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Special Report Policy with a Brain – Challenges and Opportunities for the New European Institutions Mary Baker President, Year of the Brain, European Brain Council, Brussels, Belgium Abstract The combination of ageing populations and lower economic growth is leading policy-makers to question the sustainability of European healthcare expenditure. At the same time as seeking to increase ‘cost-effectiveness’, however, we must also strengthen our focus on the outcomes our health systems deliver – for the patient, the economy and society. Disorders of the brain cost Europe €798 in 2010 – more than any other comparable disease area – and will become more prevalent as our populations grow older. The European Brain Council is launching The Year of the Brain to educate society about how to nurture and protect the brain, to improve care and treatment access for those affected by brain disease, and to increase investment in brain-related research and development. Working with the European institutions and Member States, we aim to make an important contribution to improving outcomes across Europe. Keywords Sustainability of healthcare, brain disease, brain research Disclosure: Mary Baker, MBE, has no conflicts of interest to declare. No funding was received for the publication of this article. Received: 24 September 2014 Accepted: 4 November 2014 Citation: European Neurological Review, 2014;9(2):106–7 Correspondence: Mary Baker, MBE, Fondation Universitaire, 11, Rue d’Egmont, B-1000 Brussels, Belgium. E: As the 751 new European MEPs begin their term, the European Brain Council (EBC) is launching its Year of the Brain, calling for new thinking from policy-makers to take stock of the impact of austerity on health and wellbeing in Europe. The EBC works in partnership with patients, scientists, healthcare professionals, industry and policy-makers to harness science and innovation for better societal outcomes. The economic crisis has put health back on the EU agenda. Austerity, low growth and demographic change are calling into question the sustainability of our healthcare systems. Between 2010 and 2060, age-related public expenditure in the EU is projected to rise by between 4.1 and 4.8 percentage points of GDP, 1 with the majority of the increase accounted for by health and long-term care. 2 Long-term care is described by the EC as, ‘the organisation and delivery of a broad range of services and assistance to people who are limited in their ability to function independently on a daily basis over an extended period of time’. Within the European Semester (the EU’s new economic governance framework), the EC regularly issues recommendations for Member States to improve the ‘cost-effectiveness’ of their healthcare systems. offers a salutary reminder of the dangers of ill-conceived spending cuts. Access to healthcare has been notably reduced by the combined effect of unemployment and the decision to cap health spending at 6 % of GDP – a figure agreed with the ‘Troika’ (the EC, the European Central Bank and the International Monetary Fund) as part of the Greek bailout programme. 3 In future, the effectiveness aspect of ‘cost-effectiveness’ needs greater attention. To that end, we must look more rigorously at outcomes for both the patient and society, including the benefits that come from more active, productive populations and from less social exclusion. 4 The recent EC Communication on ‘effective, accessible and resilient health systems’ defines effectiveness as “health systems” ability to produce positive health outcomes’. We also need to recognise that investments made now (for example, in early diagnosis and prevention) can contribute to more sustainable health systems in the future. Disorders of the brain, most significantly dementia, mood disorders (unipolar and bipolar), anxiety and addiction cost Europe €798 billion in 2010, more than any other comparable disease area. 5 The study While the objective of sustainable health systems is critical, the emphasis in the European Semester recommendations has tended too much towards cost-limitation, with too little analysis of the outcomes that health systems deliver. Outcomes measures are limited to a number of ‘health status’ indicators, such as life expectancy, amenable mortality and infant mortality, while performance in specific treatment areas is not addressed. by Gustavsson et al. covers 19 groups of disorders: child/adolescent, personality, dementia, headache, mood, neuromuscular, brain tumour, traumatic brain injury, psychotic, multiple sclerosis, addiction, somatoform, epilepsy, Parkinson’s disease, sleep disorders, anxiety, stroke, mental retardation and eating disorders.They afflict more than a third of European citizens (127 million people), and will only become more prevalent as our populations grow older. Brain-related disorders are, therefore, a main element in the sustainability challenge. The same emphasis on cost-limitation has been true of some national policies. Above all, Greece’s experience during the Eurozone debt crisis To make the transition to an outcomes-focused approach, we first need to understand how well our health systems currently perform. For that we 106 © Touc h ME d ic al ME d ia 2014