AbstractWelfare is a rather vague term whose meaning depends on ideology, values and judgments. Material resources are just means to enhance people's well-being, but growth of the Gross Domestic Production is still the standard measure of the success of a society. Fortunately, recent advances in measuring social performance include health, education and other social outcomes. Because "what we measure affects what we do" it is hoped that social policies will change. The movement Health in all policies and its associated Health Impact Assessment methodology will contribute to it. The task consists of designing transversal policies that consider health and other welfare goals, the short term and long-term implications and intergenerational redistributions of resources. As long as marginal productivity on health outside the healthcare system is higher than inside it, efficiency needs cross-sectoral policies. And fairness needs them even more, because in order to reduce social inequalities in health, a wide social and political response is needed. Unless we reduce the well-documented inefficiencies in our current health care systems the welfare states will fail to consolidate and the overall economic wellbeing could be in serious trouble. In this article we sketched some policy solutions such as pricing according to net benefits of innovation and public encouragement of radical innovation besides the small type incremental and market-led innovation. We proposed an independent agency, the National Institute for Welfare Enhancement to guarantee long term fair and efficient social policies in which health plays a central role.