At the 63rd session of the World Health Organization (WHO) regional committee for Europe in Çesme (Izmir, Turkey) on 16-19 September, generated ten policy lessons for health policy responses in times of global economic crisis. As Zsuzsanna Jakab, WHO’s Director for the Regional Office for Europe, explained, Ministers of Health have found out that providing effective social safety nets for people without work can largely mitigate the negative health effects of economic downturns.
POLICY LESSON 1 - It is critical to keep in mind the longer-term challenges to health systems while navigating the crisis
Shorterm policy responses to fiscal pressure should be consistent with long-term health system goals and reforms required to address the health challenges now facing European societies. These include coordinated service delivery systems based on primary, community and social care, health-in-all policies to address risk factors for noncommunicable diseases; emphasis should therefore be placed on health promotion and disease prevention.
POLICY LESSON 2 - Fiscal policy should explicitly take account of the probable impact on population health
Large increases in unemployment, especially long-term unemployment, are associated with greater morbidity, particularly associated with mental health, and increased mortality from suicides. While evidence shows an overall reduction in the harmful use of alcohol and tobacco, there are increases among some subgroups of the population. Fiscal policies, particularly those that promote austerity, should factor in this evidence and take steps to mitigate negative health effects.
POLICY LESSON 3 - Social safety nets and labour market policies are intersectoral actions that can mitigate the negative health effects of the financial and economic crises
Evidence shows that, despite the increased risk for ill health during economic downturns, concerted intersectoral action, such as active labour market policies, can limit lengthy unemployment, and effective safety nets for people without work can largely mitigate the negative health effects of economic downturns. Other economic and social policies, such as protection against loss of housing, could also be considered. The health sector plays a critical part in overall social protection by ensuring sufficient absorptive capacity for increased demand for mental and physical health services.
POLICY LESSON 4 - Health policy responses influence the health effects of financial and economic crises
Reductions in public spending on health in response to a deteriorating fiscal situation come at a time when the demand for health services tends to rise. Policy measures to absorb budget cuts through supply-side measures (e.g. price reductions) should be exhausted before costs are shifted onto patients, especially the poor, and will contribute to a more sustainable health financing policy. Across-the-board cuts may worsen the situation by failing to target areas of inefficiency, and inappropriate cuts may introduce new forms of inefficiency.
POLICY LESSON 5 - Adequate funding for public health services must be ensured
Evidence-based public health services (including health protection and disease prevention), when provided efficiently, are proven investments that can improve health outcomes at relatively low cost and sufficient funding for these services should be ensured. In addition, public health interventions can contribute significantly to economic recovery by protecting mental health, improving workplace health and focusing on interventions that save costs of the health system.
POLICY LESSON 6 - Fiscal policy should avoid prolonged and excessive cuts in health budgets
Health systems can prepare better for a downturn through appropriate, efficient investments in infrastructure, appropriate reconfiguration of service delivery, a focus on cost- effective interventions and careful expansion during periods of increasing health budgets. Raising additional funding using innovative measures, such as public health or sin taxes, should also be considered.
POLICY LESSON 7 - High-performance health systems are more resilient during times of crisis
Efficient health systems tend to have better management capacity, which in turn strengthens resilience in the face of unavoidable cuts. Systematic analysis of information during health technology assessments will support strategic purchasing and help in setting appropriate incentives throughout the system. This, combined with robust management capacity, can help ministries to set priorities for spending and minimize negative effects on health when budgets are tight.
POLICY LESSON 8 - Deeper structural reforms require more time to deliver savings
Addressing the underlying cost base of service delivery, often require up-front investment, which can be limited during a crisis and is unlikely to be available in the short term. Budget allocations to health should take this into account. Health systems should therefore seek efficiency gains continually, not only when a crisis hits.
POLICY LESSON 9 - Safeguarding access to services requires a systematic, reliable information and monitoring system
A set of readily available, specific, sensitive indicators, disaggregated at subnational level, identified and implemented to monitor the impact of policies, for example on inequalities in access to care, is a priority. Monitoring the impact on health over time or policy responses associated with the financial crisis includes fatal and non-fatal health outcomes and their determinants, including those of the health care system.
POLICY LESSON 10 - Prepared, resilient health systems are primarily the result of good governance
Addressing the challenges of the health impact of the economic crisis in a timely manner is a test of good governance in health systems: continual attention to efficiency and responsible management of public resources in the health sector, combined with prudent fiscal policy, are the most effective strategies for protecting equity and solidarity during an economic downturn.
The regional Committee adopted a resolution that requested the WHO Europe Regionto continue to provide Member States with tools and support for policy analysis, development, implementation and evaluation; and to collaborate with partners such as the European Observatory on Health Systems and Policies, the Organisation for Economic Co-operation and Development, the European Commission, the International Monetary Fund and the World Bank.
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