Healthy Europe asked three Young Gasteiners what is necessary to heal Europe’s fractured social contract and about their vision for health and society for 2040.

Samvel Grigoryan (34) works as a public health consultant within the Council of Europe project “Protection of Human Rights in Biomedicine” in the Armenian capital Yerevan.

The social contract requires a shared understanding of the values, roles and responsibilities of individuals, communities and institutions. But what exactly do we mean by that? Is it a clear agreement? Or is a shared understanding always assumed but rarely verified? And this leads to another question, on a more profound level: Who is truly included in the word “we” here? Europe is geographically small, yet internally disconnected. In many parts of Western Europe, awareness of Eastern European countries and their realities remains limited. This imbalance raises a concern: Is the social contract truly fractured, or was it never fully inclusive to begin with? The pandemic and recent conflicts may not have broken it, but they did reveal long-standing gaps that we have failed to address. The European Union includes 27 countries, whereas the European continent is home to many more. When we speak of rethinking solidarity in health, do we genuinely extend that vision to all parts of Europe? Healing requires more than policy. It requires listening, mutual recognition and inclusive dialogue. My vision for 2040 is a Europe that moves beyond structural boundaries and selective engagement, towards a truly social, fair and healthy union. One built not only on shared values, but on a commitment to understand, include and care for all who call Europe home.

Benedetta Baldini (32) is Senior Policy Advisor at the European Social Insurance Platform – ESIP in Brussels.

The social contract is a pact of mutual responsibility: all stakeholders, from decision-makers to businesses, have an essential role to play in promoting societal cohesion, wellbeing and economic prosperity. In the health sector, this translates into collaboration among patients, providers, policymakers and pharmaceutical companies to deliver equitable, high-quality and sustainable solutions. Today, this contract is under strain. Pharmaceutical companies seek high prices, while Health Technology Assessment bodies and payers demand solid evidence for responsible decision-making. These conflicting priorities often lead to a fragmented system where access to therapeutics and health technologies is delayed, at the risk of eroding public trust. To heal these fractures, early and transparent dialogue between the pharmaceutical industry and public health authorities is crucial, in order to balance innovation with the expected quality and affordability. All parties must commit to patient-centred, demand-driven innovation that prioritises affordable access and strong clinical outcomes. A level playing field between public and private interests must be ensured, with robust checks to guarantee accountability and avoid excessive power imbalances. Accordingly, a renewed social contract is achievable only if all parties take ownership of their roles and responsibilities over siloed interests. My vision for 2040 is a Europe where prevention and affordable healthcare form the foundation of both a resilient society and a productive and competitive economy, with health and social protection anchoring welfare systems, as well as Europe’s growth and production model.

Tobias Fragner (29) is a postgraduate researcher at the Centre for Public Health at the Medical University of Vienna.

The social contract promises societal cohesion through systems like health and social care. Yet for Europe’s most marginalised communities – including people experiencing homelessness, migration, mental health conditions, or an intersection of such social issues or disadvantages – this promise remains unfulfilled. They are deterred from seeking care by overwhelming barriers, such as fragmented and inflexible health systems, services having basic requirements they cannot meet (e.g. a fixed address), and stigmatisation they encounter from healthcare professionals and society as a whole. The consequences of this exclusion are severe, with health issues often going unaddressed until they become acute, leading to a heavy reliance on emergency services rather than preventative primary care. Health conditions often only diagnosed at an advanced stage contribute to significant healthcare disparities in these communities. Fulfilling the promise of the social contract therefore requires acknowledging the critical role of structural determinants of health. This demands a shift from a one-size-fits-all model towards unconditionally inclusive and integrated healthcare, focusing on tailored, person-centred care delivered through proactive outreach. This framework must be built on strong collaboration between the health and social sectors, and on a foundation of trust between providers and those seeking help from them.