Health Systems, Health, Wealth and Societal Well-being. Assessing the Case for Investing in Health Systems
(2012; 330 pages)


Member States in the WHO European Region are facing a formidable economic crisis that is also calling into question the sustainability of the European social welfare model as a whole and necessitating even greater cost–effectiveness of health systems. Policy-makers are being called on to account for each and every area of public expenditure and are expected to maximize value for money; indeed, the sizeable share of public money that is devoted to health and the ever-increasing cost pressures and demands to cut public expenditure put health systems at the heart of the policy debate. Consequently, the central message of this volume is very relevant, timely and welcome: health systems are not a drain on resources but an investment in health and wealth – that is, in the health of the population and in economic growth.

An earlier draft version of this volume served as background for the WHO European Ministerial Conference on Health Systems in Tallinn in 2008. It underpinned the deliberations of Member States as they elaborated the Tallinn Charter: Health Systems for Health and Wealth. The evidence contained in this volume illustrates how health constitutes a major component of societal wellbeing. It demonstrates that health has both a value in itself and a major impact on economic productivity and the economy as a whole. Moreover, it shows the contributions of health systems to health improvement, population health and equity: making a powerful case for investing in health systems.

These are not, however, arguments for a blank cheque. Investments in health system interventions need to be underpinned by evidence on performance, including impacts on overall population health gain and value for money.

Importantly, they must also be set against investments in other sectors because a large share of the burden of disease is preventable through early interventions not only within but also outside the health system in sectors such as education, transport, housing or employment; all these areas influence the broader determinants of health. Investments in many of these public health interventions are best value in terms of both health gain and cost-effectiveness. Policy-makers should, therefore, be held accountable both for the operation of the health services and for the health leadership that they exercise across sectors to maximize the overall health of their populations.

The WHO Regional Office for Europe in this second decade of the new century is strengthening the work of the Tallinn Charter with its central message on the value of investing in health systems. This is being done by extending the fundamental principles of the Tallinn Charter to cover the strengthening and integration of public health within the health system and, where relevant, also in other sectors. Strengthening public health is also at the core of the new WHO European health policy, Health 2020, now under discussion in our Member States. The new policy argues for "whole-of-government" and "whole-of-society" approaches that will consolidate the ideals encompassed in health in all policies. This concept emphasizes the need to improve the integration of government activities with health and to reach out beyond government to engage patients and citizens, developing a responsive and inclusive approach to governance for health. The policy will be accompanied by a raft of evidence that underlines its rationale, most particularly around enabling implementation – a lynchpin for policy success. This includes a review of social determinants and the health divide in the European Region, pointing towards successful interventions, and studies on the economics of prevention and on effective tools to improve health governance. The current volume is, therefore, a welcome and timely addition to this arsenal.

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