Willum Þór: The question remains if our healthcare system is sustainable

At the beginning of the year, Iceland assumed the Presidency of the Nordic Council of Ministers. This intergovernmental organisation established in 1971 is the Nordic frontrunner in promotion of healthcare innovations, health data exchange, healthcare research. The NCM ensures collaboration between all major stakeholders in the Nordic healthcare system. In the interview given to CIFS.HEATLH Editor, Willum Þór, Iceland’s Health Minister elaborates on his vision for future health in the Nordic region, the Nordic strengths, Iceland’s plans for the Presidency with regards to innovations in healthcare, and the coming collaboration with Copenhagen Institute for Futures Studies.

Iceland took over the Presidency of the Nordic Council of Ministers on January 1, 2023, with the headline “The Nordic Region – A Force for Peace”, a theme more relevant than ever. What is now most relevant in the health area, in your view?

Willum Þór: Peace is a known prerequisite for health. When the headline was formed there was no war in Ukraine and hardly anyone could have imagined that it would be a reality at the beginning of Iceland's presidency in 2023. Our agenda for peace has always been an important message, but now message has become even more relevant and our responsibility to enforce it has become even greater. Therefore, on a grand scale, peace and economic stability is now the most relevant in the health area for both individuals and healthcare systems and we believe that unified Nordics can have an impact in conveying that message far beyond the size of the population in the region.

The vision of the Nordic Council as agreed upon in 2019 in Reykjavik has defined three strategic priorities: a green Nordic Region, a competitive Nordic Region, and a socially sustainable Nordic Region. Please elaborate on the health dimensions of each priority. What new opportunities do you see with regards to healthcare?

Willum Þór: These 3 strategic priorities are all interconnected. I believe the Vision 2030 is solid and tangible. A strategic setup that’s outcome can become a forceful tool to work with.

Green Nordic Region. The environment influences our quality of life, health and wellbeing. Greener society means improving the quality of our environment, promoting green transition and minimising harmful pollution. It is an integral in a holistic approach towards improving public health.

Competitive Nordic Region. Without a strong healthcare system, that works with the whole of the society to improve wider determinants of health and wellbeing, no society can truly be competitive. Therefore, the key elements in promoting competitiveness, knowledge, innovation, mobility and digital integration, are crucial in healthcare systems. They cannot be underestimated in health care prioritising and planning.

A Socially Sustainable Nordic Region. This third dimension of the Vision 2030 has direct linkages to healthcare. The Nordics, as a region with shared values and cultural exchange, can lead by example in the field of social sustainability. In the Nordics we think holistically about health. The biological, psychological, and social aspects of health are equally important. A strong social care system therefore needs to coexist and be integrated with a strong health care system.

What new approaches does Iceland plan for the Presidency, to promote innovations in health in the Nordic region?

Willum Þór: We have about a dozen of meetings and conferences during the presidency that are all related to promoting health and welfare in a broad context. They can all be linked to the vision and the strategic priorities of the Vision 2030. We work closely with the Ministry of Social Affairs in this process, which is vital for strengthening our modern welfare system. Making it more productive, innovative and focused on preventive healthcare. We face huge challenges in modern health care, such as increased cost and rapidly aging population. Therefore, promoting and supporting innovation and wide collaboration will play a major role in successfully navigating these challenges.

The Nordic Health 2030 initiative seeks to identify future visions to Nordic healthcare, and to address challenges on the way to these visions. What would be your vision of Nordic healthcare in 2030?

Willum Þór: My vision for Nordic healthcare is very much in line with the Vision 2030 for the Nordic Council in developing a green, competitive and a socially sustainable Nordic Region. When thinking of the healthcare system especially I would like to put emphasis on strengthening innovation. New ways of thinking and creativity.

The Nordics are fortunate in many ways in a global context. We have a unique opportunity to be forerunners in both innovation and its implementation in to health care systems. Nordic societies are among the healthiest in the world which is due to high quality care and a generally healthy lifestyle. A stable economy and high education levels make health promotion, modernisation and digitalisation of health care, more efficient. But the question remains if our system is sustainable. In my opinion the answer to that is no, unless we change our approach to health care quicker – together. Reliable and vast public data infrastructure is one of the Nordics strength and utilising our strengths is necessary for success. Throughout the Nordics, there is also a strong collaboration between the public and private sectors. The public’s trust in government is also important and it is relatively high in the Nordics compared to many other countries.

What are the Nordic strengths that allow to implement this vision? What are the weaknesses?

Willum Þór: The main Nordic strength that will allow us to implement this vision for the health care system is our strong infrastructure and skilled workforce. Social, economic and health indicators suggest that the Nordics are doing something right. Our doctors, nurses and other healthcare workers are among the most efficient and skilled in the world. The hospitals are first class, healthcare is affordable to everyone and access to healthcare is good – nobody is left behind. We take care of our all our citizens “from cradle to grave”. There are many countries that look to the Nordic countries in that perspective.

But, as mentioned before, we are facing demanding challenges. Longer lifespan is positive but with an aging population follows an increase in non-communicable diseases, disease burden and medication and treatment cost. The rise in non-communicable diseases has been notable in the Nordic countries, accounting for around 90% of disability-adjusted life years (DALYs) in 2016, according to the World Health Organization (WHO). Also, the birthrate has stagnated or fallen leaving a shrinking proportion of the population in active employment contributing to the public system through taxes. Risking the sustainability of our healthcare system. Therefore – fundamental reform of the system is necessary.

How do you see the collaboration between Iceland as the NCM President and CIFS on Nordic Health 2030?

Willum Þór: First, I share a lot the fundamental thinking that is presented in Nordic Health 2030 vision regarding the sustainable health model and the importance of preventative health. When I became a Minister of Health in 2020 I said ; “I am not a Minister of Sickness – I am a minister of Health”. The Nordic Health 2030 model illustrates how individuals, data and the system can enable the urgent transition from sick care to preventive health. Sustainability is also one of the pillars of the Vision 2030 that the Nordic Council of Ministers have agreed upon and therefore, the two visions align.

Secondly, we must inspire and support grassroot movements and organisations to encourage self-cultivation of preventive health to secure sustainability and the long-term prosperity of the Nordic population. We must positively reinforce, motivate and reward sustainable self-care while providing the necessary support to those who need it.

I am very enthusiastic about redefining the provi­sion of preventive health services to secure the long-term prosperity of the Nordic popu­lation. We must encourage systems that en­able individuals as points-of-care. The 5/5 aspiration is very ambitious and in a way provoking.

Thirdly, I have a special interest in the new data model as presented in the Nordic Health 2030 vision. Structuring data in a way that is both useful for individuals and professionals in real time is invaluable for health care systems and in fact, the whole of the society. I am sure Iceland can contribute substantially in Nordic collaboration regarding data driven decision making in health care. But that is fine – you have to set yourself ambitious goals and go for it all the way.

I welcome the collaboration between CIFS and the Icelandic Ministry of Health and I am confident that it will be a mutual gain for both parts – and of course – the 27 million people that live in the Nordics.