European Commission

EUROPEAN COMMISSION

José Manuel Durão Barroso President of the European Commission

The Role of Europe in Global Health

Speech at the 5th World Health Summit/Berlin 20 October 2013

SPEECH/13/838

Dear Minister of Foreign Affairs, Guido Westerwelle, dear friend, Dear Minister of Health, Daniel Bahr, Dear Prof. Detlev Ganten and Prof. John Wong, co-chairs of this World Health Summit, Dear Ms Grüters-Kieslich, of the Charité Medical University of Berlin, Dear President of the Berlin-Brandenburg Academy of Sciences and all European Academies, Günter Stock Dear ministers, My dear friend Ramos-Horta, Nobel Peace Prize, great fighter for the freedom of Timor Leste, East Timor Ladies and gentlemen, Dear friends, First of all let me tell that it is indeed a pleasure to be here in Berlin in the Foreign Affairs Ministry. Thank you Guido for your very kind words in this World Health Summit, because, in fact, Germany is a country that has been doing great things for health in Europe and, through Europe, also in the world. I want to pay tribute to all those in Germany from the medical professions, political leaders, policy makers, academics, the scientists, the business companies, that have been promoting health in Europe and worldwide. Health policy in the broadest sense also touches the core of what the European Union does. It is at the heart of our social model for which Europe is working hard in order to safeguard it, and where governments have a role and a responsibility to help and protect its citizens' well-being. It is fundamental to our economic policy approach, based on effective public services supporting innovative researchers and inventive entrepreneurs. It is an essential part of the role we play world-wide, allowing others to learn from what we have learnt and profit from the successes we have achieved, and vice versa. And it is an inherent element of the European philosophy: a firm and undiluted belief in the potential of science and the benefits of cooperation. All these aspects are included in the approach taken by this conference and in a programme packed with authoritative speakers and, I am sure, very interesting debates. Clearly, this alliance of health centres, universities and national academies, bringing together political leaders, policy makers, executives and scientists, has the ideas to strengthen the health agenda of the future and the experience to influence and improve the way we tackle jointly our challenges. So I am more than happy to act as patron of this prestigious 5th World Health Summit and to highlight the role Europe has to play in global health. It is important to note that the World Health Summit and the M8 Alliance start from the same basic principles as the European Commission in its approach: connecting the public sector with the private, linking the science to the policy and the laboratory to the boardroom, sharing knowledge and giving opportunities to the knowledgeable. It has proved its added value in the past, and I have no doubt that this year's Summit will prove to be equally successful.

Ladies and gentlemen, At first glance, the emphasis on health at European level may be somewhat surprising, at least for those who follow the European debate. After all, it is still mainly Member States' responsibility to define their health policies and to organise and manage health services and medical care. That's what in Europe we call the principle of subsidiarity. So it's mainly, I insist, a national responsibility. But the European Union complements national policies to prevent diseases, address cross-border health threats and ensure a high level of public health overall. There is a lot we can do to support innovation and research in health, in education and leadership for sustainable health systems and in developing synergies with other sectors. This is more than a specific policy area, but a point of attention across a wide range of European policies from social affairs to education, from research to taxation, from consumer rights to public services reform. That's why in the European Commission we try to deal with health issues in what some call horizontal or transversal way because in fact it is, I repeat, more than just one policy area. That is why we try to make what we call the mainstream of health objectives also through other policies. For instance: climate and environmental policies or consumer policy. I will give you a few examples. There is European legislation on health products and cross-border care, for instance on clinical trials and medical devices, on fees for pharmaceuticals and a directive on patients' rights in cross-border healthcare. We deal with the determining causes of health problems such as tobacco products, which are still the biggest cause of avoidable illness in Europe. We are, with different programmes and actions, helping Member States to improve health in the European Union for the European Union citizens. Through our third Health Programme for the next European financial period from 2014 to 2020, we are directly financing projects strengthening the links between economic growth and a healthy population. And we assist on a daily basis in tackling cross-border health threats, in particular in the case of communicable diseases like avian flu and pandemic influenza that very easily spread from country to country. In the field of animal health, and notably on diseases transmissible to humans, I am proud to say that we have achieved considerable results. Diseases like avian flu have not finally had major impact on human health in the European Union, and the human cases of Salmonellosis in Europe, for instance, have decreased from around 200.000 in 2004 to less than 100.000 in 2011 and this trend is still continuing, thanks to the intensive control of programmes applied on the poultry and the pig sectors in all Member States, with the European Commission’s financial support. A considerable number of human lives were saved and hospitalization costs were reduced, while at the same time this made our meat products more competitive on the international markets, as the European Union products are more and more perceived as the safest in the world. To sum up: the organisation and the funding of health care systems in our member states is and will remain a national responsibility. The European Union, however, can positively improve the context in which Europe's member states operate their health systems and support them in their actions. And the impact of this is profound in terms of the rights of patients, the role of researchers, and the very structures of health care.

Certainly one of the most important contributions is our effort towards the effectiveness and the financial 'health' of health systems themselves. The healthcare sector accounts for 11% of the total European workforce, or around 25 million jobs, and for 10% of the European Union’s GDP. That in itself, plus the large and increasing share of healthcare costs in the European Union, makes the case for improving cost-effectiveness and the financial sustainability of health systems all the more relevant. Making our healthcare sector more resilient is one of the great challenges of today, especially in light of competitive pressures which our economies face globally. And we need to find responses to the structural changes in demography and the increasing burden of chronic diseases in Europe, while the pace of technology is increasing and the limits of public finances are more stringent than before. One figure says it all: treating just brain disorders annually costs Europe around 798 billion euro! And in this particular sector we are financing the Human Brain Project, at 1 billion € over the next 10 years. Progress in this field is already significant; just think about deep brain stimulation that alleviates the symptoms of Parkinson disease. As I said in the beginning, health systems are the cornerstones of Europe's welfare. We must cherish their success and guarantee their future. For this to happen we must accept that the time has come for structural reforms in health systems. That is the case around the world, and especially so in Europe, where they are highly developed and effective, but for that reason also elaborate and sometimes expensive. If we don’t reform, we will compromise the universality and quality of care which form the cornerstone of Europe's welfare state. If a health system is not performing well, it will not be able to provide the highest-quality healthcare to all in the future. And we must not allow that to happen. The European Union and notably the European Commission is an important factor for translating this analysis into concrete action. As part of our economic governance in the European Union, healthcare-related issues form part of the country-specific recommendations, which the Commission has been addressing to 11 of our Member States. That is one of the innovations of the new system of governance we have today in Europe. We usually call it the European Semester, where the European Commission is asked to give concrete, country-specific recommendations to all the members of the European Union. And the focus has been on the need to increase cost-effectiveness and financial sustainability of the health systems in these countries. Apart from the "programme countries", we have given country-recommendations to countries such as Austria, Bulgaria, the Czech Republic, Germany, Spain, Finland, France, Malta, Poland, Romania and Slovakia. A Reflection process on modern and sustainable health systems has been launched within the European Council. So, among Heads of State and Government of the European Union. We know, of course, that there is no one-size-fits-all solution for all countries alike, there are different traditions, different models, even if there are some points in common, namely the idea, the important idea, that health is a fundamental right and that the state has an obligation to provide this kind of protection to that right This is the European model at its best. But even if the models are very different in concrete terms, I believe that all national health systems can benefit from an efficiency check, from greater use of health technology and from a greater focus on smart investments. The question is not so much whether we spend more or less, but how to spend better. We need a smarter Europe and for this we need also a smarter approach to health.

We must also look to the benefits that greater patient choice and empowerment can play in driving change in health systems. The European Union's Directive on cross-border healthcare enables EU patients to seek care in any other Member State. I mean, this is, I can say, a real revolution. Can you imagine that in other parts of the world? It is simply not thinkable. In Europe, we have now this right. One person receives healthcare in another Member State, as if he could do it in his or her own country. And this directive also sets out their rights, particularly to information on quality and safety. Choice will help improve the efficiency of the systems. Empowerment will help to improve the quality of care offered. These must go hand in hand. That's why, as was already stated, the role of civil society is also extremely important, beyond scientists, policy makers, political leaders, academia. Civil society has also a role to play in the way we address collectively these health values and these health challenges. Health, I repeat, is a value in itself, but it is also a crucial component towards economic success. The importance of this sector and Europe's long tradition and wide experience in this field provides plenty of opportunities for future growth. I personally am convinced that this is one of the sectors that will grow more in a near future and that will bring more value for growth in Europe. Good health, of course, is first of all good for people. Good health can also be very good for business, whereas poor health is notably bad for business. Today, absenteeism represents 3 to 6% of working time lost, leading to a yearly cost of about 2.5% of GDP in Europe. In order to reap both the health benefits and the economic potential of the health sector, we need to foster innovation and keep Europe at the forefront of scientific progress. Currently, the health sector already employs 15% of university graduates in the European Union – and the demand is growing. It is precisely one of the sectors where we have a mismatch between the jobs people seek and the jobs that are on offer. Health sector, not only medical doctors but also nurses and many other professions related to health can indeed be developed in the future. The European Commission is keen to encourage the potential of this sector also for jobs. For example, we have brought together at European level around one thousand public and private stakeholders in an Innovation Partnership on Active and Healthy Ageing. This partnership aims to translate innovation into concrete solutions that assist elderly people in living healthy and independent lives, support the provision of high-quality care and help our industry to remain competitive. We also support cooperation between large-scale industry, small and medium-sized enterprises and research organisations in the field of new treatments and diagnostics tools. We have a Public-Private Partnership, the Joint Undertaking on Innovative Medicines Initiative, IMI as it is better known, to which we have dedicated important resources: no less than 1.7 billion euro. Overall, the Commission is the world's third largest funder of research on poverty- related and neglected infectious diseases, thereby contributing significantly to the long- term improvement of global health. Since 2007, we have invested an annual average of almost 170 million euro in global health research. We are intent on keeping that leading role in the promotion and financing of research and innovation. The next EU programme for research and innovation, called Horizon 2020, is the way to do this. Several societal challenges will be addressed, considered priorities under the new programme, including health, demographic change and well-being, for which a budget of 7 billion euro has been earmarked. Such research will improve our understanding of the causes and mechanisms underlying health, healthy ageing and disease, improve our ability to monitor health and to prevent, detect and treat diseases, and test and demonstrate new models and tools for healthcare delivery.

We are optimistic that European Union-funded research in the area of health will continue to deliver innovative solutions in the area of bio diagnostics, biotechnologies, and surgical and regenerative medicine building on the success of the living heart valve replacements, the use of spider silk to repair joint damage and the development of simple breath tests to diagnose cancer. These are concrete examples of projects funded by the European Union. For innovation to succeed, we not only need the funding but also need the right regulatory framework. In the past few years, the European Union has revised European legislation on pharmaceuticals, for example, and the Commission has introduced incentives for the development of orphan medicines, for the benefit of patients with rare diseases. A revision of the European Union legislation on clinical trials is also in the pipeline; it is aimed at supporting the conduct of clinical trials in Europe, while ensuring the safety of patients participating in a trial. In the field of research and innovation good progress has been made to achieve a single market, but there is still a lot of work to do. Investment in R&D is vital, but we need fully functional research and innovation systems to use that money best. We now need all Member States and all those involved in research and research funding to make a major push towards a true European research area. We also need to grasp the opportunities offered by digital technology. eHealth solutions, such as tele-consultations and tele-monitoring, are very promising. They can improve access to healthcare, increase the quality and efficiency of care and empower patients. This is why the Commission has a European eHealth Action Plan to increase the uptake of eHealth and an eHealth Network, so that Member States can align their efforts and create common policies.

Ladies and gentlemen, If we put so much emphasis on health issues and so much faith in research and innovation within Europe, it is only natural that these form a large and increasing part of our efforts world-wide as well. Health is one of the main strands of the European Union's development agenda, and we have a huge role to play. Contributing around 50 billion euro a year, the European Union is by far the biggest donor in the world, representing 56% of global public aid. Despite the crisis, Europe's track record has remained unchanged and only recently Member States have reconfirmed their commitment to dedicate 0.7% of their GNP on development aid by 2015. I think we should be proud of that effort, and confident of the fact that with this investment we can make a difference. In the context of the Millennium Development Goals campaign, for instance, over the last ten years we have helped 70 million more households to have access to drinking water, and 7.5 million births were attended by skilled health personnel thanks to direct aid from the European Union. We must keep pursuing all MDGs right to the end, and for that reason we have made available an extra billion euros to helping those countries and MDGs who are most off track, in fact I announced this last year in the margin of the General Assembly of the United Nations in New York. Some of the more problematic issues are indeed health issues: notably child mortality, sanitation and women's health.

The current MDG initiative funds 11 countries in the health sector for accelerated progress towards the achievement of MDG 4 on child health and objective 5 on maternal health, for a total amount of 280 million euro. We must build on that for the development goals beyond 2015. Our aim on the post- 2015 global development agenda is to provide a balanced approach to poverty eradication and sustainable development, ensuring basic living standards, including health for all. The European Union is also committed to allocate at least 20% of its aid budget for 2014 to 2020, the next 7 year period, to human development, including health. Even today, of the aid budget managed directly by the European Commission, which reaches some 10 billion euro annually, about 500 million is devoted specifically to health issues. The lion's share of the EU health aid is deployed through country programmes, directly agreed with the concerned developing countries, providing comprehensive support to national health systems in 30 of the poorest countries. In some of my visits to some of these countries I could see on the ground, directly, the important contribution that this funding can give to save so many lives. I think it is an important point to make, because sometimes we hear that there are people, who have doubts about aid for development. Look, if they go to Africa, if they see the difference, the lives that could be saved, because there was international funding, I think they will not keep that idea. Of course we can always look to more effective aid schemes and to improve also the efficiency of development aid, but let's be frank, we have to continue to make a big effort to the developing countries, because we see that that can make a real difference for so many people. I remember the hospitals I have seen from Tanzania to Mozambique, from Cape Verde to Senegal, to Southern Africa, and the concrete contribution of the European Union in health and in other sectors, also in refugees in Jordan, Syrian refugees. Without the European Union support these people would not be alive or they would not have the access to a minimum of health care and also the right to education. So, I think we need to make a case for the need to continue some efforts in the development aid. And these efforts, in the field of health, are complemented by our global support in particular to the World Health Organisation, the leading authority setting the agenda within the United Nations system, and with issue-specific global health initiatives like the Global Fund to fight AIDS, tuberculosis and malaria. Since it was founded at the initiative of the G8 in 2001, the European Union has contributed more than 1.1 billion euro to the Global Fund, over half of the total amount. We also strongly support the GAVI Alliance for vaccines and immunisations and the Global Polio Eradication Initiative, campaigns that over recent years have shown just how much we can achieve if we are willing to invest in the right causes and support the people of the world. Because experience has taught us that bringing the right people together is just as important as the funding as such. We live in a world of increasingly fruitful partnerships between governments and the private sector, between universities and international organizations. They are proving to be the most effective way of combining the knowledge and creativity that often comes from the bottom up with the necessary coordination and prioritisation to be done at top decision-making levels. Horizon 2020, our research programme, draws on that successful formula, aiming not only at supporting collaboration between researchers in Europe but fully open to international networks, building on partnerships with other funders, both public and private, since the scale, scope and ambition of the research and investments for global health cannot be achieved and delivered in isolation.

The European Commission's flagship research initiatives in this area will be the expansion of the European and Developing Countries Clinical Trial Partnership with sub- Saharan Africa, which already has projects involving 70 institutions in Europe and 185 in Africa, with half of the clinical trials led by African researchers, and the Innovative Medicines Initiative with the pharmaceutical industry, the largest Public Private Partnership in pharmaceutical research in the world.

Ladies and gentlemen, I am sorry if I was a little bit long, but I just wanted to give you a picture of what we are doing, respecting the subsidiarity principle, in terms of action in the health sector. I think many of our citizens are not aware of the big effort that European taxpayers are doing for health in Europe and in the world. And I think we should basically be proud of it, not being complacent of course, but being proud of it, knowing that we have still a lot to do, but thanks to our political decisions, thanks to our academia, to our business, to our universities, to our scientists, to our professionals in medicines, we are indeed achieving a lot. But I hope that all the information I have given to you just now does not distract us from the more important points. And the more important points, I think, are three: first of all, health is a fundamental right, for every human being; second, health has a value in itself, apart from the economic and other important consideration; and third, health is a global issue that requires strong international cooperation. I think these are the most important messages. And I am sure that your initiative, the World Health Summit, successfully linking academics, policy makers, civil society and businesses in a common cause is a very important contribution. I want to honour your commitment, and I want to tell that the European Commission will continue to support your efforts, add to your understanding and also learn from your experience. For all those reasons, I wish you a very fruitful Summit. I thank you for your kind attention.