Bogi Eliasen: Health As A Societal Pillar

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Bogi Eliasen is CIFS Health Director

Health has become one of the most important societal pillars in the times of the industrialization. It was the first time in the history of humankind when we – as a society – invested heavily in mechanics and machinery. It led to the massive economic growth and improvement of life conditions, though not to all. However, later developments covered more and more people. After the World War II, most OECD countries had achieved economic success. It was a result of a more advanced industrialization, that targeted automation and productivity, i.e., more output per a unit of costs. This resulted in an unprecedented economic growth and improvement of life conditions to many. Again, not for all, but to many, many more.

Since then, we have inherited the logic that we need to invest in productivity to increase production to achieve economic growth and better life conditions. However, in the last two-three decades, we have also reached the understanding that unlimited growth does not work for planetary health. Also, it affects health of individuals and societies. Hence, the question: how we improve life conditions with justice, equity, equality, fairness, while maintaining all modern societal functions and perhaps be more ambitious in our attempts to build a better world.

In these recent decades, we focused on the transformation from industrial to knowledge societies. If we want to build knowledge societies, the human capital is to become our focus, which in turn requires more holistic investments into better life conditions. Healthy people, healthy communities, healthy societies are essential to build embracing, inclusive societies.

To improve life conditions further, we need broader access to education in capacity building during  all our lifespans, that is we must focus on the life-long learning.  However, we will not be able to use these opportunities if we do not adopt the ‘health from cradle to grave’ approach. It has several aspects:

  • There’s the cost element. Today we spend significant resources on avoidable disease burden and ineffective ways of treating illnesses. There is also the focus on length of life, the life span, where we spend quite a lot on treatments to take place in the last hours, days and months of people’s life. The same resources spent on the same person earlier to keep them healthy for as long as possible, would likely improve life conditions, well-being and have a much bigger impact on the individual health and the societal growth, including happiness and wellbeing
  • There’s a need to focus on health as an investment and not as a cost. It plays into the logic of well-being economy, the concept on the rise. But it also means that we would need to focus on health on a much wider scope then in the very narrow clinical sense that is being budgeted for today. That is why we at CIFS have developed the 50/50 approach. It means that by 2030 half of the healthcare resources should go towards prevention, including secondary and tertiary prevention, not just primary. We assess that the fastest and the most efficient improvements in health budget spendings will arise from the focus on the secondary prevention. Here we need to allocate to resources to holistic improvements, health behaviour, diet and sleep. We will also have to connect them to clinical interventions. These are not new thoughts, and this is not rocket science, and there is likely a consensus among the major healthcare stakeholders that it is the way to go. Still, not much has been done yet.

The real question is not if we can afford future costs of healthcare services, but if we can afford not to invest in keeping people healthy for as long as possible. The societal goal is to have a population that is as healthy as possible and have a health system that supports that. It is not necessary to have a healthcare system that treats most complicated and advanced diseases best of all.

Lack of access to healthy lives and healthcare will breed more inequalities and opens for more injustice and societal polarization. It is a trajectory where we all lose.