The 2019 European Health Forum (Gastein) opens Wednesday under this year’s theme: “A Healthy Dose of Disruption.” The three-day Forum will explore ways in which Europe can transform health systems into levers of good health and well-being, guided by the aspirations of the recent UN declaration on Universal Health Coverage. Since its foundation in 1998, the Gastein conference has become a key annual event for the European region, bringing together, politicians, health policy decision-makers, civil society, and experts in the field of public health and healthcare. Francesca Colombo, head of the health division at the Organisation for Economic Co-Operation and Development (OECD) and a member of the Gastein Advisory Committee, explored with Health Policy Watch some of the key challenges that Europe faces, which the conference is tackling.

Health Policy Watch:  What are the biggest challenges Europe’s health systems will face in the upcoming years, and how well are they prepared to respond?

Francesca Colombo: Health challenges should be looked at within the broader context of mega trends affecting societies. Aging brings more demands for health care due to the growing number of people living with chronic conditions – requiring greater focus on prevention and primary health care. The number of retired people is rising rapidly, at the same time the working age population is shrinking – putting pressure on economic growth and on public spending on health, and long-term care in the coming years and decades.

New medical technologies add pressure to health spending, while health systems lag being other sectors in gains that could be obtained from leveraging digital data.  And there are rising levels of inequalities. Younger cohorts will not have all the benefits and opportunities as older cohorts, as younger people are no longer getting richer [than the previous generation]. There is generally less support for redistribution of resources in our society, with more tensions across generations.

We also have specific public health challenges, such as growing antimicrobial resistance and risk factors such as obesity – rates of adult obesity in OECD countries have increased over time and are now at 24%.

So, we see a complex environment for health systems. The challenge for the future is therefore to rethink the sustainability of the health system in this context, while placing people and patients much more prominently at the centre of health systems. There is a need to tackle the significant waste in the way we use resources – according to our work, 20% of health spending across OECD countries could be wasteful. We also need to invest more in public health. Fundamentally, health is about improving the health and well-being of individuals. And yet the health systems today are still focused on treating episodes of ill health. We measure what services are delivered and how much we are providing, rather than whether we are making a real difference to the lives and well-being of individuals. This must change.

HP-Watch: You mentioned that the ageing of Europe’s population puts pressure on economies, as well as healthcare systems. And indeed, the proportion of people age 65 or over is projected to increase from about 19.8% in 2018 to 29.1% by 2060. But aren’t there also opportunities that can be seized by health systems and the private sector in light of changing demographics?

Colombo: Ageing creates some economic challenges because there are fewer younger people to support a larger cohort of older people, who are retired.  Across the OECD, the median age of the population is projected to increase from 40 years today to 45 years in the mid-2050s, and the ratio of older people aged 65 and over to people of working age (15-64) is projected to rise from 1 in 4 in 2018 to 2 in 5 in 2050.

But if you can ensure that people remain healthy for longer and are able to work longer, this is not only good for people themselves, but they are also able to participate for longer in labour markets thereby easing this economic challenge. Evidence shows a strong relationship between ageing healthily and being able to work longer, with knock-on effect in terms of per capita contributions to GDP and growth. This also mitigates the growing cost of health and social care.  So, delaying the need for health and long-term care creates economic opportunities.

Healthy ageing requires addressing people’s health while they are still young – for example through strong prevention policies as well as addressing inequalities. Ageing experiences are very diverse, with some people being more fortunate than others. At all ages, people in bad health work less and earn less. And as inequalities across society grow – so is the risk that the chances of living a good life in old age will be unequally distributed. Presently, the average income of the richest 10% of the population is about nine times greater than that of the poorest 10% across the OECD, up from seven times greater 25 years ago.

Policies that look across the life course and consider the unequal experiences that individuals live throughout their lives will help to ensure that individuals can prolong being active and continue to participate in labour markets and in societies.

HP-Watch: The theme of Gastein this year is: “A healthy dose of disruption? Transformative change for health and societal well-being”. This echoes the 1948 WHO constitution, which described health as a “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Yet many people still perceive well-being as more of a luxury than a necessary – what’s your take?

Colombo: I am not sure that I would agree that well-being is regarded as a luxury. There has been recent focus to look beyond GDP [gross domestic product], to measure more holistically societal progress from the perspective of well-being – is life getting better for individuals? Are individuals able to live a good quality of life?

If you take a well-being perspective, inevitably you need to place health within a broader context of issues that matter to people. This includes housing conditions, income and wealth, environmental quality, social connection and inclusion, level of education and skills, as well as health. These are not luxuries; they are all issues that are relevant at any stage of development of a country and for individuals from different socioeconomic status. We must therefore take a broader approach, which includes different dimensions of well-being as a means of understanding what progress is being made.

HP-Watch: How can you convince health systems to invest in well-being?  Do you have examples of best practice in Europe that you would like to cite?

Colombo: A first thing is to consider health in a broader context, as mentioned earlier. There is a two-way relationship between health and wider social and economic development. Not only do poor people tend to have worse health outcomes, but also if individuals have poor health, this damages their economic prospects throughout their life and adversely affects economic growth. Looking at these two-way relationships makes you realise how important it is to invest in wider determinants of health – including the environment, housing, the workplace, and lifestyles; and, at the same time, how health can contribute to more robust institutions and economic prospects. It is by focusing on these two-way relationships that we can make the wider case for talking about health and well-being. Unfortunately, public health and prevention budgets are often the first thing that is cut during times of fiscal constraints, despite that recognition.

Second, it is important to measure better both health and well-being – see for example the OECD Better Life Initiative and the work programme on Measuring Well-Being and Progress. Several countries have already taken steps to measure improvements in well-being. Belgium has developed its own sustainable development indicators. Italy has measures of equitable and sustainable well-being.  Sweden has developed new measures of well-being policy.  Outside of Europe, New Zealand has developed its Living Standards Framework.

Third, it is important to address better areas where we are doing poorly and keep pushing for action on key elements of health that are important for people’s well-being. For example, France has placed addressing inequalities at the core of their G7 presidency, as a challenge that spans all sectors of the economy including health.  The United Kingdom has led efforts to tackle poor mental health, which damages individuals’ health but also their labour market outcomes.

HP-Watch: Digital transformation is another one of the key topics at this year’s European Health Forum Gastein. What role do you think will the digital revolution in healthcare play in providing better care to people, including for older people? 

Colombo: If you look at other sectors of the economy, such as the banking sector, digitalisation has completely transformed the way you do business. Customer service has been enhanced, for example you can do all your banking online. Businesses must deliver better customer service to remain competitive. Health, however, lags behind other sectors in implementing broader transformations that leverage data and digital solutions. Among many other industries, the health sector is among the least likely where jobs are likely to be significantly automated.

There are several reasons for this. For a start, health labour markets are rigid. Many health workers are poorly equipped to take advantage of digital data and tools.  Between one-third and two-thirds of all health professionals report gaps in knowledge and skills needed for a safe and effective use of digital tools. Second, health data are personal and sensitive. Privacy concerns and fears that the protections that the governments have in place might not be enough are other reasons that prevent the leveraging of this data in health systems.

And yet pooling health data together would create massive opportunities for improving clinical care, research and development of new treatments. It can encourage new solutions and ways of working that make health systems more efficient and coordinated, for example reducing errors and cutting repeat tests.

Digitalisation can also help doctors do their job better. Health remains a very labour-intensive sector, and fears that digitalization will significantly reduce jobs in the sector may be overestimated. That said, certain jobs like radiologists might disappear and others significantly change. Digital solutions can help doctors and nurses do tasks more accurately and faster, helping to optimize health service delivery.

HP-Watch: And finally, besides the opportunity to step back and discuss all of these critical topics, what makes the European Health Forum (Gastein) stand out from other health-themed conferences in Europe?

Colombo: The forum brings together a wide range of health stakeholders, with a great mix of participants from NGOs, public and private sector, researchers and young people. The fantastic mountain settings and cosy atmosphere encourage open discussions. The Forum organisers make constant efforts to develop innovative methods and tools to organize and run the discussions.

Image Credits: Photo: OECD/Andrew Wheeler, Eurostat, OECD (2017), How's Life? 2017: Measuring Well-being., EHF (Gastein).