Health Security Scores Low on Europeans’ Health Agendas

LISBON, Portugal — Aging populations, climate change, and addressing the determinants of health through health for all and health in all policies are of the highest priority for future health in Europe, according to results of a public debate.

Results showed support for stronger cross-sectoral action. Also, digital solutions and artificial intelligence, health security, and global health were considered of lower priority, possibly indicating confidence in current efforts, according to experts at a session at the 17th European Public Health Conference (EPH) 2024.

Two sets of study results on the future health priorities of the European Union (EU) were presented: The results of a public debate conducted by the European Observatory on Health Systems and Policies and those of a foresight study conducted by EuroHealthNet.

Matthias Wismar, PhD, chaired the session and is a program manager at the European Observatory on Health Systems and Policies in Brussels, Belgium. Speaking to Medscape Medical News afterward he said, “The results of the European Observatory public debate showed quite clearly that all of the audiences thought that addressing the social determinants of health through health in all policies and health for all policies is really key. That was very important for them.” He added that the importance of calls for coordination across different policy branches of the [European] Commission was also highlighted in discussions.

Health in all policies emphasize that other sectors have to be willing to engage with health because many health determinants are controlled by policies outside the health sector. Health for all policies relate more to the mutual benefits of the health and other sectors working together.

Wismar pointed out that the big global issues, “which will stay with us for a very long time, for example, climate change, were really a top priority and should be a top priority.” However, he noted researchers were surprised when health security was not considered a very high priority by participants in the debate.

“Future of health really, really matters. And the EU has much more impact than you might be likely to believe on health and health systems,” said Wismar.

Low Priorities Surprising but Explainable

The results of the public debate were presented by Giada Scarpetti, MPH, from the European Observatory on Health Systems and Policies, based at Technische Universität Berlin, Berlin, Germany. Caroline Costongs, MSc, director of EuroHealthNet, Brussels, presented those of the EuroHealthNet foresight study.

Scarpetti explained that the public debate involved workshops and plenary sessions at the European Health Forum Gastein 2023 and at EPH 2023, with more than 500 responses to opinion polls. An interactive webinar series with another 500 participants was also held and focused on engaging diverse health sector stakeholders, while a stakeholder survey, with 309 respondents from 48 countries, was additionally sent out with closed- and open-ended questions, she said.

“Addressing the determinants of health through health in all and health for all policies featured as a top priority in four of the five sessions and, likewise, addressing long-term challenges such as ageing or climate change also featured in four of the five sessions,” she said.

“The bottom priority was strengthening the EU’s global voice and leadership, followed by implementing digital solutions, and health security and global health,” she continued.

Wismar added that “it came as a surprise that digital and artificial intelligence weren’t high on the list. When questioned, delegates said they felt digital and artificial intelligence were important, but because they are cross-cutting and found in everything now, as such they aren’t a stand-alone topic — an end in itself.”

Rating health security as lower priority came also as a surprise to the researchers, said Wismar, because the European Commission has done much work in this area, especially given the recent pandemic experience.

“How is that possible? We don’t have an explanation, but we have a possible thesis.” This suggests that people think that much has already been done in this area. On the other hand, there could also be fatigue from hearing so much about it and the public no longer sees the point.

There was broad support for past EU health achievements that are part of the EU mandate but, added Scarpetti, “two thirds of survey respondents favored a stronger mandate, and there were concerns over political and resource barriers. We also saw an emphasis on enhanced coordination, better implementation of current tools, and pragmatic actions within existing EU treaty provisions.”

Scarpetti added that a major limitation was that the findings reflect only those who engaged in the debate, primarily from the Observatory network and health policy communities.

EuroHealthNet Foresight Report on Public Health

Costongs, who led the foresight study by EuroHealthNet, said the question they asked public health experts was: What is the role of public health by 2035 in achieving health equity through health promotion and disease prevention and in the context of the digital and green transition? Data collection involved a multi-round study between June and November 2023, a workshop, a kick-off meeting, two Delphi surveys, and a panel that envisaged alternative futures.

Three overarching recommendations came from the study.

First, there is a need to use a robust evidence base, new narratives, and participatory governance, as well as community-based approaches to generate political will and shift societal values, said Costongs.

Second, there is a need to advocate for well-being economies to facilitate new economic and financial models for health promotion and prevention within and beyond health systems.

Third, in contrast to the findings of the European Observatory survey, the foresight study had results that led to a recommendation of leveraging digital, artificial intelligence, and other technological, biomedical, and social innovations to explore new health promotion and disease prevention approaches.

Wismar, Scarpetti, and Costongs declared no relevant financial relationships.