WE, THE MINISTERS AND REPRESENTATIVES OF Australia, Austria, Belgium, Bulgaria, Canada, Chile, Colombia, Costa Rica, Croatia, the Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Korea, Latvia, Lithuania, Luxembourg, Mexico, the Netherlands, New Zealand, Norway, Peru, Poland, Portugal, Romania, the Slovak Republic, Slovenia, Spain, Sweden, Switzerland, Türkiye, Ukraine, the United Kingdom, the United States, and the European Union, met at the OECD headquarters in Paris on 23 January 2024 for the meeting of the Health Committee (HC) at Ministerial level, chaired by Belgium, supported by Australia, Chile, Germany, Norway and Slovenia as Vice-Chairs with the overarching theme of “Building Better Policies for More Resilient Health Systems” to discuss the current and future challenges facing health systems and the role of OECD, in developing and implementing transformative solutions to address them.

WE RECALL the statements of the OECD Council condemning the aggression by Russia against Ukraine in the strongest possible terms as a clear violation of international law and a serious threat to the rules-based international order; and RECALL the United Nations General Assembly Resolution A/RES/ES-11/1. WE REMAIN deeply concerned by the impact of conflicts and violence on the physical and mental health of civilians as well as on the health workforce.

WE WELCOME the opportunity to discuss together how we have addressed the many challenges related to the COVID-19 pandemic and how to strengthen further international cooperation in handling such global shocks.

WE REMAIN deeply concerned by the devastating impact the COVID-19 pandemic has had on the health and well-being of people around the world, and the huge shock to the global economy and therefore WELCOME the opportunity to reflect on what we have learned from the pandemic and how to build a much more resilient health system – one that is able to prepare for shocks, to minimise the negative consequences of such disruptions, recover as quickly as possible, and adapt by learning lessons from the experience to become better performing and more prepared – and how to strengthen further international cooperation in handling such global shocks.

WE REMAIN concerned by the impact of megatrends affecting the health of our population and our health systems: ageing, non-communicable diseases, and climate change.

WE ACKNOWLEDGE the dedication and professionalism of our health and care workers, the lifesaving work of the research community and the rapid introduction of new, digitally enabled care models. Nevertheless, the pandemic was a huge wake-up call, that cannot be ignored and indicated the need to do better in responding to future pandemics.

WE RECOGNISE the need to:

● improve the resilience of our health systems to future health shocks by making the necessary investments and ensuring the sustainable financing of health systems, recognising that such investments protect society and drive economic growth;

● prepare for disruptive events and mega-trends – the direct and indirect impact of the triple planetary crisis on health and well-being; the growing threat of antimicrobial resistance (AMR); advances in genomics and genetics; harnessing the transformative power of digital technologies including artificial intelligence; and the challenges of ageing societies;

● reduce the burden on our health systems, including by promoting healthy lifestyles and improving the wider social, economic, environmental and other determinants of health;

● identify and address gender biases, where they exist in our health systems, and guard against creating new biases;

● tackle inequalities in all their forms, within and across countries, helping to address stark disparities between high and low-income countries, and to support countries as they work to achieve, and maintain, universal health coverage; and

● add urgency to our journey towards more resilient health systems, and a steadfast commitment to transform challenges into opportunities for a healthier, brighter tomorrow through actions.

Building More Resilient Health Systems

WE RECALL the huge human tragedy of the COVID-19 pandemic. Analysis of excess mortality suggests that as many as 18 million people may have died worldwide because of the pandemic by the end of 2021. Life expectancy decreased in many OECD Members during COVID-19 and on average we are still more than six months below the pre-crisis level. There has been a strong rebound from the depth of the economic crisis generated by the pandemic, but this required unprecedented inflow of public resources that have challenged our fiscal systems.

WE RECOGNISE the importance of learning from the COVID-19 pandemic, where even the most advanced health systems in the world were not resilient enough. The world is likely to experience other pandemics and systemic shocks, which in our inter-connected world are having more extreme consequences. Furthermore, the Intergovernmental Panel on Climate Change has concluded that climate-related risks to, and impacts on, health and well-being, livelihoods, food security, water supply and sanitation, human security, and economic growth are projected to increase with global warming, the consequences of which are accelerating at an alarming pace. Exposure to air pollution is also estimated to cause millions of deaths and lost years of healthy life annually. As a result, health systems have to become more resilient, to be able to better cope with these shocks, at both the national and international level. This will require some difficult decisions given the pressure to limit expenditure increases, but there is scope to improve spending efficiency, reduce waste and focus on ways to improve value-based care.

WE NOTE that:

● the 2022 OECD report ‘Investing in health systems to protect society and boost the economy’ emphasised the need to strengthen health system resilience across three domains – health workforce, protecting people’s underlying health; and fortifying the foundations of health systems with sufficient medical equipment and better use of health data; and

● the 2023 OECD report ‘Ready for the Next Crisis? Investing in Health System Resilience’ made additional policy recommendations to improve health systems resilience and to reduce the impact of future shocks by promoting: population health; workforce retention and recruitment; data collection and use; international co-operation; supply chain resilience; and governance and trust.

WE WELCOME the renewed OECD Health System Performance Assessment Framework, which provides a shared renewed vision for assessing health system performance, approved by the Health Committee on 6 December 2023, and analyses based on it, which can be useful as a tool for cross-country comparisons, evaluation, learning and continuous improvement.

WE COMMIT to:

● further strengthen, and improve access to, our health systems in particular primary care, end of life care, mental health and digital services, and support prevention, preparedness, detection, surveillance, risk assessment, early warning, and response to future health threats to help build health system resilience, with a focus on areas where the need is greatest, according to country circumstances, taking into account relevant OECD advice, where appropriate and necessary;

● address health workforce shortages by concerted action to train, retain, and improve the working conditions of health and care workers, and introduce new working approaches such as task sharing and task shifting; thereby promoting patient safety, while also striving to ensure that health workforce capacity from more vulnerable countries is not depleted;

● reorient health systems towards health promotion and disease prevention, following a One-Health approach, including by means of health and digital literacy, addressing wider health determinants through a whole-of-government approach, and working to reduce health inequalities;

● address gaps in the resilience of our healthcare systems identified, notably, by regular testing and systematic reviews that take into account economic, social and health impacts;

● combat AMR through a One Health approach, by taking measures on infection prevention and control, surveillance of AMR and antimicrobials consumption, prudent and effective use of antimicrobials, including through diagnostic-based prescribing, and the development and accessibility of new and existing antimicrobials, as well as vaccines, diagnostics and alternative countermeasures;

● underpin our commitment to climate-neutral, and environmentally sustainable health systems, including their supply chains and medicines manufacturing, by undertaking regular monitoring, to track and drive progress; and

● work towards achieving climate-resilient health systems in the near term, and climate-neutral health systems by 2050, while ensuring no adverse impact on patient care.

WE CALL on the OECD, through the Health Committee, and in collaboration with other relevant OECD committees, and other international organisations, to assist in our effort to:

● better prepare for, respond to, and learn from, systemic shocks by analysing health systems resilience, including the interconnectedness between health and other key economic and social sectors by undertaking regular monitoring and analyses;

● strengthen the health and care workforce, including by improving the availability, quality, and comparability of key data on the health and care workforce globally;

● make our health systems climate neutral, and environmentally sustainable by developing a dashboard with robust measures;

● support the digital transformation of health systems, to increase access to health data, information, and services, in accordance with national health information policies, privacy legislation, and data protection regimes; and

● tackle medicine shortages and security of supply issues by setting up international collaborative approaches to improve long-term resilience of pharmaceutical supply chains, including by considering supply chain visibility, regulation and stockpiling approaches.

Innovative, People-Centred Healthcare

WE ACKNOWLEDGE the urgent need to make health systems more people-centred – a challenge that has been made even more salient by the COVID-19 crisis and rapid social and technological advancements.

WE WELCOME the preliminary results of the first of its kind Patient-Reported Indicators Surveys (PaRIS), reflecting the main strategic orientation from the 2017 meeting of the Health Committee at Ministerial level, that clearly highlight the importance of assessing the experience and outcomes of health systems from the perspective of patients to build people-centred and resilient systems.

WE COMMIT to:

● build on our existing commitment to assess, in a comparable way, the clinical and patient reported outcomes and experiences in our countries, including by measuring, at regular intervals, patient-reported indicators and expanding the reach of PaRIS to more countries that wish to join the PaRIS initiative; and

● make innovations, in our health systems, people-focused, based on public health needs, and which promote people’s physical and mental health, including by assessing the ability of, and cost effectiveness for our health systems to take advantage of new technologies in the areas of genomics and genetics, and digital technologies.

WE CALL on the OECD, through the Health Committee, and in collaboration with other relevant OECD committees, and other international organisations, to:

● support countries in their endeavour to assess, in an internationally comparable way, clinical and patient-reported outcomes and experiences. This may also include support to additional countries that wish to join the PaRIS initiative; and

● assist in our efforts to harness the transformative potential of new technologies for health such as genomics and genetics, and artificial intelligence, while ensuring that their application delivers better health outcomes by tracking and assessing the health and health systems implications including on health spending of these developments.

Healthier Populations

WE RECALL that:

● non-communicable diseases cause around 90% of deaths in OECD Members and that they are also a key cause of disability;

● large inequalities in health status and life expectancy exist across population groups and within the OECD Members, which are linked to many factors, including race, ethnicity, gender, differences in exposure to health risk factors, access to healthcare, and the unequal distribution of social, economic, environmental and other determinants of health;

● the pandemic disproportionately affected older adults, those with underlying health conditions, and groups that have been marginalised;

● the unprecedented impact of the pandemic on population mental health, with symptoms of anxiety and depression as much as doubling during the pandemic, adding to the high social and economic costs of mental ill-health;

● both mental and physical health are adversely affected by social exclusion and loneliness; and

● investment in health promotion and disease prevention can result in healthier populations and reduce health and care costs, and improve the fiscal sustainability of health systems.

WE COMMIT to:

● improve outcomes in the mental health of our populations and the performance of our mental healthcare systems, including community-based mental healthcare, prevention, and integration of mental health needs in public health and primary care, aiming to reduce unmet needs for mental healthcare services;

● reinvigorate previous commitments to place health promotion and prevention of disease at the centre of health systems, including addressing the social, economic, environmental and other determinants of ill-health and promoting health-in-all policies, with a particular emphasis on lifestyle factors in order to reduce levels of obesity, harmful levels of alcohol consumption, exposure to pollution, and move towards tobacco-, and nicotine-free societies, without prejudice to the use of evidence-based nicotine replacement tools[*], as well as improving healthy ageing;

● improve evidence-based cancer screening, diagnosis and treatment, and the systematic collection of cancer inequalities data;

● tackle gender inequalities in the delivery of health and care, and within the health and care workforce; and

● promote greater consideration and tailoring of care and medical products to specific sub-populations of patients, including gender-responsive care, based on racial and gender differences.

WE CALL on the OECD, through the Health Committee, and in collaboration with other relevant OECD committees, and other international organisations, to:

● develop a coordinated Government initiative to mitigate the risks of digitalisation and social media platforms on mental health, particularly on the mental health of children and young people;

● assist in our efforts to tackle gender inequalities by developing data and analysis on gender inequalities in health systems, experiences and outcomes, and extend this work to help us tackle broader inequalities, and unmet need, by supporting data collection, disaggregated by gender, and focusing analysis on other inequalities; and

● launch a programme of work to help us move towards tobacco-, and nicotine-free societies, without prejudice to the use of evidence-based nicotine replacement tools.

Better Health Systems Intelligence

WE ACKNOWLEDGE:

● the increasing use of digital health services by patients;

● the need to compare progress towards making our health systems more resilient;

● the crucial importance of trust both in the management of health emergencies and in the delivery of routine healthcare, in particular in light of the introduction of new digital technologies, such as artificial intelligence (AI) including generative AI, in health systems;

● the need to strengthen cyber security and data privacy; and

● the importance of adopting a sector-specific approach to developing appropriate policies around the use of artificial intelligence in health, while taking into account multi-sectoral contexts, such that the benefits in areas such as health system resilience can be realised fully.

WE COMMIT to:

● improve the performance, people-centredness, and resilience of our health systems, through mutual learning and continuous improvement;

● strengthen trust in the use of AI and digital technologies, including improving health data governance globally by strengthening the dissemination and uptake, in particular in other international fora, of the OECD Recommendation on Health Data Governance; and improving health literacy; and

● use artificial intelligence in health systems in a way that is responsible, people-centred and sensitive to ethical concerns; and identify areas where health-specific regulation may be needed.

WE CALL on the OECD, through the Health Committee, and in collaboration with other relevant OECD committees, and other international organisations, to:

● assess the performance, resilience, and people-centredness of our health systems using relevant indicators, including new and innovative indicators and analyses where appropriate, and also use the framework to measure, assess and address the most pressing health challenges of our time;

● assess and make policy recommendations on the implications of using artificial intelligence in health systems;

● develop a sector-specific framework for AI in health, that is aligned with existing multi-sectorial frameworks, to encourage responsible use of artificial intelligence, exploiting cross-sectoral synergies to promote fairness, transparency and accountability, while ensuring consistency across policy domains; and

● undertake further work on health including work to improve health data; improving pharmaceutical markets; strengthening patient safety; non-communicable disease; and fiscal sustainability, to provide new insights on how to approach the next generation of health reforms to strengthen health system resilience, make systems more people-centred, improve the health of all of our populations and make the best use of health data to maximise the contribution of health systems to productivity and more inclusive economies as well as environmental sustainability, and to help address common challenges.