Securing Europe’s health: An ever-widening agenda

The EU aspires to a smart, sustainable and inclusive economy, for which, a population in good health is a prerequisite.

The breadth of discussions about securing health in Europe was spelled out just days ago, when the European Commission and the World Health Organization’s (WHO) European office announced a scaling-up of their cooperation on public health. Health and Food Safety Commissioner Vytenis Andriukaitis, and WHO’s European Director Zsuzsanna Jakab, committed themselves to closer work not just on health security, but also on innovation, health information, health inequalities, health systems, and chronic diseases.

“Contemporary public health challenges are complex and interlinked,” they said, and a proper response requires “coherence” between different sectoral policies. The list they cited of “relevant policies” was extensive: it covered research, humanitarian aid and development cooperation, foreign affairs, employment, food, energy, housing, social, education, industrial, trade, economic and health policies.

WHO Europe already has a Health 2020 strategy that emphasizes political, professional and civil society engagement to improve health and reduce health inequalities, within what it calls “a whole-of-society and whole-of-government approach.”

The EU also aspires to a health-in-all-policies principle reflected in its own health strategy, Together for Health, which is part of the overall Europe 2020 strategy that aims to turn the EU into a smart, sustainable and inclusive economy promoting growth for all — for which, a population in good health is considered a prerequisite.

Complex integration

In addition, health makes numerous appearances throughout the EU treaty, in sections dealing with the
internal market, environment, consumer protection, the safety of workers, development policy, and research. Accordingly, the advocates of health in all policies want health concerns better integrated into the policymaking process, whether the specific topic is social security schemes, trade, international relations, agriculture, education, taxation or ICT.

This broader approach is reflected elsewhere. In mid-September, the United Nations General Assembly adopted a “2030 agenda for sustainable development” that underlines the need for governments to adjust their social, economic and development policies if they are to give proper priority to securing health for all.

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The Luxembourg presidency of the Council of Ministers sees securing health in Europe primarily as “putting the patient and innovation at the center of discussions while ensuring sustainable health care systems.” A senior presidency official told POLITICO: “Securing health means indeed assuring universal health coverage, i.e. access to medicines thus improving health and reducing inequalities.”

Sabine Oberhauser, Austria’s health minister, endorses the approach: Only a solidarity-based health system within a well-functioning social security system will ensure comprehensive, high quality care accessible for all, she says, welcoming broad agendas stretching from sustainability of health systems to how to provide medical care for refugees and migrants.

The scope of “securing health in Europe” has become so wide-ranging that this year’s European health forum at Gastein, at the end of September, is brandishing the phrase as a banner for its program — into which it has incorporated elements as diverse as health system performance, pricing of medicines, and European aid for foreign development.

Other items that feature prominently on the Gastein program include ensuring that social systems function well and that the economy is resilient. “Public health security remains high on the agenda, but effective health systems also need to engage with issues that lie beyond the health sector,” says Professor Helmut Brand of Maastricht University, who chairs the organizing committee.

But not everyone is impressed with Europe’s performance so far. Nina Renshaw, Secretary- General at the European Public Health Alliance, says the continent is still “nowhere near” implementing health in all policies. Until that principle influences the European semester process of budgetary coordination, or trade, migration, agriculture, or foreign policy, it is going to be “difficult to secure public health,” she says.

Ilaria Passarani, head of health affairs at Europe’s consumer federation, BEUC, sees an inconsistency in EU activities. Although the growing common challenges are leading to signs of readiness to collaborate more closely among the EU institutions and member states, she says that at the same time they are “stuck on important legislative measures — notably on medical devices,” and are “shying away from taking action on important public health issues” such as making information about ingredients mandatory for all alcoholic beverages in order to combat obesity.

‘A health union’

Passarani says the way to secure health for Europeans is to create a health union, along the lines of the energy union strategy adopted by the Commission earlier this year. Like the energy union, it should have more transparency — in concrete terms over the performance of hospitals, pricing decisions, and clinical trials — and better information for consumers — on health and on treatment options.

Magdalena de Azero, the head of industry association Vaccines Europe, also sees the need for more political leadership — but with a focus on wider immunisation programs. Right now, she says, “hesitancy and complacency towards vaccine-preventable diseases result in recurring costly outbreaks that can be prevented.”

And at the European Federation of Pharmaceutical Industries Associations (EFPIA), Richard Bergström questions the terminology of securing health, and reflects on alternative interpretations of the
concept. For him, securing health in Europe might equally mean shielding health care and public health the next time a financial crisis brings on a period of austerity. Or it might mean — by analogy to pension reform — moving from today’s financing models so as to secure the money to pay for future health care.

Or again it might mean investing in countermeasures — to tackle known threats currently without a known solution, such as anti-microbial resistance or Ebola, or to confront unknown unknowns. It could even be seen as the start of a radical new era of public health, in which the entire population is continually and individually considered, using big data in monitoring or making predictions about healthy citizens that are at risk of becoming patients.