE

Facing future issues with an expert partner As the key partner for the health reform, the Main Association of Austrian Social Security Institutions ensures that people living in Austria receive good all-round care with health/accident/pension insurance.

ustrian social security is a pillar of the welfare state. The Main Association A– as the umbrella organisation of the 21 social security institutions – ensures affordable and high-quality health, accident and pension insurance for all people living in Austria. It coordinates and manages the health-care services as well as other services. As the umbrella association, it provides for a common strategic focus and the coordination of all social security institutions. All over the world, Austria is seen as a role model of comprehensive social security. It

aims to retain this standing in years to come Photo: Fotolia.com - Alena Ozerova and that remains Austria’s policy for the future. Fairness, transparency and efficiency are the Decision-makers can therefore use these figures lifestyles are a burden to people and the health basic principles of the Austrian social security at any time for planning the further develop- system. The Main Association focusses on system. Johann Böhm, the first President of ment of the system. In addition, the Main health promotion and prevention – more the Main Association of Austrian Social Security Association is a finance hub that distributes priority has to be attached to exercise, nutrition Institutions, got to the heart of these principles 13 billion euros per year within the social and mental health at an earlier stage of life. by stating: “Social security is the most reliable security system and cooperates with the federal The effort is worthwhile as it enables people basis of democracy!” government, the federal states and foreign to grow older with dignity. countries. Many smaller invoices for treatment As part of the health reform, ten health goals A driving force of innovation in other countries are also paid. were developed in a participative process. The Main Association is the innovation driver Nine of these goals are directly related to of social security in Austria and the key partner The first point of contact health and its determining factors. The partners of the health reform, ensuring the high quality The Main Association is also the initial contact of the health reform – the federal/state and financial feasibility of care. It also conducts partner for social security throughout Austria governments and social security – have worked research into social security and derives and abroad. As the primary contact for politi- with other stakeholders to develop mutual strategic positions and goals from this. cians as well, it provides information quickly strategies for these goals. The Main Association and serves as a competent advisor regarding is intensely involved in this process and coor- Hub of information and finance social security and the health system. It rep- dinates all social security activities throughout Since 1982 the Main Association has been resents the interests of all insured people and Austria. responsible for the master data management of Austrian social security at a European and of all insured people in Austria. It is responsible international level in its role as an umbrella for the insurance history of these people, their association. employers, and also contractual partners. As the umbrella association it is responsible Health promotion and prevention for ensuring that the key figures for The health system is experiencing a process accident/health insurance and pension insur- of radical change. People are growing older ance are accessible at the touch of a button. and chronic diseases caused by unhealthy

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KNOWLEDGE Innovation for all

Medical innovations can increase the quality of life and prevent deaths. In order to encourage new ideas with real added value, it is necessary to develop innovative incentive systems as well. Text: Dietmar Schobel

nventions become innovations when they can be applied practi- Ically and economically. This was the description given many decades ago by Austrian political economist Joseph Alois Schumpeter (1883–1950), who is regarded as one of the pioneers of innovation management. From a social perspective, it is also a matter of whether an invention is adopted by a broad public, i.e. accepted by a Photo: Directorate-General for Health and Food Safety Photo: Fipra International Photo: MSD large number of people. Xavier Prats Monné: Robert Madelin: Boris Azaïs: “We should strive to make “I am optimistic that “Private industry is a partner In the area of patient care, innova- health innovations easily there will be many of the public sector and accessible to all citizens of new developments the patients.” tions in the fields of pharmaceuticals the European Union.” in the future as well.” and medical engineering can play a major role. New developments are certainly not limited to these areas, specialists and rehabilitation. In medical innovations in the European though. “Digitisation also opens up addition, greater cooperation between Union also depends on the country, many new opportunities specifically the health sector and other areas such the scope of health insurance, and in the health sector. It will change as the education and social care sys- the private funds available in each everyday working life on all levels, tem should be pursued. case. Xavier Prats Monné therefore and the spectrum of applications emphasises: “In general we should ranges from the targeted exchange Whereas such changes incur minimal strive to make innovations easily of standardised data through to or moderate costs, new medicine or accessible to all citizens of the artificial intelligence methods in di- medical technologies are frequently European Union to the same extent,” agnosis,” states Xavier Prats Monné, very expensive. However, 9 out of 10 and adds: “And therefore we must Director General for Health and Food authorised medicines have “only mar- also endeavour to shorten the time Safety of the European Commission. ginal clinical advantages for it takes for innovative products to patients”. This was established by the be launched on the market.” Innovative health systems 14 members of the “Expert Panel on Innovations are also of importance to Effective Ways of Investing in Health” However, in particular when it comes the European health systems, which appointed by the European Commis- to medical innovations, excessive in many cases are highly fragmented. sion. The recommendations of this expectations are raised and subse- In the opinion of the experts inter- panel include the identification of ar- quently disappointed,” says Robert viewed by “Healthy Europe”, the eas where there is a particular need Madelin, Chairman of the advisory most urgent change would be to for research, where true innovations company Fipra International since achieve better coordination of the should be encouraged and better 2016. “Nevertheless, I am optimistic,” different sub-areas in the interests rewards offered. emphasises the innovation expert: of integrated care: these sub-areas “It is my expectation that there will range from prevention and primary Good access for all citizens be many new developments in the care through to secondary care by Whether and when there is access to future as well, with which currently

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untreatable diseases can be healed method, which cannot be influenced development he says that the main and lives can be saved: for example, by politics, should therefore be driving forces are scientific progress with further progress in genetics and used more frequently by the health and unmet medical needs: “The in the use of nanoparticles.” Taking authorities.” industry’s pipeline is really focussed childhood cancer by way of example, on ‘frontier science’, including the possibilities can be illuminated: A common goal oncology, neurological disorders “50 years ago there was only a 20 per The fact that the cost of pharmaco- and genomics.” Public funds should cent chance of survival. Today, this logical innovations is a challenge for therefore be used to design health figure has risen to 80 per cent.” health systems is not denied by Boris systems that are centred on patients, Azaïs, Director of Public Policy at the and there should also be better In addition, “Health Technology pharmaceutical company MSD: “The incentives to create real innovations Assessment” (HTA) provides a good research-based pharmaceutical com- that bring a considerably greater method for systematically evaluating panies bring disruptive innovation quality of life for patients, agrees the benefit of medical technologies in the sense that new treatments can Boris Azaïs. He emphasises: “Phar- – from pharmaceuticals, medical de- significantly change how care is de- maceutical companies are partners vices, medical and surgical proce- livered. The best example is how the of the public sector and patients. dures through to advisory services HIV medicines have turned a deadly We all share a common goal: bringing and supply structures, Robert sentence into a chronic disease.” Re- new medicines quickly and to all Madelin believes: “This objective garding pharmaceutical research and patients.”

NEW RESEARCH MODELS

Josef Probst, General Manager of the Main Association of Austrian Social Security Institutions, on innovations in the health system, astronomical prices, and research findings as common property.

HEALTHY EUROPE in the British Medical Journal, between Josef Probst: What are the important innovations 2009 and 2013 48 new anti-cancer drugs “We need new in the health sector? for 68 indications were approved by the business models Josef Probst: They include innovations in European Medicines Agency (EMA). More for research funding.” the spheres of medical engineering, than three years after market launch, for pharmacology and information technolo- almost half of these it could not be proven gy. However, it is equally important to that they had contributed to prolongation reorganise the health system prudently in of life or an improvement in the quality order to enable improvements for pa- of life. It is true that astronomical prices tients. This involves strengthening primary are demanded for many of these new care and improving the cooperation products, such as the Hepatitis C Photo: Main Association of Austrian Social Security Institutions between the various areas of the health medicine. This puts the public health system, which also includes intensifying systems under considerable financial the collaboration with other sectors such pressure. Nonetheless, in Austria we can The research that is financed using tax- as the social system. In Austria this is rest assured that all patients benefit very payers’ money must yield a return on now being implemented in the current quickly from innovations that bring real investment for the people, and the findings healthcare reform. Oversupply should be added value. In countries that are less gained from this should therefore be reduced as well. It is not just expensive to affluent, or where the general insurance common property. This should apply to have too many people lying in Austrian protection is less comprehensive, this is both university institutions and also private hospitals unnecessarily, it is also unhealthy. not always the case. Even in Europe. companies that are commissioned with public assignments. At the same time, HEALTHY EUROPE HEALTHY EUROPE future payers should be integrated into Certain new medicines have been How can this be improved? research and development at an early launched on the market at very high On the one hand, the prices demanded by stage, more frequently and with greater prices in recent years. How can we pharmaceutical companies must become intensity, so this can be oriented to a make sure that they will be accessi- more transparent. On the other hand, we greater degree according to actual needs. ble to everyone to the same extent? need new business models for research Overall, in future we should not pay for Initially, we must point out that some of funding. Billions of euros are being invested innovations on a “pill by pill” basis, but – the innovations do not bring any at national and European levels in order to in parallel to the actual decoupling of the additional benefit for patients. For achieve this, for example in the research and value chain – also consider economic example, according to a study published innovation programme “Horizon 2020”. decoupling, in the sense of unbundling.

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KNOWLEDGE No one should be left behind Health differences are considerable in European countries as well, for both communicable diseases and non-communicable diseases. Homeless people are among the groups most severely affected. Text: Dietmar Schobel Photo: Fotolia.com - Romolo Tavani

he likelihood of growing older dropped to as low as 54 years just 13 against communicable diseases and in good health is largely kilometres away from Lenzie in the to prevent these from spreading. In Tdependent on where you were district of Calton, which is marked order to achieve this, data from across born. These differences are also large by a high percentage of unemploy- Europe is gathered and interpreted, between the individual Member ment. It is known as the “Glasgow recommendations are given to the States of the European Union. For effect”. Even though health inequal- individual Member States of the example, according to details from ities due to the social influences are European Union, and training EuroHealthNet, the European um- not quite as dramatic everywhere, in measures are coordinated for experts, brella organisation of public health many places they are substantial. They amongst other tasks. institutes and health-promotion are primarily caused by factors such The possible causes of the connections agencies, Spaniards have an average as education, income and wealth, and between social position and commu- life expectancy of 83.3 years. Their this connection has long been nicable diseases include poor hygienic counterparts in Latvia and Bulgaria, documented by numerous scientific conditions owing to substandard on the other hand, only reach an studies. living conditions, or malnourishment. average age of 74.5 years. Swedish “One example of this is tuberculosis, women who are 65 years of age can Health inequalities are determined which was always a disease that was expect to live another 16.7 years in by social factors linked to poverty,” says Andrea Am- good health, whereas this figure falls “The socio-economic situation mon. Although the number of cases to only 3.6 years for Slovakian influences health-related behaviour, is decreasing in Europe, currently women. health status and life expectancy,” approx. 59,000 people are still There are considerable internal emphasises Andrea Ammon, Director diagnosed with tuberculosis each year health differences within the coun- of the European Centre for Disease in the States of the European Eco- tries themselves too. In a report by Prevention and Control (ECDC). She nomic Area, and around 4,300 died the World Health Organization adds: “This is the case for both from this disease in 2016. (WHO) a life expectancy of 82 years communicable and non-communica- In addition, Andrea Ammon sees was documented for male newborns ble diseases.” As a European Union resistance to antibiotics and decreas- from Lenzie, a smart commuter sub- agency, it is the ECDC’s responsibility ing vaccination rates as great chal- urb of Glasgow, whereas this figure to strengthen Europe’s defence lenges in the area of communicable

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Andrea Ammon: cation materials and makes these homelessness has severe negative “The socio-economic available to the European countries. consequences here too. For instance, situation influences Its aim is to respond to lack of knowl- according to FEANTSA the rate of health-related edge and scepticism in relation to tuberculosis infections among behaviour, health status and life vaccinations and to increase aware- homeless people is up to 20 times expectancy. ness among health experts and pa- higher on average than among the tients that antibiotics should only rest of the population. Experts be used with a highly targeted and estimate that the life expectancy of consistent approach. chronically homeless people is about In order to reach vulnerable groups 50 years – this applies to people who as well, both linguistic and cultural spend their lives exclusively on the Photo: ECDC barriers must be overcome. Some street, or who sometimes live in emergency accommodation. Exact Freek Member States have therefore Spinnewijn: included these groups of the popu- data on this has already been “We should lation when gathering feedback gathered in England where, statis- make sure that to ascertain, for example, the com- tically speaking, chronically home- homeless people less men reach the age of 47 and are better prehension and acceptability of a integrated country-adapted version of an women live to the age of 43. into regular ECDC communication guide on vac- healthcare.” cination. For instance, in Romania Provide access to healthcare and Bulgaria representatives of the The most important measure from Romani people were asked. In a health perspective is to enable Photo: FEANTSA Bulgaria specific information homeless people to access healthcare. material was also produced for There are relevant projects in various this ethnic group. Throughout European countries, where doctors Europe around ten to twelve and nurses work voluntarily in million people belong to the Romani emergency accommodation, remarks diseases in Europe – at times when ethnic minority. Freek Spinnewijn: “However, we an estimated 25,000 Europeans die should also make sure that homeless from serious infections with resistant 4 million homeless people in Europe people are better integrated into bacteria each year and we see ongo- “Around four million people per regular healthcare and not just ing measles outbreaks across Europe. year are currently homeless at least treated in emergencies.” When “We urgently need countermeasures. temporarily in the countries of the homeless people are released from Otherwise the progress achieved in European Union,” states Freek hospital, they often land straight the fight against communicable Spinnewijn, Managing Director of back on the street – and are diseases over the past decades could FEANTSA, the European Federation consequently admitted back to be undermined,” says the ECDC of National Organisations Working hospital again a short time later, Director. with the Homeless. The number of states the FEANTSA managing di- people affected is currently increas- rector, who demands better contact Using targeted measures to reach ing in all countries apart from Fin- between health experts and staff at those concerned land, and in some cases this emergency accommodation, and Social issues also play a role here. increase is at a dramatically high also specific rehabilitation centres The European Centre for Disease level, he continues. Nevertheless, for the homeless. Prevention and Control therefore the homeless are frequently for- However, it would be best to tackle analyses not only the regions in gotten when it comes to policy strate- the problem at its roots, to guarantee which certain communicable diseases gies, including those concerning the right to affordable and safe homes occur more frequently, but also the health issues. FEANTSA is the only and create a better general frame- groups of the population that are European non-governmental orga- work, Freek Spinnewijn believes: particularly affected. These include nisation that focusses on the fight “One consideration would be for unemployed people and specifically against homelessness and intends the health insurance funds to pay young people without work, drug to put an end to it. A team of 15 for this. After all, there is a clear users, prison inmates, and also members is dedicated to its cause. connection between the living en- migrants and ethnic minorities, for The quality of living actually has a vironment and health, and improve- example. The ECDC also prepares decisive influence on health, and so ments would contribute greatly to relevant information and communi- it is not particularly surprising that reducing health inequalities.”

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KNOWLEDGE Understanding challenges as opportunities

Health systems across Europe are facing similar challenges owing to demographic change and increasing expenditure. Solutions to these challenges can be found relatively easily using suitable strategies, according to European experts. Photo: Fotolia.com - Jakub Jirsa ́ k

uropean health systems may have very CELEBRATING 20 YEARS different structures, but they face Esimilar challenges: the rising The European Observatory on Health Systems and Policies was founded in 1998 on proportion of elderly people among the total the initiative of the World Health Organization (WHO). Its purpose is to collect and population, the growing demand for health analyse existing data on health systems and make this comparable, and also to enable services, staff shortages and increasing costs. this to serve as the basis for developing them further. “We prepare the information What can be done to cope with these where there is an actual need, in a manner which makes it easily useable for challenges and develop sustainable health decision-makers,” explains Josep Figueras, who has been Director of the European systems? Observatory on Health Systems and Policies since the outset. Initially with a team consisting of four colleagues, 30 experts are now employed at the Observatory, which “Healthcare costs are increasing more rapidly is headquartered in Brussels. A network structure enables cooperation with around than the gross domestic product in all 650 further experts. The European Observatory on Health Systems and Policies is based European countries. There’s huge room to on a strong partnership of international agencies, national governments, decentralised improve efficiency in the National Health authorities and research institutes. Today it is regarded as one of the leading international Service of the United Kingdom, as well as knowledge brokers in this field. prevention of ill health and promotion of well-being. The greatest impact on our health

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Increased cooperation between health professionals is also desirable. Multi- disciplinary teams consisting of doctors, nurses, patients, administration staff and other health professionals can often solve problems rapidly and easily in everyday working lives. “Models for quality management could be adopted from industry, such as the ‘big room’,” remarks Jennifer The Health Foundation WHO Observatory on Health Systems and Policies Dixon. This format for regular multi- disciplinary meetings originates from the Photo: Photo: Parlamentsdirektion/Simonis Photo: Jennifer Dixon: Josep Figueras: Pamela Rendi-Wagner: automobile industry. It was adopted by a “Healthcare costs are increasing “The return on investment due to “A sustainable health system Sheffield Trust hospital in England and proved more rapidly than the gross domestic health-promoting or preventative should be measured by its such a success there that it is now practised product in all European countries.” measures amounts to 1:18.” results.” by several other hospitals in the UK as well.

is from factors unrelated to healthcare,” among the population and economies that Patient-focussed health systems remarks Jennifer Dixon, Chief Executive of are more productive. We need to communi- Better utilising patient experience is also The Health Foundation. This independent cate this even better to the decision-makers regarded as an important step towards British institution contributes to better in Europe.” greater sustainability. This should make the healthcare, more effective policy strategies health systems simpler to use and make and ultimately a healthier population in the A greater number of years them more transparent, and better designed United Kingdom (UK) using research, strategic in good health to meet the needs of users overall. “It is a analyses and grant giving. “A sustainable health system must be able matter of empowering the patients, not just to do more than just deal with the existing seeing them as observers of their own healing Worthwhile investments resources economically,” emphasises process, but as experts for their own health,” According to the experts interviewed by Member of the Austrian Parliament Pamela says Pamela Rendi-Wagner. This in turn can “Healthy Europe”, greater cost efficiency Rendi-Wagner, who is speaking at the act as a basis for “shared decision-making”. should be achieved above all by an improved European Health Forum Gastein in 2018. Using well-founded information, patients allocation of resources. This means that the She adds: “It should be measured by its should discuss with health professionals to existing resources should be utilised results, and the most important aspect is to decide which therapy is best for them particularly in those areas of the health increase the number of years that we enjoy personally. system where the best effects are anticipated. in good health.” In accordance with the These can be expected especially in primary concept “Health in All Policies”, this is a Inclusion is a criterion care and also through increased health challenge that concerns not just the health Josep Figueras describes “inclusion” as a promotion and prevention. “The return on system, but all social areas: “Here too, it is further criterion of a sustainable health investment due to health-promoting or a matter of whether people live in conditions system. It must be accessible and useable preventative measures amounts to 1:18. In that enable them to enjoy fairer health by all people to the same extent. “Equality other words, every euro that is invested can opportunities. This begins with how we is a core value of European countries, and produce a productivity gain of 18 euros,” develop childcare facilities and schools, inclusive societies are ultimately more states Josep Figueras, Director of the through to working conditions and the living efficient, too,” says the health systems expert: European Observatory on Health Systems situation of older and very old people.” “If we do not take this into account, we will and Policies with headquarters in Brussels, pay a high price in the form of poverty, dis- which is celebrating its 20th anniversary this With respect to the health system itself, ease, unemployment and other negative year (see also box: “Celebrating 20 years”). “integrated care” aims to increase quality. consequences.” The sub-areas – from the surgery of an He also points out that currently around individual doctor through to a large Inclusion is an ambitious goal, and a high 20 per cent of the resources in health systems rehabilitation centre – should be better degree of dedication is necessary to deal are wasted, for example due to unnecessary coordinated and geared to one another. The with the challenges that now face health treatments. Nevertheless, it is not just “case managers” could have a key function systems in European countries. “However, expenditure that should be at the forefront here, accompanying patients on their journey we must see the challenges as opportunities. of considerations when it comes to health through the health system and thus Then we will succeed in achieving sustainable systems, emphasises Josep Figueras: generating greater efficiency. This would health systems and secure the best possible “Investment in health is investment in the also prevent diagnoses and therapies treatment for all patients,” summarises Josep future. It ultimately enables better health occurring several times. Figueras.

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Health for All!

Fonds Gesundes Österreich is the national competence centre for health promotion in Austria. We are convinced it is better to maintain health than to treat diseases after they occur. All people should have equal health opportunities.

Fonds Gesundes Österreich, A business unit of Gesundheit Österreich GmbH, Aspernbrückengasse 2, 1020 Vienna, Austria, Tel. +43 1 8950400, [email protected], www.fgoe.org