Europe, Let’s Do More for Health

The structure of the new Commission does matter and it should reflect people’s everyday concerns. This requires a Commission Vice-President for Sustainable Well-Being and a dedicated Health Commissioner echoing and implementing the health mandate in the Treaties, ensuring that health protection and promotion is guaranteed across all EU policies.

Why? The EU has a legally binding, horizontal health competence covering all, non-health policies, which are key for positive health outcomes: the protection of a high level of human health and well-being is entrenched in the Treaties of the European Union. Mainstreaming the promotion of human well-being via a Vice President responsible for coordinating public interest portfolios (e.g. social, environment, climate, transport, consumer protection, health, food) for human well-being would avoid conflict of interest with other portfolios, including economic interests. A Vice President is also essential to reflect the political priority of public interest areas, including health, key for implementing the Sustainable Development Goals. Under the responsibility of the Vice President for Sustainable Well-Being, a Health-specific Commissioner is necessary to ensure that health-specific aspects are not sidelined throughout the development and implementation of complex policy actions.

Prevention is better than cure: the EU should add value and a European dimension to Member States’ efforts on disease prevention and promoting healthy lifestyles. Drawing on the available evidence, and in collaboration with the Organisation for Economic Cooperation and Development and the World Health Organization (WHO), the EU should propose actions, including legislation and policies as appropriate which effectively address the main risk factors for non-communicable diseases (tobacco use, unhealthy diets, physical inactivity, alcohol consumption, and harmful environmental factors such as polluted air), to promote healthy lifestyles both today and in the long-term future, and to reduce the burden on European healthcare systems.

Why? Health is an area that delivers major returns on investments. Every euro invested in public health gives an average return of 14 euros to the economy. Every additional average year of life expectancy is worth a boost to GDP of up to 4%. Moreover, poor indoor air quality is responsible for the loss of 2 million healthy life years annually in the European Union. European level health challenges need European level counter-actions.

Following requests from Member States and the European Parliament, the EU should support the fight against non-communicable diseases (NCDs), the obesity epidemic, tackle mental health problems from an early age, and address the challenges related to an ageing population. We call for an EU Framework to tackle Non-communicable Diseases (NCDs) to meet the target SDG3.4 by creating health-promoting living environments and lifestyles, by identifying good practices for prevention and treatment of NCDs, which empower patients and put them at the centre of policy-making.

Why? The high and increasing prevalence of chronic, non-communicable – and largely preventable – conditions, along with demographic changes, put the sustainability of our healthcare systems at risk. 70-80% of healthcare budgets are spent on NCDs. This corresponds to €700 billion per annum in the European Union, with the figures projected to rise in the coming years. NCDs are the number one cause of preventable death in the EU. The World Economic Forum and the Harvard School of Public Health predict that NCDs will result in a cumulative loss in global economic output of $47 trillion, or 5% of GDP, by 2030, in high and upper-middle income countries, principally through heart disease, stroke, alcohol misuse and depression. They also represent the highest expenditure for health systems, not to mention the decrease in quality of life and productivity.

The EU should play a key role in monitoring and benchmarking health systems in Member States. It should drive ambitious yet achievable goals and set milestones to reduce health inequalities in Europe. EU Heads of State have committed to delivering the European Pillar of Social Rights as well as the SDG target for Universal Health Coverage (SDG3.8, achieve universal health coverage (UHC), including financial risk protection, access to quality essential health care services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all). Both aims should be actively supported by the European Semester recommendations.
Europe needs a robust next-generation health programme which also addresses cross-border issues by introducing innovative solutions for healthcare delivery including digital health; maintaining and further developing collaborative actions, such as the European Reference Networks, in ways that strengthen public health with adequate EU funding; as well as providing support to Member States in the form of expertise and exchange of data, evidence and good practice.

There are common Europe-wide health challenges where the EU can bring added value to complement national actions. Europe is not yet on track to meet SDG3.3. We call for increased and more closely coordinated efforts to fight communicable diseases. The EU should continue to invest in innovative community-based approaches to tackle cross-border diseases such as HIV/AIDS, tuberculosis (TB) and viral hepatitis and promote a rights-based approach to poverty-related diseases which affect mostly marginalised and disadvantaged groups. Furthermore, the EU should step up its regional response to poverty-related diseases and put in place political strategies to eliminate them, in particular HIV/AIDS, TB and Hepatitis, in Europe and within the neighbourhood, given the cross-border nature of the three diseases.

As regards antimicrobial resistance (AMR), the EU has recently issued its One Health Action Plan. However, this plan lacks concrete targets, so we call on the EU to set targets which are measurable and ambitious.

Another example is vaccination. We call for strengthened cooperation at EU level on vaccination policies, programmes and communication campaigns for equitable access to vaccines and to enhance public trust in evidence-based immunisation programmes, by ensuring the highest safety standards and sharing clear, independent and transparent information.

The EU can further explore further means to support Member States on the European dimension of accessibility, whilst respecting the principle of subsidiarity. Affordability of access to safe and effective prevention measures and treatment is essential.

Why? Bacteria and drug-resistant infections cannot be stopped by borders. The impact of widespread Antimicrobial Resistance (AMR), if we fail to act, is unimaginable: 10 million deaths globally every year by 2050. No single country can tackle this challenge alone, and even wealthier countries will not be immune.

Discussions about the need to improve vaccination coverage are intensifying throughout the EU. Alongside other factors, supply shortages and the decrease of public confidence in vaccination programmes are increasingly identified as barriers to immunisation. There is an urgent need for EU leadership to step up and launch a pan-European debate on this topic, involving all stakeholders, including patients, doctors and researchers, to ensure that EU vaccination policies protect both public health and its citizens.

Stimulating investment in health is beneficial to the European economy as a whole. 550,000 people of working age die from NCDs in the EU every year. This causes a largely avoidable loss to the EU economy of €115 billion per year, corresponding to 0.8% of GDP. Health is a positive economic driver in itself, raising productivity, labour market participation, wellbeing, happiness and social cohesion.

As a means to implement the European Pillar on Social Rights, the EU should drive patients’ and citizens’ empowerment. For now, the different dimensions of patient empowerment (health literacy, self-management, shared decision-making between patients and health professionals) are addressed through stand-alone projects and initiatives. We need a framework to advance on the strategic issue of citizen and patient empowerment in a coherent, meaningful way, with a mechanism to ensure meaningful engagement of civil society in the implementation of health in all policies.

Why? Health is first of all a human right, and the EU has a duty to ensure the highest standard of protection and promotion. In addition, an EU population fully engaged in preserving and promoting health will contribute to improving health outcomes and increasing well-being – a distinct treaty objective (TEU Article 3). An additional benefit is increased productivity. Health policy strategy should empower individuals and communities to take actions for their own health, foster equality in public health, promote inter-sectoral action to build healthy public policies and sustainable health systems, and societies where all actors are fulfilled human beings, and unmet needs are addressed in compliance with fundamental human rights.

All actions and policies must ensure a high level of human health protection. Health impact assessment (HIA) is an instrument which allows regulators to identify potential risks to health in proposals for policies and actions. We call on the EU to develop and routinely deploy a robust HIA methodology to respect Article 168 of the TFEU. In a first phase, the focus could be on research, environment, agriculture, trade, transport, urban planning and cohesion policy.

Why? Population health is a precondition for economic prosperity. In line with the EU Treaties, the EU has a duty to ensure that all policies and programmes make a positive contribution and do not harm public health or undermine health goals and commitments.

Health in Europe is inextricably linked to global health. The EU should show strong leadership on health at global level, including by adopting a coherent European Global Health Strategy.

Why? EU action to improve health in third countries is underpinned by the Treaty on the Functioning of the European Union. It states that the EU and Member States shall foster cooperation with third countries and the competent international organisations in the sphere of public health, and that a high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities. Yet the EU has yet to adopt a coherent Global Health Strategy to coordinate the DGs working on global health such as DG Santé, DG Devco, DG NEAR and DG Research. Indeed, the Communication on the EU’s role in Global Health predates the SDGs.

The EU has a responsibility within the global health agenda and has a leadership role to play, not only as a donor but as a policy influencer. Both the EU and all Member States have committed to
18 Policy brief implement the United Nations Sustainable Development Goals19. Policy coherence is needed between Trade, Climate Change and other UN level initiatives and the commitments Member States made within WHO. In addition, the EU is a leading health donor towards the Global South. Between 2007-2013, 3536.5 Million Euros of EU ODA went to health. Without a targeted approach, Universal Health Coverage (UHC) as a global goal will never be achieved. Ensuring coordination and coherence will position Europe as a Union of values, including on the right to health, which is also enshrined in the WHO Constitution. The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition. The health of all peoples is fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individuals and States20. Adopting a strong Global Health Strategy which brings together the work of key Commission DGs and ensures policy coherence across its work is an important step towards achieving the SDGs and the right to health for all.