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

EUR/RC62/8
page 24
initiatives should be delivered as part of a wider portfolio of interventions aimed at creating a
social and physical environment that fosters healthy behaviour. The various behavioural
strategies are mutually reinforcing, and the effectiveness of behavioural programmes and
interventions increases when they are integrated alongside additional strategies that address the
wider social determinants.
115. A wide range of regulatory and fiscal measures have increasingly been put in place in
many countries, for instance to the curb consumption of tobacco and alcohol. A minimum age
has been set for purchasing cigarettes and alcoholic drinks, which often carry health warnings
printed on their labels. Advertising has been severely restricted, and high taxes have been
imposed on the consumption of both commodities. All these measures have contributed to
containing consumption, and WHO work has shown that most have very favourable cost–
effectiveness profiles. However, fiscal measures are complex to design and enforce; their impact
may be unpredictable; and they can bear more heavily on people with low incomes than on
those with higher incomes.
The recent economic crisis
116. Health 2020 is a policy framework that is fit for both good and less good economic
times. Nevertheless, lessons can be learned from the recent economic downturn and financial
crisis. The health and social sectors are especially vulnerable to cuts during economic
downturns, not only because of their size within any government’s budget but also because of
the often relatively weak negotiating position of health ministries. In the Tallinn Charter (24),
Member States declared that “today, it is unacceptable that people become poor as a result of ill
health”, but this can be undermined as governments look to shift the burden of financing to
households as a policy response to fiscal pressures. The economic crisis presents a great
challenge for Member States in how to remain committed to equity, solidarity and financial
protection, but it also presents an opportunity to advocate for and invest in health and to
strengthen health systems
117. The recent economic crisis has affected many countries in the European Region and
challenged commitments to social welfare objectives, including health and equity, which need
to be reinforced during economic downturns so that the policy responses to address the
economic crisis reflect public priorities rather than short-term needs to balance the budget by
across-the-board cuts. Indeed, lessons from previous economic shocks experienced by countries
in the Region offer insights to today’s policy-makers on how to mitigate adverse effects on
health and welfare of the population: health systems with strong leadership and well-functioning
governance arrangements perform better in general, and especially during a crisis.
118. The health effects of economic crises are complex, and new evidence continues to
emerge. Road traffic accidents and obesity may be reduced with declining incomes and higher
prices, and social cohesion may increase. Nevertheless, psychosocial stress increases during
times of economic hardship, leading to more suicides, a range of unhealthy types of behaviour
and greater demand for health services for both physical and mental health needs.
119. Although the balance of evidence needs to be further examined, health systems must
continue to function during times of economic downturn and to step up activities related to
psychosocial support, particularly for poor and vulnerable people, in order to prevent severe
effects on health outcomes. Beyond health effects, budget cuts lead to an increased financial
burden on people seeking care in general and medicines in particular. Shifting a significant
financial burden from pooled public sources to individuals receiving care via increased direct
payments (user fees and co-payments) may put households at greater risk of impoverishment
from ill health and reduce the utilization of health services. This may eventually result in higher
costs to the health system and worse health outcomes for individuals.