Health and well-being in times of austerity          Ms Zsuzsanna Jakab      WHO Regional Director for Europe             ...
Outline  • The context  • Promoting health in times of austerity    – Macroeconomic impacts of health    – Health systems ...
Context: changing environment for health • Demographic (fertility, ageing) • Globalization and migration (including of hea...
Health 2020A European policy frameworksupporting action across governmentand society for health and well-being            ...
Rising health inequalities in Europe                                          Life expectancy at birth, in years          ...
Europe’s major health challengesImplement global and regional mandates(noncommunicable diseases (NCDs), tobacco, diet     ...
Promoting health in times of austerity  • Macroeconomic impacts of ill health and the    economic benefits of health promo...
Economic case for health promotion anddisease prevention                              Many costs are      Today government...
Some examples                                                              €69 billion annually in the European  Cardiovas...
More examples                                           To fight childhood obesity, combination                           ...
Short-term benefits of so-called sin taxes          Tobacco                         Alcohol  A 10% price increase in      ...
Health as an economic engine • Health is not a drain on   the economy! • Health contributes to   economic growth. • Health...
Impact of health on economic growth                 (some examples)• Labour-force participation   • Absenteeism due to ill...
Health systems as an economic sector• Economic size of the health care sector  – Accounts for about 10% of GDP in the EU  ...
Health systems as an economic sector• EU pharmaceutical sector  – €196 billion, 640 000 jobs, fifth largest sector (2008) ...
Facts from present and past economiccrises                • Associated with twice the risk of illness and 60% less likely ...
Social-welfare spending: major health impactRelation between deviation from country average of social welfare spending (ex...
Health impact of social-welfare spendingand GDP growth  Social               • Each additional US$ 100 spent per          ...
Why protect public spending for health?   There is strong                                  “Today, it is correlation betwe...
Catastrophic spending is highest amongpoorer people                              Source: Võrk A et al.                    ...
Where the cost of seeking care is lower, thereduction of utilization is also lower“Reductions in routine care today might ...
Protecting public spending for health duringthe crisis: some options 1.    Countries with savings have room to manoeuvre 2...
The real measure of “priority”: government spendingon health as a % of total government spending  14 countries in the Regi...
More public money for health andmore health for the money!• Waste and inefficiency in service delivery make  it difficult ...
Improving efficiency reduces adverse effects ofthe crisis and helps secure popular and politicalsupport for more spending ...
Effective mechanisms that help in dealingwith financial crisis  • Avoid across-the-board budgets cuts  • Target public exp...
Strengthen people-centred health systems, public-health capacity and preparedness for emergenciesStrengthen public health ...
Create healthy and supportive environments Assess the health impact of sectoral policies Fully implement multilateral envi...
Health as a major societal resource and asset • Good health benefits all sectors and the whole of society,   making it a v...
Health 2020 builds on strong values  • Health as a fundamental human right  • Solidarity, fairness and sustainability     ...
Dear Prime Minister, Minister, Mayor:Health is a prerequisite for social and economic development. The health of the popul...
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Health and well-being in times of austerity

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  • The evidence indicates that there is a strong correlation between social welfare spending (excluding health) and all cause mortality in EU-15 countries.Figure explanation: Relation between deviation from country average of social welfare spending (excluding health) and all cause mortality in 15 EU countries.1980-2005. Each point represents a single country year value. Social welfare spending is in constant US dollars (year 2000) adjusted for purchasing power parity.
  • Naturally, the same applies to cuts: each 100USD cut in social welfare spending is associated with 1.19% increase in mortality.
  • Health and well-being in times of austerity

    1. 1. Health and well-being in times of austerity Ms Zsuzsanna Jakab WHO Regional Director for Europe European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    2. 2. Outline • The context • Promoting health in times of austerity – Macroeconomic impacts of health – Health systems as economic engines – Lessons learnt from the economic crisis • WHO/Europe support for Member States in difficult times European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    3. 3. Context: changing environment for health • Demographic (fertility, ageing) • Globalization and migration (including of health workers) • New technologies (including medical genetics) • More informed and demanding citizens • Recognition of importance of health to human development • Slowed economic growth and austerity policies European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    4. 4. Health 2020A European policy frameworksupporting action across governmentand society for health and well-being European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    5. 5. Rising health inequalities in Europe Life expectancy at birth, in years 80Address the socialdeterminants of healthEmphasize action across the 75social gradient and onvulnerable groups European Region EU members before May 2004 EU members since May 2004 CISEnsure that continuousreduction of health inequitiesbecomes a criterion in 70assessing health systems’ CIS: Commonwealth of Independent Statesperformance 65 1970 1980 1990 2000 European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    6. 6. Europe’s major health challengesImplement global and regional mandates(noncommunicable diseases (NCDs), tobacco, diet 140and physical activity, alcohol, HIV/AIDS, tuberculosis(TB), International Health Regulations (IHR), antibiotic Standardized death rate, 0-64 per 100,000 120resistance, etc.) 100 80Promote healthy choices Cause 60 Heart disease Cancer Injuries and violenceStrengthen health systems, including public 40 Infectious diseases Mental disordershealth, primary health care, health information and 20surveillance 0 1980 1985 1990 1995 2000 2005 Year 100%Reach and maintain recommended immunization 90%coverage 80% 70% 60% Deaths 50%Develop healthy settings and environments 40% 30% 20% 10%Attention to special needs and disadvantaged 0%populations European Region EU-15 Country groups EU-12 CIS Circulatory system Malignant neoplasms External causes Infectious disease Respiratory system Other causes European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    7. 7. Promoting health in times of austerity • Macroeconomic impacts of ill health and the economic benefits of health promotion and disease prevention • Health systems as economic engines • Lessons learnt from the economic crisis European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    8. 8. Economic case for health promotion anddisease prevention Many costs are Today governments The economic impact of avoidable through spend an average NCDs amounts to many investing in health 3% of their health hundreds of billions of promotion and budgets on euros every year disease prevention prevention European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    9. 9. Some examples €69 billion annually in the European Cardiovascular Union (EU), with health care accounting diseases (CVD) for 62% of costs Alcohol-related €25 billion annually in the EU, equivalent harm to 1.3% of gross domestic product (GDP) Obesity-related Over 1% GDP in the United States, 1–3% illness (including of health expenditure in most countries diabetes and CVD) 6.5% of all health care expenditure in Cancer Europe Road traffic Up to 2% of GDP in middle- and high- injuries income countriesSources: Leal J et al. European Heart Journal, 2006 27:1610–1619 (doi:10.1093/eurheartj/ehi733); Alcohol-related harm in Europe – Key data. Brussels, DGSANCO, 2006; Stark CG, European Journal of Public Health, 2006, 12(2); Sassi F. Obesity and the economics of prevention, FIT NOT FAT. Paris, OECD, 2010;Racioppi F et al. Preventing road traffic injury: a public health perspective for Europe. Copenhagen, WHO Regional Office for Europe, 2004. European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    10. 10. More examples To fight childhood obesity, combination of food labelling, self- Parenting and social/emotional regulation, school actions, media and learning to prevent childhood counselling is highly cost effectivebehavioural problems have 9:1 return (less than on investment. €10 000 per disability-adjusted life- year (DALY) gained). To reduce the harmful use ofFor healthy diets, taxes and regulatory alcohol, combination ofmeasures (e.g. restricting fat levels in taxation, advertising restrictions, brief products) shown as cost effective interventions and increased roadside measures in different contexts. testing is highly cost effective in Europe.
    11. 11. Short-term benefits of so-called sin taxes Tobacco Alcohol A 10% price increase in In England, sin tax has taxes could result in up to benefits close to €6001.8 million fewer premature million in reduced health deaths at a cost of and welfare costs and US$ 3–78 per DALY in reduced labor and eastern European and productivity losses, at an central Asian countries. implementation cost of less than €0.10 per capita. European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    12. 12. Health as an economic engine • Health is not a drain on the economy! • Health contributes to economic growth. • Health is a significant sector of the economy. European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    13. 13. Impact of health on economic growth (some examples)• Labour-force participation • Absenteeism due to illness: 4.2 days/worker (EU, 2009) • Average cost of absenteeism: 2.5% of GDP • Reduced age of retirement (2.8 years) due to poor health • Less likelihood to work (66% for men 42% for women) due to chronic diseases• Macroeconomic growth • 1% life expectancy increase = 6% GDP growth (Organisation for Economic Co-operation and Development – OECD) • 10% decrease in CVD = 1% per capita income growth (2009) European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    14. 14. Health systems as an economic sector• Economic size of the health care sector – Accounts for about 10% of GDP in the EU – More than financial services or retail sector• Labour-market effect – About 6% of all workers in the EU employed in the health sector• Impact on competitiveness of overall economy – Labour costs, market mobility, trade, research and development, innovation European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    15. 15. Health systems as an economic sector• EU pharmaceutical sector – €196 billion, 640 000 jobs, fifth largest sector (2008) – 3.4% of global market (2009)• EU medical technology – €95 billion, 5% annual growth, 550,000 jobs (2009) European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    16. 16. Facts from present and past economiccrises • Associated with twice the risk of illness and 60% less likely recovery from disease (Kaplan G. Social Science & Medicine, 2012, 74:643–646) • Strong correlation with increase of suicide, alcohol poisoning, liver cirrhosis, ulcer, mental disorders (Suhrcke M, Stuckler D. Social Science & Medicine, 2012, 74:647–653)Unemployment • Increase of suicide incidence: 17% in Greece and Latvia and 13% in Ireland (Stuckler D et al. Lancet, 2011, 378:124–125) • Active labour-market policies and social-protection expenditure at the level of US$ 190 per capita eliminate most of these adverse effects (Stuckler D et al. Lancet, 2009, 374:315–323) European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    17. 17. Social-welfare spending: major health impactRelation between deviation from country average of social welfare spending (excludinghealth) and all-cause mortality in 15 EU countries, 1980–2005 Source: Stuckler D et al. BMJ, 2010, 340:bmj.c3311.
    18. 18. Health impact of social-welfare spendingand GDP growth Social • Each additional US$ 100 spent per capita on social welfare (including welfare health) is associated with a 1.19% reduction in mortality spending • Each additional US$ 100 per- capita increase in GDP is GDP associated with only a 0.11% reduction in mortality European Public Health Alliance Source: Stuckler D et al. BMJ, 2010, 340:bmj.c3311. annual conference Brussels, Belgium, 6 June 2012
    19. 19. Why protect public spending for health? There is strong “Today, it is correlation between unacceptable that Catastrophic spending public spending on people become poor as is highest amonghealth and the level of a result of ill health” poorer people out-of-pocket – Tallinn Charter expenditure Medicines are the main Patients do not seek cause of spending for care or buy prescribed poorer people medicine European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    20. 20. Catastrophic spending is highest amongpoorer people Source: Võrk A et al. Income-related inequality in health care financing and utilization in Estonia 2000– 2007. Copenhagen, WHO Regional Office for Europe, 2009. European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    21. 21. Where the cost of seeking care is lower, thereduction of utilization is also lower“Reductions in routine care today might lead to undetected illness tomorrow and reduced individual health and well-being in the more distant future.” Source: Lusardi A et al. The economic crisis and medical care European Public Health Alliance usage. Harvard Business School, 2010. annual conference Brussels, Belgium, 6 June 2012
    22. 22. Protecting public spending for health duringthe crisis: some options 1. Countries with savings have room to manoeuvre 2. Those who balanced the budget and reduced government debts during the years of economic growth can opt for deficit financing 3. Those who failed to do the above are in a more vulnerable position when crisis hits, but can still avoid adverse effects on health and equity by giving higher priority to health  It is a matter of choice in public policy European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    23. 23. The real measure of “priority”: government spendingon health as a % of total government spending 14 countries in the Region increased priority for health as a response to the crisis European Public Health Alliance Source: WHO European Health for All database. annual conference Brussels, Belgium, 6 June 2012
    24. 24. More public money for health andmore health for the money!• Waste and inefficiency in service delivery make it difficult to argue for more spending• For health policy objectives, public spending on health is better than private spending, but ...• Not all public spending is good spending! European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    25. 25. Improving efficiency reduces adverse effects ofthe crisis and helps secure popular and politicalsupport for more spending in the future Eliminate ineffective and inappropriate services Improve rational drug use (including volume control) Allocate more to primary and outpatient specialist care at the expense of hospitals Invest in infrastructure that is less costly to run Cut the volume of least cost-effective services
    26. 26. Effective mechanisms that help in dealingwith financial crisis • Avoid across-the-board budgets cuts • Target public expenditures better to the poor and vulnerable • Seek efficiency gains through wiser use of medicines and technologies • Seek efficiency gains through rationalizing service- delivery structures • Think long term and implement counter-cyclical public spending (save in good times to spend in bad times) European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    27. 27. Strengthen people-centred health systems, public-health capacity and preparedness for emergenciesStrengthen public health functions andcapacitiesStrengthen primary health care as ahub for people-centred health systemsEnsure appropriate integration andcontinuum of careFoster continuous quality improvementImprove access to essential medicinesand invest in technology assessment European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    28. 28. Create healthy and supportive environments Assess the health impact of sectoral policies Fully implement multilateral environmental agreements Implement health policies that contribute to sustainable development Make health services resilient to the changing environment European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    29. 29. Health as a major societal resource and asset • Good health benefits all sectors and the whole of society, making it a valuable resource • What makes societies prosper and flourish also makes people healthy – policies that recognize this have more impact • Health performance and economic performance are interlinked – improving the health sector’s use of its resources is essential European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    30. 30. Health 2020 builds on strong values • Health as a fundamental human right • Solidarity, fairness and sustainability European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
    31. 31. Dear Prime Minister, Minister, Mayor:Health is a prerequisite for social and economic development. The health of the population can beseriously damaged by the financial crisis that is affecting many countries, in many ways. But it can alsopresent an opportunity to do more and better for people’s health. All sectors and levels of governmentcontribute to the creation of health.Your leadership for health and well-being can make a tremendous difference for the people of yourcountry or city and for Europe as a whole.Your support for Health 2020 is truly essential. European Public Health Alliance annual conference Brussels, Belgium, 6 June 2012
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