Health underpins defence planning, demographic strategy and economic reform

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Credit: WHO

Across much of the world today, governments are reassessing their priorities. Defence budgets are rising in a volatile geopolitical landscape. Migration and demographic decline are climbing up the political agenda as our societies age and workforce shrinks. Economic competitiveness, sovereignty and resilience dominate public debate.

Yet, one essential truth still risks being overlooked: none of these priorities can be addressed without a healthy population.

Health is too often treated as a downstream social sector — something to be funded once other priorities are secured. In reality, health is the pre-condition that determines whether societies are safe, policies sustainable and economies productive. This is the central message of WHO/Europe’s new five-year strategy — the second European Programme of Work (EPW2) — which was recently adopted by all 53 member states of the WHO European region. EPW2 reframes health as a necessary investment that underpins broader national and regional priorities, rather than a sector competing for scarce resources.

Europe is facing a convergence of pressures. Our region is ageing faster than any other in the world. Chronic conditions such as cardiovascular and respiratory diseases, cancers and diabetes account for the vast majority of premature deaths and disability. The European region ranks among the worst in terms of alcohol and tobacco use. Mental health conditions are among the leading causes of lost productivity. Climate change and conflict are increasing health risks while public budgets tighten. In this context, the question is not whether Europe can afford to invest in health. The question is whether Europe can afford not to.

With more than 100 countries increasing their defence budgets in 2024, global military spending hit a record $2,718 billion, up nearly 10% on the previous year. Yet, modern security also depends on a much broader range of dimensions that define societal strength — on whether populations are physically fit and mentally resilient, on whether countries are prepared to face epidemics and emergencies and are able to sustain essential services during crises. Recent emergencies such as the COVID-19 pandemic have shown that fragile health systems can become national security liabilities. Investing in health security, primary health care and workforce resilience strengthens a country’s capacity to withstand shocks just as surely as investment in infrastructure or equipment.

Now consider demographics. Many European countries are grappling with low fertility rates, shrinking workforces and longer lives. By 2050, more than a third (35%) of Europe’s population will be aged 60 or over. Yet, ageing itself is not a problem — it represents the triumph of longer, fuller lives and the opportunity to harness decades of experience and wisdom. Policies aimed at boosting our health and social care workforce, remaining economically active for longer or integrating migrants more effectively will fail if large parts of the population suffer from preventable illness, disability or poor mental health. Healthy ageing is not just a social aspiration; it is a demographic necessity — and an opportunity to reimagine what an active, meaningful life looks like.

Or look at economic competitiveness. Poor health is already one of the main constraints on productivity growth in Europe. Chronic disease, stress-related conditions and long-term sickness cost economies billions every year. By contrast, strong health systems foster innovation, create jobs and attract investment. With digital health technologies expanding, the health sector itself drives growth in ICT, data governance and life science industries. Evidence consistently shows that investment in disease prevention, mental health and clean environments delivers some of the highest returns of any public expenditure.

This is why EPW2 makes a deliberate strategic shift: placing health as an enabler of other policy goals, not as a competing budget line; moving from ‘health in all policies’ to ‘health for all policies’. For example, when health is embedded into climate policy, transport planning, housing, education, labour and fiscal strategies, meeting our health priorities does not depend solely on health budgets. It flows through multiple channels, because multiple objectives are being served. This integrated approach is not new; it was at the heart of the Ottawa Charter for Health Promotion 40 years ago, and, in today’s increasingly complex and interconnected world, feels more relevant than ever.

Investing in healthy living pays dividends. Health taxes on tobacco, alcohol and sugary drinks, for example, simultaneously reduce disease, generate domestic revenue and lower future healthcare costs. Cleaner air policies reduce emissions and cardiovascular disease. Strong primary healthcare keeps people in the workforce longer while reducing pressure on hospitals. Investing in preparedness protects lives while safeguarding economic continuity in the face of a health emergency.

Scarcity demands clarity. EPW2 is intentionally focused on interventions that are high-impact, evidence-based and economically rational. It prioritizes what protects people and systems first — because without healthy people, no strategy endures.

The adoption of EPW2 by all 53 member states sends a powerful signal: Europe understands that health is not a passive beneficiary of prosperity, but an active driver of it; that unity around health can be a bridge to cooperation and peace. The task now is implementation — aligning health with defence planning, demographic strategy and economic reform, and measuring success not only in lives saved, but in resilience built.

In an age of uncertainty, Europe’s greatest strategic asset is not found in any single policy domain. It lies in the health of its people. Protect that — and every other priority becomes more achievable.