Improving estimates of spending on prevention and public health in the European Union

Investing in health promotion and disease prevention is essential for improving population health and strengthening the resilience of health systems to emerging threats. Yet available data indicate that prevention accounts for only around 3% of total health expenditure across the European Union. This low share has attracted considerable policy attention but also partly reflects limitations in available data. Countries often struggle to identify and allocate preventive expenditure, particularly when activities span institutions or are embedded within broader health programmes. This can lead to underreporting and limit international comparability. This working paper assesses the quality and completeness of countries’ reporting on health promotion and disease prevention and develops methods to quantify identified gaps. Initial results suggest that reported expenditure may underestimate preventive spending by around one-quarter, with the largest gaps in healthy condition monitoring programmes and epidemiological surveillance. The paper also explores the scope for additional granularity for policy purposes by identifying expenditure targeted at particular risk factors, population groups and diseases. Most feasible seems disaggregating immunisation spending by type of vaccine and identifying the costs of individual cancer screening programmes. On the other hand, granular reporting of collective activities such as health promotion and epidemiological surveillance is more challenging for countries because aggregate programme information is frequently lacking in detail making attribution to specific public health activities more difficult.