Basing decisions about our health systems on sound analysis, scientific evidence and reliable data will ensure no one is left behind – and build health care for all with people at its heart
The COVID-19 pandemic has challenged long-standing assumptions about the way countries’ health systems are organised and managed. Around the world, millions of hard-working and dedicated health workers responding to COVID-19 have been stretched to the limit by systemic weaknesses in our health systems. For finance ministries, COVID-19 has also underscored the importance of considering health as an investment. Despite countries’ commitment to provide high-quality care, the enormous and growing pressures they face have prompted many searching questions about how we can improve health system resilience.
The solutions are not straightforward and involve many trade-offs. As we have seen – all too clearly – with the COVID-19 response and as countries double down to strengthen their health systems, health is a political choice. The decisions politicians make will be more important, and scrutinised more closely, than ever before. Many difficult decisions need to be made on critical issues, including appropriate levels of funding, hospital capacity, workforce numbers and skills, supply chain management, the role of digital technologies and new product development. We need to improve our ability to respond to surges in demand, in terms of staffing, infrastructure and resources. As we move into the digital era, we also need to think hard about skills needed for the future, how we can protect critical supply chains, and how we can improve the way people are involved in decisions about their health and the care they receive. It is essential to strengthen multilateral cooperation, looking at how we resource global public goods – including new vaccine development – and at responses to antimicrobial resistance.
COVID-19 – and the way it has disproportionately affected the most vulnerable in society – has also shone a very powerful spotlight on issues that have been hidden for too long, particularly the impact of health inequalities. In non-communicable diseases, the interdependence of health, employment and education outcomes is clear. In the absence of appropriate policies, health inequalities can become self-perpetuating, particularly for the most disadvantaged, with significant effects on our economies. The problems start early in life – OECD data show that children with a healthy weight are 13% more likely to achieve good results at school. In adulthood, being overweight lowers labour market productivity, which reduces the workforce by the equivalent of 18 million full-time workers in OECD countries. This matters for the economy, but is also devastating for the families affected. People with diabetes, for example, are 14% less likely to be employed, and people with strokes 23% less likely, leaving families with less disposable income and lower capacity to lead healthy lifestyles. More than 4.3 million premature deaths could be averted across G20 countries between 2020 and 2050 if a further rise in obesity rates is prevented, reinforcing the need to place much greater emphasis on prevention to promote healthy lifestyles, as health systems are transformed through strengthened primary health care.
A cross-cutting approach
The interlinkages among health, employment and education underscore the importance of a multidisciplinary approach to improving health outcomes. Furthermore, most of the big health challenges the world is facing today – whether it is COVID-19, antimicrobial resistance or the rise of non-communicable diseases – have major economic impacts. Addressing those impacts reaches far beyond the remit of individual health ministries.
With its multidisciplinary expertise across diverse policy areas, including health, economics, tax policies, agriculture, education, social policies, international development and science and technology, the OECD is very well placed to provide policymakers with the evidence they need to promote more people-centred, high-performing health systems. We are working closely with other international organisations – including the World Health Organization and the World Bank – and with international forums such as the G20 to develop the solutions needed to address 21st-century health challenges.
The OECD’s cross-cutting approach also enables us to look critically at how health systems are organised, understand why they are under severe financial pressure and consider how they could be transformed. This approach also provides an opportunity, working with the UHC2030 platform, for low-income countries to build on the lessons learned as they shape their health systems, and strive to achieve universal health coverage, thereby avoiding some costly mistakes that higher income countries have made. Innovative approaches developed in a low-income context equally find a role in higher income systems. The challenges are well known – rising costs driven by high expectations of health systems, increasing costs of technology and growing life expectancies, including for people with multiple long-term conditions.
There is also broad agreement that countries need health systems to focus more on people so they have a say in the care they receive. Yet there are few tools for measuring what matters to people in ways that enable comparisons between countries. To address this gap, the OECD is developing Patient-Reported Indicator Surveys (PaRIS) to standardise and implement new indicators that measure the outcomes and experiences of health care that matter most to people. The PaRIS initiative aims to fill a critical gap in primary health care, by asking about access to health care and waiting times, as well as quality of life, pain, physical functioning and psychological well-being.
So whether it is preparing for the next pandemic, addressing health inequalities or making health systems more people-centred, health is always a political choice. The more we can base decisions about health systems on sound analysis, scientific evidence and reliable data, the better. The OECD stands ready to provide this support and help governments design, develop and deliver strong, resilient health systems for better lives, leaving no one behind. Together we can, and must, do better.