Who’s Going to Be Disrupted by Shifts in European Health Strategy?

In a quiet, offseason week in a remote Aus­trian ski resort, hundreds of European health professionals and policymakers gathered with the express intention of promoting what is now fashionably called “disruptive” change in European health systems. There could be implications for everyone in the health sector-including everyone involved in clinical trials.

The heady aspirations were spelled out by some of the leading policymakers as the meeting got underway at the start of Oc­tober, with the main focus on transforming health systems so as to achieve greater eq­uity and sustainability in citizens’ health ex­perience. The tone was set by Piroska Östlin, who is acting at present as the World Health Organizations (WHO’s regional director for Europe, increased average life expectancy and levels of health across Europe, “obscure gaps between the most and least advan­taged socio-economic groups,” she said. In her view, tackling health inequities requires policies spanning government sectors. And going that way, “would accelerate progress towards inclusive growth and sustainable economic development.”

Outgoing EU Health Commissioner Vyte­nis Andriukaitis-he left office Nov. 1-reit­erated the call he made when he took up the job five years ago: instead of health being governed in separate silos of responsibility, the challenges should be met in a compre­hensive manner-covering the environmen­tal, commercial, economic, behavioral, and social determinants of health. “It is time,” he said, “to make a reality of that other fashion­able slogan, ‘health in all policies.’”

Eila Mäkipää, Finland’s deputy health minister, invoked the theme of the current Finnish presidency of the EU to, “improve EU decision-makers’ understanding that well-being policy and economic policy should go hand-in-hand and that investing in well-being enhances productivity and generates economic growth.”

Slovenia’s Minister of Health Aleš Šabeder, wants equity in health, “not only as a value but also a fact,” and makes the case that, “investments in the health sys­tem, including in preventive services and in reducing health inequalities, contribute to growth, sustainable development, and soci­etal well-being.”

Christopher Fearne, Malta’s deputy prime minister-and also its longstanding minister of health-said it is time to, “overcome po­litical inertia and push for implementation of policies, even if it means disrupting certain health harming industries”-without speci­fying which those were. He said it was vital, “to protect and support those who are falling behind in today’s society and carrying the large proportion of disease burden.” But de­spite the evident industry-skepticism behind his remarks, he also indicated that he was ready to “work with healthcare providers, professionals, and healthcare industries to embrace the opportunities offered through technology in order to transform our health services.”

The potential of new technologies is an­other of the themes underlying policymak­ers’ concerns. “Digitization is indispensable for healthcare transformation,” said Brigitte Zarfl, minister of health in Austria.” But, she added, it must be “fully patient-focused.” Tanel Kiik, Estonia’s minister of social affairs, shared much of that enthusiasm. “Health­care must undergo a data-driven transfor­mation to become more personal and sus­tainable,” she said. In her view, “we need to better harness health data to advance healthcare delivery, health policy, research, and innovation.” And she foresaw coopera­tion with researchers and industry as an in­dispensable element in advancing “the good of all Europeans.”

Skeptics may legitimately point out that these are not the major figures on the Eu­ropean stage-they are from mid-sized or small countries, and they are speaking very much off-piste rather than on the main Euro­pean stage. But similar sentiments are being heard with increasing frequency and volume in Italy, Spain, France, and the UK. And this is, as this meeting in Gastein underlined, “a time of new beginnings for Europe, with a new European Parliament installed, the next mandate of the European Commission kick­ing off [this month], and the election of a new regional director for WHO Europe.”

For the research community and devel­opers of healthcare products, the suggested shift in emphasis in healthcare strategy could reduce the attention-and funding-to therapy, or might subject research fund­ing to tighter controls over the suitability of research projects for the new agenda. It might equally well impose tougher limits on the provision of healthcare that fails to meet preordained objectives. Or, again, it might mean a big boost for all aspects of innova­tive healthcare. Whichever way the trend goes, it is certainly one to keep watching.

Peter O'Donnell is a freelance journalist who specializes in European health affairs and is based in Brussels, Belgium.