Beyond the Basics: Tackling post-Covid healthcare challenges in Central and Eastern Europe (Guest blog)
After almost 18 months of crisis, with our healthcare systems almost exclusively pre-occupied by tackling the coronavirus in its many variants, it's now time to start thinking seriously about how to reinstate comprehensive healthcare in our European countries.
Of course, the challenge posed by the Covid-19 pandemic often felt so enormous it threatened to overwhelm health services around the world. Like the financial crisis a decade earlier the pandemic poses severe risks for the entire global economy. Indeed, it might not be too much to say that humanity feels threatened more today than for many decades if not centuries. Now, as advanced countries begin to unwind social restrictions and economies start to "return to normal" lessons are being drawn.
The key lesson I drew at a recent virtual event organised by MSD pointed to the elephant in the room rarely mentioned: Europe's healthcare systems have been proven to be unable to tackle a pandemic and “normal” healthcare at the same time. As health authorities have put virtually all their efforts into dealing with Covid, in many countries it frequently became a case of tackling one or the other. In Europe this was above all true in already hard-pressed Central and Eastern European countries.
So, when European Commission vice-president Margaritis Schinas told MEPs a day before our webinar that the lesson he drew was that the EU had "not taken health preparedness seriously enough before the pandemic" and greater health co-ordination was vital, he's correct. But the truth is also broader and deeper: we need to start to reimagine our healthcare systems. We cannot afford to go back to where we were before. Now is the time for under-resourced and often, ill-equipped pre-Covid healthcare systems to be totally redesigned. When we talk of "building back better" this should mean root and branch reform which is "a whole lot better", not just adaptation and tinkering at the edges.
Strengthening our healthcare systems is a socio-economic and political imperative. Europe’s healthcare will no longer be an afterthought after, say, social welfare and defence. We now recognise how critical healthcare is to our survival. Healthcare resilience must rise to the top of the agenda and, as finance ministers and others ponder how best to rebalance the books, health spending needs to increase. Healthcare spending should not be squeezed as part of the process of cutting Covid-era borrowing: it needs in future to be recognised as an investment, not a fiscal burden. We must also recognise, however, that increased spending alone will not be a universal panacea; re-allocation of budgets and more efficient reimbursement systems are also needed.
In Europe this is especially the order of the day in the CEE region where health spending was inadequate before the pandemic even under conditions of robust GDP growth. It has, of course, risen in recent years but, at or below 5% of GDP in some countries, undershoots the EU-27 average (7%), let alone that of Switzerland (some 12%). One sad effect is that life expectancy in the region remains lower.
Now, western Europe is here far from an untarnished exemplar. In the country I once knew best (the UK) the almost exclusive focus on fighting the virus has left up to half a million people waiting for surgery. And meanwhile, the recent Marmot report found that some parts of England have a death rate a quarter higher than England as a whole, while life expectancy is also falling in some regions. Health inequalities are rampant in the CEE region, but they are significant – and rising – across the EU where life expectancy fell by a year in 2020.
Can we prevent a snowball effect?
The EU’s Beating Cancer Plan is a core element of meeting Europe’s new health imperative. As Professor Christoph Zielinski of the Central European Cooperative Oncology Group warned us at the event, the CEE region will have to deal with "a tsunami of cancer cases" and is ill-prepared to do so. Its pre-pandemic record was poor, with care shortages and inadequate screening and diagnosis. Survival rates fall significantly below those in the west. Research levels are lower. Waiting times are longer.
Again, the CEE region is not uniquely affected. We know that as many as a million Europeans have missed out on their cancer diagnosis during the pandemic; and accordingly treatments have been curtailed or postponed. But, more than that, the pandemic has accentuated systematic differences in health between social groups both within countries and between EU regions. See here.
And here I make a special plea. Europe has been swift and adept at using its powers in the area of employment law and specifically in the area of discrimination, from the early cases on equal pay for equal work to today’s focus on much broader aspects of diversity and inclusion. Now is the time for the EU to tackle discrimination to ensure equitable treatment of cancer survivors in the labour market. This is about having the political will to act and to build a Europe-wide framework to beat cancer, the number two killer after cardiovascular disease. Doing this will sometimes mean going beyond healthcare into other areas of policy and law.
Cancer, its diagnosis and treatment, must be high on the list of healthcare priorities for the post-Covid era. Indeed, the pandemic has highlighted inadequacies across the healthcare spectrum that must be remedied as our priorities change. Failure to address the challenges will simply create a snowball effect in future. The EU's ambitious recovery programme now being rolled out in national plans (and its possible successors) needs to be focused towards transition in our healthcare systems in Europe – along with the green and digital transitions. It's never too late to think again.