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European Public Health: a single system for healthy populations following COVID-19 pandemic experience


The COVID-19 pandemic has led to a dramatic loss of life worldwide and represents an unprecedented challenge to public health, food systems, and work. As of October 31, 2022, almost three years after the pandemic's start, more than 620 million cases of infection and 6.5 million deaths due to the virus had been reported worldwide. Europe has contributed more than 230 million cases and 1.9 million deaths to this performance. Preliminary estimates also say that all-cause mortality in 2020 and 2021 increased by about 13% compared to the 2015-2019 average. Life expectancy decreased by 1.2 years during the pandemic, from 83.6 years in 2019 to 82.4 years in 2020 (compared to an average reduction of 0.6 years in OECD countries).


On October 10, 2022, about 70% of the world population received at least one dose, with at least half of it being fully vaccinated. Latin America has the highest vaccination rate (81% with at least one dose), while Africa lags behind with a meager 29%. These are some of the main "direct" effects on public health caused by the pandemic. There are other equally important effects that often, for various reasons, risk being overshadowed. The OECD reminds us that the COVID-19 crisis has significantly and negatively impacted mental health. For example, compared to 2019, in Italy, the prevalence of depression tripled to 17.3% at the beginning of 2020. In addition, the pandemic led to delays in treatment, including a 38% drop in breast cancer screening in 2020 compared to 2019. It caused a sharp increase in healthcare spending as a percentage of GDP, from 8.7% in 2019 to 9.7% in 2020 (compared to the average growth of 0.9 percentage points in the OECD area).


Economic and social aspects complement these health aspects. The upheaval caused by the pandemic is devastating: tens of millions of people worldwide have been and are still at risk of falling into extreme poverty, while the number of undernourished people, currently estimated at almost 690 million, is estimated to be increasing by another 132 million by the end of 2022. Nearly half the global workforce of 3.3 billion people risk losing their livelihoods. Workers in the informal economy are particularly vulnerable because the majority lack social protection and access to quality healthcare and have lost access to productive resources. Many cannot feed themselves and their families without the means to earn money during lockdowns. For most of these people, not having income means no food, or at best, less and less nutritious food. While it is true that this effect may be typical of developing countries in the south of the world, it is not entirely foreign to our most affluent societies. The above events occurred relatively short, and their effects were more disruptive than any other emergency in the last 150 years (except the two world wars). As already highlighted in the previous year's Healthcare Report (Farmafactoring Foundation, 2021), the COVID-19 pandemic is a watershed for modern society, more than the attack on the twin towers in 2001 or the Great Recession crisis in 2008/9. Although many today strive to imagine a return to the pre-COVID-19 state, the world we knew until February 2020 will unlikely return.


The pandemic has been impactful not only because it af fected the health of nearly 6 billion people but also because it affected production globally due to shortages of row material and essential goods (e.g., masks, lung ventilators, oxygen, microchips, etc.), evidencing significant limitations of the organizational structures of the supply chains. If these could benefit the overall socio-economic system in regular times, in emergencies, like this one, they can act as a dangerous boomerang. As a result, the economic, health, and social organization of all countries, and the relations between nations, need to be reviewed, rethought, and adapted to the new context.


Now is the time for global solidarity and support, especially with the most vulnerable in our societies, particularly in the emerging and developing world. Loss of the substantial development gains already achieved in the last 20 years will be necessary to overcome health, social and economic problems imposed by the pandemic and to prevent the escalation of a long-running humanitarian and food security catastrophe. We need to recognize a significant opportunity for us to develop long-term sustainable strategies to address the challenges for the health and economic sectors. We must rethink the future of our environment and tackle climate change and environmental degradation with ambition and urgency. Only in this way can we protect all people's health, livelihoods, food security, and nutrition and ensure that our "new normal" is better.


This year's Report aims to explain a complex phenomenon that, also due to not consistently effective communication (institutional and scientific), has left doubts and uncertainties among those who want to understand.


The first part of the Report seeks to fill some of these gaps by providing answers to several questions, including how it was managed, how long we have to live with it, how it affected the economy, who will be hit hardest, how the new world will change us, and how our way of seeing the world will change.


The second part deals with the scars that the COVID pandemic has left on the healthcare systems in the present era. In particular, it discusses distinct issues regarding patient backlogs and the strategies adopted by single countries to recover them. It also discusses staffing and financing issues that permeate the different settings. Finally, it devotes attention to telehealth and how the new digital solutions are expanding in the countries under analysis.


In the third part, the Report revises policies and strategies adopted in the countries studied in terms of crisis management, governance, and economic measures. It provides a focus on the issues of healthcare resilience, procurement, biomedical supply chains, and communication infodemic. Finally, it discusses the integration between hospital and primary care, shedding light on the importance of the transition between the two settings.


Finally, the fourth part of the Report offers a broader perspective on international integration in the general healthcare domain from the point of view of the EU and global cooperation. It discusses the limitations and weaknesses of international cooperation in the case of WHO and analyzes the premises for the enforcement of the European Health Union.


As usual, our Report aims to offer a comprehensive analysis and comparison of 8 healthcare systems in the EU, namely those in Croatia, France, Greece, Italy, Poland, Portugal, Slovakia, and Spain. These healthcare systems are based on different funding principles due to heterogeneous economic conditions and societal views on income redistribution, institutions' presence, and government interference with healthcare provision, frequently shaped by various historical and cultural footprints.

Furthermore, they have different characteristics regarding basic founding principles, financing, organization, management, and population size. They also have been hit differently by the pandemic, which led to implementing various policies to respond to the shock. Thanks to data obtained from official sources and an ad-hoc survey administered to about 20 professionals and experts, the Report offers a multilevel overview of these healthcare systems, highlighting common challenges and country-specific issues that might be crucial from both practitioners' and policymakers' perspectives.


Request the full Report by sending an email to [email protected]