Robert Madelin: there is a business case for healthy citizens

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Those who adopted healthy life as one of the key performance indicators for Lisbon understood that there is a business case for healthy citizens, explains Robert Madelin.

In an interview with EURACTIV, the Commission’s Director General for Health and Consumer Protection, Robert Madelin, speaks about the current Finnish Presidency approach ‘Health in all policies’, the seriousness of the obesity problem in Europe and explains the Commission thinking on health warnings on alcohol products.

The Finnish presidency currently highlights the integration of health into all policies. How does Commission contribute to this vision? 

Health in all policies vision is exactly the same as joint-up policy making and policy integration. It is the health equivalent of better policy making as we have already tried to develop it in the Commission in general. In DG SANCO we have already three Treaty based obligations to make sure that policies in general ensure a high degree of health protection, consumer protection and animal welfare. The Finnish Presidency is trying to give some political push for this exercise. 

There is very strong line between the political objective of the Finnish Presidency and the Treaty obligations and the new policy culture in the Commission. For DG SANCO it coincides with our perception of that the main health determinants for Europe are often determined outside the health care system – it is what we drink and eat and smoke. The drivers of poor health behaviour are our environment and the drivers of better behaviour are the environment outside health: schools, workplaces. Therefore, I think a holistic approach to changing behaviour is essential and ‘health in all policies’ is very consistent with our analysis of why Europe is unhealthy and how it should get healthier. Health in all policies also requires a multi-stakeholder approach

What is DG SANCO doing to directly involve national stakeholder and multipliers into communicating health and consumer protection policies, so that stakeholders at national level feel the value added of EU? 

The policy department are in a conflict here. On the one hand, you want the communication of your policy to be as effective as possible for the policy objectives, On the other, because we believe in what we do, we think that knowledge of our policies should also drive recognition of Europe. But the two things can sometimes be in conflict. 

I am proud of what Europe does in order to prevent young people from taking up tobacco  smoking, but when you come along to want to achieve the objective of youth not smoking, saying “Brussels says don’t smoke” is exactly the wrong way to do it. They are two very different objectives. We are not necessarily saying let’s sub-ordinate the effective achievement of the policy objectives to using our policies to sell Europe. 

We try to involve national stakeholders (doctors associations, networks of health professionals etc.) more, essentially by giving them tools. An example from the health side is the recently launched EU Health Portal, which, progressively, will be available in all EU languages. It does not talk about EU policies, but provides a source of knowledge in the disease areas or in the health promotion areas which can be of interest to our stakeholders. A similar example on the consumer side is the Dolceta (Development of on line consumer education tools for adults), which we recently launched for consumer education purposes. It is an online tool, available in all languages, where you can learn about consumer policy issues. It is essentially designed to be used as a teaching tool in adult education but it can be used by everybody. A lot of it is about EU law, but a lot of it is also about general economic principles and concepts. 

How serious is the obesity problem in Europe? 

The most striking graph for me is the year by year gain in prevalence of childhood obesity. The worst performing countries in Europe, Poland and the UK, are now catching up with the US. Adolescent obesity rates go up to over 30% in Greece, Italy. And although there are variations within countries, the situation is getting worse at European level. It is getting worse very fast in the UK and Poland and it is already very bad in the Mediterranean countries. I think this is a phenomenon which in 10-20 years undermines the central assumption about our demography, which is that we’re all going to go on living longer and healthy lives. It is that bad. 

How do you define the personal, EU and member state role/responsibility in this fight? 

It is clear that obesity is a behavioural issue. Ultimately, each individual could be of an ideal body weight – so why are we not ? Partly because of the genes, partly because of the way we have learned to behave and partly because of the way we live today here and now. So, a lot of it is environmental. Public policy makers have to make it easy for the individual to make the right choices. At EU level it should be something at EU’s competence such as food labelling or where the EU can reach a catalyzing effect – providing for a space at European level where increased political commitment can be generated. The EU can also be used as a space to learn what works, to share best practice and to try to accelerate the discovery of the most effective intervention. 

We are currently analysing the results of the consultation on our Green Paper on nutrition and physical activity. This autumn (2006) we will need to do some checking of our synthesis of the results through the nutrition platform and the WHO ministerial conference, which takes place in Istanbul in November. We hope to have a White Paper on nutrition very early in the year 2007. 

The deputy secretary of the US department for health, Alex Azar, talking about obesity, said that “markets should go before mandates”. Do you share this view for Europe? 

Markets should go before mandates, yes. The Commission is, through the nutrition platform, trying to stimulate private actors, both NGOs and economic operators, to do effective intervention. The more effective intervention, the less market failure, less amount of public intervention needed. 

Let’s test the hypothesis that everybody is doing enough already. But you can’t really say that whatever is out there today is enough because everybody is doing something and obesity trends are increasing. The question is can we do something a bit more and then obesity trends might start to halt and reverse, which is the objective of the EU platform. 

If there is a business case for healthy food, what can the EU do to promote it? 

When we adopted the revised Lisbon strategy in 2005, the European Council adopted Key Performance Indicators (KPI). One of the KPIs for Lisbon now is the Healthy Life Years (HLY). Those who made that decision understood that there is a business case for healthy citizens. If people have healthy, longer lives, the GDP increases. It is not a surprise, they stay in the work life longer, they earn more, they spend more, they don’t have to save it all for nursing. We don’t have that yet in Europe. The difference between life-expectancy at birth in Sweden and Lithuania is huge, 15 years. Everybody is living longer, but what proportion of that longevity is actually healthy life years? Here again there are big variations between the EU-25. The economic case for health is, however, increasingly accepted. 

For the food chain the business case is in the sales. The best data on that is currently coming from Tesco. Their data on front-pack labelling of products and sales show that within two-three month period the sales, for example, of products labelled “70% of daily intake of saturated fats” dropped considerably, whereas the products labelled “low amounts of saturated fats or salt” increased/gained in sales. The business case is increasingly understood. The problem is: does business case exist also for retailers at the lower end of the market, of the value chain. Is the message going through faster now? Here, public policy intervention can say to business: accelerate the move of the market, the market is moving, let’s move faster. Secondly, the public authorities can help the market to be ready for this change. 

An illustration on this can be done with salt: before a public education campaign on how too much salt is bad for your health, the UK citizens’ tasting groups were reluctant to even taste products with reduced amounts of salt. After the campaign they accepted comparative tasting of reduced salt offerings. They still wanted the products to be tasty but recognized that there is a reason to looking at the issue. There is an interaction between public education and the market. 

So, one could say that education and information campaigns should prevail over regulation? 

The philosophy is “don’t regulate unless you have to”. You need some regulation, if there was, for example no regulation on food labelling, companies would be very distressed. One labelling is better than 25, 26, 27. Then the question becomes, instead of not to have a law or to have one, what is the efficient content of that law. 

The obesity debate includes hardly any debate on the positive role of sports and physical activity in fighting obesity. Why is that? 

Sports is much more grass roots than food. There’s a lot people in Brussels talking about food because it is regulated. Sport is largely unregulated. You need to go much more local to do sports and physical activity right. But if you look at the platform, the first step we took in 2005 was to get the vision right: to define the answer to the problem is about food and about physical activity. Secondly, our colleagues in the sport side sat together with the platform, which lead almost immediately to a statement by the sports ministers in Liverpool, who set up a working group on the issue, and this has accelerated the process towards the White Paper on Sports. 

Are there any practical sports-related activities around the platform? 

In the framework of the platform, there will be some concrete steps coming out from the platform commitments, from sports goods manufacturers, sports NGOs and food companies, which are sometimes quite active in local settings in supporting marathons and school sports events etc. 

There will be a high level brain storming on the White Paper on Sports under the Finnish Presidency in September 2006, but we are still currently at very early stages on this. The challenge is to make sports for all and for sports to be seen as a physical activity and not only an issue of World Cup or the elite. It is thus also about changing the image of sports, to really promote sports for all and to empower people to do more of it. But then again it means that everybody should build more physical activity to their daily planning and then it becomes an issue of urban planning, less cars etc. 

What will the EU alcohol strategy consist of? Can we expect warning labels on alcohol products any time soon? 

The Commission will present its strategy in the autumn. It will not cover taxation, for example, as it is already being discussed elsewhere. On warning labels, France and Finland are already in a process of introducing mandatory health warnings on alcohol products. As it is about health, the Commission does not consider these as a damaging attack on the single market. The message from Brussels is: we want to accommodate health protection labelling in the drinks sector but we don’t necessarily want to prescribe at EU level what that labelling should be

It is easy to overestimate the impact of these local requirements on the single market. French wine producers have added health warning labels to their bottles for the US markets for years without finding that a barrier for trade. The health considerations constitute a legitimate reason for not objecting these requirements. 

What is the current state of play in the adoption of the Health and Consumer Protection programme for 2007-2013? 

Commission proposed a single programme. Council and the Parliament preferred two programmes, which they will get. Since the final decision on the financial perspective, the discussions on both programmes are going much more smoothly. On the consumer side people are no longer arguing about the money but more about its allocation, the fine-tuning of the priorities inside the programme. On the health side, some in the Parliament are still against the proposed budget by the Commission and want more money. Debate on the level of proposed expenditure thus continues in the Parliament. For the Commission it is more important now to look at the quality of the spending and not the quantity. The Commission expects both programmes to be adopted by April-May next year (2007).

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