Summary: October 3, 2003: David BYRNE, European Commissioner for Health and Consumer Protection on "Health equals Wealth" at the European Health Forum (Bad Gastein)
Minister Waneck, Dr. Leiner, Ladies and Gentlemen,
The crisp clean air of the Gastein Health Forum, is always a pleasure after the Brussels hothouse! I would like to thank our hosts Dr. Gunter Leiner and his unique team for their welcome and their professionalism in making this event a reality. Because the Gastein Health Forum remains one of the most important events on the European Health calendar.
Over the years here, I have used this unique setting to take soundings with the health policy community on the future direction of health-related policy at European level. In the past I have spoken about the public health agenda, the challenge of enlargement, and the need to develop a "Europe of Health".
On all of these fronts, remarkable progress is being made. The new, 6-year public health programme, is up and running. Before too long, we will begin to see a comprehensive health knowledge and information system take shape. Led by the EU, a ground-breaking global agreement on public health has been agreed - the Framework Convention on Tobacco Control.
This is the first international health agreement of its kind. But not, I hope, the last.
Before the summer break, the Commission adopted our important proposal to have a European Centre for Disease Prevention and Control up and running in 2005. Public health's institutional landscape is changing to deal with new European realities.
Several other major networks and structures are under development, such as the EU Health Forum and the health portal. At a high level our ministers and stakeholders are examining the best way forward for patients, professionals and health systems.
As committed advocates of this "Europe of health", I would like to thank my services and you the wider community of health advocates, for helping to make this happen.
Because looking back at the last four years, I can safely say one thing. We don't come here just to look at the mountains, we come here to move them!
So what is the next health summit to be scaled? Which is the next policy mountain? Having spent more than a year working to bring home the centrality of health to any meaningful definition of European citizenship in the new Treaty, I have a few mapping suggestions.
I have been struck by the fact that while we are winning the political argument on health at European level, we have only begun to address the economic case. And in the end, in government, it is the economic case which is definitive.
For finance ministers, the word's "health", "spending" and "bottomless pit" tend to go together. Therefore, if we are to win the argument for greater European co-operation on the protection and promotion of health, we must speak to Finance Ministers on their terms and in their own language.
They must be convinced that intelligent investment in health, increases financial choice and feeds economic productivity. To do this, the argument about health needs to be turned on its head.
In summary, we must begin to ask simply not what economists can do for health, but what health can do for the economy.
Health and Economic Prosperity
Our wealth is predicated on our health. Modern economic prosperity could not have developed so quickly, without what one writer calls "a culture of pills and soap". In a knowledge-driven society, to add economic value, you must first add years of healthy living.
In an ageing Europe, a healthy active workforce will be a key determinant of sustainable productivity. For the EU's Lisbon Agenda to work, a healthy society will be a key condition.
Yet in political terms the broad subject of health is all too often seen in a negative light. Health as an "overhead". Health as a "drain" on public finances. Health always calculated as a cost, never as a benefit. Health as current expenditure, never as long-term human capital investment.
We need to fundamentally challenge this thinking. Because it is selective, short-termist, unproductive thinking. We know that good short-term financial tactics, can sometimes mean bad long term economic strategy.
Of course, the challenge is to separate out genuine self-financing investment in health, from the escalating current expenditure which needs to be carefully managed if our social model is to remain sustainable.
We need to encourage a counter-current in health economics thinking. A new perspective on health as a productive force in economic prosperity needs to take hold in Europe. Based on agreed methodologies and hard data, this new perspective should confirm a few key messages.
That health is a limited, fragile and invaluable resource.
That well-managed health systems are positive, forward looking investments.
That health is a productive economic factor in terms of employment, innovation and economic growth.
That significant reductions in avoidable and costly ill-health, can be achieved with relatively modest investments.
That effective health promotion and disease prevention can eventually improve the options available within tight budgets.
That the health of our politics, will depend on managing the politics of health. For our European citizens, access to affordable high-quality healthcare, is one of the benchmarks of successful modern governance.
That in many ways, the long term health of the European economy, will depend on the health and longevity of its citizens.
The message is clear. Health is a driver of economic prosperity. Or to summarise it.
Health equals wealth.
The Economics of Positive Health
Professor Sach's work for the WHO Commission on Macroeconomics and Health, confirmed that increasing life expectancy, increases the economic growth rate.
He also revealed that as much as half of the growth differential between rich and poor countries is due to ill-health and demography.
So just how does investing in health and healthcare help economic performance? Allow me to give just a few examples.
The case of SARS has conclusively demonstrated the economic value of effective public health measures. The economic costs of pandemics are measured not in millions, but in percentages of GDP.
Secondly, the indirect costs of ill-health - such as productivity - are very high. One recent study has calculated the lifetime costs of cardio-vascular disease to Germany. Direct health costs are estimated at 25 billion dollars. The indirect costs in productivity are nearly double, at 48 billion dollars!
And this is just the projected cost of one, largely avoidable, existing condition. But there are new health challenges for the population.
In Finland, 40% of new disability pensions are now for mental health reasons.
Looking to the US, we can see the approaching tide of ill-health. In a country half the size of the enlarged EU, one study estimates that the direct and indirect cost of obesity, diabetes and tobacco, each top the 100 billion dollar mark annually. According to another survey, mental ill-health already accounts for 2.5% of GNP in the US.
In the Europe of 25, between 5-10% of GDP is spent on health. Healthcare is a leading source of new employment. It already accounts for around 10% of employment.
If ill-health will continue to affect economic prosperity on this scale, then improving the population's health must be an economic priority. The health of the population will continue to set the economy's metabolic rate. You could say that in the longterm, No pain, means gain!
Wise investment in health, as in education or infrastructure, is investment in the productive capacity of the economy.
Clearly, the issue of effective investment in health systems preoccupies our governments. But in a world of brilliant technological innovations and rising treatment costs, greater efforts are needed to reduce the avoidable disease burden. Effective prevention and promotion can ease the pressure on treatment.
We already have data from the US, that every dollar invested in physical activity leads to medical cost savings of 3 dollars.
With inactivity contributing 75 billion dollars to the US health bill, investment in physical activity looks cheap at the price.
In another project at Stanford, the effect of basic multi-risk programmes are clear. Under one scenario, for every 5 dollars annual per capita investment in education and prevention on blood pressure, smoking and cholesterol - the US economy would save 16 billion dollars of direct costs over a 25 year period.
In addition, there would be indirect benefits to the economy and to society. And by the way, 16 million added life years!
In citing these examples, I hope that you will have been as struck as I am on the absence of equivalent data for the EU as a whole. If we are to be serious about economic growth in the EU, then we must prioritise the systematic gathering of data, to facilitate difficult policy choices. The information strand of the new public health programme will provide a first step in this direction.
I would like to have a more complete picture of EU health, based on a handful of indicators. These indicators should measure:
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