Setting the stage for sustainable health care

Driven by economic pressures, the European Union has increasingly linked the concept of sustainability with health. There is plenty of logic to that. Healthcare is expensive, and poor health exacts a high price from economies — as well as from individuals. The concerns are reflected in recent Council conclusions on modern, responsive and sustainable health systems and a European Commission Communication on effective, accessible and resilient health systems.

As a result, discussion flourishes in the EU on projects linked to cutting spending and avoiding patient harm — such as debates on drug pricing and protecting patients from fake medicines. Similarly, the Commission is leading talks between member states on how they can improve health service performance, raise quality of care, or tackle multi-morbidity. It is currently consulting on how access to health services in the EU might be improved, suggesting closer links between health needs and financial resources.

The reflex to seek best value for money in health care spending is unsurprising: this is an item that accounts for an average of 15 percent of all government expenditure, and with current trends is expected to increase to 20 percent by 2060. The emphasis in the Commission document on sustainability of health systems is clear: “Ensuring efficiency and making the provision of health services more cost-effective and efficient is crucial.”

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But a focus on securing better therapeutic bang for health care bucks risks missing out on other policy areas that could also yield better health — and arguably better economic returns. Intense discussions on sustainable health care as an item in its own right can sometimes appear as self-absorbed as a man digging to find water with his back turned to a river only ten meters away.

The recent revelations about car emissions have drawn new attention to what was already an obvious, but conspicuously neglected, candidate for attention in the search for better health and better economies. Every year, air pollution causes nearly half a million premature deaths in the EU, as well as impairing quality of life with asthma or respiratory problems. It also imposes direct costs on health care systems of €4 billion a year, and indirect costs approaching €100 billion, according to the European Commission.

The European Parliament last month backed the latest plans for capping some of the more noxious emissions, but overall progress in improving air quality across Europe is limited — as is demonstrated by the constant stream of legal actions against member states for breaching what many see as still-timid EU rules. Similarly, more effective EU action to discourage smoking or excessive alcohol intake, or to promote better nutrition and more active lifestyles could pay dividends.

The EU’s own environmental program adopted in 2013 recognizes the unsustainable trends in health and quality of life, but action is still awaited on revitalizing its sustainable development strategy, or adding a health dimension to the Common Agricultural Policy. Meanwhile, the proportion of the EU population at risk of poverty or social exclusion continues to rise beyond 25 percent — factors closely linked to poor health, and dramatically highlighted in the latest World Health Organisation figures showing the high incidence of extensively drug-resistant forms of tuberculosis in Latvia and Lithuania.

“Given this alarming situation, it is unacceptable that the new European Commission has allowed public health issues, and TB in particular, to slip down the political agenda,” says Fanny Voitzwinkler, Head of the EU office of Global Health Advocates and coordinator of the TB Europe Coalition. She said her call for “political cooperation to tackle cross-border health threats in the EU and its eastern neighborhood” was all the more urgent “in the context of the current migration crisis.”

Nor are improvements in life expectancy among EU citizens leading to longer life in good health. Inequalities of access to health services, often linked to low-income, inner-city communities mired in poor housing, continue to take a toll.

Environment Commissioner Karmenu Vella has recognized that EU environmental actions are “good for the environment, but they’re also good for growth, jobs, health and general well being.” If he can convert his words into deeds, his policies might prove to be as influential on sustainable health as any other Commission initiative.