March 19, 2018
Whatever is the fate of EU health policy and the Health Programme in the EU budget (MFF), it is crucial to avoid conflict of interests as regards decision about EU initiatives affecting citizens’ health. Putting health under the supervision of Directorates responsible also for industrial policy, trade or agriculture will simply not work and will not improve citizens’ health. Here is why.
Cooking a healthy EU budget
The future of the Multiannual Financial Framework (MFF) of the EU slowly became the Elephant in the room in the European policy and advocacy arena. While I am writing, its potential architecture is taking its final shape via ongoing discussions and hard negotiations – behind closed doors.
Why are we talking about health at all?
Health is among the core values of the EU – citizens’ health is a pre-condition of economic prosperity and societal well-being is one of the ultimate goals of the whole integration process. EU policy action is meant to complement the Single Market and was introduced by the Treaty of Maastricht in 1993. While the EU has strong competence to impose policy action in the area of prevention (regulating alcohol, food, tobacco, medicines, audiovisual media services, air pollution etc.) it is often overshadowed by the complementary competence in the area of healthcare where the EU – indeed – supplements Member States which are responsible for their health systems.
Where would the European Commission put Health in the EU budget?
There were letters leaked recently in which Commission President Juncker and Vice-President Oettinger unveiled the future menu for the budget. It is remarkable, that the place of health is still an open question.
Option 1: – Health will be part of the ‘Single Market’ instrument as ‘Food safety; human, animal and plant health’
Option 2: – ‘The inclusion of a separate health programme as part of an investing in people cluster remains a possible option’
What are the pros and cons?
Putting health under the single market is a logical step as the completion of the common market cannot be achieved without a health component. It is expected that this cluster will be given more financial resources which would – de facto – mean more money for health. Flexibility could be also helpful as in case of need, this structure would allow more money allocation. However, the danger is very high that health will be dissolved in a large pool and in case of conflict of interests, most likely economic aspects will be dominant. In other words, there are lack of guarantees that health aspects will dominate and prevail.
What does the European Parliament want?
The European Parliament has adopted its resolution of 14 March 2018 on the next MFF: Preparing the Parliament’s position on the MFF post-2020 (2017/2052(INI)) which suggests a different structure and strong political commitment to health.
100. “Recognises the European added value of collaboration in addressing common public health threats; notes that no single Member State can tackle cross-border health challenges alone, and calls for the next MFF to reflect the EU’s responsibility to implement the SDG on public health, health systems and environment-related health problems, and to support Member States in eliminating growing health inequalities; considers that, on the basis of the positive outcome of the ongoing actions in this field, the next MFF should include a robust next-generation health programme that addresses these issues on a cross-border basis, e.g. by achieving innovative solutions for healthcare delivery, including digital health, such as the European Reference Networks, and that provides support to Member States in the form of expertise and exchange of data, evidence and good practice; recalls that good health is a prerequisite for achieving other goals set by the EU and that policies in such fields as agriculture, environment, employment, social issues or inclusion also have an impact on the health of Europeans; calls, therefore, for the strengthening of health impact assessments and for cross-sectoral cooperation in the next MFF in this field;”
According to the EP structure, health would be part of ‘Heading 2: Stronger cohesion and solidarity in Europe’ as health and food safety.
Conflict of interest in EU health policy
We all can agree on that the current status of EU health policy is no option anymore and revision is needed. But this should not mean killing EU health policy and reducing it to the absolute minimum as health is a core value of the integration since 1993. We have witnessed the attempt in 2014 to put the political responsibility of pharmaceuticals under the industrial commissioner, which has failed. Another attempt was to withdraw the directive regulating air pollutant emissions which failed again, in both cases due to a strong civil society campaign and movement. You can not be credible about citizens’ health is you are at the same time responsible not to put burden on industries. Sometimes, burdens are necessarry to protect health (eg. regulating tobacco products, food or air pollution). You can not make both the wolf and sheep happy.
How to avoid ‘conflict of interests’ in EU health action?
I see the need for ensuring an independent, coherent EU health approach protecting citizens’ health from the failure of the internal market but also to tackle common challenges to some extent at EU level to help member states to make their own political decisions. As the next place where decisions will be made will be within the framework of the MFF, securing an independent health budget line in the form of the health programme could be the first step to that direction. This is important but not enough: without a strong vision and political leadership, the EU will fail to deliver to show its social face and our leaders can not be surprised if euroscepticism will raise again.Zoltán Massay-Kosubek