Leading health professionals from across the EU have challenged politicians on the cuts in public expenditure that will impact on the health of their communities
Brian Edwards CBE
University of Sheffield, UK
HOPE (European Hospital and Healthcare Federation),
As cost cutting continues in European countries, health professionals have started to resist those cuts in public expenditure that will impact on the health of their communities. Thirty-four leading professionals from Greece, Spain, Ireland and Portugal have circulated an open letter to European political leaders.(1)
They argue that no significant impact assessment on health was conducted in any of their countries before decisions were made about cuts in public expenditure. As a consequence, they argue there has been a sharp deterioration in the health of their communities. There is, they claim, extensive and deep human suffering that defies professional ethics and basic notions of human dignity.
Loss of self-esteem, depression and suicides are on the increase and there is growing evidence of increased susceptibility to communicable diseases. The negative impact on health staff is beginning to reach patients. To make matters worse, no governments are measuring the health impact of austerity policies. If they did, of course, it would narrow down the options for action.
These signatories also worry about the migration of young professionals seeking work in richer countries. This is not a new problem but it seems to be growing and impacting on more Member States.
Some European policy makers will reject all of this as special pleading. Health systems will, they argue, have to learn to provide better healthcare with less money, and target what investment they have on those patients who need it most.
However, more thoughtful leaders will worry that some short-term decisions may have generated expensive long-term problems. Very high unemployment rates will inevitably have health consequences, which leads one to think about a greater short-term investment in mental health services, even if this means a cut-back in other parts of health systems that are not as important.
It is not easy to get a clear picture of the extent of the cuts in health expenditure but, in the whole of Europe, they do now appear to be real and are impacting on systems that have, for many years, been used to growth in response to increased patient demand. If politicians want to sharply reduce health expenditure, they have to play their part in deciding where to cut and where to grow. They should look again at the notion that targeted investment in health could be an engine for growth. Instead of building more roads to generate employment, why not build some green, energy-efficient hospitals and close the old ones down?
The Commission meantime sails on with implementing policies that have been so long in gestation that one wonders about their relevance. A new Directive will deal with cross-border prescriptions, which are an important part of patients’ rights to secure cross-border care. It will impact on only 200,000 people.
The priorities of the Irish Presidency are focused on three long-standing issues: cross-border health threats, clinical trials and medical devices. A fourth is getting the European Public Health Programme 2014–20 through the European Parliament. If you were looking for evidence that this programme is finely attuned to austerity or growth, you won’t find it. The whole system is too cumbersome to react to quickly changing environments.
How long would it take, I wonder, for the programme to be reviewed and its scale compared with expenditure in other EU policy areas? Once changed, we might see it expanded as a positive response to the consequences of austerity.