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European Commissioner for Health and Consumer Protection

Future priorities in EU health policies

European Health Forum on "Common Challenges for Health and Care"

Gastein, 26 September 2002

Dr. Leiner, Ladies and Gentlemen,

It is a great pleasure for me to return to Gastein. This year's theme 'Common challenges for health and care' brings us to the very core of the debate on the future direction of European health policy.

As we are at a crossroads in the history of health at european level, I appreciate having this opportunity to address these issues.

Today, I would like to explore how I intend to meet the 'common challenges for health and care' during the remainder of my term in office as Commissioner for Health and Consumer Protection.

We are at a crossroads in Europe today. Our Institutions and the Convention are discussing the future of our continent. Perhaps all this would be clearer to our citizens - if we obsessed a little less about 'Europe', and a little more about 'Europeans'.

Health is a preoccupation of Europeans. We need to get it right on health, if we are to get it right on a new Europe that means something to our citizens. The ongoing reunification of Europe is also a time of political renewal for our Union.

But renewal requires connection.

Connection means citizens believing that this Europe, is their Europe. That it exists to serve their needs, to protect their interests, to promote their values.

That far from being a threat to their cherished traditions, systems and values - in fact Europe empowers them to greater choice. That in short Europe is good for their health!

Indeed our citizens are telling us that the European Union should not only be preoccupied with better markets, predictable rules, stable international relations, sustainable jobs and public finances.

They are telling us that there can be no Europe, without a Europe of Health.

Because they know that decisions affecting their own health, and the future direction of their cherished health systems, are increasingly influenced by events at EU and global level. And they expect their Europe to put their health at the centre of its agenda.

But before I begin to set out the journey ahead, I wanted to recall that as people with a professional interest in health, we must not forget the bigger picture. Health is a testcase for Europe. Whether we speak of subsidiarity, transparency, rights, security, economic sustainability or quality of life health is at the centre of the action.

In launching this debate about what should or should not be involved in creating a 'Europe of Health', I am fully aware that this is only the beginning of the story.

Indeed our new public health framework programme provides us with a vehicle of discovery. But now we need to discuss the journey ahead and to agree on some clear policy destinations.

But it is a good time to begin. In our soon-to-be-enlarged EU we will face major health challenges in relation to:

  • combating communicable diseases;

  • ensuring the safety of sensitive products, such as foodstuffs or blood;

  • and more generally, the functioning of health systems within the single market.

Enlargement is a priority for action and will occupy a lot of our energy in the time ahead. Furthermore, enlargement is taking place at a time when all European countries are having to adapt to the challenges posed by globalisation. In this global dispensation, we are all « economies in transition ».

I am convinced that as European integration and globalisation progress, this process of adaptation cannot take place solely at national level. There must be a role for the Community to influence further, health and health systems in Europe.

In my opinion, this is a key argument for giving greater priority to the health and social affairs agenda in Europe.

Let me link this to a second line of thought: our responsibility to protect our citizens against health threats. Quite simply, this can no longer be achieved by the health authorities in Member States acting on their own.

Health Security is a good example. In today's world, the days when quarantine could act as an effective defence of a state against communicable diseases are well and truly over. We need to work together in new ways to meet these new challenges.

Of course, we do need to be much clearer about the division of work between the European Community and the Member States and also between what the Community can and should do as part of its specific powers in health, and as part of its other competences.

The new public health programme, which begins next January, signals a clear reorientation of our approach. We are moving from being a project-driven fund, to being a policy-driven programme.

We are moving away from a multitude of small projects towards broad, horizontal and sustainable actions, which reflect our policy priorities.

We shall be preparing a solid basis for policy development by creating a large-scale system of health information.

We shall be investing in finding ways to respond effectively to health threats.

And, by influencing the determinants of health, we shall act to tackle the major burdens of disease.

The programme's three 'strands' of action are of course only organising principles and not ends in themselves. They are tools to develop work to support and underpin our health policy.

The initial challenge is to ensure that the new programme is properly focused and yields maximum value for money.

But we need to take the process of policy reflection further. Early next year, I intend to publish a Communication on how Community health policy should develop to meet the challenges we face. This document will help to define its goals, objectives, and its priorities.

Without such clearly defined priorities, we face the danger of simply adding another item to a long shopping list. Setting priorities also means not getting involved in certain areas. Inevitably this means that we have to concentrate our resources on our priorities.

Decisions on priorities should be transparent, based on clear principles, and on as wide a consensus as possible. Without prejudicing what our communication will say, I would like to set out here today, some key areas on which I intend to concentrate.

These are all linked to one central goal: to create a Europe of Health relevant, tangible and visible to our citizens.

First, the EU must act to protect citizens against health threats. We already have in place a Community network on communicable diseases, and a number of activities are under way on bioterrorism.

But I am concerned that we are by no means fully prepared for epidemics of major communicable diseases, and other serious health threats, which require a rapid and co-ordinated reaction. We lack fully effective and co-ordinated surveillance and response capacities.

In view of this, we have committed ourselves to creating a European Centre for Disease Control by 2005. This will bring together the expertise in Member States and will act as a reference and co-ordination point both in routine and in crisis situations.

A second priority for me is to see real progress in improving co-operation between health systems across Europe.

While I do not believe that there will ever be massive movements of patients across Europe, there are cases where citizens would like to have access to health care in other Member States. This is true for border regions, for example, or where patients wish to seek treatment at a specialist centre.

There is also the issue of sharing spare capacity to cope with the pressures on some of our health systems.

If European health systems can find ways of intensifying co-operation, this can bring concrete benefits to patients, to health professionals and health authorities. Possibilities for action will be discussed in the high level process of reflection on patient mobility and health care developments, which I am launching with health ministers.

But in advance of the outcome of that process, let me ask some simple questions:

  • How can we find ways of bringing the advantages of European integration to the health field?

  • How can we respond to the growing expectations of citizens that their healthcare will match the best that they can see being provided elsewhere in Europe?

  • How do we justify sending patients to hospitals outside Europe, when specialist care capacity is available next door, in another Member State?

  • Does it not make sense to use spare capacity in other Member States to cut waiting times for essential medical interventions?

In short, we need to work together to find ways to make our health systems more open, transparent and effective, while ensuring that national needs and concerns are fully respected, and that their functioning is not disrupted.

Third, I want to bring together health and other policies to ensure that we tackle health determinants with the full force of the powers and instruments the Community has at its disposal.

Our work on health impact assessment will help us learn more about how certain actions generate specific health outcomes.

But this needs to be complemented by strategies that combine decisive actions in different policy areas.

For example, working with Margot Wallström we will need to take forward a new strategy providing key data and policy instruments on health and environment in the months ahead.

Another key issue is that of combating obesity, where I am determined to bring together agendas in public health, food law and agriculture.

In this context, we will need to begin to address seriously the enormous problem of inequalities in health. This will need to be tackled over the long-term by a concerted approach that brings together health, social, employment and economic policies. But we can begin by identifying the issues with more precision and defining a clear agenda for action.

By the end of my mandate, I want to have established strong partnerships across Commission services in order to tackle major health determinants.

Finally, I am convinced that the Community has an important role to play in the dissemination of information and the empowerment of citizens. Many of whom have become active partners in managing their own health.

One key action is to improve health information and make it more widely available. By ensuring easy access to timely, accurate and authoritative information, we can minimise the risk of people relying on partial, biased or misleading information and advice.

We therefore need to make a real effort to provide the information that patients, health professionals and authorities require. A major action will be the establishment of a health portal, which can point patients towards authoritative online information. I want to see this up and running by 2004.

The Community cannot do all of this on its own. In addition to support from the Member States, we need to develop our co-operation with specialised organisations such as the World Health Organisation - which will be a principal partner in planning and developing our future activities.

We have also been trying to ensure that our actions are fully in line with the expectations of the many stakeholders in the health sector including the NGOs and professional organisations. The EU Health Forum, which we have created in Brussels, is one way of helping to achieve this. We intend to develop the EU Forum further in the coming years.

All this, Ladies and Gentlemen, is possible under the current Community powers related to health. But it is evident that as part of the debate on future Community health policy, we will have to look at the legal basis of our work.

At the moment, of course, the European Convention is reviewing the whole of the EU Treaty framework and structures.

When it comes to health, there are several questions, which I want to see addressed. For example:

  • What powers does the Community need, to address health problems that transcend borders, such as communicable diseases and environmental threats?

  • How can we ensure the proper balance between the operation of the single market and the functioning of national health systems?

  • How can we ensure clarity about what the European Union can and should do in health, and the responsibilities of individual states?

Allow me to finish by making a few comments on my general approach.

I would stress that my approach is not based on a wish to greatly expand the Community's powers as regards health, although some adjustments in competences are probably needed.

My main concern and perhaps this reflects my legal background is to achieve an effective and practical balance between the Community and Member States, founded on clear and unambiguous legal principles. This is certainly far from the case at present.

If I were to mention tobacco and the inability of the Community to take binding action under the present Treaty Article on public health, you will see the contradiction.

Half a million lives go up in smoke every year.

We find ourselves caught in a quandary: we cannot take vital public health action on which there is a broad consensus using our public health powers. And we cannot take it using our other powers related to the single market.

Big tobacco and its allies, must be laughing all the way to the graveyard.

Needless to say, what applies to tobacco applies in the same way to other key health areas. So, its time for a change.

Time to entrench the health of our citizens into the new Treaty.

Time to hear the voice of patients and the needs of professionals.

Time to ringfence our Member States responsibilities in the delivery of care that is accessible, sustainable and of high quality.

But as history has taught us, we will only build this new Europe, this Europe of health together.

Let us together form a coalition for a Europe of Health. Because the Health of Europe depends on it.

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