It is clear that something needs to change

Hans Kluge, Director of the Division of Health Systems and Public Health at the World Health Organization Regional Office for Europe, in an interview for the magazine “Healthy Europe” on how the economy affects our health. A short version of the interview is part of an article on page 12 of the print magazine “Healthy Europe”.


HEALTHY EUROPE

Mr Kluge, are health and economy in opposition to one another and do the two sectors collide? If yes, how can we make them dovetail?

Hans Kluge:

  • I’m not sure that they collide per se, but it is clear that many in finance circles view health as a ‘black hole’; where money is poured in but with little in the way of return on investment.
  • We know, however, that this is something of a simplistic caricature of the situation.
  • There is an increasing body of evidence, building already on the compelling work profiled at the 2008 Tallinn Ministerial Conference which led to the Tallinn Charter on Health and Wealth, that the health system contributes economically, and that healthy populations provide a boost to the economy.
  • It is precisely for this reason that, along with the European Observatoryon Health Systems and Policies, my division at the World Health Organization (WHO) Europe has developed a workstream to firstly strengthen the evidence base, and secondly to explore how best to get these important messages across.
  • Messages such as the fact that health systems contribute to human capital at all ages; that the health system is an industry in its own right and major source of employment; and that, as we learned from the initial and spin-off work of the Commission on Macroeconomics and health, good population health allows for more people in employment, greater individual and collective productivity in employment, and more people investing in education, retirement and the economy itself.
  • Nonetheless, we often hear financial decision-makers talk about waste and inefficiency in the health sector as a reason for not investing in health, and it is important to not simply dismiss these accusations but to engage with them – for it is only by doing so that we can better understand why they are made and what type of information is needed to counter them.
  • In this regard, we are working to examine ways to improve the dialogue between health and finance decision-makers and to see how best they can work together when it comes to budget and spending decisions around health.
  • In saying this, I must admit that while I understand that we in the health community need to do better in speaking the language of the economists – they are after all the ones holding the purse-strings – I nonetheless would argue that as health has an intrinsic value of its own and should not necessarily be defined economically.
  • And I do think that other sectors are wasteful, perhaps in some cases more so, and we should not always be as defensive as we are here.

HEALTHY EUROPE

What is the impact of economic development on health?

Hans Kluge:

  • We know that people who are employed and earn more are in the main healthier than those who do not.
  • The reasons for this are many, some relating to socio-economic factors and the social determinants of health – so difficult for individuals to change themselves – some to education and access to information, and some to ability to pay for health services or health insurance etc.
  • So at a micro- or individual level, a better economic standing has a positive impact on health.
  • At a more macro-level, however, the picture is less clear.
  • Economic development and growth would suggest benefits across the population such that everyone’s standard of living is raised and that households have more disposal income, ideally to be spent on health.
  • But individuals may choose to spend any additional income or wealth on non-health related commodities; some of which might even worsen their health status beyond what being poorer might have done.
  • Economic development would also suggest that the social safety net can be drawn wider and strengthened, providing greater health coverage and health for more people.
  • But again, it depends where any additional money is spent – we know that even in richer countries, the amount spent on public health is far lower than it ought to be.
  • So while economic development should suggest greater health, it always comes down to choices and where resources are distributed.

HEALTHY EUROPE

Do we need a different, new form of economic development to get more health for all?

Hans Kluge:

  • This is of course a more philosophical issue than I am usually asked in my capacity as Director of Health Systems and Public Health at WHO Europe.
  • And I’m not sure that I am qualified to answer this!
  • What I can say is that with the Sustainable Development Goals (SDGs) of United Nations and the growing attention given to economic and social disparities worldwide, including in Europe, thinking about people’s access and right to health is coming to the forefront of discussions even those about the economy.
  • The push for sustainable development suggests an alternative to current models of economic development, re-emphasising the need for solidarity and looking out for the needs of the many rather than the few.
  • It is difficult to understand how we can be generating so much wealth across the globe, and yet in many cases we see inequality rising rather than falling.
  • It is clear that something needs to change, and a clear focus on redistributive models under the SDGs is a step in this direction, and with a positive effect on our pursuit of health for all.

HEALTHY EUROPE

What has to be done to ensure good health of the workforce?

Hans Kluge:

  • I’m not sure that anything specific needs to be done for the workforce as opposed to those not working – at WHO Europe, we of course subscribe to the health for all view.
  • This is not intended to be reductionist or a lowest common denominator approach, rather it is the opposite.
  • It’s about everyone attaining their own highest possible level of health.
  • So everyone, not just those in the workforce or of working age, should benefit for universal health coverage and have affordable access to the highest quality care that they need.
  • Yes, of course, in different professions there are important occupational health guidelines which should be adhered to, and WHO has helped developed guidelines here.
  • But what is important is that workers have health coverage and financial protection – these are key issues particularly in the WHO European Region where access to care, and access to quality care is generally better for most people when compared to other regions; not everyone, of course, but our populations in Europe are generally better off than elsewhere.
  • Ensuring a strong people-centred health system will generate and maintain a healthy workforce, with a consequent benefit for the economy.

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