Most of Europe’s public health systems are designed to provide lifetime free services at the point of delivery to all those who cannot afford private healthcare. Adequate free public health services for all should be a hallmark of caring societies. Conversely the US healthcare model relies heavily on the private sector medical services and health insurance – it is the world’s most expensive, inequitable and least effective health system.
Still, the pandemic has highlighted areas of European countries’ healthcare systems that have long been a concern for the public health community, especially those who work on the coalface of the system. The slow-burning issues include the steady increase in life expectancy, the widening gap between life expectancy and healthy life expectancy, especially for the most disadvantaged, and the influx of poor migrants that adds pressures to already stretched public health systems.
The response of some governments has been to copy the US model by making healthcare insurance mandatory for all. France and Germany, for instance, already have a compulsory insurance model for funding the healthcare system. In contrast, other countries like the UK impose an insurance charge on all workers to support various social benefits, including pensions. Shifting from the UK model to the US model or even the German model is no more than a relabelling exercise and another example of political, magical thinking.
Public health involves a complex and wide array of issues and activities that go beyond the confines of running hospitals, clinics and other healthcare services managed by the health authorities. An effective healthcare system should represent society’s organised effort to improve health across the entire population and the entire life course for present and future generations.
John Clarkson, deputy chair of Cambridge Public Health, argues: “Without joined-up thinking, the UK public health system will continue to suffer from a severe lack of resilience. Such resilience must be designed in, which takes time and multidisciplinary expertise. Creating an efficient system means considering how one part affects all the other parts, each of which might constantly be changing depending on the pressures it is working under.”
Redesigned public health systems must be better prepared for future pandemics. This transformation will necessitate sufficient investment in the systems to ensure we are always ready for the worst. Disregarding the pressures on human societies created by inequalities, increased life expectancies, global people mobility and the destruction of ecosystems will impact the resilience and effectiveness of healthcare systems.
The pandemic has highlighted areas of European countries’ healthcare systems that have long been a concern for the public health community
Perhaps the biggest failure of most European healthcare systems is the underfunding of social care. This is why many people are blocking beds in public hospitals in some European countries. Social care has to be given the same importance as hospitals with our ageing populations and those in younger age groups with complex medical needs.
Re-engineered public health policies must think more carefully about building a seamlessly integrated system where people can provide ongoing levels of care in the community right through the end of life. Integrating mental and physical healthcare is crucial for addressing evolving inequalities in most communities.
The pandemic has managed to break down temporarily the public sector’s prevalent mentality of operating in silos. For instance, homeless people were provided with safe housing in hotels to reduce the risk of the COVID spread. It will be tragic if policymakers now revert to tolerating societal scandals like not caring for families with children going hungry or older people not affording to cater for their basic living necessities.
Business leaders can also play an essential role in helping to overhaul public health systems. This role is not about providing outsourced medical services, which is the preferred option of public healthcare policymakers who prefer to manage by crisis. It is about private enterprises promoting healthy lifestyles and well-being both as creators of new healthy products and, as employers, healthy workers.
Carol Brayne is a professor of public health medicine affiliated with the Cambridge Clinical School. She argues that overhauling healthcare systems will only be successful if it is based on a bold population-level, cross-sectoral approach to addressing inequalities, adverse living environments, obesity, poor mental health, multi-morbidities, addiction and other threats to health and well-being in a way that is sustainable for future generations.
These objectives will not be achieved with magical thinking, which is the worst feature of populist politics. Only strong leadership determined to address growing inequalities can bring about the change needed to make European healthcare systems the rock base of social equity in European communities.