How prioritizing health can be a prescription for Romania’s prosperity

Better use of known interventions could help reduce Romania’s overall disease burden over the next two decades.
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As Romania emerges from the grip of the COVID-19 pandemic, the country has a unique opportunity to learn from the crisis and build a better future. We could take this moment to go beyond rebuilding society and the economy and work toward advancing health and prosperity.

There have been plenty of hard lessons learned. We have seen that underlying health issues can suddenly take a bigger toll, as people with preexisting health conditions are more likely to get seriously ill from COVID-19. We have experienced an unwelcome reminder that health and the economy are inextricably linked. And we have seen vulnerabilities exposed in our healthcare system.

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However, there have also been encouraging lessons: the rapid development of COVID-19 vaccines, the adoption of digital health tools, and companies’ implementation of fast operational changes to adapt to the pandemic all speak to the country’s ability to respond effectively in times of crisis.

Better health is not just a matter of peoples’ well-being—it promotes economic growth by expanding the labor force and by boosting productivity.

The pandemic has underscored the importance of long-term health trends that impact life expectancy in Romania and has shown us the value of a cohesive, overarching public strategy for healthcare, with policies carried over from one political administration to the next. Better health is not just a matter of peoples’ well-being—it promotes economic growth by expanding the labor force and by boosting productivity.

In recent decades, Romania has taken some steps to improve the health and life expectancy of its population, but we see now that we have not yet put public health and improving the well-being of citizens at the top of the agenda.

We need a national health strategy focused on prevention rather than treatment, one that is built on the stable pillars of policies that address tobacco use and misuse of alcohol, diet and physical activity, vaccination, health screenings, as well as policies on road control and working conditions. Ensuring such a systematic approach with cross-party support would help Romania address life-expectancy issues and their economic impact head-on.

What is Romania’s demographic landscape?

The Romanian population is aging and shrinking, with a median age—43 years—that has increased by nearly ten years since 2000 (Exhibit 1). While the birth rate has decreased over time, the death rate has increased rapidly, leading Romania to record one of the highest death rates in Central and Eastern Europe. The main cause is cardiovascular disease, which accounts for 57 percent of deaths among Romanians.

The median age of Romanians has increased by nearly ten years in the past  two decades.
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There are, however, public-health policies that proved to be beneficial in tackling cardiovascular disease, which could have a positive impact in Romania. According to the World Health Organization (WHO), most cardiovascular diseases can be addressed by raising awareness and encouraging lifestyle changes, such as limiting the use of tobacco and the harmful use of alcohol and reducing obesity with a healthier diet and increased physical activity. 1 Romania could benefit from committing to targets similar to what WHO uses to reduce the occurrence of deaths due to cardiovascular disease. In its campaign to reduce the avoidable noncommunicable disease burden, WHO has committed to delivering two targets directly related to cardiovascular health: first, reducing the global prevalence of elevated blood pressure by 25 percent between 2010 and 2025, and second, ensuring that at least half of eligible people receive drug therapy and counseling to prevent heart attacks and strokes by 2025.

Total years lost to poor health, including both morbidity and mortality, disproportionately belong to people of working age in Romania (about 63 percent), posing additional risks to the economic health of the country (Exhibit 2). Further aggravating that is Romania’s high rate of traffic fatalities, an avoidable cause of death. In 2019, Romania had the highest number of traffic fatalities per capita in the European Union. 2 The problem disproportionately impacts the working population as compared to EU averages, with Romanians aged 50 to 64 years overrepresented in such deaths.

The majority of years lost to poor health in Romania are within the working-age population, accounting for two-thirds of the total.
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What is Romania’s health-improvement opportunity?

Research by the McKinsey Global Institute (MGI) shows that investing in health is a powerful way to both rebuild in the wake of the pandemic and learn from the crisis while growing stronger as a country. Here is why:

MGI researched what it would take to make the Romanian population healthier and then calculated the potential social and economic benefits. The findings show that by using known interventions more widely, such as administering vaccinations, adopting healthier behaviors, expanding access to primary care, and improving adherence to prescribed medications, the country’s overall disease burden could be reduced by 36 percent over the next two decades (Exhibit 3). Further, the disease burden of cardiovascular illness could drop even more—by 39 percent. A detailed, actionable national health strategy, including policies on reducing cardiovascular disease, could help address this burden.

The potential to reduce the disease burden varies significantly by disease type; chronic conditions are more challenging to tackle.
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How can Romania achieve the health-improvement opportunity?

Prevention is key to reducing the disease burden and can best be addressed through a national health strategy. MGI research indicates that 70 percent of the health benefits of such a strategy would accrue from preventive and lifestyle interventions, including vaccines, as well as from environmental, social, and behavioral factors, such as education for behavioral change and smoking cessation (Exhibit 4).

Seventy percent of the health-improvement potential for Romania could come from preventive and lifestyle interventions.
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Preventing cardiovascular diseases through preventive medicines for heart disease, stroke, and diabetes are among the most effective measures in this regard, contributing 15 percent to the overall potential reduction of the disease burden. Other interventions that could make a difference include those targeting cancers and digestive diseases.

By modeling healthcare policies to other EU member states, Romania could take a number of steps to tackle the leading causes of death in the country and increase life expectancy.

The remaining 30 percent of the benefits could come from therapeutic interventions, such as basic and specialist surgeries. Such approaches often combine education with psychological support, physical therapy, and medicines.

By modeling healthcare policies to other EU member states, Romania could take a number of steps to tackle the leading causes of death in the country and increase life expectancy through a comprehensive national strategy.

First, reducing the number of tobacco-related diseases could be a priority. Key interventions could include awareness and media campaigns, comprehensive bans on tobacco advertising, assistance programs for quitting smoking, and higher taxes on cigarettes. 3 Second, a national strategy to promote a healthier lifestyle through physical activity and better diet could have an impact on the prevalence of cardiovascular diseases and therefore benefit the national life expectancy. Third, the strategy could address the country’s high road-death rate by including a set of road-control-management policies through better speed-legislation enforcement and improved infrastructure. Finally, a detailed, actionable national action plan for reducing overuse of alcohol could also help curb a major cause of, and contributor to, poor health.

What is the size of the economic prize?

Romania has a chance to reap economic rewards as healthier people prosper, employment expands, and productivity increases. MGI estimates that better health could add $26 billion to the Romanian economy by 2040, a 9.0 percent boost to GDP that translates into 0.4 percent faster growth every year. Almost half of the potential economic benefit could come from expanded participation, a third could come from fewer health conditions, while the remainder could come from increased labor productivity and fewer early deaths.

These gains could help Romania not only recover from the impact of the COVID-19 pandemic but also counter the longer-term demographic headwinds arising from an aging population.

And there is a further advantage: focusing on proven health interventions could deliver an incremental benefit of $1.70 for each dollar invested for the Romanian economy. MGI’s research found that implementation costs could be more than offset by productivity gains in healthcare delivery.

Would innovation play a role?

While known interventions could make a significant impact on Romania’s disease burden, there remains a need for innovation, particularly to combat diseases that lack cures or scalable and sustainable treatments. In its research, MGl identified more than 150 innovations that may reach the market by 2040, including innovative vaccines, such as a cholesterol-lowering inoculation, and digital therapeutics such as an AI-powered app to enable behavior change (Exhibit 5). Innovations in the current pipeline could further reduce the disease burden by 6 to 10 percent by 2040.

Innovations in the visible pipeline that may enter the market by 2040 could reduce Romania’s disease burden by 6 to 10 percent.
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Next steps

Orchestrating a national health transformation is challenging, as past reform efforts have demonstrated, but public-health responses to the COVID-19 crisis have shown that rapid change is possible when the situation demands it. By creating a national health strategy, Romania could further build on these changes and make health a priority for all—individuals, companies, and governments.

The research conducted by MGl leaves us strongly convinced that improving health by using existing tools could be a socioeconomic game changer. Few investments enhance well-being and reduce inequity so effectively, while also delivering such high economic returns.

The notion that health can be an investment for economic return rather than merely a cost has largely been absent from policy discussions in recent years. Confronting the pandemic gives us a unique opportunity to recognize this fact and take the steps needed to advance both broad-based health and prosperity. Romania cannot afford to miss it.

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