By Masha Smirnova, Policy Coordinator for EU Semester and Social Pillar
European health systems are facing a number of growing challenges. From population ageing associated with a rise of chronic conditions and multi-morbidity, to disparities in access, cost containment pressure and uneven distribution of healthcare professionals, there are many common challenges, while others are more region specific. To pursue the goal of reducing regional disparities and promoting stronger growth, more and better jobs and improved living standards, cohesion policy and EU structural funds need to be better equipped to respond to societal challenges and to consider a life-course approach to social investment.
EU key economic indicators should be expanded and aligned well beyond GDP, by including other frameworks such as the Social Progress Index (SPI) and the useful OECD indicators on well-being. Flexibility to combine various funding instruments of the European Structural and Investment Funds (ESIF), such as for example the European Regional Development and Social Funds (ERDF and ESF) , offer possibilities to reach out to marginalized groups such as the Roma, and a similar approach could be taken to help regions support the inclusion of migrants.
Consistent and transparent communication is also required to explain to everyone involved about the evolving role of the European Fund for Strategic Investments (EFSI), especially with regard to investment opportunities in intangible assets associated with key social and health returns, and possible combinations with other funding instruments.
While the implementation of cohesion policy through the European Structural and Investment Funds (ESIF) for the 2014-20 period continues, post-2020 programming deliberations have already begun. The European Cohesion Forum, held every three years in Brussels, will be the next key event for the preparations of the post-2020 framework for ESIF at the end of June. The presence of key social and health actors at this occasion is essential.
Under the current 2014-20 programming period, although health does not represent a stand-alone objective, health investments are relevant to a series of priority areas such as innovation, support for SMEs, combatting poverty and promoting social inclusion, skills, workforce and institutional capacity, under the Europe2020 strategy. In this respect, the current programming period for structural funds offers a more integrated approach and a wider scope of financial instruments for health, including the possibility to combine different funds under a common objective. As demonstrated by a recent study of ESIF in health, this implies that the scope of investments has generally broadened to include a stronger focus on areas such as de-institutionalisation, community-based care, promotion of active and healthy ageing and e-health, while scaling back on infrastructure funding.
At the same time, many questions arise not only around the future of health-related investments, but also on the future of cohesion policy in general. Let’s not forget that one of the Scenarios for the future of Europe would scale back EU action on public health and regional policy. However, the substantial regional disparities within the EU have considerable consequences for population health outcomes. Sustained investment is required for the many good initiatives that have already started and further steps to adjust funding to new challenges will be essential. Many key players in European governments still consider health to be exclusively under the remit of health departments, while a cross-government approach is a prerequisite to act on key social and economic determinants of health and implement a truly integrated approach to health investment in the future.
Policy Coordinator for EU Semester and Social Pillar Project Manager FRESHER