Health Promotion: Future Challenge for the European Union?

Editorial

Health inequalities/inequities within and between EU Member States are widely recognised as a growing public health problem [1, 2]. In addition to reducing the well- being of the population, health inequalities/inequities undermine fundamental values of the European Union such as equity, non-discrimination, solidarity and justice; This is primarily because responses across the EU have often been fragmented and characterised by reactive approaches to the social determinants of health [3]. Moreover, the imbalance of powers granted to the Union, which favours economic and market integration over action to address social challenges, is more stark and more inhibiting in tackling health inequalities/inequities than any other element of health policy [4].

In addition, civil society organisations face a shrinking civic space despite increasing demands by non-governmental organisations for the institutionalisation of greater dialogue and a level playing field for them to participate on an equal footing with other stakeholders involved in democratic and political processes. We refer to the legal and political framework within which individuals and groups can participate meaningfully in the political, economic, social and cultural life of their communities, exercising the right to express opinions, the right to information, the right to meet, associate and dialogue among themselves and with authorities to formulate and develop public policies [5, 6].

As the European Community navigates these complexities of the socio-political landscape, newly elected parliamentarians should rethink priorities in the model of care; this requires an urgent transformation of institutions and their approach to health with a commitment to renewed leadership that not only strengthens resilience but fosters an inclusive and equitable society [7, 8]. To develop a long-term vision, a more fundamental rethinking of ways of working is required that, in addition to new and improved health security mechanisms, must translate into the development of systems that are more focused on the perspectives of families and communities as participants and beneficiaries of trusted health systems that are organised around people’s holistic needs and respect their crucial role in shaping public policy. All of this is fundamental to creating better living conditions [9, 10].

Against this backdrop, it is imperative to ensure health and wellbeing for all/with all and, to achieve this goal, a long-term vision must be developed with an approach that addresses the social dimensions of good health, rather than focusing solely on an interpretation aligned with the biomedical paradigm and a financial burden to be avoided [11]. There is global consensus that health promotion is an essential strategy for improving equity and a key action for health systems transformation in Europe, when driven by core values centred on partnership working across sectors and meaningful participation of citizens and communities [12, 13].

In that spirit, at the 76th World Health Assembly, held from 21-30 May 2023, Member States adopted World Health Assembly Decision A76 (22), Achieving well-being: a global framework for integrating well-being into public health using a health promotion approach, which strives to enable all people to thrive and reach their full physical and mental health potential throughout their lives and across generations. Effective implementation of these strategic directions should be part of a national governance system based on a whole-of-government and whole-of-society approach [14]. The principal feature of this approach - and herein lies its advantage - is the challenge of directing efforts towards those areas, both in policy and in everyday life, that drive the protective factors for the right to health/ well-being. It involves identifying relevant policy attributes; considering components that may enhance or inhibit policy change; assessing options for change that offer benefits both for health goals and for the specific intent of various sectors; and planning the policy process to achieve the necessary legislative, regulatory, financial, organisational or educational changes [15, 16].

The transition to the proposed model is urgent and requires a great deal of political will and capacity for concerted action. The approaches described by McKee M, et al. [17], could be the first key steps for the European Union to develop a more health-enhancing public health and to achieve its objectives; in prescribing priorities, it should: a) Develop a shared, comprehensive and coherent vision of health promotion and wellbeing. This means agreeing a policy framework that allows:

Identify opportunities where the health promotion strategy brings additional benefit to the achievement of the Union’s own core objectives;

• Prioritise health promotion actions in those areas where governments, acting individually or collectively, can influence the social determinants that cause inequality/ inequity;
• Implement actions that can contribute to the re-launch of the Sustainable Development Goals in vulnerable communities.
• b) Design a set of public policies and programmes that ensure the meaningful participation of governmental decision-makers in member states, interacting fully with a wide range of other actors - including civil society- either in the legislative process or in shaping their structure, implementation, monitoring and systematic evaluation;
• Strengthen the social capital of civil society organisations to reinforce the capacity of communities to take control of their health in order to address issues related to achieving positive impacts and outcomes for collective well-being;
• Develop a capacity building plan for political and governmental actors to ensure synergy in relation to coordination, cooperation and participatory financing of health promotion.