Health systems, health, and wealth: a European perspective

Countries from WHO's European region met in Tallinn, Estonia in June, 2008, to discuss a new way of thinking about health systems. For the past three decades, much of the debate on health care in Europe has been dominated by cost containment. Informed by detailed background analyses,1, 2 a 2 year consultation process began by asking “what is a health system actually for?” The answer depends on who is asking the question. For some, a health system is a means of redistributing society's resources—from healthy to sick and from rich to poor. For others, it is for commercial opportunity like any other service sector. However, there is widespread consensus around the goals set out in the 2000 World Health Report.3 These aims are improving health, ensuring responsiveness to legitimate expectations, and ensuring fairness of financing.

The participants discussed a model of relations between health systems, health, and wealth, in which each can be mutually supportive, creating the possibility of a virtuous circle of mutually reinforcing relations whereby carefully targeted investments benefit both the health of the population and economic growth (figure). In this model health systems are thus seen as a productive sector rather than a drain on resources, forcing reassessment of concerns about financial sustainability. We examine each relation in turn.