Making the case for sustainable investment for equity in health and well-being: skills-building seminar at the 12th European Public Health Conference

Urgent action is needed to address the increasing health, economic and environmental challenges that threaten the well-being of present and future generations. There is substantial evidence to demonstrate the multiple benefits that can be derived through investment in fair, evidence-based, cross-sector public policies and interventions towards social, economic and environmental sustainability.

Jointly organized by the WHO Collaborating Centre on Investment for Health and Well-being (Public Health Wales), the WHO Regions for Health Network (RHN), the WHO European Office for Investment for Health and Development, Venice, Italy, of the WHO Regional Office for Europe, and the European Public Health Association (EUPHA), a skills-building seminar was held at the 12th European Public Health Conference: building bridges for solidarity and public health (Marseille, France, 20–23 November 2019) to discuss practical approaches to and exchange examples of making the case for sustainable investment for equity in health and well-being.

The seminar was chaired by Natasha Azzopardi-Muscat, President of EUPHA, and Francesco Zambon, RHN Coordinator, WHO European Office for Investment for Health and Development. Two in-depth presentations were followed by a panel discussion with audience engagement (through live polling) and debate.

Step-by-step process towards sustainable investment for equity for health and well-being

Mariana Dyakova, Deputy Director of the WHO Collaborating Centre on Investment for Health and Well-being, Public Health Wales, Cardiff, United Kingdom, introduced the Centre’s practical step-by-step guide to the process of synthesizing, translating and communicating evidence related to public health and economics into policy and practice to advocate investment for equity in health and well-being. The ultimate aim of the guide is to facilitate measures towards prosperity for all that prevent disinvestment in health, increase investment in prevention/public health, and mainstream cross-sector investment in addressing the wider determinants of health and equity.

Building on the Canadian Knowledge-to-Action Framework and the results of an extensive international multi-disciplinary consultation, the guide describes four key phases:  (1) project scoping and planning; (2) evidence gathering, synthesis and design; (3) dissemination and communication; and  (4) monitoring and evaluation. One of its essential elements is the use of health-economics-related approaches and tools to illustrate the burden of inaction in parallel with available sustainable solutions that can bring social returns on investment. The process outlined in the guide is geared to the development of evidence-informed, context-tailored advocacy documents and tools to enable healthy-policy-related decision-making across different sectors/levels of government and country settings.

Tools and approaches

As illustrated by Tatjana Buzeti, Policy Officer, WHO European Office for Investment for Health and Development, health systems can choose various approaches and tools in advocating, planning and monitoring investment for equity in health and well-being.  For example, they could systematically mainstream equity into health services, employment and procurement practices to improve social and economic benefits, introduce the use of the Health Equity Impact Assessment tool to support implementation of Health in All Policies (HiAP) and the United Nations 2030 Agenda for Sustainable Development, and/or conduct voluntary national reviews on progress towards the Sustainable Development Goals. All these approaches present a need for disaggregated data, new evidence and methods, and monitoring.

In recent years, there has been a steady increase in requests from WHO Member States for evidence about what works and how, as well as for continuous-training and capacity-building initiatives. In 2019, the WHO European Office for Investment for Health and Development developed the “European Health Equity Status Report” and is in the process of designing a flagship course – Equity in Health in All Policies – based on the latest evidence and tailored to country/community needs. The aim of the course is to support Member States in implementing intersectoral action to improve equity in health and well-being.

The above reflections were further developed during a panel discussion involving:  Marleen Bekker, President, Public Health Policy and Politics Section, EUPHA, and Assistant Professor at Wageningen University and Research, Netherlands; Alison Maassen, Senior Coordinator, EuroHealthNet; Peter Beznek, Head, Centre for Health and Development Murska Sobota, Slovenia; and Ana M. Carriazo, Senior Advisor, Regional Ministry of Health and Families of Andalusia, Seville, Spain. The discussion touched on: key challenges in and practical solutions to making the case for investment for health equity; application of the HiAP approach to resource allocation; ways of effectively communicating about and advocating equity in health and well-being; mobilization and synthesis of evidence from both the health and economic angles; and assessing and enhancing the impact of action taken.

Lessons learned

The seminar resulted in the following key messages.

• Equity in health and well-being is an outcome of societal values, cultural context and policy choices that create the necessary conditions for prosperity for all, leaving no one behind.
• In evaluating investment, the concept “social return on investment” goes beyond the traditional tools for economic evaluation by taking social value into account. It considers the benefits of investment to multiple stakeholders in all three dimensions of development: economic, social and environmental.
• Health inequities can be reduced through transparent, whole-of-government approaches and by incentivizing and rewarding policy coherence and shared accountability across sectors towards the delivery of integrated solutions. These solutions are based on social value and social return on investment that can accelerate progress towards health for all.
• Advocating sustainable investment policy and action requires a systematic process of synthesizing evidence, involving stakeholders, communicating effectively, and conducting monitoring and evaluation exercises.