Renewing the social contract in Europe: Building new bridges for health and wellbeing

Sciana Network represented in panel discussion at 2024 European Health Forum Gastein

Several representatives from the Sciana Network convened to discuss social contracts at this year's European Health Forum Gastein (EHFG).

Ilona Kickbusch, Bogi Eliasen, and Steve Clarke (Cohort 3) were among those who participated in a session titled "Renewing the social contract in Europe: Building new bridges for health and wellbeing." They were joined by:

• Frank Vandenbroucke, deputy prime minister and minister for social affairs and public health, Belgium; 
• Martin McKee, professor of European public health, London School of Hygiene & Tropical Medicine;
• Anca Tomma, executive director, European Patients' Forum;
• And Pia Hollenstein, co-founder of Swiss Senior Women for Climate Protection.

The session took place in September and was co-organised by EHFG and World Health Summit, with support from Bosch Health Campus.

Renewing the social contract in Europe is a topic connected to and inspired by the work of Sciana's fourth cohort, which focused on collaborative leadership for health and wellbeing.

Starting the conversation, Ilona Kickbusch said, "We are not talking about a fortress Europe protecting its social contract, but also a Europe that is open and aware of its responsibilities in the world.

"Therefore, we've also called [this session] 'Building new bridges for health and wellbeing.'  And the bridges are not only between countries, between regions of the world but also between various areas of concern [...] various policy areas, [and] various challenges because there is much talk that new social contracts need to include new dimensions."

Kickbusch, who chaired Sciana Network Cohorts 2 to 5, suggested social contracts need to consider geopolitical, ecological, and digital challenges as and when they emerge. We can start by asking ourselves how we define a "social contract" and what people feel they owe one another.

Reflecting on the status quo

Bogi Eliasen, co-chair of the Sciana Network's fourth cohort, spoke about his work at the Copenhagen Institute for Future Studies. Discussing the move from analogue to digital in health care, he said, "The social contract – the solidarity – has been very territorial based, but when you go into a digital world, it's not necessarily territorial [anymore]."

He outlined how some European countries were more digitised than others in health care and the challenges that remain. Eliasen said, "We have a health system, which never has had more money, never had more staff, never had more technology and knowledge, and yet never had more dissatisfaction from patients and the staff. So how do you go about working with these things?"

"Here we have been pushing really to say, 'Okay, what happens if health is the most important societal pillar? [...] What if we use health for solidarity, for equity, for fairness, but also for wellbeing economy, but most importantly, to reduce the avoidable disease burden [...]

"One of the reasons why you can't really deal with the burden on the health system today is that we are responding to something very late. So, we apply technology [at] a very late stage where people are already very ill. So, the impact of what we do is much lower than it could be."

Eliasen then discussed some of the reform proposals currently being explored in Denmark. He said, "We cannot do a societal system without really thinking about the value instead of just thinking about money first. So, how do we use health as an investment to drive this process forward?"

Panellists stressed that health and wellbeing and prioritising long-term solutions must be the essence of policymaking. 

Steve Clarke, national clinical lead for mental health at NHS Wales, suggested Europe had become "an unhappy continent" based on the data he had reviewed. He said any new social contract had to place mental health and wellbeing at its centre.

He discussed the Well-being of Future Generations (Wales) Act, which mandates attention is given to the long-term consequences of public policy decisions. Clarke said, "What we're seeing is that our thinking is starting to shift in terms of how we deliver public policy and how we deliver tangible things on the ground.

"For example, we had very recently a plan to build a brand new motorway that was going to cost around £1.5bn. Thinking about the generations to come, not just the environmental considerations, but the wellbeing considerations of that road, it was decided not to proceed with that but to invest in alternative means of transport instead.

"So that was a really tangible example of how that really impacted on our future planning. But also in terms of my work, in terms of transforming health systems and health services, that's absolutely key and critical.  

"So we're not just thinking about how we solve the problems of today, but we have to have to think about how we solve the problems of tomorrow. So, that's just a little example of how Wales responds to that, and that's a fundamental part of our social contract."

Looking to the future and improving communication

When asked if Nordic countries were better at delivering and explaining health services, Eliasen said, "I think some of it is storytelling, and what is working in the Nordic society is not necessarily that you have the best health [...], but you have a safety net, and you get access to care."

Eliasen agreed you need to show you can provide access when needed.  

He added, "But the health workforce challenge is not going to be solved with more money because we can't find more people to work in the way that we are working. And we have not changed our way. And this is what I'm seeing is being addressed in the Nordics now.

"So our health system's logic is still on acute [acute] - so communicable diseases and accidents. Eighty-five to 90 per cent of our challenge is [chronic] diseases where you only can become more efficient for the patient [...] if you intervene as early as possible, which then is a leaner intervention, which is better for the people."

Eliasen said there is a belief that politicians should solve everything, but we must consider how we can involve other parts of civil society.

"If I'm being a little bit critical, what we are missing also in the Nordic [countries] is redefining what does dignity mean? Can you make a social contract... can you make solidarity without saying, 'Okay, do we keep dignity for the person?'  

"And I do think that that is the huge challenge we have. We are good at some things, we're good at opening the door, we're good at the safety net, but we lost dignity in the system."

Clarke said we need to create the right conditions for mental health and wellbeing in all countries and all policies so we can start to reframe the role of the social contract. He also highlighted the role of communication and the stories we need to tell more concerning health services.  

"So much of the reporting that we hear about health services and healthcare performance is all about scandal and poor performance and about people not getting access.  

"And those things are unavoidably true, but there is also equally a great number of stories where people get treatment, they recover, they go on to lead productive and fantastic lives."

The panel discussion ended with closing remarks from Clemens Martin Auer, president of the European Health Forum Gastein. He described the discussion as timely and important, given its focus on building a political and societal consensus.

Auer said we need political systems that care, and while social contracts are about care, we should also think about what harms people. "Let's talk about these harms and about the causes which make people sick and then act accordingly. It's about acting and not inaction."

The European Health Forum Gastein aims to provide a neutral and inclusive platform for the discussion and advancement of health, solidarity, and equity in the European Union and beyond.

This year's conference was titled "Shifting sands of health: Democracy, demographics, digitalisation." Watch a recording of this panel discussion below, and view other session recordings on YouTube.