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

In a quiet off-season week in a remote Austrian ski-resort, hundreds of European health professionals and policymakers are gathering 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 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 leaves office this month-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 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 health care providers, professionals and health care 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, in Spain, in France, in 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 in November 2019, 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 pre-ordained 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