EU ZMK's Diary

“All the so-called secrets of success will not work unless you do.”

This blog entry can be regarded as some kind of reaction to another interesting note of Mr. Eberhard Rhein visible on his blog: EU Health Policy should focus on Disease Prevention

In this current post we will follow the next topics:

1. The first part covers some aspects of the legal bounds which limit our efforts in the European public health field.

2. The second part adress the state of health of European citizens through the following sub-items:

a) the possibilities of the Union and the Member States to fight diseases
b) the connection between the ageing pupulation and public health policies, and finally
c) my thoughts with regard to the disease prevention, as the suggested best way forward.

1. Legal limits and opportunities
In order the better adress the public health relevances, I would like to set up the legal framework as limits of my thoughts.

(Comment: I refer here to my earlier clarification and I mostly repeat it [see under number 12. or under date: 5/5/2012]. People often say that “the Treaty of Lisbon lays down that…” which is not really correct. The Treaty of Lisbon only introduced the necessary modifications to the original texts of the Treaties. However, the Treaty of Lisbon only _modified_ the Treaty on the European Union (TEU) and not only modified but renamed the Treaty establishing the European Community to the Treaty on the Functioning of the European Union (TFEU). Therefore, the primary sources of the law of the Union are now the TEU and the TFEU and not the Treaty of Lisbon, and from a legal point of view the text of the Lisbon Treaty does not prevail.)

The changes of the Lisbon Treaty affected the article regulating public health and the numbering has been changed: the old Article 152 EC became the new Article 168 TFEU. In order to make clear the changes we are talking about, I insert here a reference to the examined article before and after the change:

1.) Paragraph 1 of Article 152 of the Treaty establishing the European Community:

“1. A high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities.
Community action, which shall complement national policies, shall be directed towards improving public health, preventing human illness and diseases, and obviating sources of danger to human health. Such action shall cover the fight against the major health scourges, by promoting research into their causes, their transmission and their prevention, as well as health information and education. The Community shall complement the Member States’ action in reducing drugs-related health damage, including information and prevention.”

2. Paragraph 1 and 5 of Article 168 of the Treaty on the Functioning of the European Union

“1. A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities.
Union action, which shall complement national policies, shall be directed towards improving public health, preventing physical and mental illness and diseases, and obviating sources of danger to physical and mental health. Such action shall cover the fight against the major health scourges, by promoting research into their causes, their transmission and their prevention, as well as health information and education, and monitoring, early warning of and combating serious cross-border threats to health.
The Union shall complement the Member States’ action in reducing drugs-related health damage, including information and prevention.”
(…)
5. The European Parliament and the Council, (…) may also adopt (…) and measures which have as their direct objective the protection of public health regarding tobacco and the abuse of alcohol, excluding any harmonisation of the laws and regulations of the Member States.”

In my opinion, the most important aspect of the EU’s public health policy is in the first sentence of paragraph 1 of both Article 152 EC and Article 168 TFEU: a high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities. Which means that instead of creating an independent and overregulated public health legal framework, the intention is rather to include the public health aspects in every segment of the EU policies (ex. new technical standards, safety of workplaces, authorization of new dangerous substances, food security and animal health, safety on roads and the enumeration would be run on).

However, we may not overestimate the significance of the exact naming of physical and mental health as well as of the fight against serious cross-border threats such as the tobacco and abuse of alcohol since these are not crucial, revolutionary inclusions. made by the Lisbon Treaty

Thus, in my opinion, regardless the exact wording of the law of the Union, even before and after the Lisbon Treaty, there were no major changes included, and either the EC or the TFEU provided with the necessary legal approval to take appropriate actions which seems necessary to adress a given public health problem.

2. Which actions do seem necessary to improve the state of health of European citizens?

May I make my position quite clear already at the beginning: I share either the methodology or the main findings of the referred article. However, it seems to be useful to highlight some other elements after the above presented legal clarifications.

a) the possibilities of the Union and the Member States to fight diseases
Based on the legal text and my fiindings, we can stress, that within the public health policies, the Member States have a more accentuated role and opportunities than the EU does.

(Comment: In other words the public health belongs to the so-called ‘weak’ European politics as Education or Culture do which operates mainly with soft-law in spite of the ‘strong’ European politics such as competition or the common currency, operating with binding hard-law.)

As I clarified earlier, the legal changes of the Treaties did not touch upon seriously the divison of the competences between the EU and the Member States. Therefore it is up to the 27 Member States to find appropriate solutions, and the EU can rather help and promote this procedure. Hence, the solution is in the hands of the 27 Member States, which may result theoretically 27 different approaches. A program or a treatment policy which might work quite well in a given Member State, would be completely ineffective in an other-one.

b) the connection between the ageing pupulation and public health policies

Let’s be clear: the high level of the healthcare services is mainly a question of money. And under the financial and economic crisis the financial resources are limited. It does not mean necessarily a bad thing: this can promote the cost-friendly solutions and might make result a more effective healthcare system.

And the ageing population is also a crucial cause of healthcare expenditures, that is also true. But it is a complex problem – mainly related to the rate of births – which has a social dimension., too Therefore, this is rather a social policy problem than a health-related one, although it has doubtless serious health implications. In that regard, I would like to refer to my findings concerning the subsidiarity of the public health policy.

Therefore it is not up to the ongoing healthcare reforms to resolve this problem although a cost effective and efficient healthcare system is in the best interests of everyone.

c) my thoughts with regard to the disease prevention, as the suggested best way forward.

I share most of the findings of the referred Blog including that “Life-long health prevention must therefore become the buzzword.” The prevention is the most effective method and as efficace as much money will be spent to it.

Unfortunately the positive effects of any preventive health policies will occur only in long term which is a goal difficult to achieve in the crisis hit countries where the governments face serious political turmoils (see the recent example of France or Greece).

Referring back to the responsabilities of the Member States, the viable solutions can differ among the Member States. But even if the need for cost-efficiency is highly appreciated, I believe in the need of appropriate financing of the Member States’ efforts to make them possible to create effective prevention programs. It might be advantagous to re-think the sources allocated to these purposes since with a clever use, this investment could result the most vaulable benefit of any economies: a healthier society.

Conclusion

1.) Concerning the legal side, my conclusion would be that although the Lisbon Treaty introduced some changes, the core content of the public health part of the Treaty is rather unchanged or only slightly modified.

2.) a) It is up to the 27 Member States to adress the particular problems of their healthcare systems. However the co-ordinating role of the EU would be highly appreciated with special regard to the cross border issues.

b) The ageing population is a serious problem whith remarkable health effects. Nonetheless, it is rather a social than a pure healthcare problem and it is mainly up to the integrated social policy to promote the raise of births and to adress the problem taking into account the public health aspects.

c) The cost efficiency of the healthcare systems is highly desirable but without appropriate European budget allocations, even the cleverest prevention cannot be effective.

I remain at your disposal.

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Related earlier EU Hemicycle updates:

10. How Healthy is Our Way of Thinking about Healthcare Cost Cuts?

9. The Choice is Yours: either You Drink or… Re-think the EU’s Alcohol Strategy

Zoltán MASSAY-KOSUBEK

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(Cover Photo © Taber Andrew Bain)

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