COLLECTION
Health, Public Health, and Health
Economics
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Editorial
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João Vasco Santos1-4
1 – MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences,
Faculty of Medicine, University of Porto, Portugal
2 – CINTESIS - Centre for Health Technology and Services Research, Portugal
3 – Public Health Unit, AceS Grande Porto VIII – Espinho/Gaia, ARS Norte, Portugal
4 – Vice-President of the EUPHA Public health economics section (European Public Health
Association – EUPHA)
While public health was de�ned by Sir Donald Acheson in
1988 as the “the science and art of preventing disease,
prolonging life and promoting health through the organized
e�orts of society”, Professor Alan Williams framed health
economics in a “plumbing” diagram in 1987, as a broad
discipline [1,2].
Some public health professionals or researchers might relate
health economics to all those analyses using econometrics or
anything related to health costs. Others immediately relate it
to economic evaluations only. The opposite is also true: some
economists might relate public health mainly to economic
evaluations of public health interventions. However, public
health (economics) or (public) health economics is much
broader
Oxford than this.
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Journal of Public
information can beHealth, �nding
found in similarities
our Cookie Policy. in both
disciplines.
A. What influences health? (other than health
care)
There are many health determinants besides health care,
from constitutional and individual lifestyle factors to
socioeconomic and cultural ones, as well as many models to
frame these. For example, Holstein et al. showed us that low
parental education and problematic parent-child relations
are predictors of childhood mental disorders [3]. In another
perspective, looking at lifestyle behaviours, Rovira and Rehm
described that 2.3% of alcohol-related cancers in the
European Union are related to light to moderate alcohol
consumption [4].
B. What is health? What is its value?
There is still an open debate on the de�nition of health and
its value. For instance, the European Commission’s “Expert
Panel on e�ective ways of investing in Health” has widened
the concept of value in “value-based healthcare” into four
pillars: personal, technical, allocative and societal value.
While there is an increasing body of literature in value-based
health care, there is still much to be done related to
monitoring population health status, with several
approaches related to burden of diseases pursued recently.
Many health concepts and measures are used in speci�c
evaluations with a limited number of measures for
monitoring population health, such as self-perceived health,
disabilities or frailty scores. While Nielsen et al. described the
healthy life expectancy at 70 years old based on frailty state
across Europe, Tarazona et al. showed that the yearly
collected Global Activity Limitation Indicator still does not
assess disability as we would like [5,6].
C. Demand for health care
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and behaviour is paramount to design and adapt supply,
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based mainly on health needs. The agency relationship
between suppliers and demanders is included in this topic.
For example, a recent paper from Smits et al. showed that the
use of out-of-hours general practitioner care seems to
depend on organisational models such as gatekeeping,
telephone triage or �nancial thresholds [7]. Another paper
related to this topic from Romana et al. highlighted that
multimorbidity patients have more medical visits and
hospitalisations, which can help predict and adapt provision
of care [8].
D. Supply of health care
On the other side, costs of di�erent ways of delivering care,
as well as substitutes and production systems, can help
tailoring the supply of health care. While Damiani et al. show
that there is no strong evidence related to mergers on
primary care organisations, Leão et al. describe the costs of
di�erent youth tobacco-control policies, including bans and
school educational programmes, from a health system
perspective [9,10].
E. Micro-economic evaluation at treatment level
This topic is the most commonly related to health
economics, being one of the most developed due to the need
of health technology assessment for the introduction of
technologies in health systems. Recently, two cost-utility
studies were published focusing on interventions: to prevent
type-2 diabetes in women with prior gestational diabetes, by
Werbrouck et al. [11]; and to promote adherence to cervical
cancer screening, by Firmino-Machado et al. [12].
F. Market equilibrium
Balancing demand and supply to reach market equilibrium is
no easy task. There are so many approaches for studying such
tensions. Van der Schors et al., for instance, showed that
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doing so do [13]. However, when analysing needs and supply
in a health system setting, there are other types of demand.
Nguyen et al. showed us that there is much to be done to
increase supply of tissue donations through tailored health
policies [14].
G. Evaluation at whole system level
This topic focuses mainly on health system performance
analysis, including e�ectiveness, e�ciency and equity. While
we’ve previously described increasing e�ectiveness of the
European Union health systems, through the evaluation of
population health indicators, an important West-East gap
still remains [15]. On the other hand, Hrzic et al. highlighted
the time trends of mortality inequalities, showing that
although beta-convergence is increasing, sigma-
convergence does not follow the same pattern, remaining
similar or increasing dispersion of mortality across European
Union countries [16]. However, there is still much to do
regarding this and the other health system performance
assessment dimensions, such as e�ciency and equity of
health systems.
H. Planning, budgeting & monitoring
mechanisms
Health systems depend more and more on rigorous resource
allocation, with growing pressures for increasing supply and
expenditures. Health planning, budgeting & monitoring
mechanisms are the cornerstone of this allocation, with
current methods requiring more, and longer, applications.
Foresight analysis is one such example, having the potential
to assess trends and consider di�erent scenarios for more
uncertain and distant futures. Verschuuren et al. [17]
described an application in the Netherlands, being this Dutch
Public Health Foresight Study 2018 the basis for the National
Health Policy Memorandum, showing the increasing
importance of health planning techniques like this for health
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From this exercise, we can conclude that there are many
similarities between both disciplines. In fact, there is much
ground to join e�orts and tackle the future of health
together, even more after the COVID-19 pandemic and the
need to get health systems back on track. There are many
stakeholders to listen in the health-related decision-making
process but, clearly, listening to public health professionals
or researchers and health economists should be a priority!
References
1 – Acheson, D. (1988). Public Health in England. Report of
the Committee of Inquiry into the Future Development of the
Public Health Function. London, HMSO.
2 – Williams A. (1987) Health Economics: The Cheerful Face
of the Dismal Science?. In: Williams A. (eds) Health and
Economics. British Association for the Advancement of
Science. Palgrave Macmillan, London.
The papers
3 - Holstein BE, Pant SW, Ammitzbøll J, Laursen B, Madsen
KR, Skovgaard AM, Pedersen TP. Parental education, parent-
child relations and diagnosed mental disorders in childhood:
prospective child cohort study. Eur J Public Health. 2021 Jul
13;31(3):514-520. doi: 10.1093/eurpub/ckab053.
4 - Rovira P, Rehm J. Estimation of cancers caused by light to
moderate alcohol consumption in the European Union. Eur J
Public Health. 2021 Jul 13;31(3):591-596. doi: 10.1093/eurpub/
ckaa236.
5 - Nielsen CR, Ahrenfeldt LJ, Jeune B, Christensen K,
Lindahl-Jacobsen R. Healthy life expectancy by frailty state
in Europe from 2004 to 2015: �ndings from SHARE. Eur J
Public Health. 2021 Jul 13;31(3):554-560. doi: 10.1093/
Oxford Universityeurpub/ckab012.
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allʼ you are agreeing to our use of cookies. You can change your cookie settings at any time. More
information can be6 -found
Tarazona
in our B, González-Enríquez
Cookie Policy. J, Almazán-Isla J,
Alcalde-Cabero E, de Pedro-Cuesta J, Galán I. Validity of the
Global Activity Limitation Indicator (GALI) to evaluate
severity of disability. Eur J Public Health. 2021 Jul
13;31(3):539-540. doi: 10.1093/eurpub/ckaa214.
7 - Smits M, Colliers A, Jansen T, Remmen R,
Bartholomeeusen S, Verheij R. Examining di�erences in out-
of-hours primary care use in Belgium and the Netherlands: a
cross-sectional study. Eur J Public Health. 2019 Dec
1;29(6):1018-1024. doi: 10.1093/eurpub/ckz083.
8 - Romana GQ, Kislaya I, Cunha Gonçalves S, Salvador MR,
Nunes B, Matias Dias C. Healthcare use in patients with
multimorbidity. Eur J Public Health. 2020 Feb 1;30(1):16-22.
doi: 10.1093/eurpub/ckz118.
9 - Damiani G, Pascucci D, Sindoni A, Mete R, Ricciardi W,
Villari P, De Vito C. The bigger, the better? A systematic
review on the impact of mergers on primary care
organizations. Eur J Public Health. 2021 Apr
24;31(2):244-252. doi: 10.1093/eurpub/ckaa248.
10 - Leão T, Perelman J, Clancy L, Ho�mann L, Kinnunen JM,
Mélard N, Nuyts PAW, Richter M, Rimpelä A, Lorant V, Kunst
AE. Cost of youth tobacco-control policies in seven European
countries. Eur J Public Health. 2020 Apr 1;30(2):374-379. doi:
10.1093/eurpub/ckz150.
11 - Werbrouck A, Schmidt M, Putman K, Annemans L,
Benhalima K, Simoens S, Verhaeghe N. Cost-utility analysis
of lifestyle interventions to prevent type 2 diabetes in women
with prior gestational diabetes. Eur J Public Health. 2020 Jun
1;30(3):473-478. doi: 10.1093/eurpub/ckz196.
12 - Firmino-Machado J, Soeteman DI, Lunet N. Cost-
e�ectiveness of a stepwise intervention to promote
adherence to cervical cancer screening. Eur J Public Health.
2020 Jun 1;30(3):401-410. doi: 10.1093/eurpub/ckz222.
13 – van der Schors W, Brabers AEM, de Jong JD. Why do
Oxford Universitypeople
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market? You canevidence
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the Netherlands.
information can be found
Eur in our
J Public Cookie2020
Health. Policy.
Aug 1;30(4):633-638. doi: 10.1093/
eurpub/ckaa044.
14 - Nguyen NT, Maxwell AP, Donnelly M, O'Neill C. The role
of motivational and legal contexts in understanding support
for tissue donation across 27 European countries. Eur J Public
Health. 2021 Apr 24;31(2):259-264. doi: 10.1093/eurpub/
ckaa148.
15 - Santos JV, Souza J, Valente J, Alonso V, Ramalho A, Viana
J, Ricciardi W, Freitas A. The state of health in the European
Union (EU-28) in 2017: an analysis of the burden of diseases
and injuries. Eur J Public Health. 2020 Jun 1;30(3):573-578.
doi: 10.1093/eurpub/ckz203.
16 - Hrzic R, Vogt T, Janssen F, Brand H. Mortality
convergence in the enlarged European Union: a systematic
literature review. Eur J Public Health. 2020 Dec
11;30(6):1108-1115. doi: 10.1093/eurpub/ckaa038.
17 - Verschuuren M, Hilderink HBM, Vonk RAA. The Dutch
Public Health Foresight Study 2018: an example of a
comprehensive foresight exercise. Eur J Public Health. 2020
Feb 1;30(1):30-35. doi: 10.1093/eurpub/ckz200.
This e-collection received co-funding under an operating
grant from the European Union’s Health Programme
(2014-2020).
Disclaimer: The content of this e-collection represents the
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it cannot be considered to re�ect the views of the European
Commission and/or the Consumers, Health, Agriculture and
Food Executive Agency or any other body of the European
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