Jana MICHAILIDU

Director of the Progressive Analytical Centre

Europeans are living longer. This is one of the achievements of our social model. The question is whether we are living those additional years in good physical and mental health and whether this progress is shared equally across society.

The pursuit of longevity cannot simply mean adding years to life. It just as well means adding life to those years. In other words, extending the time in which we can take a full part in society, keep our relationships, feel accomplished and live with dignity. Importantly, though, healthy longevity must not become another privilege that correlates with income or social status. The right to healthy longevity needs to become an imperative of the progressive agenda for Europe.

What kind of prevention?

European health policy increasingly prioritises prevention. Europe’s Beating Cancer Plan emphasised reducing preventable risks and improving health literacy, while the Healthier Together initiative recognised that tackling non-communicable diseases requires looking beyond treatment. More recently, European policy has addressed cardiovascular health, nutrition and physical activity. This is important progress. But it raises a political question: do we want prevention that relies on individual choices in unfavourable environments, or prevention that reshapes the commercial, social and structural determinants of health across the life course?

The answer is not a policy that relies on individuals making better choices. People certainly make choices about their health, but these are not made under equal conditions. A parent working two jobs does not have the same time to exercise or prepare healthy meals as someone with greater socio-economic security. A child in a disadvantaged neighbourhood has fewer opportunities for sport or limited access to healthy food. A worker with little control over the working load or hours cannot simply eliminate chronic stress. People struggling with mental health or addiction need considerably more than information.

The progressive case for prevention starts from a simple principle: good health depends on whether healthy options are affordable, accessible and achievable for everyone. This means addressing the social determinants of health (income, housing, education and employment). The evidence is consistent, regulations and structural policies achieve more, faster and more fairly than campaigns aimed at individuals.

Where policy can make a difference

We grow up in families and schools. We spend a significant part of adulthood at work and within our communities. Today, we also spend considerable time in digital environments. If Europe is serious about healthy longevity, these are precisely the places where policy needs to make a difference. Schools can help children develop health literacy, resilience and healthy habits while providing access to physical activity, healthy food and mental health support, regardless of family background. The workplace is equally important. Good work can provide security, purpose and social interaction. Excessive workloads, insecurity and work-family conflict generate psychosocial stress, negatively impacting health.

This was also the key lesson of last year’s FEPS event on “Healthy minds, stronger Europe“. Whether we looked at work, digital technologies or addiction, the conclusion was the same: mental health cannot be treated simply as an individual medical problem. Well-being is created, or undermined, by the environments in which people live.

This year’s State of the Union speech provides openings for this debate. Its focus on children’s digital experiences, the proposed European Care Deal and the European Pillar of Social Rights point towards a broader understanding of resilience and wellbeing. Progressives should turn these openings into binding commitments.

Who benefits?

A healthier Europe, on average, is not enough if the gains go mainly to those who were already healthy. The real question is who benefits when Europe’s health improves. People with fewer economic and social resources are more likely to live and work in conditions that damage health, while having fewer resources, protections and opportunities to avoid or mitigate those harms. They are also likely to be disproportionately targeted by, or exposed to, harmful products and commercial practices. 

The scale of the gap is striking. In some European countries, people with low levels of education live up to eight fewer years than those with a university degree. The gap in years lived without disability is wider still. Regions with the lowest education, lowest incomes and highest poverty risk also lose the most years of life.

Progressive policy neither blames individuals nor denies individual responsibility, it neither moralises nor infantilises. Its purpose is to change the environments that shape choice. Regulation, taxation, information and education all have a role. But we also need healthier schools and workplaces, safe and accessible public spaces, affordable opportunities for physical activity in daily life, and strong primary care and mental health support available before problems escalate. 

Policies must reflect the circumstances of different groups. This requires evidence-based policymaking, informed by practitioners, organisations working directly with vulnerable populations as well as including the lived experience of those affected. Prevention needs to be designed with people through meaningful participation and shared decision-making.

Solidarity before illness

Longer lives is good news. But if we are extending the time people spend with preventable disease, disability, or poor mental health, the human, social and economic costs grow. Healthy longevity is central to the European social model. Within this model, human beings are not valuable merely for their economic input, and health policy cannot be reduced to extending working lives. At 65, more-educated Europeans can expect around four and a half more years free of disability than the less educated. Simply keeping everyone working longer asks most of those whose healthy years run out first.

One of the greatest Social-Democratic achievements of the 20th century was to socialise risks that individuals could not reasonably carry alone: illness, unemployment, disability and old age. Today, we must extend this upstream: reducing exposure to avoidable risks earlier in life, so that security depends less on inherited advantage or personal wealth in the first place. That also means sharing responsibility according to capacity, and according to who contributes to the problem, including industries that profit from harmful products.

We should not wait until people become ill before solidarity begins. We should organise our society to give everyone a fairer chance of remaining healthy. Living longer is an achievement. Living longer in good health is a greater achievement. We must ensure that a long and healthy life does not depend on whether people can buy their way into wellbeing. Healthy longevity should not become another lifestyle trend for Europe’s better-off. It should become a new chapter in the European promise of social solidarity.

Photo credits: Shutterstock/Tony Dunn