Re-thinking the Role of Prevention in Addressing Healthcare Systems Challenges

Towards More Sustainable Healthcare Systems in Europe

European Files December 13 – January 14

Andrea Rappagliosi, Vaccines Europe President

“Health is a fundamental right of every human being and is a value in itself. Only with a healthy population EU Member States can achieve their full economic potential. Europe is facing an increase in ageing populations and patient demand, posing tremendous pressure on healthcare services and budgets to delivery quality care in an equitable and efficient manner. In times of austerity, delivering sustainable and cost-effective healthcare is at the top of the EU Member States’ agenda. 

Cost-effectiveness analyses are a very useful tool for decision-making to assess the value of healthcare interventions. Nevertheless when we look at prevention, we need to make sure that the formulas used comprehensively take into account the full benefits of healthcare measures not only from a healthcare system perspective but also from a societal point of view. The latter is often difficult to quantify in monetary terms and, in the field of vaccination, current economic evaluations do not usually take into consideration a range of long-term benefits intrinsic to prevention. In addition,
they do not capture potential economies of
scale that may be generated as spin-off benefits.

Although health is inextricably linked to productivity and therefore the economic well being of individuals and populations, in times of austerity prevention is the first sector to suffer from budget freezing or outright cuts. On average estimates suggest that only 3% of the EU Member States’ health budget is allocated to primary prevention. This covers a wide array of interventions, ranging from immunisation programmes, to smoking cessation, alcohol consumption, and promotion of healthy life-styles (e.g. nutrition and physical activity). According to the OECD this small share of spending is being further impacted by the current financial crisis.

While there’s no doubt that we’re living longer than previous generations, we need to do a better job at keeping people healthier for longer. The most effective way of doing so is by preventing people from falling ill and by enabling them to make the right choices to stay healthy. Health literacy is key in this regard and more should be done in the prevention sphere, fostering a culture of health rather than of treatment and cure.

During the 20th century immunisation has been one of the public health measures that had the greatest impact on the reduction of the burden from infectious diseases and associated mortality, mainly in children. Vaccination should however not be regarded as a childhood matter only; adult and senior vaccination is now as important to the 21st century as childhood immunisation has been in the past.

As we grow old, our immune system weakens and we are more at risk of contracting long-term chronic conditions – often more than one at the same time. Vaccinating across all age groups can help keeping people outside hospital beds by preventing complications in chronic patients as well as by protecting vulnerable groups who cannot fully benefit from vaccination.

Different age groups have different vaccination needs and there is a need to put in place a strategy allowing all of them to equally benefit from access to vaccines. This would not only promote efficient healthcare resource allocation by cutting on avoidable expenses but it would also allow freeing resources for treatment.

Sustainability of healthcare systems should first of all be about maximizing or improving the way we use the tools we have at hand. This will only happen if we succeed in establishing a coherent EU health policy agenda capable of embracing the entire healthcare spectrum from prevention and early diagnosis to treatment and cure.

Such responsibility does not only lie with governments but requires broad stakeholder collaboration, particularly the involvement of the healthcare profession as the front line deliverer of advice and care to the public. The current landscape appears rather fragmented and we need to foster a more meaningful dialogue around prevention, why prevention contributes to smarter growth and how we can achieve this.

We need to shift our mindset and stop thinking about patients only. We should start speaking about people and how to help healthy people to stay healthy. This may be more a question of improving population health sustainability than sustainable healthcare systems”

The full European Files issue where this article has been published is available for download here