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Having challenged health systems globally, COVID-19 has highlighted the imperative of health system resilience. With over 6.8 million reported COVID-19 deaths and over 19 million excess deaths estimated worldwide by January 2023, the pandemic is a global catastrophe that has revealed significant weaknesses within health and interconnected systems. Governments need to urgently adapt their health systems to be ready for the next crisis—whether a novel pathogen, a natural disaster or an armed conflict, among other threats. Otherwise, the costs will be larger and the impact on people greater.
The OECD report Ready for the Next Crisis? Investing in Health System Resilience sheds light on three major, pre-existing vulnerabilities exacerbated by the COVID-19 pandemic. Health systems were underprepared, understaffed and underinvested in. Resilience is the ability of systems to prepare for, absorb, recover from and adapt to major shocks. Using a resilience lens, this report recommends six policy areas for attention and calls for major investment in the health workforce, alongside increased spending on prevention and digital infrastructure.
Six key policy areas to improve health system resilience
Resilient populations for resilient health systems: tackling wider determinants of health
Maximising the health of people before a crisis minimises the harm to the population, lowering the risk of death and long-term health problems. A strong primary and preventive care system also reduces demand for health services during a shock, benefiting everyone. Indeed, as the Dutch philosopher Desiderius Erasmus said over 500 years ago, “Prevention is better than cure”. Despite this widespread knowledge, only 2.7% of total health spending across OECD countries in 2019 went towards prevention, underlining why health systems were underprepared.
Despite record high numbers of health care workers across OECD countries, over 3 million more health and long-term care workers will be required to improve health system resilience.
As the COVID-19 crisis highlighted, elderly and multimorbid people were disproportionately affected and suffered worse outcomes upon infection. Nearly half of people with lower incomes had longstanding illnesses or health problems before the pandemic. The social gradient of death from COVID-19 illustrates the neglect of social determinants of health—lifestyle, poverty, unemployment. Investing in public health, by promoting healthier lifestyles and addressing wider determinants of poor health, will help achieve resilient health systems and more equitable population outcomes.
Read more on the Forum Network: Eliminating Existing Epidemics: Investing in neglected tropical diseases strengthens our ability to fight global pandemics by Thoko Elphick-Pooley
Health workers are the beating heart of health systems: restoring a normal pulse
Health workforce shortages pose one of the biggest threats to resilient health systems. Lower numbers of health and social care workers per capita were associated with higher excess mortality across the OECD in the first two years of the pandemic. Despite record high numbers of health care workers across OECD countries, over 3 million more health and long-term care workers will be required to improve health system resilience.
Increased numbers of health and social care workers associated with lower excess mortality during the first two years of the COVID-19 pandemic
Source: OECD Health Statistics 2022, https://doi.org/10.1787/health-data-en
Front-line health workers are overstretched, exhausted and readier than ever to leave their jobs. The threat of a “great resignation” is a wake-up call to invest more in retaining and recruiting health workers. An exodus would compound the strain on those remaining in the sector and stretch the ability to deliver high-quality care. The pandemic led to elective care being suspended to divert health care to COVID-19 patients, resulting in 11 million fewer diagnostic exams and surgical procedures in 2020 - across 31 OECD countries. Revitalising health systems by boosting the workforce will make post-crisis recovery less onerous and future-proof them against other shocks.
A shot in the arm for health systems: addressing underinvestment
With the onset of the COVID-19 pandemic, OECD countries suffered a 4.7% drop in GDP in 2020. To avoid the catastrophic effects of future shocks, targeted investments are needed. Annual investments to improve health system resilience across OECD countries would represent around 1.4% of GDP on average, relative to 2019 expenditure.
Investing in health system resilience is not purely a matter of spending more—it is also about spending better by targeting priority investments in areas where health systems proved insufficiently resourced to withstand shocks.
While many countries have increased spending since the pandemic, rushed crisis spending does not boost resilience for the future and costs more than upfront targeted investments. Greater efforts are needed in three critical investment areas: preventive care; health workforce; and health information systems and infrastructure, to improve the use of data for better decision making, surveillance and research. Other investments are also needed to stockpile emergency supplies, ensure reliable medical supply chains and increase availability of critical equipment.
Ensuring that the next shock does not leave such a challenging legacy requires preparedness, adaptation and improvement of those systems that interconnect with health. Promoting global co-operation will be key to finding better ways to pay for global public goods like the benefits of vaccines. Public support will be essential for financing, regulation, manufacturing and provision of health technologies needed for resilience. These changes must be accompanied by credible obligations if such technologies are to be equitably distributed, especially in times of crisis. The pandemic demonstrated the importance of a whole-of-society approach in addressing population needs and responding to threats. For health systems to withstand future crises, countries should strive to build strong governance structures that value and maintain the trust of communities. Trust, in people and in institutions, was important during the first years of the pandemic, with higher trust contributing to more effective COVID-19 containment.
The next crisis may not take the form of a pandemic, and the global community faces the prospect of a continuing “polycrisis”. Against this backdrop, there are significant social and economic benefits of investing in health system resilience. Doing so now is vital to facing tomorrow’s challenges.
For more information please see:
OECD (2023), Ready for the Next Crisis? Investing in Resilient Health Systems, OECD Health Policy Series, OECD publishing, Paris
Morgan, D. and C. James (2022), "Investing in health systems to protect society and boost the economy: Priority investments and order-of-magnitude cost estimates", OECD Health Working Papers, No. 144, OECD Publishing, Paris
OECD (2021), COVID-19 and Well-being: Life in the Pandemic, OECD Publishing, Paris
Visit the OECD Health Systems Resilience webpage