A hard-hitting report published today by WHO/Europe reveals a marked decline in trust across the WHO European Region between people and institutions, including governments, threatening pan-European solidarity.
“Transforming the health and social equity landscape: promoting socially just and inclusive growth to improve resilience” plots the inextricable links between widening health and social inequities, the ever-increasing number of people living insecure lives, and the associated significant reductions in trust.
Coordinated by the WHO European Office for Investment for Health and Development in consultation with key United Nations and other global agencies [1], the groundbreaking analysis highlights that when people do not feel the benefit of government policies – including those that protect health – yet see others benefitting, they increasingly turn away from government and other public entities and institutions. The report also offers a range of measures and solutions to address this challenge.
“We owe it to the nearly 1 billion people living in WHO’s 53 Member States across Europe and central Asia to invest in ways that deliver a better life and a healthier society for all, both today and for generations to come,” noted Dr Hans Henri P. Kluge, WHO Regional Director for Europe.
“All governments and policy-makers should take note of the report’s ominous findings and implement concrete policy solutions that benefit everyone, including and especially the most neglected and vulnerable. Strengthening trust and transparency are truly crucial if we are to absorb and implement the painful lessons of the COVID-19 pandemic and other emergencies as we prepare better for the future,” Dr Kluge added.
The report presents the following key findings:
- Lack of trust is linked with insecure living: For those living on a low income, trust in other people is 40% lower compared with those on a high income. At the same time, trust in government has declined significantly since the start of the pandemic among those out of work [2].
- Widening health and economic inequities have fatal consequences: Member States that spend the least on health systems and human development had higher mortality rates during the pandemic, amounting to an estimated 600 000 preventable deaths across the Region [3].
- Lack of social protection to support those most in need further widens inequities: People who are discriminated against on the basis of race, education or gender are being left further behind, particularly young people and women, as low pay and lack of work drive economic exclusion, poor health and declining levels of trust.
- Digital technologies and green transitions must be implemented equitably: Digital and green investments can address health, social and economic inequities through, for example, job creation; digital literacy programmes for women, young people and low-skilled workers; and community regeneration.
“We stand at a critical turning point,” warned Ms Christine Brown, Head of the WHO European Office for Investment for Health and Development. “Our new analysis further confirms that profit-only economic policies do not work, reinforcing the importance of health as a beneficiary and a driver of well-being economies. This report stresses that health, the economy and the social fabric of our daily lives are interwoven. We see that when the benefits of government policies fail to create better lives and opportunities for all in society, solidarity and trust are compromised, leading to a breakdown in the dynamics of relationships between people, governments and institutions, all of which is at the heart of social stability and the well-being of our Region.”
The new report calls for high-quality, accountable and transparent public policies and services – such as ensuring that social support targets those who need it most – to build and strengthen social cohesion, resilience and trust, and to reduce the widening health gap.
The report calls for 5 concrete actions:
- Invest in young people to realize the greatest returns for health, well-being, a flourishing economy and trusting societies. This includes prioritizing mental health, particularly for those left behind.
- Develop responsive and integrated social and health protection systems to address multiple insecurities and build resilience to future shocks. For example, integrate social protection into local housing, health, education and employment services. This will further protect young people, promote social cohesion and increase trust in government.
- Ensure community voices, particularly those of young people, are heard and included in decision-making processes to enable all policies and services to deliver higher levels of trust in institutions.
- Promote well-being through equitable digital and green economic recovery as the main engine for recovery in the Region, recognizing that people need skills and resources to participate in a digital world and to take advantage of green solutions, to truly ensure no one is left behind.
- Ensure mechanisms for equitably distributing health and care resources to enable people to thrive and live lives of dignity. Access should be universal and proportionate to needs across the socioeconomic gradient, rather than targeted, to ensure the needs of the most disadvantaged are met.
“When governments don’t invest in creating the means for all people to thrive, then people’s willingness and ability to contribute to society are severely compromised. These policy solutions show how public investment can rebuild European solidarity,” explained Dr Ben Barr, Professor of Applied Public Health at Liverpool University, United Kingdom. Dr Barr also heads the WHO Collaborating Centre for Policy Research on Determinants of Health Equity, which led the analysis with support from the WHO Scientific Advisory Group on Health Equity.
“The solutions underscore how digital and green transitions can promote health and well-being – and they highlight the importance of listening to and working with diverse groups impacted by widening social and economic insecurities to build trust, resilience and social cohesion.”