From What to How – the new report

A new repost is pushing the need for a new way of thinking within healthcare. We asked some of the central players to explain more about it.

At EHiN 2024, there will be a copy available of the report “Nordic Health 2030 – From What to How” for all delegates. 

The report is an updated “Part 2” of a study presented by the Copenhagen Institute of Future Studies, which was published in 2019.

“There is a need for a fundamental shift from sick care to preventive health to ensure the longevity of our healthcare systems and improved quality of life. The Nordic Health 2030 Movement can drive this transition.“ the 2019 report writes on the question “why do we need a new way of thinking?”. http://nordichealth2030.org/

Based in well known dilemma´s like the demographic shift and the lack of resources, as well as a thrilling tech revolution giving us totally new ways of using (health) data, the expert group formulated a bold ambition.

THE 5/5 ASPIRATION

A sustainable approach to healthcare requires a fundamental shift from sick care to preventive health. By 2030 the Nordic countries should allocate 5% of the GDP to treatment and 5% of the GDP to prevention.

In 2019, only 0,3% of GDP was used for prevention, while 9,7%was used for “sick care”. So the need for a new, data driven way of organizing health care .

Now how?

The new report, written in the spring of 2024, is focusing more on how this vision of a more preventive, data driven health system can be accelerated into the Nordics. To this purpose, the Copenhagen Institute of Future Studies uses workshops with special scenario processes, in which different pathways for the future are elaborated.

The new report explains the vision and the Nordics can take a quicker road to the goal – a more sustainable healthcare system.

Question asked is: 

We have never had more staff (health care professionals), more funding, more technology, medicine, treatments and knowledge, and yet our health systems are in systematic crises with lack of staff, burnout at the same time as the societies disease burden is growing. 

With all of these red flags raised it was a time to ask:  are we doing the right things – and are we doing things right.

– Our health systems logic were built 100-150 years ago with a high focus on hospitals and acute treatments for communicable disease and injuries of accidents and violence. Our challenge has changed. Today in the Nordics approximately 87,5 % of the disease burden is chronic disease – and to a large extent with a big life style component, tells Bogi Eliasen from the Copenhagen Institute of Future Studies.

Eliasen is the driver behind the report. 

– The efficient way of reducing the burden of these disease is early and precise intervention before the disease become very serious and acute. That requires new way of thinking, working and paying – with much more focus on primary prevention on reducing onset of disease; and secondary prevention, on keeping people as healthy as possible for as long as possible when they have chronic disease, he says.

What was different from the first round in 2019, and the one done this year?

– The first round in focused building a common Nordic approach to health, especially with how to-restrenghten the Nordic Welfare model and solidarity, in short defining the cornerstone of a fair, collaborative  and sustainable health system of the future – based on the fact that we need to respond to the big systemic crises of our healt systems – with a belief that the Nordics country would be much stronger together.

– The second round has been focusing on HOW do we get there. Building cooperation and initiative on things we already can do- apply what we have – to build better health in accordance with the Nordic Health 2030 vision, Eliasen.

The most prominent conclusions in the 2024 report are considered to Eliasen:

Overarching there is a clear focus on developing much stronger and more dynamic private public partnership (PPP)models as a necessity to solve the challenges and harvest the opportunities in health.

The current health care crises cannot be solved with the way that we have been working – new ways of working and acting is needed – here PPP on how to apply new knowledge and technology is key

• All levels of society, national, regional, local, business and civil society need to be part of building the solutions

• High focus on much better health services for chronic diseases, (which today is 87,5% of the disease burden) with much more on early detection and intervention, so people are healthier for longer 
• That we need to be much more inclusive in health services, where the patient is a part of the solution, especially in data and information.
• Most importantly 21 proposed practical initiatives that can start today – and to build partnerships across the Nordics to do so.
• Enviromental friendly, economical resilient and more preventive apporaches to health services are interlinked – we need payment models that incentives them. 

Social drivers impacting health and well-being

Clayton Hamilton from the WHO has been observing the scenario process as one of the participants in this years study.

– I think there are drivers internal and external to the Nordics to consider here. Firstly, while the structure of health systems across Nordic countries differ, there is broad alignment across a range of health and social drivers impacting health and well-being of Nordic populations. The Nordics also share similar health service delivery models and a significant degree of commonality in disease profiles and public health priorities. The commonalities here help to drive much-needed cooperation. However, there are external factors outside of the Nordics which arguably today act as bigger incentives for alignment and cooperation, such as shifting market positions, new trade blocs, geopolitical tensions, technological development and the impact of climate change. Staying competitive in a world that is facing this confluence of challenges, and identifying where opportunities lie, will only be possible through multi-lateral cooperation among Nordic nations.

Within the context of building resilient health systems of the future, how has Nordic Health 2030 call for a shift from a paradigm of reactive care to preventive health resonated to the World Health Organization? 

– Not surprisingly, the fundamental drivers which underpin the Nordic Health 2030 initiative’s call-to-action are shared by several, key public health frameworks being used by countries to create adaptable and resilient health systems of the future. These include the WHO European Well-being Economy Initiative, the Pan-European Commission on Health and Sustainable Development, the WHO European Programme of Work and the WHO Regional Digital Health Action Plan 2023-2030. What this alignment illustrates is a shared understanding of the implications if governments don’t think differently about how investments in health are made, and a recognition that good health and well-being is not created in hospitals and clinics, but in homes, schools, and the places we work, grow and socialize. It’s the NH2030’s model of interconnectedness of these factors, and its proposed use of data and new social contracts for health which I believe makes it highly valuable in guiding the necessary shifts we all have to make in our societies.

How do you think the Nordics can become a lighthouse for the rest of the world within healthcare?

– Well, the answers to that question will of course be addressed in this year’s EHiN conference. So be sure to tune in and be an active part of the discussion and learning!😉

A mix of fascination and confusion

Lars Münter, from the Danish-based ”Nordic Wellbeing Academy”, has been an advocate for the new way of thinking.

You have been active in involving people into the Nordic Movement. What have the reactions been on the first report from 2019?

– The first report initially was met with a mix of fascination and confusion. Especially before the pandemic, there were fewer that felt a sense or urgency about the need for transformation, so the concept of using a paradigm shift as basis for new strategy and approach felt daunting for some – bordering on escapism for others. But both during and after the pandemic, it is clear that our work has been prescient and have gained a different level of energy.

Do you think the new report, which has some more concrete pathways for health policy, will have more impact?

In terms of tangible actions yes; in terms of mindset shift ironically perhaps less so. It takes time to rewire brains and communities towards different conversations, so while the tangible actions were fewer, the ripple effects have been there – and these pave the way now for the pathways of the second report to hit the ground running (to use a worn phrase, perhaps).

How do you think we can involve more people in the Nordic Health 2030 Movement?

– Well, EHiN 2024 is a perfect place to begin. A natural next step for us is to nudge more stakeholders at local level, at city level, and in other regions to be inspired to follow the methodology and start reimagining and rebuilding their health systems. The support and interest from WHO/Europe also means a lot – I look forward to help more stakeholders in their network to grasp the mindset, the models, and movement; given the new mandate for Regional Director Hans Kluge, this has a lot of energy. But also our conversations via OECD creates a lot of ripple effects, Lars Münther says.

– We’re very soon at the point of also gathering clear cases from across countries of practical actions based on the mindset of the NH2030 – and this will create another positive feedback loop I look forward to. Especially considering that the need for transformation – and support for it – has only increased. Urgent action is what we all need.

“Establishing a high number of concrete pathways for action. And also the strong basis for support in international communities and initiatives. The report creates the basis for synergies; so you can read, reflect, and react; and start being part of a movement of change.”

At EHiN 2024, you can meet the following people who have been involved in the From What to How repost: Anders Tunold-Hanssen, Unni Kvisvik, Mette Maria Skjøth, Lars Münther, Nard Schreurs, Clayton Hamilton, Stein Olav Skrøvseth and Eric Sutherland.

http://nordichealth2030.org/magazine/