One of the lasting outcomes of the Invest4Health project is the publication of a new White Paper addressing one of the biggest challenges facing health and care innovation in Europe: how to move successful projects beyond the pilot phase towards sustainable implementation and scale-up.
The White Paper, Hard but not Impossible: Scaling What Works in Health Promotion, Disease Prevention and Integrated Health and Care through the “Missing Middle”, was developed by a joint Working Group bringing together Invest4Health and Work Package 9 of the European Partnership on Transforming Health and Care Systems (THCS), with additional contributions from the AAL Programme.
Although Europe continues to invest significantly in research and innovation, many promising solutions struggle to become part of routine practice. Between the successful completion of a project and large-scale implementation lies what the authors describe as the “missing middle”. It is a phase where many innovations lose momentum due to fragmented governance, insufficient financing, limited collaboration, and a lack of implementation support.
Building on the experience gained through the Invest4Health testbeds, the Smart Capacitating Investment (SCI) approach, and discussions with European partners, the White Paper analyses the structural barriers that hinder scaling and proposes practical recommendations to overcome them. Rather than focusing solely on financing, it highlights the importance of strengthening governance, regional ecosystems, stakeholder collaboration, capacity building, and long-term investment approaches that enable health promotion and disease prevention initiatives to become sustainable.
The publication is intended for policymakers, regional and local authorities, innovators, researchers, funding organisations, and all stakeholders interested in creating stronger health ecosystems and accelerating the implementation of effective prevention initiatives.
The White Paper also demonstrates the value of collaboration between European projects and partnerships. By bringing together the complementary expertise of Invest4Health, THCS WP9, and the AAL Programme, it provides a broader perspective on the conditions needed to transform successful innovation into lasting impact.
The White Paper is available together with other Invest4Health resources, including scientific publications, reports, podcasts, Information Briefs, and the SCI Package, on the project website.