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Publications, policy documents

EUREGIOIII - Position statement: EU Structural Fund Strategy for the future (14 June 2011)


Council conclusions: Towards modern, responsive and sustainable health systems. (Council of the European Union, 6 June 2011)


Final Report - PTOA Workshop on Health and Structural Funds - 12-13 May 2011, Rome, Italy (5 June 2011)


 Jonathan Watson: How health systems can address health inequities through improved use of structural funds (2010)

This briefing on policy issues was commissioned by the WHO Regional Office for Europe as a deliverable for the WHO/European Commission joint project on equity in health (2006WHO03). This is one of six briefings on policy issues produced through the project, which has as its focus improving health intelligence, building capacity and know-how for policy-makers and practitioners on tackling socially determined health inequalities as part of health system performance. WHO partnership in this project is in keeping with strategic objective 7 of the WHO Medium-Term Strategic Plan (2008−2013). This strategic objective is to address the underlying social and economic determinants of health through policies and programmes that enhance health equity and integrate pro-poor, gender-responsive and human rights-based approaches. The project has received funding from the European Commission under the Public Health Programme 2003–2008. However, the sole responsibility for the study lies with the author and the European Commission is not responsible for any use that may be made of the information contained therein.


EUREGIO III Project: Venice Stakeholder Event Report (April 2010)

Within the European Union in recent years there has been growing recognition of the importance of sustainable regional development and the contribution of health to achieving it. This means health development leading to growth in social and human capital and the multiplier effect this can have in contributing massively to economic growth. This is reflected in the EU’s Cohesion Policy and the 2007-2013 round of Structural Funds which explicitly included health sector investment.

In the newer Member States and Convergence regions across Europe governments, politicians and policy makers see SF as an important funding source for supporting the modernisation of health services. But, the health sector is starting behind other sectors in using Structural Funds, and also faces the consequences of the current economic climate and financial instability. In this evolving operating environment It is likely that Member States will increasingly look to SF as a source of support for health sector investment and health gains.

The Venice Stakeholder Event held 25-26 February 2010 in Venice, Italy was part of a critical conversation between key stakeholders and EUREGIO III project about to respond to these challenges effectively and sustainably.

The attached report is the summary of the discussions between the particiapants who represented key stakeholders working at (i) policy level (EU, national, regional); (ii) managing Structural Funds at national and regional levels (Opeartional Programme Managing Authorities and Programme Secretariats), as well as the end-users (organizations and intermediary bodies who seek access to SF for health-related investments).


Jonathan Watson: Health and Structural Funds in 2007-2013: Country and regional assessment, Directorate-General for Health & Consumer (2009)

This summary report reflects work regarding health investments and Structural Funds in the 2007-2013 period. Where clear financial figures are used these reflect planned spending of Structural Funds. The mid-term review of the current funding period in 2011 should provide a clearer picture of real and probable health spend.

Three main areas of investment are identified. The first two areas of direct and indirect health investment indicated in the National Strategic Reference Frameworks (NSRFs) and Operational Programmes (OPs) for 2007-2013 include: health infrastructure, e-health, inpatient care, access to health care by vulnerable social groups, emergency care, medical equipment, screening, health and safety at work, health promotion and disease prevention, education and training for health professionals. Overall, these investments and the third area “non-health sector investments” with potential health gain address the basic principles of the White Paper “Together for Health: A Strategic Approach for the EU 2008-2013” adopted by the European commission in October 2007. Although many Europeans enjoy a longer and healthier life than previous generations, major inequities in health exist between and within Member States and regions, as well as globally. In particular, by using Structural Funds for health, the EU principle of “Health in all Policies” reaches a new dimension that can be systematically pursued within member states and regions.

The identifiable element of planned direct health sector investment (mainly in health infrastructure) at around €5 billion represents just 1.5% of total Structural Funds and draws mainly on available ERDF funding (Figure 1).

Also, indirect health sector investment (Figure 2) does not yet clearly indicate what investments will flow into the health sector as a result of relevant investment priorities. For example, workplace health might be initiated by employers and organisations in the public, private and NGO sectors but will need onward investment into public health services to support development and implementation.

Relatedly, Figure 3 and the associated the EU27 country assessment templates identify a wide range of non-health sector investment where added value in terms of health gain is possible, though difficult to quantify. Instead, attention should be given to extending the impact evaluation of non-health sector investments to assess anticipated and unanticipated health gains related to the wider economic, social and environmental determinants of health.


B. Rechel, S. Wright, N. Edwards, B. Dowdeswell, M. McKee: European Observatory on Health Systems and Policies: Investing in Hospitals

This book is one of the first to offer a systematic treatment of the decision to invest in the health care estate (wider than hospitals alone, but this is a useful abbreviation). It is in some senses an interim report, attempting to understand the current state of evidence of what works, and to bring that evidence to bear for decision-makers. A sister volume, to be published in the Observatory Studies Series, reviews some topical case studies. This evidence – and more – has been subject to a searching examination. There are some cross-cutting themes: the importance of systematic planning; the increasing role of markets as a factor contributing to action but, even without that, an awareness of the financial and other resource flows entrained in the hospital; the human capital aspects of the workforce, which spends its whole working life – rather than just the few days of a typical patient – within the hospital walls; along with sustainability. It should not be neglected that hospitals are often the biggest single energy consumers, and therefore emitters of carbon, in a city.

Running through this book is the leitmotif of the critical nature of the model of care, explicit or perhaps even implicit, as a structure for the role of the hospital. “Form follows function”, and thus the shape and size of the hospital are determined by the services it tries to deliver. In planning a hospital, it is naturally the future demands that are most important, futures that are always uncertain because of unpredictable trends and technological developments. Decision-makers should be aware that capacity is not usefully indexed simply by the number of beds, and space should be as “loose-fit” and flexible as can be designed and built. We can surmise that the more the underlying care processes can be systematized, the more efficiently and effectively flows of patients can be managed.

Perhaps inevitably, this volume raises more questions than it answers, and thus indicates a research agenda to come. In any event, the book should make a major contribution to a lively debate about the nature of the decision to invest in future hospitals.



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