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Recession hit Europe 'missed opportunity' to improve public health

More could have been done by European policymakers, finds WHO-backed report

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European health policy responses to the global financial crisis represented a “missed opportunity”, according to a report backed by the World Health Organization (WHO).

Some countries used the crisis to increase efficiency, but little was done to enhance value through policies to improve public health, says the WHO's Health Evidence Network.

It surveyed the responses of the European region's 53 member states to the global financial crisis that began in 2007 and found very few pursued health promotion policies such as healthy eating, exercise and screening in response to the crisis.

“Where the short-term situation compels governments to cut public spending on health, the policy emphasis should be on cutting wisely to minimise adverse effects on health system performance, enhancing value and facilitating efficiency-enhancing reforms in the longer run,” the Health Evidence Network said.

Inevitably, the scale of the research project found a mixture of health policy responses across the region.

Some countries introduced no new policies, others introduced many and some health systems were better prepared than others due to fiscal measures they had taken before the crisis.

Health Evidence Network's Health policy responses to the financial crisis in Europe (pdf) report also found many instances in which policies planned before 2008 were implemented with greater intensity or speed as they became more urgent or politically feasible in face of the crisis.

Between 2007 and 2011 several countries increased taxes on alcohol and cigarettes, including Bulgaria, Estonia and Ukraine, or pursued health promotion policies. These included encouraging healthy eating, exercise and screening (Belgium, Bosnia and Herzegovina, Greece, Hungary, Republic of Moldova). 

But there was also evidence of deep cuts to some countries' public health spending. 

In Italy, there were plans to cut the fund for disease prevention and health promotion from €29.6 to €5.9m in 2011, while in Latvia the public health budget was cut by 89 per cent from 2008 to 2010 and the country's Public Health Agency closed in 2009.

In a recent article for PMLiVE, IMS Consulting Group noted that only a few countries are pursuing real reforms intended to improve care, such as the comprehensive reforms in Poland, or the introduction of SwissDRG for the hospital sector of Switzerland, both implemented in 2012. “But these are exceptions in relatively healthy economies,” the authors, Steven Flostrand and Raja Shankar, noted.

“Over the last three years, healthcare reform has become synonymous with cost containment and this is likely to continue” they said, citing the extreme example of Hungary, which is cutting drug spend through a succession of measures by more than 40 per cent.

Last month a report by the Organisation for Economic Co-operation and Development (OECD) found healthcare spending across its member countries fell sharply between 2009-10.

This was due in part to austerity measures implemented by European countries hit hardest by the global recession.

And such austerity measures are having a devastating impact on the physical and mental health of people in Europe, a coalition of MEPs, trade unions and other organisations concluded in June.

21st August 2012

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