IANPHI Europe Hosts Webinar on Investing for Health Equity during COVID-19

Held on October 22, 2020, the IANPHI Europe Webinar entitled 'Balancing Investment for Wellbeing and Health Equity in the Context of COVID-19' is the second of three webinars of the virtual 2020 IANPHI Europe Meeting.

Moderated by Prof. Mark A. Bellis, director of the WHO Collaborating Centre on Investment for Health and Wellbeing at Public Health Wales, the session outlined current and potential challenges and impact of COVID-19 (and related response measures) on population wellbeing, equity, social and economic development, and highlighted the importance of urgent and sustainable investment in wellbeing and health equity. It explored theoretical approaches and solutions, as well as examples of good practice and country experiences, developing and using different models and tools towards sustainable investment. 

To open the meeting, Prof. Mark A. Bellis highlighted the main objectives of balancing investment for wellbeing and health equity. Relevant investments could support achieving sustainable health systems, prosperity for the current and the future generations, and to mitigate against the harmful impacts of restrictions brought in to prevent the spread of COVID-19.

The session was organized into two parts dealing with i) the rationale, issues, challenges and potential solutions to drive sustainable investment in wellbeing and health equity in the context of COVID-19 and ii) applied tools and examples of potential solutions.

Reporting and Understanding Health Inequities in Europe by Chris Brown, head of the WHO European Office for Investment for Health and Development, Venice Office (download presentation)

The first question raised by Chris Brown of the WHO European Office for Investment for Health and Development tackled the negative effects of the COVID-19 pandemic on health and wellbeing. In its European Health Equity Status Report Initiative, WHO has developed health and wellbeing indicators to measure inequities, including life expectancy, life satisfaction, mental health or self-reported health. There are five essential factors, which are significant in explaining these significant inequities: i) access to and quality of health services; ii) income security; iii) living conditions; iv) social and human capital; and v) working conditions. The COVID-19 pandemic has exacerbated health inequities in terms of exposure to the virus, containment measures and the socio-economic effects of lockdowns. In this context, public policies should face new health and economic vulnerabilities, new health and social needs, and an increased insecurity in access to essential health goods and services.

Public Health Wales Making the Case for Investment in Health and Well-being by Dr. Sumina Azam, policy lead, Public Health Wales, WHO Collaborating Center on Investment for Health and Wellbeing (download presentation)

Since devolution 20 years ago, Wales has introduced a range of policies that support health and equity, such as the Wellbeing of Future Generations Act, and the Public Health Act. Dr. Sumina Azam presented the work that Public Health Wales (PHW) has carried out to support investment in health and wellbeing. The presentation used investment in housing as an example of how evidence has been built over time. The first such report by PHW was published in 2016, and brought together the evidence for investment in three areas including addressing the wider economic, social and environmental determinants of health. This was followed by a report that advocated for the health benefits of, and return on investment in, tackling unhealthy homes and homelessness and improving housing suitability. PHW has also produced a range of reports that further highlight the importance of housing for health and equity, such as the links between Adverse Childhood Experiences and homelessness.

Regarding the COVID-19 pandemic, PHW has produced a health impact assessment report to understand the effects of the ‘Staying at home and social distancing policy’. Here, housing has been identified as an important theme that has both positively and negatively affected health and wellbeing. PHW continues to undertake work in a broad range of areas such as basic income, mental wellbeing, and climate change, where investment in health in the context of COVID-19 response and recovery could bring benefits for both current and future generations.

The Eyes and Ears of the European Union Approach by Caroline Costongs, director of EuroHealthNet (download presentation)

One of the priorities of the current European Commission president, Ursula von der Leyen, is “to build a stronger European Health Union”. But for EuroHealthNet, the EU approach should encompass both biomedical and psychosocial elements of a health union. For example, the next EU4Health program will focus on disease prevention and health care issues, but risks to not provide sufficient attention to health promotion, mental health and the social determinants of health equity. The COVID-19 pandemic can be seen as a “syndemic”, as NCDs and inequities are interfering with the disease pattern of COVID-19. Integrated solutions are needed, where social, economic, environmental factors must be considered together.

EuroHealthNet highlighted the social sector investment gap; public sector investment is decreasing, whereas the demand is rising. To support a more balanced approach to investment, the concept of “economy of wellbeing” is important. In this perspective, C. Costongs explained the role of the European Semester, which offers links to various funds for social and health reforms. Finally, NPHIs are well-placed to respond to the need of leadership and international cooperation to increase the public health workforce and build capacities for increased investments for health for all.

The Health Equity Status Report Initiative solution platform by Tatjana Buzeti, policy officer, WHO European Office for Investment for Health and Development, Venice Office (download presentation)

The Health Equity Status Report Initiative (HESRI) solution platform put four questions forward: i) who is being left behind; ii) what is holding people back; iii) how to close the gaps; and iv) why it matters. To build this solution platform, WHO develops different tools and actions. For example, they share data on the Online Health Equity Dataset Platform, and they will soon publish an assessment tool and guidance on COVID-19 impacts on health equity.

In this context, WHO encourages Member States to work on national HESRI reports, which allows countries to take part in the development of a Live Policy Innovation Site. They also develop partnerships, including the Nobody Left Outside coalition, which developed a briefing paper about the effects of the pandemic in marginalised groups.

Finally, the WHO Venice Office strongly encourages advocating at national levels for this health equity and sustainable investment. According to the Strategic Mapping of Public Perceptions of Health Equity, 84% of Europeans see the reduction of inequities as a major issue that can save lives.

Practical Approaches to Advocate for Sustainable Investment in Well-being and Health Equity by Dr. Mariana Dyakova, international health lead, Public Health Wales, WHO Collaborating Centre on Investment for Health and Wellbeing (download presentation)

The WHO Collaborating Centre (WHO CC) at Public Health Wales (PHW) has developed different tools to facilitate and support sustainable investment for well-being and health equity. Most recently, an interactive Practical Guide: How to make the case for sustainable investment in wellbeing and health equity was published. It outlines four phases with relevant resources: i) project scoping and planning; ii) evidence gathering and synthesis; iii) dissemination and communication; and iv) monitoring and evaluation.

Dr. Dyakova presented the Social Return on Investment (SROI) approach, based on the social value of public health services and interventions, towards a Value-Based Public Health. The WHO CC is also working on a Welsh Health Equity Status Report Initiative (WHESRi), together with WHO and Welsh Government, developing a digital Health Equity Solutions Platform.

Concerning the COVID-19 pandemic, PHW has adopted the “syndemic” approach to find sustainable solutions. For example, PHW publishes bi-weekly reports on COVID-19 International Horizon Scanning, and is producing projections on the economic consequences of the COVID-19 pandemic in Wales.

EuroHealthNet Financial Tools and Application by Alison Maassen, senior coordinator, EuroHealthNet (download presentation)

EuroHealthNet introduced its E-Guide for Financing Health and Promoting Services, which has two objectives: i) illustrating how to mobilize resources; and ii) demonstrating ways to strengthen health promotion and disease prevention services. A. Maassen detailed three of these case studies:
1. Social Impact Bonds, which are based on the principle “Payment by results”. The first years are often loss making, but as the impact grows up, the program is able to pay returns, and is expected to deliver more savings to the public sector in the long term.
2. Joint Budgeting, which promotes co-financing across benefiting sectors to be able to finance a program.
3. Disinvestment, which means reallocating the resources and improving the use of existing assets.
Thanks to these case studies, the e-guide explores new sources of funding, which can be relevant to advise policy makers.

Next Steps

The panelists invited IANPHI members to take part in the Health Equity Status Report Initiative, to be able to learn from each other and to reduce health inequities faster. They also encouraged IANPHI members to share their relevant case studies or resources with EuroHealthNet to add them in the E-Guide for financing health and promoting services. Those interested can contact the IANPHI Secretariat at secretariat@ianphi.org.

Finally, Chris Brown highlighted four ways to use all the useful tools presented during this webinar in order to make a difference in people lives. Using them to: i) prove to policy makers that reducing inequities is possible; ii) show them what are the consequences of inequities; iii) explain that investment for health equity is also a way to solve other problems; and iv) show them that there is a real demand within the society for improving health equity and wellbeing.

Watch the Webinar

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