Development of public health policy in the Community

1) OBJECTIVE

To stimulate a broad debate on the overall direction of the future Community public health policy in order to be able to put forward concrete proposals once the Treaty of Amsterdam has been ratified.

2) COMMUNITY MEASURE

Communication from the Commission of 15 April 1998 on the development of public health policy in the European Community

3) CONTENT

The Community strategy on public health is in need of fundamental revision in order to be able to cope with a number of major developments, such as new health threats, the increasing pressures on health systems, the enlargement of the Community and the new provisions of the Treaty of Amsterdam.

It is therefore necessary to launch a debate on the new direction of Community public health policy.

In recent decades, the health of the Community population has improved dramatically, as shown by the fact that life expectancy at birth has risen by five years since 1970. While there is every reason to welcome this development, it must not be allowed to hide the fact that there are still serious health problems in the Community:

• one person in every five still dies prematurely (before the age of 65) from avoidable diseases, particularly relating to lifestyle, or as a result of accidents;
• new risks to health are emerging, especially from communicable diseases;
• there are still wide variations in health status from one socio-economic stratum to another;
• the ageing of the population is giving rise to a substantial increase in diseases related to old age, such as Alzheimer's disease.

Health care systems in the Member States are subject to conflicting pressures.

On the one hand, the proportion of GDP devoted to health care spending has doubled over the last three decades and is rising steadily: this is mainly due to demographic factors, the cost of new medical technologies and citizens' increased expectations.

On the other hand, the general constraints on public finances make it necessary to reform health care systems in order to contain expenditure while optimising the sector's cost-effectiveness in a context of increased competition.

Member States must manage these conflicting pressures without losing sight of the importance of health to people's well-being and the economic importance of the health systems.

Community public health policy must take account of both the prospects of enlargement and the world context.

The health care systems of the countries of central and eastern Europe compare poorly with those of the existing Member States, mainly on account of inadequate resources. For this reason, the problems with which they are faced are different. It will be necessary to help these countries improve the effectiveness of their health system, as well as to examine the potential impact of enlargement on health in the present Member States.

Moroever, cooperation with international organisations, such as the World Health Organisation (WHO), is also necessary to address the threats to health at the global level.

Although health issues have featured in the Treaties since the beginnings of the construction of Europe, it is only since the ratification of the Treaty of Maastricht that the Community has been able to implement a genuine public health strategy: five specific action programmes (cancer, AIDS, drug dependence, health promotion and health monitoring) have been adopted and three others proposed (rare diseases, injuries, pollution-related diseases) alongside other initiatives (reports on the state of health in the European Community, recommendations on the safety of blood products, etc.). In addition, a number of other Community policies have an impact on health.

The Commission has drawn the following conclusions from the experience gained in implementing the 1993 framework of action:

• the approach involving distinct action programmes has made it possible to overcome the differences between Member States as regards the order of priorities;
• on the other hand, it has led in practice to a considerable administrative burden, a lack of flexibility, a dispersion of financial resources and difficulties of coordination between the programmes.

In the last two years, several developments, such as the "mad cow" crisis, have contributed to a new awareness of the importance of health policy at Community level. The extension of the legal basis of the Community's public health activities in the Amsterdam Treaty reflects this growing interest.

In order to meet this demand, the Commission considers that the future Community policy should comprise three strands of action:

• improving information for the development of public health: building on the activities and outputs of the programme on health monitoring, a structured and comprehensive Community system should be developed for collecting, analysing and disseminating information on general trends in the population's health status and health determinants and on developments concerning health systems;
• reacting rapidly to threats to health: this involves creating Community surveillance, early warning and rapid reaction mechanisms to meet the threats to health which might arise at any time (the proposal to create a European network for communicable disease surveillance and control is already contributing to this objective);
• tackling health determinants through health promotion and disease prevention: this third strand comprises actions aimed at strengthening individuals' ability to improve their health, including social, economic and environmental conditions, and the many activities linked to prevention (vaccination, screening, etc.).

Implementation of these three strands would facilitate compliance with the provisions of the Treaty regarding the incorporation of health requirements in all Community policies.

There must be a debate, involving all the institutions and parties concerned, on the ideas for a policy set out above and on how the policy should be put into effect. In the light of this debate, formal proposals will be drawn up as soon as possible after the entry into force of the new Treaty.