Investments that prioritise making people truly matter are the key to unlocking health for all and achieving the Sustainable Development Goals, and progress is being made across Europe towards well-being economies
Charles Dickens said “science mattered when it transformed lives by curing disease or cleaning streets”.
More than 150 years later, the science on how our social circumstances drive health inequities is irrefutable. We know the importance of people feeling that they genuinely matter, as feeling otherwise can be a key driver of inequality in health outcomes.
With growing pressure to accelerate progress on delivering the Sustainable Development Goals by 2030, addressing the issue of ‘mattering’ is key for SDG 10 to reduce inequalities – which in turn is connected to achieving SDG 3 to ensure healthy lives and promote well-being for all, at all ages.
Yet, according to the World Health Organization’s recent Transforming the Health and Social Equity Landscape, inequities are widening, with devastating implications. Between 2019 and 2023 the European region saw 600,000 excess deaths due to low investment in health systems and low human development. The WHO analysis also finds widening gaps in trust, due to people not benefiting from government policies. These findings underscore that health, equity and economic factors are inextricably connected, with social capital the foundation of prosperous and fair societies. This analysis reinforces why societies and economies must focus first and foremost on people and the planet.
A sense of mattering
People’s sense of mattering and well-being is linked with being treated with dignity and respect. This simple truth has profound implications. Across Europe 81% of people believe that governments should prioritise reducing inequities. And the WHO’s analysis shows health equity must be central in all policies for people to feel they are valued.
The analysis highlighted five main opportunities to deliver trust, health equity and prosperity: investing in young people, investing in responsive social and health protection systems, engaging communities in decision making, making sure that green and digital transitions are equity-proofed, and distributing health and social care resources equitably to enable people to live in dignity.
These policy solutions show how public investment can contribute significantly to rebuilding European solidarity by listening to and working with diverse groups affected by widening social and economic insecurities, exacerbated by the multiple and often overlapping crises of our times – from the Covid-19 pandemic to protracted conflicts to the ever-mounting climate crisis. The evidence that climate change is also a health emergency becomes even more overwhelming as human catastrophes of fires, floods and heat-related deaths increase.
This is why the WHO Regional Office for Europe is championing well-being economies, where all public and private investment delivers human, social, economic and planetary well-being. The concept of well-being economies may not be new, but it has a new-found urgency given current regional and global circumstances.
The need to invest in solidarity-based policies and embed health within economic and business frameworks were strong key messages from the Pan-European Commission on Health and Sustainable Development. This message is increasingly being taken up in diverse sectors including finance. Mark Carney, former governor of the Bank of England and the United Nations Special Envoy for Climate Action and Finance, has highlighted why markets must be shaped to deliver equity, social capital and sustainability. Investors with assets worth over $5 trillion have pledged to embed health in their investment decisions.
Yet more needs to be done to ensure the health component is clearly situated alongside the environmental, social, governance elements (from ESG to ESHG).
Committed to well-being
Countries in the WHO European Region have been showing how a commitment to well-being across government can be used to deliver fairer, more prosperous societies. Indeed, investing in well-being also delivers better performance on traditional measures of economic performance. Since the 2008 global financial crisis, Iceland has invested in supporting people with high levels of debt or low income, and has seen growth in gross domestic product often above 4% and low unemployment. It recently connected its fiscal strategy with well-being priorities. Many more countries are using indicators of well-being that go beyond pure GDP to measure progress. Indicators include measures of mental well-being, trust, living wages, circular economies and balanced development as key markers of successful societies. Luxembourg recently used its index of welfare and the WHO’s model of a well-being economy to set out a future vision for its health system.
This growing movement towards well-being economies recognises the significant contributions that health, well-being and equity make to economies and society. Significantly, addressing health inequities across most EU countries would also reduce the nearly €1 trillion in avoidable welfare losses each year. Fairer, more cohesive well-being economies are critical to securing more stable societies and delivering more effective public policies. The benefits of better health and well-being multiply across the SDGs. Poor health costs the United Kingdom over £100 billion annually, related to absence from work and inability to work. Health services have a high employment multiplier effect and are more resilient to economic shocks than other sectors.
It is therefore encouraging that the health, finance and economy sectors increasingly find common ground on shared well-being priorities and challenges. In June 2023, the WHO Regional Office for Europe partnered with the Bank of Italy and Italian National Institute of Health to convene central banks, finance and health officials along with leading experts – with the aim of creating healthy and fiscally resilient societies. The first meeting focused on modelling the fiscal implications of improving youth mental health and inclusion and the costs of inaction; future areas of focus include ageing and regional inequalities. Already innovative modelling is connecting health and the economy and this can be built in to enable policymaking for healthy, financially resilient societies.
These developments are leading into the Summit of the Future 2024, driving a surge in financing for sustainable, prosperous and healthy lives. Countries must consider measuring progress beyond GDP to include well-being, equity, trust and cohesion, and ensure the interests of the coming generations are included in decisions. Health, equity and well-being are vital leverage points for delivering the broader SDGs.
For people to thrive
We need to invest to create secure lives where people can thrive, be healthy and play a meaningful role in society. This includes innovative social protection that transforms the lives of those falling behind, leveraging the health equity and technological gains from green and digital investments, and using employment, education and procurement policies to deliver social value and better places where people live, work and learn.
We can achieve this by using new instruments to unlock the health equity and well-being dividends from public and private investments, including using the full potential of windfall taxes and wealth taxes, debt swaps and social bonds. It also means involving people in decision-making – this has been linked to lower inequalities in life expectancy, alongside greater trust in governments and innovation.
Integrating well-being, equity and healthy societies into government investments is no longer optional. It is essential for a more inclusive and sustainable future, where people matter. The challenges we face are significant, formidable, even overwhelming. However, to paraphrase Dickens, “these are the best of times, these are the worst of times” – the forecast depends on how one views both challenge and opportunity.
With political determination, through relentlessly focusing on delivering health and well-being for all, and ensuring people’s needs and voices are at the heart of our approach – making people truly matter – we can together unlock progress on Health For All, the vision that underpins the WHO, and through Health For All achieve wider gains across the SDGs.