January 9, 2018
Following the White paper of the Future of the European Union, the European Commission plans to make its proposal for the next, 7 year Multiannual Financial Framework (MFF) in May 2018 with the aim of having an agreed budget before the EU elections in 2019. While the European Commission discussed with high level speakers including the President of the Commission, many Commissioners and former Prime Ministers the different aspects of the future EU budget, little attention was paid to the role of EU health policy in the upcoming EU budget.
Filling the Brexit budget hole
Whether we like it or not, the United Kingdom is planning to leave the European Union in March 2019 which will leave a hole in the EU budget. Instead of planning with a smaller budget, the Commission is committed to keep the current amount – which is around 1% compared to overall EU income and public spending – with slight increase aiming at 1,1+ % which will be covered by 50% from cuts and 50% of ‘fresh money’ from Member States.
The Health Programme has a potential to lead more savings. The size of the 3rd Health Programme programme itself is not significant with its budget of €449,4 million € representing less than 0,05% of the whole EU budget but using the proframme wisely, EU level health actions can avoid illness-related social and financial costs. Premature death of 550 ,000 people of working age across EU countries from chronic diseases, representing according to OECD a loss to the EU economy of €115 billion per year, 0.8% GDP can be tackled .
European added value and health
‘Europe is much more than a cup of coffee per day!’ highlighted Commission President Juncker by opening the high level, ‘Shaping our Future – designing the Next Multiannual Financial Framework’ conference indicating that the amount spent in EU level is the price of a coffee per day. Commissioner for Budget and Human Resources Oettinger made it clear that the next MFF will finance no actions without European added value.
The European nature of today’s main challenges cannot be denied anymore: the burgeoning burden of non-communicable diseases, the obesity epidemic, infectious disease epidemics and antimicrobial resistance are health threats having a European dimension by their nature and no single country, no single government, can tackle those cross border health challenges alone.
Health as a core European value
President Juncker warned that the real discussion is about our policy goals which should happen first before discussing the numbers. Economic added value is one thing but it was highlighted during the conference by various speakers that there are core principles and fundamental values which are difficult to quantify but are equally important. Having a common decision making process, conducting negotiations for example is a value itself. The importance of keeping the cohesion policy, to reduce the differences is also a key European goal.
Sticking to the Treaty objectives would also imply to ensure a health dimension of the budget. Protection of a high level of human health and well-being is entrenched in the Treaties of the European Union. Article 168(1) TFEU requires that ‘A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities.’ This ‘mainstreaming’ obligation can also be found in Article 114(3) TFEU, and has been further reinforced following the entry into force of the Lisbon Treaty, by Article 9 TFEU and Article 35 of the EU Charter.
Investing in the Future
Innovation and Youth will be the cornerstone of the future EU budget. The ERASMUS+ and the post Horizon 2020 research projects will be protected from any cuts as they are considered as policies of the future. There are many differences between big and small, rich and poor member states but the support of health is common: 70% of Europeans want the EU to do more for health, according to the most recent Eurobarometer survey.
EU institutional capacity is needed to implement Health in All Policies
Vice-President Oettinger was asking for avoiding any further cuts to the EU administration to ensure that the EU is in fact able to implement its policies. This is a core principle valid for keeping a strong Directorate General for Health (DG SANTÉ) to ensure that health actions will not be simply assigned to other areas where they are doomed to be considered less as a priority if there is no dedicated DG SANTÉ ensuring their implementation.
Health in the future MFF
The Commission launched an open public consultation where stakeholders – including the European public health community – can have a say. Health comes under the consultation in the single market.
In February, the European Council will have the first discussion about the plans for the MFF. The own initiative report in the European Parliament on the MFF as well as about the own EU resources is under discussion which will be followed by the Commission proposal in May 2018.
To truly reflect the EU competence on health in the MFF, securing an increased budget for health collaboration in the next EU budget post 2020 is fundamentally important; additional resources for the health programme are justified by the return on investment and economy of scales to date and considering health as a core value for European citizens.Zoltán Massay-Kosubek