Health – compatible systems in the region mean better quality of life?
By Maria Ruseva and Gergana Koleva

Improving health is a universal goal of governments, whose pursuit inevitably reveals untapped opportunities to improve citizens’ quality of life by involving non-health sectors and industries. Recognizing those opportunities and acting on them is the best way to ensure inclusive and sustainable economic development in South East Europe, which is only possible by assigning health and well-being the same importance to economic growth as productivity and competitiveness. They are two sides of the same coin.

How does integrating a health perspective in all government silos move societies forward? For one, collaborating across systems and ministries allows decision-makers an expanded view of which policies ought to be developed or how existing processes could be improved to better serve people in their daily lives. This has an effect on health, which is by and large determined by the place where individuals live, the conditions in which they work and study, the food they eat and whether they can afford a healthy diet, and the opportunities for them to rest, exercise, or recover from illness.

Moreover, embedding a consideration for health in non-health governance and operations is necessary because of the explicit risks to health certain services and products carry – risks which often materialise as diseases and impose a health and economic burden on individuals and societies only years later when damages are harder to reverse than to have had prevented in the first place.

Last but not least, aligning development processes with health makes economic sense in that ensuring safe and healthy working environments, including fair labour conditions, not only enables employees to contribute their best work and be properly compensated for it, but also provides them with motivation to remain in their country of origin rather than look for more attractive job opportunities abroad.

Barriers to alignment

Although the benefits of integrating health with economic growth for jobs and prosperity – the key targets of the South East Europe 2020 Strategy – have been acknowledged by policymakers in the region, the SEE economies face unique challenges in uniting diverse business interests around this vision. The principal reasons for this are a stagnant labour market and a lack of foreign investment, which has eroded confidence that the “economic pie” can be expanded and has instead fortified a perception that the players who stand to gain the most are those who manage to rope off a larger share of it. In this mentality of scarcity the concept of “health-proofing” non-health operations is inherently foreign and health-related spending can be seen as a discretionary budget item rather than as a vital investment in human and economic potential of the workforce.

Health-compatible systems rise above narrow self-interest when they recognize through appropriate policies and actions that investing in health contributes to sustainable growth at the same time as it limits societal exposure to health risks. In Bulgaria the Health Ministry recently announced a plan to introduce a tax on foods with salt and sugar content above the recommended levels. The proposal follows similar public health taxes launched in Hungary in 2011 (known as the “chips tax”) and in Finland the same year (known as the “sweet tax”). It aims to signal to food manufacturers to shift to healthier product alternatives or face declining demand, and at the same time serves as a behavioural nudge to consumers to encourage better eating habits [Fig. 1]. Oddly, the initial response came not from the food industry but from representatives of opposition parties who swiftly reframed the plan as “a war on consumer choices.”

Figure 1. Healthy diets save lives, WHO Regional Office for Europe, 2015

In the language of public health, the Bulgarian example represents an effort to limit the influence of commercial determinants of health – those products and services that increase the odds of developing diseases, such as diabetes, cardiovascular disease, or other (usually) long-term conditions. Other examples include indoor public smoking bans and minimum unit pricing for alcohol. However, fiscal, legislative or advocacy measures alone cannot change culture or force people to adopt new societal norms, especially with regard to personal consumption patterns; health literacy also has a key role. This is where a health-compatible education system can help by cultivating early on a sense of personal responsibility for health as an asset worth preserving.

Mobilizing support for health-compatible systems

Health system leaders must anticipate resistance to common sense proposals, which often threaten interests that profit from the status quo, and be prepared to counter the tyranny of cheap populism with facts. They must make the case that economic development cannot be measured only in terms of meeting short-term objectives and ought to consider employee well-being and the negative health externalities imposed on society as a by-product of business activities. But it would not be fair to expect health ministers to fight this fight alone: the determinants of ill health are spread across society and require a coordinated, multi-sectoral approach.

What are the benefits of health-compatible systems on the quality of life? Health systems developed and supported with the active contribution of other sectors are able to offer comprehensive “wraparound” services to people in their time of need, such as non-emergency medical transportation, social support, and help with reintegration in the workforce. At their best and highest form of alignment, health-compatible political systems make room for the voice of civil society – patients, carers, and communities – to be heard and integrated through public consultations and joint decision-making [Video].

Political and technical leaders in SEE economies can meet the challenge of smart, sustainable and inclusive growth by protecting and reinforcing the most essential component of growth, and the engine everything else depends on – human capital. Ensuring that a health dimension is integrated with governance and policymaking across all sectors is the best way to achieve this.

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Dr Maria Ruseva is an international expert on public health and health systems, co-opted member of the Executive Committee of the SEE Health Network, and a founding member of the International Health Partnerships Association (IHPA), Sofia, Bulgaria. Previously she was Programme Manager for Public Health Services at the WHO Regional Office for Europe and Director-General for Public Health at the Ministry of Health of Bulgaria.

Gergana Koleva is an international public health consultant, researcher, and advocate for patient experience-based co-design of health policies and services. She wrote and co-produced “Journeys to Health: Experiences in people-centred health systems” for the WHO Regional Office for Europe and is a former health journalist.

Winner of the Round 8, Voice of the Region Competition

Nothing but health...
Essay by Vladan Racic, 26 years, Banja Luka

We have wondered so many times what the most important thing in the world is. Money? Education? Power? No. None of these things matter without health. Health is the alpha and omega of each individual personality.
Without health life becomes hell and loses its meaning, the world gets bleak.
There is an old adage “value your health now before it’s too late”. This is true. In our country and the region, health institutions are experiencing hard times. They struggle with various issues: poor capacity, old equipment, inadequate drugs, poor staff expertise, etc. One can find sick people throughout the country...
What we, as individuals, can do is to strive never to get sick. It is the primary solution. If we go to ‘the other side’, no one can guarantee us health.

However sick people are out there, around us and will be there always – and this is the fact. What to do about this problem? How to improve health and the system of health care institutions?
The health issue is tied to a topic which is often associated with our region -corruption. Bad people in power, corrupt health ministers, too little investment in useful things. This issue is not an easy one to solve as it takes years for that, and even to mitigate it requires radical and major changes to the entire system. 

People are accustomed to corruption, and no one is generally complaining much, while corruption in healthcare is growing every day.
Poorly equipped health institutions in small communities are a big issue today. Many people are doomed to travel to larger towns for health services or even to neighbouring countries because the towns do not have the necessary equipment. Mobility and collaboration between the health institutions in the region and between cities is almost non-existent.

It is necessary that those in power realize that health is the most important factor of a society and that health care must be corruption-proof. They need to understand that there is much to be invested into healthcare. Cooperation between all health institutions in the region, in all fields of medicine, needs to be in place. It is the only way we can preserve the most important thing of all- human life. If it succeeds we will at least increase the life expectancy a bit.