EUR/RC62/wd08 (Eng) - WHO/Europe - World Health Organization

EUR/RC62/8
page 21
social insurance systems, which traditionally use payroll taxes. As a result, the boundary
between tax-funded and social insurance systems is becoming blurred, since many insurancebased
systems use a mix of different revenue sources, including general taxes. These changes
raise questions about effects on access to and quality of care.
The economic case for health promotion, health protection and disease
prevention
97. Health expenditure poses a greater challenge to governments than ever before. Health
expenditure has grown at a pace exceeding economic growth in many Member States, resulting
in increased financial pressure that threatens the long-term sustainability of health care systems.
A large burden of disease in the European Region, particularly chronic noncommunicable
disease, severely affects labour markets and productivity. Diseases fuel disparities in
employment opportunities and wages, affect productivity at work and increase sick leave and
the demand for welfare benefits.
98. The development and introduction of expensive medical technologies and treatments
drive up the cost of managing chronic diseases and multiple morbidities. These cost pressures
provide a strong economic case for action to promote health and prevent disease. Real health
benefits can be attained at an affordable cost by investing in health promotion and disease
prevention. A growing body of studies on the economics of disease prevention shows how such
policies can bend the cost curve of health expenditure and reduce health inequalities by focusing
on the people who are most vulnerable.
99. Not enough use is being made of social and technological advances, especially in
information and social media. These now offer huge opportunities to achieve health benefits at
an affordable cost, sometimes reducing health expenditure and helping to redress health
inequalities at the same time. A tangible share of the burden of disease and of the economic
costs associated with it could be avoided through actions promoting health and well-being and
by deploying effective preventive measures within and beyond the health care sector.
100. The rationale for government action to promote healthy behaviour is particularly strong in
the presence of negative externalities from unhealthy behaviour or when behaviour is based on
insufficient information. The victims of second-hand smoke and drunk drivers provide dramatic
examples of negative externalities that can be corrected by either excise taxes on tobacco and
alcohol or other policies such as public smoking bans and drink–driving laws. Inadequate
consumer information justifies interventions to promote healthier behaviour by informing
people about the risks of smoking, obesity and other causes of disease.
101. The complex nature of chronic diseases, their multiple determinants and causal pathways
suggest that pervasive and sustained efforts and comprehensive strategies involving a variety of
actions and actors are required to successfully prevent disease. However, the reality is that
governments spend, at best, only a small fraction of their health budgets on preventing disease
(about 3% of total health expenditure in OECD countries).
102. Expectations concerning the benefits of disease prevention must be realistic. Preventing
disease can improve health and well-being, with cost–effectiveness that is as good as, or better
than, that of many accepted forms of health care. However, reducing health expenditure should
not be regarded as the main goal of disease prevention, because many programmes will not have
this effect. Narrowing health inequalities may also be difficult to achieve through certain forms
of prevention that have shown low uptake among the most vulnerable people and which
therefore carry the unintended consequence of further increasing inequalities. Furthermore, the
determinants of many diseases and behaviours develop through the life-course, and programmes
are therefore often designed only to manage the late effects of disease.