Campaigner: ‘For the first time, the EU has power over national health budgets’


As the EU gains more power over national healthcare systems, the health debates in each country are still focused on national issues, says Monika Kosi?ska, from the European Public Health Alliance (EPHA), which launched a new think tank to deal with those issues.

Monika Kosi?ska is the secretary-general at the European Public Health Alliance (EPHA). She spoke to EURACTIV's Henriette Jacobsen.

EPHA will soon be launching a new think tank. What issues is this think tank going to be dealing with?

There are three questions that we will be looking at in the next 12 months. One is the health competence. So we’re going to go back to the Treaty and look at how health is governed from the Treaty. That’s the first part. The second part is looking at economic governance and its impact on health. Basically, how the European semester [the yearly cycle of EU economic policy guidance and country-specific surveillance] impacts on health and how we want it to impact on health. The final part will be looking at the implementation of the European semester at national level from the health aspects.

What’s unique about what we’re trying to do here, is that it’s a health think tank, by health actors for health actors. Of course we have a European dimension to it in whatever will emerge in terms of the output. It will be aimed at European decision-making both in Brussels but also at national level. But ultimately, these are questions that we as a health community have to answer for ourselves. There are many think tanks and organisations doing this at national level so we know that there are discussions going on for example on the impact of demographic change and this impact on health and health systems, but actually no one is doing this systematically at a European level. Not by health actors for health actors so this is what we are bringing to the table.

Why is it important to discuss these issues at a European level?

The main reason is that we have seen a shift in competence so we’re still buying into this idea that Europe doesn’t do health as a national competence issue, but it’s still quite clear that the European semester has a direct set of competences. So for the first time, on the basis of economic integration and fiscal management, the Commission has the power to govern national health budgets. This is unique. This is the biggest shift in health competence that we have seen in 30-40 years.

It means that we need to wake up as a community and recognise that the EU has a level of power and a level of input that it hasn’t had in the past. On one hand this is a new need, but it’s not completely new because it’s been growing certainly the past 10 years. The impacts are becoming more and more explicit. They were implicit before, but now it’s very much explicit. It makes sense as we’re increasingly integrated as economies. It’s inevitable that that has a knock-on effect on society and also on health systems.

We also need to look at the workforce; basically health within the workforce both in terms of maintaining our population in order to be healthy, active and productive, but also the increasing responsibility for employers. With increases in stress, pressure on mental health, even things like work-life-balance, which have been perceived as soft issues, are actually very important and I think most of us will recognise that.

The final part is technological changes; the impact of new technologies, both in terms of healthcare efficiency, maintaining health and healthy behaviours, but also in terms of things like cyber security. How are we prepared for a brave new world in technology, for our care to be shifted towards a new way of functioning?

How has EPHA been viewing the way health has been debated at a European level?

It’s not so much at the European level, but the quality of the discussions within the European space has not been good enough for us. This is something that emerged from my own community, from the health community. There are many different actors that are trying to have health discussions at a Brussels level and actually the quality of these discussions are very mixed. So this is a direct response to our members, but also our partners to take on a leadership role on an issue where we are experts. So it’s not just the European level per se though there is an element of that.

I wouldn’t necessary say that we are unhappy with all of the discussions, but generally we’re concerned that health is an increasingly important issue at European level, but no one from the member states have said "Now we want Brussels to lead on discussions on health and health systems", in fact actually the opposite.

We still see a number of member states saying that health isn’t the responsibility of the EU and that’s not based on reality. We would like to change that around and say “Fine, if we have to do health at a European level then let’s do it with the right objectives. Let’s not do it because it’s a side effect of our fiscal objectives for example.”

Are you only unhappy with the quality of the debates or are you also unhappy with the fact that health may not be seen as important as, for example, finance, the environment, etc?

Well, health is seen as important. Even from the highest level, President Barroso, if you look at the EU’s 2020 strategy though the implementation isn’t always there. It’s hobbled by the fact that competence is supposedly at a national level. This is something that we would like to challenge.

What do you hope to achieve with the think tank?

The main objective is to improve the quality of European discussions on the issues of health. This is to provide a space. A safe, independent space for different partners and different actors within the health community to get together talks in quite technical details about some of the issues and how they are governed at European level.

Why we don’t do this as EPHA is because as an NGO, and all our members being NGOs, this creates a natural boundary to our partnerships, especially on how we interact with operators for example. So this gives us a new operating environment where we can expand our partnerships, we can talk to other actors who we would not be able to work with as an NGO. It will increase the breadth of the issues and quite separate us from our other objectives.

In a way we are already a think tank with the difference being that we have a work programme with our members, and that we as an organisation tend to work with the political calendar, so we follow what’s going on in the European Parliament. We have a mandate and policy objectives to the work of the European institutions that link to our members, but for some time now our members recognised that there was another conversation, a higher level conversation, that had to happen where we as a health community didn’t have that space to do so in Brussels.

The work of a think tank is beyond our business plan, beyond the day-to-day work of EPHA as an NGO. The work will be more about framework or more abstract perhaps. Another important aspect is the partnership aspect. It’s not appropriate to work with economic operators that we sometimes disagree quite strongly with in our NGO work.

Who are the experts that could be working with you at this think tank?

We have a fantastic breadth of experts within the academics, but also active practitioners and the policy community. So we have a huge support to draw on depending on the issue and how we move forward. We’re very excited. We have done a lot of ground work and been working on this for about two years and had a lot of conversations with different actors. We think we will be able to provide a product and a conversation that will be very useful. We would also like to invite new partners. Anyone who would be interested in collaborating and talking with us… We would be very happy inviting them to do so.

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