Co-benefits of health: from evidence to governance, politics and advocacy

From the foundational texts of public health, like Alma-Ata’s call for ‘Health for All’ and Ottawa’s Charter for Health Promotion, it has been clear that public health is everyone’s business. These landmark declarations recognized that health extends far beyond healthcare systems, demanding action across all sectors of society. Health represents a common good fundamental to Europe’s security, prosperity and democratic resilience. Yet recent crises, from the pandemic to geopolitical instabilities, have exposed both the profound interdependence between health and other policy domains and the persistent fragility of governance arrangements meant to operationalize this foundational understanding. The contributions assembled in this special issue illuminate not merely the available policy options, but the critical strategic choices Europe confronts in bridging the enduring gap between public health principles and practice. The scientific foundation presented in this supplement is robust and convergent. Research on financing demonstrates that direct payments deepen inequalities and undermine universal health coverage, while prepayment and pooling mechanisms prove both more equitable and more efficient. Studies examining health and care professionals reveal structural gender inequalities and underscore the need for transformative rather than reproductive leadership models. Urban health research highlights the potential of integrated interventions—from low-emission zones to sustainable school meals—to generate climate, health, and social co-benefits. Analysis of waiting times shows not only health costs but productivity losses, connecting service backlogs to broader economic impacts. Individually, these findings are compelling. Collectively, they signal a fundamental shift from treating health as a sectoral cost centre towards recognizing it as a strategic investment aiming at cross-cutting returns. This broader shift is further illustrated by the contributions in this special issue, which show how public procurement can drive health innovation and system preparedness (SDG 9), how circular-economy approaches can reduce environmental impact in healthcare (SDG 13), how poverty influences access to healthcare (SDG 1), how waiting times for health services impact health and labor market outcomes (SDG 8), the interconnection between gender inequalities and the health workforce crisis (SDG 5), the shaping of integrated policies for urban health (SDG 11), the politics of integrating health systems and public programs (SDG 16), and the politics of health and the role of multi-level governance (SDG 17). Together, the articles illustrate the value of aligning public health action with broader economic, environmental, and social systems. They also demonstrate that governance, equity, and sustainability are inseparable from the technical performance of health systems. Translating evidence into impact demands governance structures capable of enabling intersectoral action. The distinction between Health in All Policies and Health for All Policies proves an instructive concept. The former emphasizes health consequences of decisions across sectors; the latter underscores broader benefits that accrue to other sectors from health investments. Yet for practitioners and stakeholders on the ground, these distinctions matter less than the practical question of implementation: how do we actually create the formal mechanisms needed to align incentives, allocate resources effectively, and ensure meaningful accountability across sectoral boundaries? Effective intersectoral collaboration rests fundamentally on shared understanding and culture. Capacity building programmes that build common language across sectors, from urban planning to education, from transport to finance, prove essential for translating policy aspirations into operational reality. When professionals from diverse backgrounds understand how their decisions have health outcomes and how health investments strengthen their own sectoral objectives, the foundation for genuine collaboration emerges. The politics of integration demand equal attention. Evidence from health and social service integration reveals that reforms can strengthen public institutional trust but only when designed to minimize administrative burden and prevent fragmentation. Similarly, addressing waiting times requires transparent and equitable prioritization frameworks, supported by robust workforce planning and capacity development. Reforms never occur without political will. Health policies invariably create beneficiaries and bear costs, with sustainability contingent upon building broad-based coalitions of support. In an era of polycrisis, where health, climate, economic, and geopolitical challenges intersect and amplify each other, the imperative for collective action becomes even more pronounced. This context transforms public health from a primarily social concern into a security imperative. Resilience, preparedness, and security now dominate geopolitical agendas, and public health sits at their intersection. A population’s health determines its capacity to withstand shocks, from pandemics to supply chain disruptions. Health systems’ resilience becomes national resilience. The ability to respond rapidly to health emergencies translates directly into economic stability and social cohesion. Yet community resilience rests not merely on emergency response capacity, but on the everyday foundations of health promotion and prevention, interventions that strengthen population health upstream, long before crises emerge. These preventive approaches represent significant value-added components of health systems, yet remain persistently under-recognized in policy discourse focused on treatment and crisis management. When framed in these terms, public health investments become matters of strategic sovereignty, social solidarity, and whole-of-society resilience. Stakeholder engagement must therefore transcend traditional boundaries, but also deepen understanding. Municipal leaders may embrace active transport for its visible benefits in air quality, mobility, and social cohesion, yet without considering distributional impacts, such policies can reinforce inequalities. Employers increasingly invest in wellbeing, but too often limit their efforts to recreational activities or tokenistic programmes, overlooking the structural determinants of workplace health, equity, and inclusion. Educators know that health matters for learning, but without grasping the psychosocial and environmental complexity of issues such as childhood obesity, interventions can risk being ineffective or even harmful. What transforms these sectoral initiatives into true public health action is evidence: rigorous, evidence-based knowledge that explains complexity and helps align sectoral goals with population health and wellbeing. Public health offers this integrative value, enabling leaders across domains to become not just supporters, but credible champions of health as a common good. Civil society organizations and professional associations prove indispensable in this regard. They amplify lived experiences, maintain health prominence on political agendas, and facilitate the transformation of technical debates into shared social priorities. In times of crisis, these networks become critical infrastructure for democratic resilience, ensuring that public health remains a unifying rather than divisive force. Advocacy, therefore, becomes not an auxiliary function but a structural component of effective governance, one that builds the social solidarity necessary to navigate complex, interconnected challenges. The contributions to this issue collectively suggest three strategic imperatives for Europe: Reframe health as investment, recognizing it as a driver of equity, prosperity, and institutional trust rather than merely a budgetary obligation. Institutionalize intersectoral governance, this occurs when collaboration is embedded in laws, structures, budgets, data systems, routines, and organizational culture. This allows joint work to continue even when leaders change. Strengthen collective action for public health, building broad coalitions through meaningful stakeholder engagement, ensuring that diverse sectors and civil society unite in defending and advancing public health in an era of intersecting challenges. Health as a common good requires more than resilient systems; it demands embedding public health across the whole of government and society. The evidence is clear that when health is placed at the centre of decision-making, the co-benefits extend far beyond health outcomes: stronger economies, fairer societies, more sustainable environments, and more resilient democracies. The task ahead is to ensure that these insights are not only documented but institutionally and politically embedded, so that public health fulfils its role as Europe’s shared value and collective strength. Conflict of interest: None declared. None declared.

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