Welfare Economics and Health in All Policies: Unpaid Debt in Post-COVID-19 Times

Editorial

In the months since March 2020, when the World Health Organization first declared COVID-19 a global pandemic, the situation has rapidly evolved from a public health crisis to a syndemic, with far-reaching consequences affecting the way we live, work and interact. Both direct and indirect impacts have fallen disproportionately on vulnerable population groups, increasing inequalities in health/wellbeing [1, 2].

These challenges require integrated responses across many sectors to mitigate their health and other eco-social impacts, demonstrating once again the imperative need for an integrated ‚whole-of-government‘ and ‚whole-of-society‘ approach [3].

The World Health Organization‘s 10th Global Conference on Health Promotion for Well-being, Equity and Sustainable Development took place in the middle of the crisis. The concluding document [4] calls on non-governmental and citizen organizations, academia, business, governments, international organizations and all stakeholders to work in partnership for the decisive implementation of strategies that address the challenges comprehensively and help people take control of their health and well-being, and thus drive changes towards sustainable and engaged wellbeing societies for future generations.

These partnerships would implement bold policies and transformative approaches underpinned by a positive and holistic vision of health/well-being through a commitment to sustainable development based on people‘s empowerment, inclusion, equity and deliberative participation.

At the same time, many countries have spoken out in favour of proactive economic policy initiatives that seek to create the social conditions necessary for all people to realise their aspirations, meet their needs and ensure participation, engagement and opportunity to influence the course of events involving key aspects of the common good [5].

These‚ Wellbeing Economy‘ movements aim to endorse a social order, in which all people achieve life-cycle-specific accomplishments that favour both individual and social development. The individual, because these achievements give them the ability to live a dignified, healthy and prolonged life. The social, because in a community, individual and group actions are indisputably linked to expanding opportunities to help the most neglected, reduce inequity and promote ecological and social sustainability [6].

It is underpinned by cross-sectoral collaboration between different strategic and policy areas to achieve trade-offs between economic growth, the sustainability of the resources a person/community has access to and the challenges they confront in their daily lives.

This proposal is important because it shifts our focus from ‚means‘, i.e. economic growth, to ‚ends‘, i.e. our collective well-being. Moreover, it is not only about different measures or policies, but also about changing our relationship with the economy and our approach to its management and governance [7].

To develop a Wellbeing Economy with social justice, there is no one-size-fits-all strategy, as each government/society has different structures, economies and objectives. However, there are lessons learned from successful experiences in several countries that we can benefit from.

A multi-faceted approach is needed to promote these initiatives. We must recognise that we do not usually speak of isolated interventions, but rather of packages of actions sensitive to conditions, culture, infrastructure and resources [8]. In addition, a fundamental reorientation of eco-social values and action consistent with the 2030 Agenda for Sustainable Development is required.

This process will demand significant work to foster a shared vision among the different actors, a concerted strategy and a common action plan at territorial levels for collective decision-making, as well as monitoring and feedback. In this sense, the Health in All Policies approach, which has been successfully developed in several countries, offers the ideal umbrella. In this short manuscript we suggest some key strategies to try to guide the proposed transformation [9]. We believe it necessary to:

• Establish a temporary administrative unit in charge of negotiating public sector commitments and defining strategies to create a formal structure to strengthen the process through two cross-cutting work streams: the first requires formalising the proposal in the short term and the second requires elaborating a bottom- up operational plan with a medium- and long-term perspective;
• create a coordinating entity that will thereafter oversee successive work streams through formal structures and citizen networks, aiming at collective well-being by involving all sectors of government and society at large;
• setting up governance methods to build coalitions with different stakeholders;
• fostering social capital at the local level, strengthening associativity and citizen engagement;
• establishing an Advisory Council to support the development and implementation of the welfare economy at different levels;
• developing innovative financing modalities to follow the thematic well-being package;
• carry out action plans at the local level, as a result of broad agreement between the three levels of government, community networks and private enterprise through three stages: extension, expansion and consolidation.

The action plans should be designed on the basis of productive and sustainable projects that contribute to health/well-being; • design and implement participatory analysis, monitoring, evaluation and feedback mechanisms.