Better Health For All

• By Dr Stephen Dorey and Dr Joanna Nurse

Prevention and public health don’t actually save money, you still have to pay for another illness later on. Even if prevention does save money it takes so long to see outcomes that it’s can’t be a priority right now.

Variations on these two statements, sadly all too commonly expressed, by ministers of health and other policy makers were the drivers for a new publication by the World Health Organisation’s regional office for Europe and developed with the support of FPH. ‘The case for investing in public health ’ attempts to dispel these myths in a format accessible to decision makers.

This publication supports WHO Euro’s policy framework, Health 2020, which seeks to support a wide range of actions that can improve health. A component of Health 2020 is the European Action Plan for Strengthening Public Health Capacities and Services, which is structured around the 10 essential public health operations (EPHOs). The ‘Case for investing in public health’ specifically supports the strengthening and delivery of EPHO 8: Assuring sustainable organizational structures and financing.

Many governments have responded to the global economic crisis by reducing budgets. As the second largest area of public expenditure for most countries, health is in the financial spotlight. At the same time, there is upward pressure from the rising costs of technologies and pharmaceuticals and, to a lesser extent, from demographic changes, most notably our ageing populations. Austerity policies themselves provide an additional upward pressure from ill health associated with rising unemployment and, for those still in employment, increased job insecurity combined with wages that fail to keep pace with inflation.

This publication describes the economic and health benefits for individuals and governments of a public health approach by setting out the costs of failing to address current public health challenges. It then provides evidence of the cost–effectiveness of public health and prevention approaches across all levels of prevention including the wider determinants of health, resilience, health behaviours, risk factors, vaccination and screening. It includes the recommendations from WHO’s study of the costs of scaling up action to prevent and reduce the impact of non-communicable diseases (NCDs) and identifies those preventive interventions that show evidence for early returns on investment, not just longer-term gains.

The current costs of ill health are significant for governments in Europe: trends indicate we are headed down an unsustainable path of ever increased cost unless cost-effective policies are put in place.
•    Ageing populations with higher rates of NCDs have increased demand, while health care costs have generally increased.
•    The costs of health inequalities – the total welfare loss across 25 European countries – are estimated at 9.4% of gross domestic product or €980 billion.
•    Cardiovascular disease and cancer cost the countries of the European Union €169 billion and €124 billion respectively each year.
•    Tobacco use reduces overall national incomes by up to 3.6%.
•    Air pollution from road traffic costs the countries of the EU €25 billion, while road traffic injuries cost €153 billion each year.
•    Obesity accounts for 1–3% of total health expenditure in most countries; physical inactivity costs up to €300 per European inhabitant per year.
•    Mental illness costs the economy £110 billion per year in the United Kingdom

Some of these health costs could be avoided by shifting investment to prevent harm and increase activity in health improvement, disease prevention and health protection. Funding for public health and prevention remains a small proportion of overall health spending, despite potentially representing excellent value for money, with gains in the short and the long term, and savings for both healthcare and wider sectors of society. European governments currently spend an average of only 2.8% of their health sector budgets on prevention .

The economic justification is clear. The trend for steadily rising health and social care costs, as well as the costs of inaction, show an unsustainable situation. There is good evidence to support an expanded role for health improvement and disease prevention to increase value for money and, for some approaches, to go further and actually create a return on investments for health and other sectors, as well as potentially promoting an increase in wider economic productivity.

Many of these cost-effective interventions can also help to reduce inequalities. For example, those addressing mental health and violence prevention, which are issues disproportionately affecting population groups already suffering from adverse effects of health inequality. Investing in upstream population-based prevention is more effective at reducing health inequalities than funding more downstream approaches .

The publication provides examples of economic evidence for interventions in different areas relating to health. This illustrates the cost of inaction or “business as usual” and then outlines the cost–effectiveness of interventions. The evidence shows that a wide range of preventive approaches can be cost-effective, including interventions that address the environmental and social determinants of health, build resilience and promote healthy behaviours, as well as vaccination and screening.

Examples of prevention interventions that can give returns on investment within 1–2 years are provided and include the areas of: mental health promotion, violence prevention, healthy employment, road traffic injury prevention, promotion of physical activity, housing insulation as well as some vaccinations.

The evidence presented demonstrates the potential benefits of cost-effective prevention, using whole-system approaches and inter-sectoral partnership working. It shows that public health can be part of the solution. This is presented in an accessible format with short quick to read text and explanatory diagrams to encourage its use beyond the traditional public health world and help provide a tool for advocates in countries where public health may not be as strong as here in the UK.

This short video presents the key messages featuring international public health experts including a former president of FPH:

References

1) The case for investing in public health. Copenhagen: WHO Regional Office for Europe. 2015. (accessed 3 July 2015)
2) Health 2020: the European policy for health and well-being. Copenhagen: WHO Regional Office for Europe. 2012 (accessed 3 July 2015).
3) European Action Plan for Strengthening Public Health Capacities and Services. Copenhagen: WHO Regional Office for Europe. 2012 (accessed 3 July 2015).
4) Scaling up action against NCDs: How much will it cost? WHO report 2011 Copenhagen: WHO Regional Office for Europe (accessed 3 July 2015).
5) Global health expenditure database. Geneva: World Health Organization (accessed 3 July 2015).
6) Orton LC et al, (2011). Prioritising public health: a qualitative study of decision making to reduce health inequalities. BMC Public Health.11:821.