Zoltán Massay-Kosubek

A review by MEPs, the Commission and the Civil Society in order to make some useful remarks to the new Health Strategy (2014-2020)

“If you don’t know where you are going, any road will get you there.” ~Lewis Carroll

I had the honour to participate in a public workshop organized at the European Parliament on the 30th May 2012. The meeting provided an open platform for an exchange of views among the European Decision Makers (EP, Commission, Member States) and the civil society (NGOs). As an independent expert for the time being, I think that I am in the best position to sum up what has been said from a stakeholders point of view.

Comment: Instead of preparing the unofficial minutes of the meeting, I found more useful to present the most interesting comments about the “old” European Health Strategy 2008-2013 taking into account that probably all participant had in mind what could be included into the new European Health Strategy 2014-2020. I am delighted to provide the list of the invited speakers, as follows:

Alojz PETERLE, MEP (EPP), co-chair
Glenis WILLMOTT, MEP (S & D), co-chair
Adrzej RYS, Commission, DG SANCO
Monika KOSINSKA, European Public Health Alliance (EPHA)
Raed ARAFAT, Ministry of Health of Romania
Chris DECOSTER, Ministry of Health of Belgium
Loukas GEORGIOU, Permanent Representation of Cyprus

Introduction – the Skeleton of the European Health Strategy 2008-2013

The global public health tendencies are not only challenges for the health sector but they can be considered as opportunities to help to develop the quality of health services. Those global public health tendencies are: population ageing, threats to health (Climate change, bioterrorisme), and new technologies (e-health)

There are 4 core principles underpinning 3 strategic objectives in the strategy. The most important characteristic of the EUs health policy is the Health in All Policies (HIAP) approach.

Comment: I already covered the complementary character of the EUs health policy in an earlier blog entry The Choice is Yours: either You Drink or… Re-think the EU’s Alcohol Strategy


1. A strategy based on shared health values.
2. “Health is the greatest wealth”
3. Health in all policies (HIAP)
4. Strengthening the EU’s voice in global health


1. Fostering good health in an ageing Europe
2. Protecting citizens from health threats
3. Supporting dynamic health systems and new technologies

Health from a political point of view

The fact that the participating MEPs belong to different political family clearly shows me that the overall population health condition and the need for better health is regardless of political affiliation. It might not be obvious but health is clearly linked to growth. The motor of growth can be the investment in health prevention instead of direct healthcare. The improved expenditures on prevention are costs in a short term, but they can be considered as savings in long term. (This was the main political message of the meeting in my opinion.).

The point 14 of the Council Conclusion on the Commission’s European Health Strategy stresses this message:

“THE COUNCIL OF THE EUROPEAN UNION NOTES that population health contributes to competitiveness and prosperity, hence the importance of reviewing the evidence on health as a “productive” rather than a “spending” sector.”

Comment: I have argued earlier in this blog for the necessity of raising health-cost in the European budget. How Healthy is Our Way of Thinking about Healthcare Cost Cuts?

The twofold approach of the European Health Strategy

As it is highlighted in the EU Health Strategy itself, Member States have the main responsibility for health policy and for health systems. Nonetheless, in some regards they cannot act alone effectively, since major health threats such as pandemics or bioterrorism have a cross-border nature. Therefore, the 27 Member States have to find coordinated solutions to the global challenges at European level. Based on this approach, there were 2 aspects of health policy on the table during the meeting: what can an effective (new) Health Strategy do (better) at European level (1) and what kind of impact can such a European Strategy have at Member State level (2)?

The EU Health Strategy at European level (1)

The careful analysis of the EU Health Strategy is based on a questionnaire filled by Member States the completion is still ongoing of. From the perspective of the EU Health strategy the adoption of the cross border healthcare directive (2011/24/EU) in March 2011 under the Hungarian EU presidency was an important step forward. Moreover, particular attention should be given to its implementation since its deadline is October 2013. The EU was also very active recently in the pharmacovigilance system field (falsified medicines, clinical trials, medical devices) as well as on EU Directive on Organ Donation and Transplantation in 2010. The EU tried to make its voice heard at international level, mainly in WHO.

Comment: I experienced personally how difficult was for the EU to speak in one voice when I was member of the EU team (EU delegation + rotating Hungarian EU presidency) in Geneva in April 2011 during the debate of Pandemic Influenza Preparedness, and in May 2011 during the 64th World Health Assembly.

The health systems do not necessarily mean only cost-savings

There are different ways to further evaluate the EU health strategy following the lessons learned from the available results. There is ex. a possibility to link the health issues to Europe 2020 which doesn’t have a robust health dimension, yet. The different use of available EU funds may be another opportunity to improve the efficiency of the strategy. Moreover, in the framework of the European semester, even the country specific reports can contain some health aspects. The health systems don’t necessarily mean only cost-savings. The system itself can also boost economy through creating jobs not only for health professionals.

The new form of innovation

Another key word for the health sector can be the new form of innovation. Unfortunately, innovation meant only industry based investments so far. However, strengthening the public health system would be also desirable. To achieve this goal, an evidence based approach is needed.

Hence, the success of any kind of health strategy is in the hands of the people. Therefore, improvement of health literacy (the ability to read, filter, and understand health information in order to form sound judgements) is of utmost importance. It can help people to become capable to make healthy/healthier choices.

The efficiency of an ante crisis strategy

At the moment of the adoption of the current EU Health strategy 2008-2013 the long-term duration of the financial and economic crisis wasn’t predictable, so the old strategy reflected the time of the Lisbon strategy. But now, in the middle of the economic difficulties, the necessary changes shall be included somehow into the new strategy.
Another meaningful remark is that according to different surveys, wealth does not necessarily mean health. In other words, the good performance of the economy alone doesn’t resolve the problems, special actions are needed to protect public health. Not only the EU but also other international organizations (OECD, WHO) are working on smart and specific policies aiming

1. to keep people as healthy as possible, and
2. to provide them with the best possible care if they became sick.

The EU must give effective answers to the challenge of ageing (see EPHA’s statement on Healthy and Active Ageing) and children do not have enough emphasis in the health strategy, either.

Comment: Children were on focus in the Hungarian EU Presidency’s health program, as well

The EUs Tobacco policy

Some consider the Tobacco question as one of the most important health risks. Although the tobacco industry might not be happy with the new legislation, the Commission intends to present its proposal at the end of November 2012.

Comment: It will be probably highly debated since smoking is allowed even in the buildings of the European Parliament under certain circumstances.

Chronic diseases

Most of the Chronic diseases (diabetes, cancer, COPD, etc) can be prevented. They are usually very costly for the health systems and investing in prevention not only people’s life can be saved but also a large amount of money can be economized. Thus, commonly agreed indicators may help to realize such savings since they can numerically present the results achieved. Another additional element could be the relation between health and workplace. Health protection can be more effective there since people spend considerable part of their lifetime at workplaces.

Placing useful ideas on the table, we can conclude that the NGOs can play a crucial role to give an impetus to the common thinking about the future EU health strategy, and since they are in direct connection with doctor/nurse/patient organizations, they can express the voice of the civil society.

The EU health strategy and the challenges of the health systems from the perspective of Member States (2)

Although the resources allocated to health are increasing at EU level, they aren’t sufficient to the full implementation of the EU health strategy. Therefore, there are 2 possible solutions: either to allocate more resources to that purpose or to re-focus the priorities to re-direct the money to the most important fields. In order to better use these opportunities, Member States do need more technical support for special programs. But without a higher level of infrastructure, neither the health inequalities (defined as inequalities in health that are avoidable and unfair) can be beaten nor the cross border directive can be properly implemented.

Shortage of health workforce

Some member states are particularly affected by the lack of sufficient health professionals. With regard to the connections between the different health sectors of different Member States, a reform in a Member States’ health system can affect the health system of another Member State (ex. if a MS reduces the working time of health professionals, it will need more doctors, therefore health professionals from another MS will migrate to that MS). Therefore, the European health policy has to tackle the shortage of health professionals in some Member States due to the fact that these vacancies cannot be filled easily from outside the EU.

Links between European and Member State level health policy

Hospitalisation is not always the best solution. The resources allocated to that purpose shall be redirected to prevention. The agenda of the EU can be used for promoting some subject at member state level. Ex. Belgium managed to include the question of e-Health into the text of the Council Conclusions. After its adoption, every member state had to prepare reports in that regard which could further promote the elaboration of such programs not only in Belgium but in all 27 Member states. Another important health policy issue is the Mental Health which is unfortunately not well developed at EU level.

The effects of the crisis on the health costs

In most countries, the Health Ministries and Finance ministries are fighting concerning the amount of health costs. Countries with significant financial difficulties are in close collaboration with IMF which prepares country specific recommendations mentioning sometimes a certain maximum level of health costs. However, the legitimacy of such a procedure is questionable since IMF is not a democratically elected and accountable body. There are the national Parliaments and governments who are responsible for the electors for any decision made concerning health costs.

In that situation, ministries of health are in a very difficult situation when they try to defend the need for health spending against the ministries of finance. An EU wide policy may help a lot to demonstrate that the short term health expenditures are long term savings.

A specific solution would be a European study stating that a basic x% (?6 / ?6,5% / ?7%) of the national GDP must be spent on health since unfortunately, in some member states this rate is in a very low level. Such a study may help national ministries of health their position.
Another European cost-saving method would be the preparation of common European guidelines. By finding common professional standards, the 27 MS would not have to invest in preparing separate guidelines and that can reduce costs.

Short term health expenditures are long term savings

I remain at your disposal.

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Related earlier updates:

Last But Not Least: Strategy for Strengthening the Rights of Vulnerable Consumers and the Democratic Function of the EP

Improving Patient Outcomes through Intensive Care Medicine (ICM) – Lessons Learned after the Policy Debate in the EP on 16/05/2012

Legal Framework for Public Health Policies and Financial Viability of Lifelong Disease Prevention

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

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

(on the photo – John Dalli Commissioner for Health © European Commission audiovisual service)

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