Editorial: Strengthening Rehabilitation in Europe.

In light of population ageing, a rise in the prevalence of many chronic health problems, and the potential for long-term consequences of the COVID-19 pandemic, the World Health Organization's “Rehabilitation 2030” Call for Action has initiated a world-wide effort to recognize the increasingly importance of integrating rehabilitation services, across the continuum of health care, into national health systems [1]. Recognizing rehabilitation as a key and increasingly important health strategy [2], the WHO is well aware of the need to make the economic case for rehabilitation, to clearly identity potential beneficiaries of rehabilitation [3], and as a general matter to set the stage for a rehabilitation implementation action strategy.

In Europe, as elsewhere, a strong case can be made for putting rehabilitation on a firm and sustainable footing within health systems in order to meet anticipated, increasing population needs. Rehabilitation is the health strategy that has the primary objective to optimize functioning for individuals with chronic health conditions, reducing the burden of disease, and preventing disability [4]. Securing the place of rehabilitation in health systems is clearly an issue that is best handled by adopting a systems approach. Such an approach reveals the need for close linkage and integration with related health systems challenges and on-going issues, such as dealing with multimorbidity in the ageing population, the lived experience of having a chronic condition, disease, the need for integrative care and continuity of care, person-centered care, and the benefits of personalized care.

To meet the challenges that Europe will face addressing WHO's call for action, crucial preliminary steps need to be taken. In a set of papers in this issue, we offer three recent studies that explore the most salient of these preliminary steps. In the first paper, a logic framework is presented to evaluate rehabilitation services and serve as a guide for countries to monitor and evaluate progress in strengthening rehabilitation in national health systems [5]. This logic model, and recommended indicators, can service as a starting point for customized monitoring and evaluation approaches.

The second paper sets out a policy action framework to guide policy action for rehabilitation in European countries [6]. This framework draws upon and combines previous global frameworks while incorporating contemporary European health and disability strategies, new disease specific tools, evidence-informed recommendations and aligns with the principles and objectives of the European strategy Health 2020. The third paper describes a case study of the implementation of an essential step in the application of the learning health system approach for strengthening rehabilitation, namely health system issue prioritization [7]. Arguably, of all health strategies, rehabilitation is the one most dependent on the application of the learning health system approach in order to be fully integrated into national health system. This paper presents, as a case in point, a rehabilitation service identification and prioritization exercise conducted in Switzerland using a stakeholder dialogue methodology.

Taken together these three studies helps to clarify the pathway of health systems reform that the WHO Rehabilitation 2030 call for action anticipates in order to both raise the profile of rehabilitation as the key health strategy for the 21st century [8], but also take essential implementation steps to ensure that the full benefit of rehabilitation services can be realized across Europe in the decades to come.