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Countries across Europe and the World are faced with growing health, inequity, social security, economic and environmental challenges. We need urgent, innovative and priority-focused investment to ensure sustainable development for the present and future generations. Doing business as usual is unsustainable with high costs for individuals, families, communities, society, the economy and the planet. Governments can have a major impact on all factors influencing health and wellbeing, on the way people live and on their everyday choices. The interconnected nature of current challenges and possible solutions needs strong leadership, strategic and political commitment, and coherent action. It also requires new approaches and financing mechanisms building on cross-sector collaboration and citizen involvement in decision-making, i.e. participatory governance for health. An overarching Framework for investment for health and sustainable development1 has been developed recognizing the complex reciprocal link between investing in health and achieving prosperity for all. It supports the recently adopted WHO Roadmap2,to implement the United Nations 2030 Agenda for Sustainable Development3,building on the Health 2020 Policy Framework4 in the European Region. A sustainable investment approach positions health as a driver of sustainability in the health sector; as well as an enabler of governance and regulatory processes that steer investment in other sectors which contribute to sustainable development, and hence to health and wellbeing. National and global prosperity, security and peace can be achieved only by developing dynamic, sustainable and inclusive systems, infrastructures and services across all sectors and levels, integrating health and equity into all policies. On the basis of most recent European evidence synthesis,1 12 key public health policies for priority investment have been identified. All of them address areas of high health, social, economic and environmental burden and demonstrate strong co-benefits to achieving sustainable inclusive economic growth. The report uses a Social Return on Investment (SROI)5 approach. This method not only aims to capture the financial benefit, i.e. monetary or monetarized economic and socioeconomic return on investment, but also uses a wider concept capturing aspects across the triple bottom line of economic, social and environmental value. These areas are as follows: Address social, economic and environmental determinants of health through a proportionate universalism approach; Ensure gender equity, women’s and girls’ rights and empowerment and address violence; Ensure the best start in life, leaving no child behind; Ensure early and youth education, health literacy and decent employment; Ensure healthy and active ageing; Reduce smoking, alcohol misuse, obesity, unhealthy diet and physical inactivity; Address noncommunicable diseases and communicable diseases; Ensure universal health coverage and minimize out-of-pocket payments; Strengthen public health systems, capacities and services to ensure health security; Transform, expand and optimize the health workforce; Establish healthy and health-enabling places, settings and resilient communities, including sustainable natural and urban environments; Ensure a green and circular economy (minimizing waste and negative impacts) with sustainable production, consumption and procurement. The evidence review has also identified three pathways through which investment for health and wellbeing drives (directly through the health sector) and enables (indirectly through other sectors) sustainable inclusive economic growth: A health and security pathway through increasing life expectancy, improving quality of life, building human capital, enhancing labour productivity, and ensuring national and global health security; A social and equity pathway through reducing the health gap along the social gradient and gender, building social capital, creating political stability, and achieving employment equity for women, young people and the poorest; An economic and innovation pathway through direct, indirect and induced economic effects, such as ensuring employment and decent jobs, building skills, delivering communications and logistics, creating competitive medical services and technological innovations (especially ‘walking the talk’ by the health sector), etc., which drive sustainable production and consumption. Looking forward, the developed framework for investment for health and sustainable development and the policy options suggested align with and support strategic processes and documents already in place with the United Nations and the World Health Organization. A momentum is building for adopting new sustainable investment approaches driven by fair, rights-based, evidence-informed prioritization of resources across all sectors. Working together with people and communities in a participatory way (whole-of-society approach) as well as across different governmental sectors and levels (whole-of-government approach) is essential to inform, develop and implement successful policies that are conducive to health and sustainable development. Further work focusing on national and sub-national level is needed to translate regional and global commitment into transformational action to achieve prosperity for all now and in the future. Disclaimer The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated. Conflicts of interest: None declared. References 1 Dyakova M , Hamelmann C , Bellis MA , Besnier E , Grey CNB , Ashton K , et al. Investment for Health and Well-Being: A Review of the Social Return on Investment from Public Health Policies to Support Implementing the Sustainable Development Goals by Building on Health 2020 . Copenhagen , WHO Regional Office for Europe ; 2017 (Health Evidence Network (HEN) synthesis report 51). 2 Roadmap to Implement the 2030 Agenda for Sustainable Development, Building on Health 2020, the European Policy for Health and Well-Being (EUR/RC67/9) . Copenhagen , WHO Regional Office for Europe ; 2017 . 3 Transforming Our World: The 2030 Agenda for Sustainable Development. New York, NY, United Nations, 2015 . https://sustainabledevelopment.un.org/post2015/transformingourworld (31 July 2017, date last accessed). 4 Health 2020: A European Policy Framework and Strategy for the 21st Century. Copenhagen, WHO Regional Office for Europe, 2013 . http://www.euro.who.int/__data/assets/pdf_file/0011/199532/Health2020-Long.pdf? ua=1 (31 July 2017, date last accessed). 5 Hamelmann C , Turatto F , Then V , Dyakova M . Social Return on Investment: Accounting for Value in the Context of Implementing Health 2020 and the 2030 Agenda for Sustainable Development . Copenhagen , WHO Regional Office for Europe , 2017 (Investment for Health and Development Discussion Paper). © The Author(s) 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)
The European Journal of Public Health – Oxford University Press
Published: May 21, 2018
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