Continuing controversy over the European Union’s entire financial framework for 2007-13 has alarmed the EU’s public health community, who consider it a direct threat to implementing effective public health measures across Europe.
The European Commission’s ambitious new public health and consumer protection strategy looks set to have its proposed budget almost halved from about €1.8bn (£1.2bn; $2.2bn) to less than €1bn. As a result, it may have to be totally rethought and rewritten. The strategy was drawn up after 18 months intensive consultation with many national and regional health authorities, universities, and citizens and more than 100 non-governmental health organisations.
"To say we are facing a crisis is to put it mildly," said MEP for London John Bowis at a conference in Brussels last week. The conference was convened by European Voice (a weekly newspaper covering European issues) to discuss healthcare policy in Europe and where EU action can "add value."
"There has never been a time of such uncertainty over the budget. Finance ministers must be persuaded that expenditure on health is central to the achievement of Europe’s targets for economic growth and competitiveness," said Joseph Figueras, research director of the European Observatory on Health. He drew attention to the commission’s 2005 publication The Contribution of Health to the Economy of the European Union (http://europa.eu.int/comm/health/ph_overview/Documents/health_economy_en.pdf): "Evidence of the link between health and wealth is strong and we have got to do a much better job of publicising it."
Key objectives of the commission’s new health programme include sharing best practice, disseminating information, and taking direct action to improve health promotion and disease prevention throughout the EU (http://europa.eu.int/comm/dgs/health_consumer/index_en.htm).
Interventions that reduce and compress the morbidity of Europe’s ageing populations should reduce healthcare costs, increase the productivity of the labour force, and enable more people to stay in work beyond the age of 65, the meeting heard.
Stepping up action to tackle inequalities in health and health service provision is another stated objective of the new programme. The enlargement of the EU from 10 to 25 member states, with Bulgaria, Croatia, Romania, and Turkey in the wings, is well recognised as presenting the community with considerable challenges (BMJ 2005;331:169-70). The decision to allow new member states to apply for EU structural funds to improve health care should help narrow the gap, said a spokesman from the commission.
Reducing proposed funds for pan-European agencies, notably the European Medicines Evaluation Agency, the European Food Safety Authority, and the new European Centre for Disease Prevention and Control in Stockholm, was highlighted as a serious potential problem.
"If our agencies are underfunded they can’t support policy development," said Mr Bowis. "Heads will roll if the avian flu pandemic hits Europe."
In the past, the commission has been criticised for focusing on disease based programmes rather than tackling the underlying determinants of health. A balance between the two was needed, agreed participants.
Willy Palm, director of the Association Internationale de la Mutualité advocated countering the "evaluation bypass" which allows new diagnostic tests, drugs, and devices to be used without adequate proof of "added value." He also called for EU-wide exploration of the variation in use of medicines, particularly antibiotics, and frequency of health interventions. EU recommendations should be introduced to curtail "over prescription and over consumption," he said.
Susanne Logstrup, director of the European Heart Network, called for an EU ban on smoking in all public and work places, raising and harmonising the tax on tobacco, and a ban on advertising unhealthy food to children. She welcomed news that Europe’s soft drink producers, including Coca Cola, have agreed voluntary measures to reduce selling and advertising to children in response to growing concern about rising rates of obesity (Financial Times 25 January). "I hope that other companies [that] market unhealthy foods to children will follow suit," she said.
Tamsin Rose, adviser to a Swedish public health agency, said that the EU should do more to mitigate the effects of alcoholism by introducing random breath testing and a ban on advertising and promotion of alcoholic drinks. Tony O’Sullivan, president elect of the International Diabetes Federation flagged up the fourfold gradient in mortality between north and south Europe and urged the commission to take action to harmonise disease management programmes for diabetes to reduce the high costs and burden on patients of suboptimal care.
Clive Needle, director of Euro HealthNet, got a third of the meeting’s participants to their feet to illustrate the fact that each year 27% of the adult population experience mental health problems. The cost of mental illness in terms of lost productivity and early retirement ranges between 3% and 4% of gross domestic product, he suggested. "Action to ensure all countries adopted effective strategies for mental health should be a priority," he said.
By the end of the meeting it was clear that the EU health community is not short of advice. However, what it needs is to harness a louder and more concerted voice to convince politicians and "the big lions in the commission" of the cost effectiveness of investing in public health, several speakers stressed.
A full transcript of the meeting is available at www.europeanvoice.com.