PHSSR European Union Investing in Health 2025

10 Investing in Health for a Competitive, Secure, and Resilient Europe: A Strategic Call to Action The Partnership for Health System Sustainability and Resilience1. The need for sustainable health financing in the EU A. HEALTH IS A STRATEGIC INVESTMENT, NOT A COST As European Commission President Ursula von der Leyen affirmed in her speech at the State of the Union conference of the European University Institute in 2021, “[the COVID-19] crisis exposed our fragility. The fragility of our health. The fragility of our livelihoods. … We must now move from the ad-hoc solutions of this year towards a sustainable system.”6 This imperative underscores a growing consensus that building resilient health systems requires sustained structural investment rather than short-term, reactive measures. A similar message was delivered by Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organisation (WHO), at the World Economic Forum in January 2020, where he emphasised that “health is an investment, not a cost.” Together, these perspectives reinforce the need for a paradigm shift in how health is prioritised in both European and global policy agendas. The reality of these messages became clear in the months that followed, as countries around the world were faced with one of the most significant health and economic crises of the past century. The economic benefits of investing in health have been demonstrated to far outweigh the costs. A systematic review in high-income countries found that public health interventions were cost-saving to both health systems and the wider economy, with a median return on investment of 14.3 (which significantly outperforms the typical return on financial investments).7 Furthermore, interventions followed a public health ‘effectiveness hierarchy’, with national-level interventions typically yielding greater returns than local-level interventions. For example, adult immunisation programmes can return up to 19 times their initial investment, considering the lasting benefits to population health, the health system, and wider society.8A recent study found that every euro spent on early detection and treatment of non-communicable diseases (NCDs) can yield returns of up to 4.9 euros.9 Even modest positive returns reinforce the value of health investments in alleviating future financial pressures for a government managing competing fiscal demands. Yet health systems today continue to bear the consequences of chronic underinvestment, marked by cyclical patterns of ‘panic and neglect’ in health spending—where funding surges in response to crises but wanes during periods of relative stability. In 2022, the EU had an average of only 4.2 doctors and 8.4 nurses per 1,000 in population.10 This situation is compounded by significant regional disparities, where the density of physicians and nurses differs by twofold and fourfold between the regions with lowest and highest densities, respectively.11 Only 2.7% of total health expenditure across OECD (Organisation for Economic Cooperation and Development) countries was dedicated to prevention in 2019, rising to 5.5% in 2021 with the mobilisation of funding for COVID-19 related measures, then falling again to 4.3% in 2022.12 Multi-morbid populations with high utilisation of healthcare are particularly vulnerable to disruptions in health services; prior to the pandemic, 35% of the population in OECD countries had a long-standing illness or health problem, with greater prevalence among those having lower incomes.13 Maintaining care for chronic conditions posed challenges for many health systems. In Europe, those with chronic conditions were over 40% more likely on average to report forgoing or postponing medical care due to COVID-19 among those aged over 50 years.14 The growing burden of NCDs as the population ages continues to strain health systems and reduce economic productivity: between 2011 and 2030, the global output lost to NCDs is estimated at $47 trillion.15 The vulnerability of health systems exposed by the pandemic was an inevitable consequence of this insufficient preparedness. Although life expectancy had grown steadily from 2000 to 2019, the pandemic reversed that upward trend; in 2023, a gap of over seven months in lost life expectancy remained.16 The International Health Regulations core capacity scores, which evaluate countries’ preparedness for public health emergencies, have failed to improve since the pandemic, with an average score of 73% in the WHO European region in 2023.17 Vaccination rates in most Member States remain below pre-pandemic