Health challenges do not emerge in isolation, nor should they be dealt with in silos. Climate change and air pollution, the financial crisis, the digital revolution, where and how we live, the way we work; these are just a few elements that define citizens’ physical and mental health and that, sooner or later, will have a direct impact on the resilience of European health systems.
To be able to guarantee the sustainability of our health systems, we need to be proactive about finding ways to ensure that health has a central role in all our different policies, but also about making health a key consideration in ‘all politics’. The ‘Health in all policies’ (HiAP) concept was coined by the international health community in 2010.
It epitomises the idea of making public health and wellbeing a primary consideration in every action plan, across all policy fields. The approach recognises the interconnectedness of policy fields and, in consequence, the effects of public policy in general on public health and wellbeing. It is meant to serve as a recipe for sustainable development.
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Now, 20 years later, and as we are preparing for the challenges that come with the post-2020 agenda, we understand that HiAP does not suffice.
This is why the 2017 European Health Forum Gastein promotes the inclusion of health in all politics in addition to HiAP; health as an inherent aspect of high-level dialogue and overarching political strategies.
The need for an even more forward-looking and holistic health approach has been made all the more evident by the recent contaminated egg scandal that hit the Netherlands, Belgium and several other EU member states.
Moreover, the lurking outbreak of chikungunya in France demonstrates the need to take the health debate to yet other levels, while even successfully fighting terrorism has been linked to stimulating people’s ‘inner hygiene’ and mental health. That’s right. Health is moving from its politicised status to the advanced level of securitisation. All the more reason to tackle health in all politics.
Take another example: the recent measles outbreaks. Is there anyone who can argue that this is not a cross-border health threat endangering more than one member state? I was happy to hear European Commission President Jean-Claude Juncker, at his State of the Union speech on 13 September, addressing this very issue and raising it high in his political agenda.
The President said that the Commission is working with all EU countries to support their national vaccination programmes. In addition, a joint action on vaccination should be ready next year, because this is yet another issue that can’t be dealt with in silos or by one member state alone.
Not to say, of course, that we are not heading in the right direction. At high political levels, EU member states are increasingly working together on health-related matters, from health technology assessment to joint procurement of medicines.
There is voluntary cooperation on health-related issues already taking place, and earlier this year, the Maltese EU Council presidency made major efforts to properly frame and move forward this issue.
But health in all politics should go far beyond this health-only voluntary cooperation. It requires a clear understanding of what it is, what it entails and why it is significant. Some first steps are already being made in this very direction.
Health is addressed in the European Semester process, as well as the European Pillar of Social Rights. It’s not possible to discuss national budgets and state reforms without looking into the effects these will have on health systems and patients’ wellbeing.
The focus on social and employment policies is undoubtedly extremely interconnected with the structural determinants of health. These are concrete examples that show we can’t decouple health from a number of non-health policies and politics.
Member states understand that Europe’s contemporary health challenges do not respect geographical borders, even less so on a single market with free movement of people, goods and services.
They see that an effective response warrants a cross-border approach.
But this is also where the problem lies: existing efforts are too much about responding, whereas we need to get ahead. Especially here is where ‘health in all politics’ can make a difference.
Health in all politics is about finetuning the HiAP approach with a forward-looking vision. It is about engendering sustainability by being pragmatic in moving the debate and, consequently, our policymaking forward.
The Health in all Politics approach asks decision makers to innovate their thinking and look beyond the ‘usual suspects’ in view of ensuring a healthy life and society. It is about making connections before our time does it for us. Most of all, however, it is about political will.
Becoming a bit more granular, health in all politics for me means going beyond a policy plan that looks into health implications for the citizens.
I see it as understanding the needs of the stakeholders who operate at local, national and EU level and translating this knowledge into good governance, having health as a deciding factor for any proposed plan. It’s about building bridges between different policy areas, centred on human health and wellbeing. The ultimate goal is to create a better future for EU citizens.
This appears to be a rising challenge amid the rising populism and post-truth politics that endanger the future of the European project. We are obliged to respond with solid investments in the people of the Union.
The 25th edition of the European Health Forum Gastein will take place from 4-6 October 2017 in Bad Hofgastein, Austria, and focuses specifically on how to integrate health in all politics.
The forum gathers 500 key stakeholders, rendering it an excellent place to get started. I look forward to meeting the passionate participants of the forum, interacting with them and debating how we can make health in all politics a reality.