DIRECTORATE GENERAL FOR INTERNAL POLICIES POLICY DEPARTMENT A: ECONOMIC AND SCIENTIFIC POLICY
WORKSHOP
Mid-Term Review and Evaluation of the EU Health Strategy
Brussels, 30 May 2012
PROCEEDINGS
Abstract
This is a summary of the presentations and discussions at a Workshop on the Mid-Term Review and Evaluation of the EU Health Strategy 2008-2013 held at the European Parliament, 20 May 2012. The aim of the workshop was to provide insights into the state of play of the EU Health Strategy, to discuss the future of the European Health Programme and to share selected Member States' experiences with regard to the implementation of the Strategy.
IP/A/ENVI/WS/2012-06 June 2012 PE 475.125 EN This document was requested by the European Parliament's Committee on Environment, Public Health and Food Safety
CONTRIBUTORS Dr Andrzej Rys, Director, DG SANCO, European Commission Dr Antonyia Parvanova, MEP and ENVI Shadow rapporteur for the EU Health Programme Ms Monika Kosinska, Secretary General of the European Public Health Alliance (EPHA) Dr Raed Arafat, Undersecretary of State, Romanian Ministry of Health Mr Chris Decoster, Director General, Belgian Ministry of Health Mr Loukas Georgiou, Health Attaché, Permanent Representation of Cyprus to the EU
RESPONSIBLE ADMINISTRATORS Dr Marcelo Sosa Iudicissa Dr Purificación Tejedor del Real Policy Department Economic and Scientific Policy European Parliament B-1047 Brussels E-mail: [email protected]
SUMMARY PREPARED AND EDITED BY: Mr Matthias Verstraeten, trainee Dr Marcelo Sosa Iudicissa
LINGUISTIC VERSIONS Original: EN
ABOUT THE EDITOR To contact the Policy Department or to subscribe to its newsletter please write to:
Manuscript completed in June 2012. Brussels, © European Union, 2012.
This document is available on the Internet at: http://www.europarl.europe.eu/studies
The video recording of the workshop is available on the Internet at: http://www.europarl.europe.eu/ep-live/en/committees/search
DISCLAIMER The opinions expressed in this document are the sole responsibility of the author and do not necessarily represent the official position of the European Parliament. Reproduction and translation for non-commercial purposes are authorised, provided the source is acknowledged and the publisher is given prior notice and sent a copy.
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CONTENTS
LIST OF ABBREVIATIONS 4
EXECUTIVE SUMMARY 5
PART 1: THE EU HEALTH STRATEGY - STATE OF PLAY 6 1.1. Welcome and Introduction by the Co-chairs 6 1.2. Andrzej Rys, Director of the Health Systems and Products Directorate of DG SANCO, European Commission 6 1.3. Antonyia Parvanova, MEP and ENVI Shadow Rapporteur: The Future of the European Health Programme 8 1.4. Monika Kosinska, Secretary General, European Public Health Alliance (EPHA) 9 1.5. Questions & Answers 10
PART 2: VIEWS FROM SELECTED MEMBER STATES 12 2.1. Introduction 12 2.2. Raed Arafat, Undersecretary of State, Romanian Ministry of Health 12 2.3. Chris Decoster, Director General, Department of Health, Belgian Ministry of Health 13 2.4. Loukas Georgiou, Health Attaché, Permanent Representation of Cyprus to the EU 14 2.5. Questions & Answers 15 2.6. Concluding remarks 16
ANNEX I: WORKSHOP PROGRAMME 17
ANNEX II: SHORT BIOGRAPHIES OF EXPERTS 18
ANNEX III: PRESENTATIONS AND TEXTS 21 Presentation by Dr Andrzej Rys 21 Contribution from EPHA 27 Presentation by Chris Decoster 31
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LIST OF ABBREVIATIONS
EC European Commission
EPHA European Public Health Alliance
FCTC Framework Convention on Tobacco Control
HIAP Health In All Policies
MDGs Millenium Development Goals
PV Pharmacovigilance
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EXECUTIVE SUMMARY
The workshop on the “Mid-Term Review and Evaluation of the EU Health Strategy" was organised by Policy Department A (Economic & Scientific Policy) at the request of the Committee on Environment, Public Health and Food Safety (ENVI) of the European Parliament (30 May 2012), and was hosted by MEP Alojz PETERLE (EPP, SI) and MEP Glenis WILLMOTT (S&D, UK), Co-Chairs of the Health Working Group within the ENVI Committee. The workshop was structured into two sections: the first provided insights into the state of play of the EU Health Strategy and discussed the future of the European Health Programme; the second focused on the views of selected Member States. The aim of this meeting was to acquire an overview of the public health actions of the European Union, carried out under the 2008-2013 Health Strategy Programme, which was subject to a mid-term review by the European Commission (published in August 2011). For this purpose, the contribution of the European Commission's General Directorate for Health and Consumer Protection (DG SANCO) provided the main input to the discussion. The workshop also highlighted first-hand experiences of a small sample of Member States; providing valuable hints on how things work under different national circumstances, the experience of Belgium, Cyprus and Romania where presented. The presentations and discussions on the past experiences were complemented with others concerning the new strategy. As the future EU health programme is well under preparation, many speakers made reference to how the present programme is feeding the definition of the next lines of action. The ENVI Committee of the European Parliament appointed MEP Françoise Grossetête (EPP, FR), as Rapporteur for this file; given its importance, a number of Shadow Rapporteurs are also working on this file. Unfortunately, Ms Grossetête was unable to participate in the workshop. However, MEP Antonyia Parvanova (ALDE, BG) - a Shadow Rapporteur for this file with vast experience in this subject area - made a very valuable contribution to the workshop debate. It is worth noting that Ms Glenis Willmott, who is Co-Chair of ENVI's Health Working Group, not only chaired the workshop, but is Shadow Rapporteur for the S&D Group. One of the salient points emerging from the discussions was the widespread impact that the present financial crisis is having in the health sector. The cuts and reductions of investments in the health sector have started to have a strong impact in recent years; at present, they are having a tremendous effect on the ability of Member States to cope with on-going health promotion, health prevention and even certain health care activities. Health ministries and regional or local health administrations are facing one of their most difficult periods as a result of the austerity and budgetary cuts decided by the economic and finance ministers. Most speakers agreed that the only reasonable approach was to continue, as the health sector has always done, to convince others that the money spent on health should be seen as an investment, that the health care sector was important in terms of employment and jobs, and that economic growth and progress is only possible with a healthy work force and a healthy population.
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PART 1: THE EU HEALTH STRATEGY - STATE OF PLAY
1.1. Welcome and Introduction by the Co-chairs
The event was opened by MEP Alojz PETERLE and MEP Glenis WILLMOTT, co-chairs of the Health Working Group within the ENVI Committee. Mr Peterle pointed out that it is an appropriate time to deal with the mid-term review and evaluation of the Health Strategy and stressed that the ambition has not diminished as far as health is concerned. Mr Peterle was looking forward to hearing what would be reported in line with the main points of the Strategy "Health for All" and "Health in all Policies" (HIAP). Ms Willmott underlined that the mid-term review is very important because there are less than 2 years left of the current EU health programme. She explained that we are currently in the process of deciding the next Health Programme for 2014-2020 which the Commission wants to call "Health for Growth". Ms Willmott is concerned about the direction the Commission wants to go with the future "Health for Growth Programme". She would like to rename it as "Health for All" because health shouldn't only be seen as a driver for growth; by contrast it should be seen as an end goal in itself. Ms Willmott referred to the Belgian Viasano project, a project under the current Health Programme which successfully reduced child obesity by around 22% in just 3 years to point out that outcomes aren't about short term economic growth but rather about the huge long-term benefits, as those children grow up into happier, healthier adults with much less chance of developing diseases. Therefore, we must continue to invest in prevention measures which, in turn, will result in huge savings in health costs further down the line. Ms Willmott concluded that we have to take on board some of the lessons learned from the last health programme and try to incorporate those into the next Strategy. She also expressed her interest in the opinions and experiences of the NGO-sector, the Commission, the Member States as well as fellow MEPs regarding the current Health Strategy.
1.2. Andrzej Rys, Director of the Health Systems and Products Directorate of DG SANCO, European Commission
Dr Rys started his presentation with a brief overview of the principles and objectives of the current Health Strategy. The first principle: "Shared Health Values" is based on universal access to good quality care, equity and solidarity. The second principle: "Health is the Greatest Wealth" was a challenge because economists, the society and employers had to be convinced. The third principle: "Health in All Policies" (HIAP) is still in the developing phase as well as the fourth and last principle: "A strong EU voice in Global Health". In this respect, the EU still needs to find a way to speak with a single voice. The three objectives are: "fostering good health in an ageing Europe", "protecting citizens from health threats" and "supporting dynamic health systems and new technologies". Dr Rys explained that since the implementation of the Health Strategy, many things changed. The economic crisis, the adoption of Directive 2011/24/EU on patients’ rights in cross-border healthcare and the progress with regard to the Pharmaceuticals and Medical Devices can be seen as important developments under the EU Health Strategy legislation. In addition, Dr Rys said an ageing population, financial stability, chronic diseases, health inequalities and health technology are areas of growing importance.
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Dr Rys pointed out that some key achievements could be made through cooperation; the best example of this being the adoption in November 2011 of the Antimicrobial Resistance Action Plan. In addition, the adoption of the Action Plan for the EU health workforce in April 2012 is an important realisation. This plan will be linked to the wider job recovery agenda of the EU. Dr Rys stated that the reflection processes in the Council are helpful in order to link the agendas of the Commission and Member States. The focus within these processes lies on Health Systems and chronic diseases. The Commission is trying to be more active at international level; especially with regard to the implementation of the health treaties. In this respect, the Framework Convention on Tobacco Control is a clear example. Regarding financial instruments, Dr Rys pointed out that the most significant financial instrument is the Health Programme 2008-2013. According to the Commission proposal of November 2011, the budget for the Health for Growth Programme 2014-2020 will increase. Dr Rys also mentioned some key adjustments since the mid-term evaluation such as: work on establishing a contribution in the area of health to Europe 2020 and its economic governance; the increasing focus on health systems; strengthening cooperation between different policy areas; the use of other funds for health (e.g. structural and research funds); and finally the reinforcement of existing implementation mechanisms (e.g. cooperation with the Council Senior Level Working Party). Dr Rys emphasised that the Commission is satisfied with the achievements of the current programme. For future Health Strategies, the EC is aiming to define a programme which will be broadly coherent with the actions of individual Member States and consistent with overall EU strategies and funding programmes. The Commission strongly believes that health is important in respect to economic governance. On the one hand, expenditures related to health represent a significant part of the budget in many countries; on the other hand, health is a contributor to growth in Europe. Dr Rys concluded that, after evaluation from consultants and debate in the Council, all principles and objectives of the Strategy are still valid and that a way must be found to prolong the²m. The Commission believes the debate should continue and is interested in the views of Parliament and other stakeholders. Dr Rys' presentation can be found in Annex III.
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1.3. Antonyia Parvanova, MEP and ENVI Shadow Rapporteur: The Future of the European Health Programme
Ms Parvanova emphasised that substantial financial resources should be allocated for the future Health Programme. At the same time, she raised the question as to whether we think the same Strategy, with the same priorities and objectives, should be extended into the new Health Programme. Looking at the EU Health Strategy 2008-2013, the four main principles are still relevant. Indeed, some of the objectives have already been addressed by legislation. Therefore, it is crucially important for the Commission to figure out how the EU Health Strategy should be updated to reflect the new situation. Ms Parvanova stressed the importance of health determinants. By having a clear idea of these determinants, it becomes easier to define priorities and to achieve significant change. She also mentioned that, especially in supporting dynamic health systems and in developing new technologies, many improvements can be made. Ms Parvanova highlighted the financial resources dedicated to innovation, which, until now, had mainly only been made available to industry - more specifically to the pharmaceutical industry. In the Public Health Programme 2014-2020, the European Parliament would like to see more emphasis on innovation in the area of management, health technology assessment and other public health priorities which have not been covered so far. Ms Parvanova referred to a survey on health literacy run by Maastricht University and financed by the EC. According to the study, there is a problem in eight Member States with regard to health literacy. In Bulgaria, for example, 52% of the population has a health literacy qualified as problematic or inadequate. In regard to health prevention and promotion, 70% of the population is qualified as problematic or inadequate. Ms Parvanova stressed that every strategy and programme that wants to have a public health impact should be understandable for those citizens to whom it is actually directed. Ms Parvanova pointed out that these data should be collected in all Member States. As a result, it would appear that substantive resources would need to be directed towards enhancing the health literacy of our population. This would enable them to make healthy choices and take care of themselves in a more responsible way. In conclusion, Ms Parvanova underlined that there are plenty of issues requiring political and financial support. She expressed her interest in seeing what the new Commissions' Health Strategy will include.
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1.4. Monika Kosinska, Secretary General, European Public Health Alliance (EPHA)
Ms Kosinska pointed out that the current Strategy was developed in a different time, where the crisis was unthinkable. She expressed her concern that in the current context, where some countries are recommended to make cuts in health care, people will think that growth will resolve everything. She stressed that wealth and growth do not automatically lead to good health. Our policies have to be smart and specific to make sure that we get the best out of the crisis and not just more of the same. Ms Kosinska voiced her hope that the future Strategy will deliver new, post GDP indicators to measure wealth. She also asked if the present strategy is still fit for purpose or whether it is necessary to review the priorities. According to Ms Kosinska a Health Strategy must contain two key elements: keeping people healthy as long as possible; and ensuring they receive the best possible care if they are no longer healthy. The future strategy must find a right balance between these two areas. Ms Kosinska doubted this is the case with the current strategy. Ms Kosinska said that "Health in all Policies" is difficult to achieve. It is very difficult for the health sector to keep people healthy, because the sector has no control over the drivers of a healthy - or rather an unhealthy - life (e.g. marketing of alcohol or junk food, and selling of tobacco). It is, therefore, very important that politicians and the EP address these issues. Ms Kosinska noted there are very good recommendations regarding Health in all Policies and on how to deliver this in reality. She referred to Canada and the WHO, and would like to see that the future Health Strategy shows how to put HIAP into practice. Ms Kosinska mentioned there is some criticism coming from the NGO community of the focus placed on the ageing population. From the healthcare perspective, this focus can be seen as developing another area of growth rather than keeping people healthy. Ms Kosinska suggested we should look more at the health promotion and disease prevention aspects of ageing, which include investing in children. She said there is still not a sufficient health strategy focussing on children. This reflects a massive gap when we know that 80% of health interventions are effective, if they begun in preschool years. Ms Kosinska briefly mentioned some other points, such as the voluntary mechanisms that are in place for regulating some of the industries. She doubted whether these are really working. As to innovation, Ms Kosinska said we need to ensure we are investing in innovation that adds values to the existing methods currently in use. Innovation should really result in better care and better practices, which are accessible to the majority of the population and not just the wealthy and north-western parts of the EU. In addition, she believed most of the chronic diseases to be preventable. If we don't get the balance of our health strategy strategy right, then we are actually merely postponing the problem of health to a later date. Ms Kosinska concluded that it is still not completely clear how the different institutions have taken on board the Health Strategy as part of their daily work. Some Member States have reflected the priorities in their national plans, but how this is coordinated and fits into the overall strategy is not clear, nor is the role of the EP in the delivery of the implementation of the Health Strategy. Ms Kosinska's text can be found in Annex III.
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1.5. Questions & Answers
Question 1
Ms Willmott said tobacco is the most significant issue when it comes to the impact on public health and yet we keep waiting and waiting to implement the Tobacco Products Directive. When will the Commission finish its proposal? Dr Rys assured him that the Commission is working hard to finalise the proposal. Due to many factors, such as lobbying, problems with definitions and new products, the publication of the proposal has been delayed, but Dr Rys is optimistic and believes the EU is a house of anti-tobacco policy and can be seen as setting an example for the rest of the world. A few days before the workshop, Commissioner Dali said there is a chance the proposal will be finalised by the end of November.
Question 2
Mr Peterle wondered how to deal with the wide range of illnesses that require awareness and resources for research and treatment? Which elements do we have to take into account to develop a special approach? Ms Kosinska said prevention is the main underlying criterion to be taken into account in all main chronic diseases, not only for healthy people, but also for those that suffer a condition and are at risk of other chronic diseases. Prevention is not just for people who are well or are preventing chronic diseases, but for everyone within the scope of the population. Also, comorbidity needs to be properly understood and addressed, which is something we don't have enough information about: how to live in increasing ill health with different conditions. The final aspect on which a lot of work had been done - and this to a high standard - is rare diseases; however, this work is not accessible to people living in small countries. Dr Rys said the whole process is quite complicated. The Member States decided to work together under one umbrella in the fight against chronic diseases. At first, this was done through the UN; now it is done in the Health Council (EU). The Commission hopes firstly to define the European added value, secondly that we can collaborate and thirdly that we can bring some additional value to the work of NGOs and economic organisations.
Question 3
Mr Peterle's second question addressed the health indicators. Where do we stand with them and when will we be able to measure the efficiency of our policy at European level? In his comment, Dr Rys said that there has been a certain degree of inflation, with some people proposing sets that went up to 400 indicators in order to define health. He said that the Commission is working very hard to establish a number of indicators that can serve and be useful in defining health strategies. The EC is trying to define and reach agreement with the Member States on the number of indicators in the field of health systems performances. In this debate, you must find a balance between health and health systems. The compromise involves looking at how these two sets of measures are reflected in existing health policy.
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Question 4
Mr Peterle finally asked if there has been an evolution in regard to prevention. Is there more prevention or more efficient prevention? Is this really a key issue or is it just a keyword in our resolutions? Ms Kosinska responded that prevention should be the main priority. At European level, we are not doing very well in terms of policies that benefit prevention. For example, on the domain of labelling and public health measures, a lot of progress can be made. However, at Member State level, we see an increasing appetite for some difficult issues. Since Romania for example started with its proposal for a junk food tax in 2009, we are seeing more and more Member States becoming in favour of taxes on alcohol, junk food and soda. It is a trend which we can't ignore. At European level and certainly within the EP the debate is less vivid.
Question 5
Professor Alan White, Professor of Men’s Health at the Leeds Metropolitan University and author of the report on The State of Men's Health in Europe, which was ordered by the EC, asked if the EU health strategy is focussing on both well-being and health. It showed worrying figures about premature deaths in men; many of which being avoidable. Ms Parvanova was positively surprised that the issue of men's health was raised. She stated we have failed to address men's health in our policies. She also stressed the importance of identifying priorities and updating those priorities with evidence that we already have. Data analysis should provide insights on how to reshuffle the financial portfolio. Not just to show political concern, but also to obtain a real programme that delivers results and which is cost effective. Ms Kosinska responded that the issue the Professor raised is potentially one of the most important issues that we have at the moment. In the context of the country-specific recommendations and changes at national level, where we see, for example, a rise in pension age, the issue of men's health and their ability to stay in employment is incredibly important for our economies.
Question 6
Leonardo Palumbo from the EPHA asked how the EC and EP wanted to achieve continuity between the accomplishment of the current Health Programme and the future Health for Growth Programme. If you look at the health strategy and the public health programme, a lot of work has been done on health inequalities and Health in all Policies. Many of these aspects don't seem to be addressed in the Health for Growth Programme. What is the view of the EP and EC on this? Dr Rys said it is important to find an institutional way to prolong the current strategy. There needs to be a reflection in order for it to become a renovated health strategy. He stresses the Commission really believes the main principles and objectives make sense, and underlined that there is room for new ideas, which bear in mind the different economic situation we are facing now.
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PART 2: VIEWS FROM SELECTED MEMBER STATES
2.1. Introduction
Mr Peterle introduced the second part of the workshop and said he was honoured to announce three other excellent speakers from three different Member States: Romania, Belgium and Cyprus (which takes over the Presidency in July 2012). He was interested in listening to the experiences of those dealing with the Strategy at Member State level.
2.2. Raed Arafat, Undersecretary of State, Romanian Ministry of Health
Mr Arafat underlined that the Strategy is very important for all the Member States and reduces inequalities, which is crucial for the future of Europe. Mr Arafat highlighted some key issues. Due to the fact that the current Strategy contains such a broad spectrum of issues, the allocated resources, although on the increase, are still insufficient. He stressed the need to raise the amount of funding available for the implementation of the Strategy or to focus on some issues, whose implementation during the next strategic period is considered to be more important. Another issue Mr Arafat addressed was the need for more technical support for local experts to implement the programme. Moreover, Mr Arafat referred to infrastructure. He said one of the major problems Romania faces as a country is its very old infrastructure. This makes the system less credible for patients and when Directive 2011/24/EU on patients’ rights in cross-border healthcare is implemented, Romania is afraid it will be the subject of great business issues of cross- border care delivery for its patients. With regard to future funds, Mr Arafat said infrastructure is part of developing health and of reducing inequalities between our countries and must go together with the "Cross Border Directive". Finally, Mr Arafat raised the issue of workforce. Some decisions taken in one Member State can influence other Member States. Mr Arafat referred to measures taken in some countries (e.g. the reduction of working hours to 35 hours a week) that require attracting more qualified personnel. As a result, a country like Romania is losing its nurses and physicians to other Member States. This threatens the quality and the continuity of the health care. Mr Arafat concluded that the new Strategy must take these issues very seriously; ensuring that they are tackled by and in cooperation with all the Member States.
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2.3. Chris Decoster, Director General, Department of Health, Belgian Ministry of Health
Mr Decoster said the Commission's White Book was an important step towards a strategic EU approach to the challenge of Public Health and recalled the key elements of the Health Strategy. The first principle which puts forward shared values, universal access to quality care and equity is today, more than ever, of great importance. In Belgium, near 100% of the population has access to the Health System. In spite of the present difficult times, the Belgian authorities intend to do everything in their power to keep this objective. The second principle "Health is Wealth" can be seen as one of the best arguments towards the preservation of investments in health and health care in times of crisis. Mr Decoster explained that the third principle "Health in All Policies" still needs to be defended. More and more budgetary constraints are taking precedence over health. He stressed the horizontal impact on other EU policies and funding programmes still need to be improved. In the context of Global Health (the fourth principle), Mr Decoster underlined the objective to reach the Millennium Development Goals (MDGs) as soon as possible and Belgium's commitment to the Paris Declaration and the Accra agenda. Mr Decoster stressed that the principles and objectives of the strategy remain more or less up-to-date. The EU is still facing the same major health challenges with a particular focus on sustainability. Mr Decoster highlighted that Belgium has put different plans in place in relation to the objectives of the Health Strategy. He referred to initiatives of prevention and health promotion (e.g. colorectal cancer screening for risk groups); a plan for chronic illness, an issue put forward during the Belgian Presidency of the EU; a National Cancer plan, which is a success and will be complemented in the future; a plan for hospitals was prepared in order to address quality and patient safety; and a plan for rare diseases (especially in this field the added value of European Collaboration was, he felt, very important). Mr Decoster stated that it is important to realise this plan within the framework of the "Cross Border Directive". Belgium is working on the implementation of e-health applications in order to increase the communication among caregivers, to optimise data collection and to simplify the administrative burden for caregivers. Belgium also created an institute for health studies in order to increase the evidence-base of policy making. Mr Decoster said they are trying to use those studies for example to design or chronicle new disease plans. Another important issue is the European Directive on organs. The collaboration between the Euro transplant countries is very important. Mr Decoster noted that Belgium is preparing a mental health reform. It will be an evolution towards a more community based health care. The whole country will be covered by this reform and the next objective will be to realise a similar reform in relation to mental health for children. Mr Decoster is convinced that hospitalisation is not always a good solution. Therefore, we must have more mental health care in our communities. Mr Decoster said that Belgium has a strategy for HiAP and pointed out the Joint Action on Health is a very good framework to develop a HiAP policy. Mr Decoster also stressed the actions on some infectious diseases (such as tuberculosis) and the rise in hospital infections (with the famous CPE, which poses a real threat). We will have to work more together to address those threats.
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Even if many of these actions can't be directly attributed to the mere existence of the strategy, it is difficult to consider the new proposal for a Health Programme without a general frame recalling these important principles. It is even more difficult to imagine the implementation of the EU 2020 strategy and a new budgetary discipline to the health sector without a frame recalling our common values and principles, and advocating the following message as health benefits: economic growth, social equity, and the welfare and well-being of people. Mr Decoster concluded that the future Strategy must be based on those kinds of values. Mr Decoster's presentation can be found in Annex III.
2.4. Loukas Georgiou, Health Attaché, Permanent Representation of Cyprus to the EU
Mr Georgiou noted that the evaluation of the work performed in the fields of health and individually developed and implemented strategies, as well as the recognition of areas that need more work, is of utmost importance for the health of EU citizens. The mid-term evaluation can definitely help us to understand all these aspects and get a clearer view of how to tackle future needs for citizens' health and wellbeing. Mr Georgiou pointed out that the results of the mid-term evaluation show the current Health Strategy to have successfully addressed various issues, such as the legal framework for Patients’ Rights in Cross-Border Healthcare, the revision of the Pharmaceuticals Package, the issue of colorectal cancer screening guidelines, and coordinated actions in the field of nutrition. Actions were also addressed through the Public Health Programme 2008- 2013, focusing among others on the reduction of Health Inequalities, Health Information and Data Protection, identification and assessment of Health Risks, Tobacco Control, Nutrition, Healthy Ageing, Mental Health, Alcohol, Drugs, Injury Prevention, Rare Diseases, HIV/AIDS, Health Workforce etc. Mr Georgiou stressed there is still a lot of work to be performed in areas such as Chronic Diseases, Information to Patients, Health Security Initiative, Joint Procurement of pandemic influenza vaccines and antivirals, and revision of legislation on medical devices, clinical trials and tobacco control. Mr Georgiou mentioned that the flagship initiatives of Europe 2020 for smart and sustainable growth from back in 2010 develop a new scene for the implementation of actions in the field of Health. In particular, the launch of the Innovation Partnership on Active and Healthy Ageing has revealed the need for cooperation among stakeholders in order to introduce innovative tools in healthcare, which will contribute to the increase in Healthy Life Years. Mr Georgiou said it is now the right time to adopt new actions based on the results of the mid-term evaluation of Health Strategy and the initiatives of EU 2020. It is also the time for acknowledging the importance of innovation in healthcare services and adopting relevant actions. Speaking as an upcoming Presidency of the Council, Cyprus recognises the current challenges of economic crisis and demographic change with the ageing of population, and their negative effects in the healthcare sector. The increasing need for healthcare services in combination with the cut-backs in budgets make it necessary to evaluate existing programmes and promote the implementation of new ones focused on early prevention of disease and promotion of health; this should be achieved through the adoption of innovative healthcare programmes.
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Mr Georgiou said the Cyprus Presidency is committed to working closely with all involved stakeholders towards these directions. Efforts will also focus on underlining the importance of: disease prevention and health promotion in every stage of life to assure Healthy Ageing; the importance of adopting innovative approaches in healthcare and, equally, of delivering high quality healthcare services; and the importance of building capacity into the surveillance and control of communicable diseases in a cross-border perspective. It has once again be clear that health is a matter of coordinated actions not only at national but also at European and at global level. Mr Georgiou concluded that, in order to complete these challenging tasks, Cyprus will, amongst others, need the cooperation and support of the European Parliament. He is convinced that, with close collaboration, common ground will be found in favour of the Union’s citizens.
2.5. Questions & Answers
Question 1
Mr Peterle asked how we can collaborate more? Are Member States interested in more recommendations, advice, information or exchange of best practices? In line with the Lisbon Treaty, what could we transfer to the higher level? What should the EU do for Member States in order to get more health for all? Mr Decoster said the European level is very interesting, because it enables a country to place issues on the agenda that can be used in the Member States. In this way, EU policy can reinforce countries' own policies. Mr Decoster also identified some issues that could be stressed more in Europe. Within the framework of the Cross-Border Health Care Directive data exchange across borders is needed. Therefore, it is very important to have an e-health system. Another issue that is not well developed in Europe is mental health. In Mr Decoster's view, this is an issue of European competence. Different countries are trying to reform the mental health sector, but there is no collaboration. Also within the domain of infectious diseases and infections (and especially with regard to antibiotics), there was room to work more closely together. Mr Arafat stated we cannot consider health as being an issue dealt with by each Member State alone. Whilst fully respecting the subsidiarity principle, many issues should be dealt with at supranational level. For example, health security issues involve the whole EU security. Mr Arafat also emphasised that Member States can use much more support from the EU through recommendations and by defining the baseline which each Member State has to respect. Mr Georgiou said that, for a Member State as Cyprus which is a small island, it is very useful to see good experiences and best practices from other Member States in order to learn and implement these examples with the aim of ensuring that citizens enjoy better health. Mr Georgiou added that Cyprus is a small country, which makes it much easier to reform their health system than for larger Member States.
Question 2 and 3
Ms Kosinska wondered how the European context could be used in order to strive for more investment in health. Her second question was addressed to Mr Arafat. Has the crisis influenced problems in regard to workforce and infrastructure?
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Mr Arafat answered both questions. As for the first question Mr Arafat emphasised that at this moment the health sector mostly is led by financial ministries and not by the ministry of health. The impact in the medium and long term will be much more costly compared to the cuts that are taking place right now. Monitoring institutions, including the EC, should advise on which aspects you can really economise and on which aspects you can't. As regards the second question, Mr Arafat explained that the crisis is having a negative impact; it is further deepening the gap. Mr Decoster emphasised that, wherever possible, cuts must be made and that whenever necessary, funds reinvested. Through guidelines and campaigns, Belgium is trying to reduce certain expenses in order to use the money elsewhere (e.g. with regard to the mental health care reform, Belgium has been able to reduce the amount of hospitalisations and to reuse this money for more community-based treatment). Each country must look for itself to see where it can reduce costs and where it can use the money in another way. Europe can play an important role for us in giving good examples, in giving priorities and in enhancing collaboration. Not every country must make guidelines: if Europe could make them for the Member States, savings would be made. Mr Arafat agreed with Mr Decoster and emphasised that Romania wants to implement health technology assessment in order to cut unjustified expenditures. In addition, Mr Arafat addressed the issue of the average expenditure on health in relation to the EU's GDP. According to Mr Arafat, the average is around 8% of GDP. Mr Arafat said there are countries (such as Romania) that are spending as low as 5% of its GDP on the health system. He suggested a Directive is needed stating you cannot spend less than a given % of the average expenditure from the GDP of the EU Member States. This will help countries to escape from the control of the finance ministers.
Question 4
Mr James Kennedy from Rohde Public Policy referred to mental health care and the need to see health as an investment. He said that, in Ireland, policy responds very badly to empirical data. In contrast, this is something the EU level does very well. Mr Kennedy stated if you want to see health care as an investment, you have to respond to empirical data and continue to make recommendations and adapt resolutions in this way in fields such as depression. Mr Decoster responded that health data are very important, because measuring means knowing. Also with regard to indicators, you need a good collection of data to measure and compare. In addition, it can help you to see where to lay the priorities and where you must invest first.
2.6. Concluding remarks
Mr Peterle said it was very interesting to first listen to the representatives of the European institutions and then to the invited representatives of the Member States present and stated that the two hours were used very well. Mr Peterle thanked the panellists for their input and pointed out some of the recommendations could give added value to the next Health Strategy or for the continuity of the existing one. Though this would, of course, also depend on the Member States. Do they just wish to continue current policy or should some adjustments be made? Mr Peterle highlighted the following words: stimulation, inspiration and good examples.
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ANNEX I: WORKSHOP PROGRAMME
Organised by the Policy Department A - Economy & Science for the Environment, Public Health and Food Safety Committee (ENVI)
Workshop on Mid-Term Review and Evaluation of the EU Health Strategy
Wednesday 30 May 2012 - 16.00 - 18.00 European Parliament, Brussels, Room: Altiero Spinelli 5E-2
PROGRAMME
16.00 Welcome and opening by the Co-Chairs of the Working Group on Health: MEP Alojz PETERLE and MEP Glenis WILLMOTT
Part 1: The EU Health Strategy - State of Play 16.10 Andrzej Rys, Health Systems and Products Director, European Commission, DG SANCO 16.20 MEP Antonyia Parvanova (Shadow Rapporteur): The Future of the European Health Programme 16.30 Monika Kosinska, Secretary General, European Public Health Alliance (EPHA) 16.40 Questions & Answers
Part 2: Views from Selected Member States 17.00 Raed Arafat, Undersecretary of State, Romanian Ministry of Health 17.10 Chris Decoster, Director General, Belgian Ministry of Health 17.20 Loukas Georgiou, Health Attaché, Permanent Representation of Cyprus to the EU 17.30 Questions & Answers 17.50 Closing remarks by the Co-chairs 18.00 End
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ANNEX II: SHORT BIOGRAPHIES OF EXPERTS
Dr Andrzej Rys, Director of the Health Systems and Products Directorate of DG SANCO
Andrzej Rys is a medical doctor, who graduated from Jagiellonian University in Krakow, Poland. He specialised in radiology and public health. In 1991, he established the School of Public Health (SPH) at the Jagiellonian University and he was the SPH's Director until 1997. From 1997 to 1999, he was the Director of Krakow's city health department, and from 1995 to 1999, Director of the ‘Harvard-Jagiellonian Consortium for Health’ - a project focusing on local governments' role in health care. From 1999 to 2002, he was the Deputy Minister of Health in Poland and developed a new system for emergency medicine and also a new education system for nurses. He was a member of the Polish accession negotiators team.
In 2003, he established and was a Director of the Centre for Innovation and Technology Transfer at Jagiellonian University in Krakow, Poland. He was also Director for Development at Diagnostic Ltd., Executive Director of the Polish Association of Private Health Care Employers and Chief Editor of the Journal "Health and Management". He joined the European Commission in June 2006 and is currently the Director of the Health Systems and Products Directorate of DG SANCO.
Dr Antonyia Parvanova, MEP and ENVI shadow rapporteur (ALDE)
Dr Parvanova studied Medicine and Health Management in Varna, Public Health at Maastricht (the Netherlands) and Health Policy in England. She worked as a paediatrician, expert and researcher in the field of healthcare management.
After working as a doctor and researcher in Britain, Dr. Parvanova was elected as a Member of the Bulgarian Parliament from the National Movement for Stability and Prosperity in 2001 and then again in 2005. She was Vice-Chairman of the Committee on Public Health and was actively working on public health issues and health legislation at national level.
In 2005, Dr Parvanova was designated as a euro observer in the European Parliament and in 2009, she was elected as a regular Member of the European Parliament and as Vice- President of the Alliance of Liberals and Democrats for Europe (ALDE). She is an ALDE coordinator in the Committee on Women's Rights and Gender Equality and Vice-President of the Committee on Energy, Environment and Water to the Parliamentary Assembly of the Union for the Mediterranean.
In addition, she is a Member of the Committee on the Environment, Public Health and Food Safety, the Committee on the Internal Market and Consumer Protection, the Delegation for relations with Canada, the Delegation to the Parliamentary Assembly of the Union for the Mediterranean, the Delegation for relations with the Mashreq countries, as well as the Delegation for relations with Iran.
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Ms Monika Kosinska, Secretary General of the European Public Health Alliance (EPHA)
Ms Kosinska holds a first class degree in Social Sciences and an MA in International Peace and Security, and was educated in Liverpool, Bonn and at the King's College in London.
Ms Kosinska has extensive knowledge of public health issues at EU and national level. She was previously acting Executive Director of a think tank, working in the US, France and the UK to develop new thinking on future population challenges to health. She also worked as International Corporate Affairs Manager at a global retailer, engaging globally with senior company executives to improve understanding and relations with national authorities and local stakeholders. She is also founder and co-chair of EUREGHA, bringing together local and regional authorities from across Europe working on health. Her experience in high-level and strategic representation includes being a board member for the Health and Environmental Alliance, the Civil Society Contact Group, the European Bachelor and Master in Public Health programme at Maastricht University, and former Chair of the Action for Global Health Network. In addition, she is a member of the EY Alcohol and Health Forum, EU platform for action on diet, physical activity and health, the EU Health Policy Forum,and the DG SANCO Stakeholder Dialogue group
Ms Kosinska joined EPHA in February 2008 and leads the Secretariat. EPHA is a non- governmental organisation committed to bringing about change to national and EU policy that impacts health, social justice and equity. Ms Kosinska represents EPHA and its members in its work with European policy and decision makers, and provides an overall steer for the work programme and management of the Secretariat. In addition, she oversees the management of EU and other funded projects, the management of the EPHA team and the Communication and Advocacy strategies.
Dr Raed Arafat, Undersecretary of State, Romanian Ministry of Health
In 1991, Mr Arafat created the Mobile Emergency Service for Resuscitation and Extrication (SMURD), which began collaborating with the Romanian Firefighting Service and the Fire Service of Scotland: working for it as a volunteer until 1998, when he gained Romanian citizenship. He was also a first aid instructor and coordinated international niche lectures in several countries (including Austria, Denmark, Greece, the Netherlands, New Zealand, the Republic of Ireland, the United Kingdom and the United States).
In 2003, he was awarded the title of Knight of the National Order of Merit of Romania (also a Grand Officer since 2005). In 2010, he was invited to be a professor at the University of Medicine and Pharmacy "Victor Babes" Timisoara. He currently holds the position of Undersecretary of State at the Health Ministry of Romania.
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Mr Chris Decoster, Director General, Health Department, Belgian Ministry of Health
Mr Decoster is a Law and Criminology graduate. From 1981 to 1988, he worked as adviser to the Belgian Ministry of Social Affairs. Since 1992, he has been Director-General of the Department of Health (divisions: health care, accountancy and management of the hospitals and medical practice). He also was acting Secretary-General of the Ministry of Social Affairs, Public Health and Environment (from 1 August 1995 to 30 September 1996 and from 1 March 2001 to 15 October 2002). In addition, he is a visiting Professor at the State University of Ghent, academic consultant at the faculty of medicine at the Catholic University of Leuven and Chairman/Secretary of several Committees and Conferences such as the Belgian Interministerial Conference on Health.
Mr Loukas Georgiou, Health Attaché, Permanent Representation of Cyprus to the EU
Loukas Georgiou is the health attaché at the Permanent Representation of Cyprus to the European Union. He will be Vice-Chair of the Public Health Working Party and is in charge of the two new legislative proposals put forward in the Council and the European Parliament. Mr Georgiou graduated from Anglia Polytechnic University, where he gained a Masters Degree in Education and Management in Health. Prior to his arrival in Brussels, he worked for the Ministry of Health in Cyprus and also worked as a part-time teacher for Intensive Care Nursing in the European University of Cyprus.
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ANNEX III: PRESENTATIONS AND TEXTS
Presentation by Dr Andrzej Rys
EU Health Strategy
Andrzej RYS, Director of Health Systems and Products European Commission, DG Health and Consumers Presentation given at the EP Health Working Group 30th May 2012
The EU Health Strategy An overarching policy framework
4 principles: Shared EU health values (universality, access to good quality care, equity and solidarity) Health as the greatest wealth Health in all policies Strong EU voice in global health
3 objectives: Fostering good health in an ageing Europe Protecting citizens from health threats Supporting dynamic health systems and new technologies
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Questionnaire for Member States on mid-term evaluation
Number of most important actions at national level linked to the EU Health Strategy (total 213) 50 46 47 45 42 40 36 35
30
25
20 16 14 15 12 10
5
0 Values Health as HIAP Global Prevention Health Health wealth Health Promotion threats Systems
Ongoing developments under the EU Health Strategy Legislation
Adoption of the Directive on Patients' Rights in Cross-border Healthcare (March 2011) - deadline for transposition Oct 2013
Progress with regard to the Pharmaceuticals and Medical Devices Pharmacovigilance: New provisions (agreement in 2010) to become applicable in July 2012; further Commission proposals for a Regulation and Directive (Feb 2012) Falsified Medicines (adopted May 2011, transposed by Jan 2013) Clinical Trials (proposal for revision planned in 3Q 2012) Medical Devices (proposal for revision planned in 3Q 2012)
Organs (adopted in Jul 2010 and Action Plan 2009-2015), Blood (adopted in Apr 2011), Tissues and Cells (adopted in Aug 2010)
Commission proposal for a Council and EP Decision on serious cross border health threats (7 Dec 2011)
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Key achievements under the EU Health Strategy Cooperation
Antimicrobial Resistance Action Plan (adopted 17 Nov 2011)
Action Plan for the EU health workforce (adopted 18 Apr 2012)
Reflection processes together with Member States (Health Systems, Chronic Disease)
Health Promotion and Disease Prevention Nutrition/Tobacco/Alcohol Cancer, Mental Health, Rare diseases, HIV/AIDS Health Inequalities: Joint Action
International cooperation World Health Organization/Framework Convention on Tobacco Control/International Health Regulations/Global Health
EU Health Strategy Financial instruments
Health Programme 2008 - 2013 Budget of € 321.5 million
Health for Growth Programme 2014 - 2020 (Commission proposal Nov 2011) Budget of € 446 million Contribute to innovative, efficient and sustainable health systems Increase access to better and safer healthcare Promote good health and prevent diseases Protect citizens from cross-border health threats
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Lessons learnt from the 2011 Mid-term evaluation of the EU Health Strategy
The Strategy acts as a consistent guiding framework and as a reference for actions taken at national and EU level: - is broadly coherent with the actions of individual Member States; - is consistent with overall EU strategies (e.g. Europe 2020) and funding programmes
Limitations on direct impact on national and other EU policies
Key adjustments since the mid-term evaluation
Work to establish Health contribution to Europe 2020 and its economic governance Increasing focus on health systems and supporting reforms in the Member States: reflection processes, monitoring health systems Strengthening of the cooperation with other selected policies and use of funds (HIAP): e.g. structural funds, research funds Reinforcement of the existing implementation mechanisms, e.g. multiannual work programme in renewed Council Senior Level Working Party
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Economic Governance Monitoring Country Health Systems as part of European Semester
Why ? Budget reform (healthcare > 14% of public budgets) Health as a contributor to economic growth and Europe 2020 Reflection Process on Health Systems
Which Countries ? Countries with recommendations on health systems in European Semester 2011 Countries Receiving European Financial Assistance
Economic Governance Health Systems in European Semester 2011 - 2012
2012 Annual Growth Survey: Better uptake of the health theme compared to 2011
2012 Country Specific Recommendations (CSRs) increase in number of health-related CSRs continued importance of budget reform; increased attention to job potential of 'white jobs'; employability/health of the workforce
Work with Member States in the Reflection Process on Health Systems, e.g. Better present health systems reform in National Reform Programmes, establish linkages between health investments, healthy workforce and poverty reduction. Define success factors for structural funds investments in health
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Next steps and post 2013
The objectives and principles of the EU Health Strategy 'Together for Health' remain valid. Overall reflection on the ways to extend their validity beyond 2013, based on: inter-institutional debate about the Health for Growth Programme and MFF; Council Reflection Processes on health systems and chronic disease; Europe 2020 and its flagships initiatives Partnership on active and healthy ageing Views/contributions from the European Parliament?
Thank you
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Contribution from EPHA
ENVI Committee Workshop on Mid-Term Review and Evaluation of the EU Health Strategy
May 2012
EPHA is the European Platform bringing together public health organisations representing health professionals, patients groups, health promotion and disease specific NGOs, academic groupings and other health associations. Our membership includes representatives at international, European, national, regional and local level. EPHA's mission is to protect and promote public health in Europe. EPHA brings together organisations across the public health community, in order to share learning and information and to bring a public health perspective to European decision-making. We help build capacity in civil society participation across Europe in the health field, and work to empower the public health community to ensure that the health of European citizens is protected and promoted by decision-makers. Our aim is to ensure health is at the heart of European policy and legislation. Please see www.epha.org for more information.
Monika Kosinska emphasised the historic view of the EU Health Strategy. EU policy makers designed this strategy at a time of economic growth; in 2006, many had considered the Lisbon Strategy for growth and jobs successful. The political context we are living in has changed and now the economic crisis is having an impact with worse health outcomes and greater inequality, but the crisis only highlights what we already know: investment in health improves wealth; health investments create jobs: and protecting health budgets throughout the economic downturn is, therefore, essential.
Five years ago, one of the main discussions was “health is wealth” and, although this is true, wealth and growth do not necessarily lead to health. Indeed, five years ago, the EU was in a period of economic growth, and yet it was not experiencing better health outcomes. There is a current worrying trend that countries in the EU are reducing their health spending and reforming pension systems in countries, such as Greece. The political debate has focused on how to return to a period of economic growth, when this was not creating more equal and healthier societies. Health authorities across Europe recognise that the present economic system does not distribute wealth with solidarity and equity, and even hinders improvement of health. The poorer countries are the most vulnerable when it comes to health loss. In this context, it would, in any future EU strategy, be good to go beyond GDP indicators to include ones that also measure progress in different ways. Eurostat, the OECD and several countries like Bhutan, the UK and Canada have been exploring different ways to measure progress.
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There are two key purposes to a health strategy – keeping people healthy as long as possible and giving people the best possible care when they are no longer healthy. It is difficult for the health sectors, as the causes of ill health often lie outside. The health sector does not sell tobacco, market alcohol to children or produce food high in fat, sugar and salt. This is the importance of health in all policies as a priority in the adoption of an EU health strategy “Together for Health.”
This also highlights that the role of policy makers and the European Parliament. Members of the European Parliament can take bold action to ban advertising to children, promote better information to consumers, and ensure accurate health claims. The WHO has recommendations on health in all policies and considers that every Minister is a health Minister. The public health community has long called for people outside of the health sector to also hold responsibility for the health and wellbeing of our society. Health in all policies will ensure that different Ministries and governmental bodies work together towards advancing human development, mainly through social determinants of health, sustainability, advancing gender equity, reducing inequalities and improving health outcomes across a social gradient.
Regarding the implementation of the EU Health Strategy, the EU Health Policy Forum, of which EPHA is the Secretariat welcomed the health in all policies approach and for more action to be taken. Another recommendation was to invest more in healthy ageing, as Europe is facing serious demographic changes. The Commission has listened to this advice and developed an Innovation Partnership on Healthy and Active Ageing, aimed at increasing healthy life years by two by 2020. However the public health community often makes a critique that the partnership is more about creating a market and less than preventing disease and promoting health. The Partnership has a strong focus on treatments, products and technology, however there is also a strong need to further work on health promotion and disease prevention. According to the latest World Health Organization figures, 86% of all deaths occurring in the WHO European Region are caused by chronic non-communicable diseases. Four major health determinants: nutrition, tobacco, alcohol and a lack of physical activity - account for most chronic diseases knowing that they also are the most preventable causes of deaths. In this context, the recent WHO Global Recommendations on Physical Activity for Health emphasised the need for people beyond 65 years old to "be as physically active as possible". Therefore, EPHA strongly believes that there is an urgent need to act on health determinants, especially when attempting to reach the goal of increasing healthy life years by two years.
EPHA has previously called on the Commission to develop a child’s health strategy and encouraged the ENVI Committee to have an own-initiative report on children’s Health. Such a report would be useful to complement the European Innovation Partnership on Active and Healthy Ageing that aims to increase by two years the healthy life years or older persons by 2020. EPHA advocates for a life course approach, as healthy ageing implies leading a healthy lifestyle from cradle to grave. Although it is never too late to start making healthy choices, the root causes of later healthy life years are laid early. Just as for the general adult population chronic, communicable and non-communicable diseases are also growing among children. As you know, a health promotion and disease prevention approach is cost- efficient, and in general habits are easier to develop at a younger age. From a public health perspective, the most effective approach to improving children’s health would early prevention and health promotion that continues across the life course, which can increase healthy life years in Europe and save lives.
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Injuries and accidents are at highest levels within children population and are number one cause of child mortality in Europe. Notably, just as for the general adult population chronic, communicable and non-communicable diseases are also growing among children. To conclude for the future health strategy to be successful, there will have to less focus on innovation for the sake of innovation and DG SANCO will need promote public health interventions from a health in all policies approach. Innovation should add value and bring better care to patients and improve working conditions for health professionals. Although many member states base their national health strategies on the EU healthy strategy, it is not clear how all the EU Institutions use the health strategy in their daily work. The public health community foresees an important role for the European Parliament in scrutinising the drafting and implementation of a future EU health strategy and urges the ENVI Committee to engage fully in taking forward health across all policies from 2014 onward.
For further information: EPHA response to the European Commission discussion document for a health strategy – Health in Europe: a strategic approach: http://www.epha.org/IMG/pdf/EPHA_response_Health_Strategy_final.pdf EU Health Policy Forum Input to the Council Working Party at Senior Level on the implementation of the EU Health Strategy: http://ec.europa.eu/health/interest_groups/docs/euhpf_wpsenior_en.pdf The EU Health Policy Forum Resolution on the Implementation of the EU Health Strategy: http://ec.europa.eu/health/archive/ph_overview/health_forum/docs/euhpf_resolutio n_en.pdf EPHA Report on Beyond GDP : www.epha.org/a/5016
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Presentation by Chris Decoster
SPF SANTE PUBLIQUE, SECURITE DE LA CHAINE ALIMENTAIRE ET ENVIRONNEMENT Workshop Mid-term review and 1 evaluation of the EU Health Strategy
VIEWS FROM BELGIUM
C. DECOSTER Director General
SPF SANTE PUBLIQUE, SECURITE DE LA CHAINE ALIMENTAIRE ET ENVIRONNEMENT
VIEWS FROM BELGIUM 2 •Health conditions => global society CHALLENGE
•IN EU AND OECD COUNTRIES: ageing, non communicable diseases, technology costs
•WHITE BOOK from the Commission: • Universal access to quality care and equity • Health is Wealth • Health in All Policies • Global Health
•EU => growing challenge => SUSTAINABILITY
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SPF SANTE PUBLIQUE, SECURITE DE LA CHAINE ALIMENTAIRE ET ENVIRONNEMENT
VIEWS FROM BELGIUM 3 •BELGIUM PUT IN PLACE • Different initiatives of prevention and health promotion • Plan chronically ill • National Cancer plan • Preparation plan for rare diseases • implementation of ehealth applications • More attention for health threats • Quality and patient safety policy in hospitals • Organ transplantation/EUROSTRANPLANT • Mental health reform
•STRATEGY INCREASE • HIAP APPROACH • Awareness HEALTH INEQUALITIES • evidence-base of policy making in the health sector
SPF SANTE PUBLIQUE, SECURITE DE LA CHAINE ALIMENTAIRE ET ENVIRONNEMENT
VIEWS FROM BELGIUM 4 •Health for Growth 2014-2020
•EU 2020 Strategy
=> Need of a general frame under supervision of Senior Level Working Party
« HEALTH BENEFITS THE ECONOMIC GROWTH, THE SOCIAL EQUITY, THE WELFORE AND WELL-BEING OF PEOPLE »
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SPF SANTE PUBLIQUE, SECURITE DE LA CHAINE ALIMENTAIRE ET ENVIRONNEMENT
VIEWS FROM BELGIUM 5 BELGIUM IS WILLING:
•COLLABORATION EU COMMISSION / MS •RESPECT division of competences (COM, EC, MS) specificities health systems
•EPSCO and SENIOR LEVEL WORKING PARTY => ROLE TO PLAY •UPDATE of the STRATEGY •WHO EURO HEALTH 2020 STRATEGY
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