SPECIAL REPORT / The European Commission is required by the EU treaty to follow a “health in all policies” approach, but this principle is often put aside due to inconsistency of single market rules, according to health advocates.
The Commission has acknowledged health as playing an important part in growth, jobs and sustainable development. And so have EU member states, according to Austria’s Finance Minister Hans Jörg Schelling, who sent a video message to the European Health Forum Gastein (EHFG) last week.
Although it must not be forgotten that individuals need to take responsibility for their own health, public authorities can also play a key part by minimising risks, Schelling said.
They can do so, for example, via rules on maximum daily working hours, emissions from automobiles, rules for the use of drugs, alcohol and smoking. This will benefit society and increase productivity in the population, he argued. Finance ministers may play a more important role for people’s health, as prosperity and the prevention of unemployment are crucial components for good public health, Schelling continued.
His claim was accepted by Richard Bergström, the director general for the European Federation of Pharmaceutical Industries and Associations (EFPIA), an industry group. But the health sector also needs to be seen as innovative and a creator of jobs and growth, he retorted.
“Finance ministers need to see health not just as a cost. I’m amazed by the reactions of finance ministers and policymakers that see health as a cost, as an expense. We need to be transparent about what the whole sector is doing. We can create competitiveness. In the EU, the pharmaceutical sector is a net exporter where the US is a net importer of our products,” EFPIA’s director general said.
The single market policies
Nina Renshaw, Secretary General of the European Public Health Alliance (EPHA), took a different approach. Despite the EU treaty’s promise that health needs to be taken into account, this is often forgotten in EU legislative proposals, she claimed.
Taking the EU’s Common Agricultural Policy (CAP) as an example, she said that plant and animal health were discussed in great detail during the last reform, but human and public health did not get a mention in the review of the EU’s biggest spending programme.
Other examples of policy inconsistency cited by Renshaw include the taxation of unhealthy food and alcohol. Recently, Finland was told to repeal its taxation of confections as being inconsistent with internal market laws. And Scotland was challenged at the European Court of Justice for introducing a minimum unit price on alcohol in order to fight compulsive drinking.
“There is always this question whether something is in line with other single market rules, as if there is this natural assumption that the single market takes precedence if there is policy inconsistency,” Renshaw said.
Likewise, public health was not taken into account in the ongoing trade negotiations with the US, athough it might impact, for example, food and tobacco labelling and pharmaceutical companies’ patents and intellectual property measures, Renshaw continued.
Andrzej Rys, Director for Health Systems and Products at the Commission’s DG Sante, said that the EU executive is well aware of the criticism, but stressed that health remained on top of the Commission’s agenda. For instance, he said, health was one of the most important policies in the Juncker Plan.
“The first three projects recommended by the European Investment Bank are linked to public health, for example one on bio research. In the single market strategy, there are links to health,” Rys said, adding that lately, the refugee crisis and its impact on public health has been much debated in the Commission.
For the ‘Health in all policies’ principle to work in the EU, it’s key to have an intersectoral and societal approach, and to understand the role of the government, said Piroska Östlin from the World Health Organisation (WHO).
“Intersectoral action in itself is a political choice because it is so complex and you really need a strong and firm political commitment for this. Or else it will not really work. The WHO is of course very keen on supporting member states in implementing intersectoral action and we have platforms where we can share experiences,” Östlin stated.
The European Health Forum Gastein meeting in Austria is Europe's largest gathering of health policymakers.
After having discussed how to set up sustainable EU health systems in times of crisis, and the EU elections in 2014, this year’s conference will focus on for example responses to threats that lie outside of the public health sector.
- 28-30 September 2016: Next year's European Health Forum Gastein.