Zoltán Massay-Kosubek

If von der Leyen, having health administration experience with her public health master background will not prioritise health within the new Commission then quite frankly, who will? The challenges Europe faces are complex so it is simplification to say that the background of the Commission President-elect shall determine the new Commission policies. But exactly because of her background she is in the best position to recognise: business as usual is over and if the EU does not take seriously European Health challenges, the sustainability of societies will be in danger.

Background
On 16th May 2019, Ursula von der Leyen, former German defense minister, nominated earlier by Head of States and Governments has been elected by the European Parliament, as President-elect of the European Commission. She is now asking nominations for individual Commissioners from Member States and her team is working hard to design the new Commission structure, define the priorities of the next Commission and allocate individual portfolios for candidates. It is known that she would prefer a a gender balanced Commission but little is known which candidates did show interest for the health portfolio and whether health will be among the priorities of the new Commission at all.

Health does matter and it is a European issue

It is not only me saying that but pretty much the whole public health community: researchers, patients, doctors, nurses, the health industry, pro-health politicians, health public servants within the Commission, health consultants, disadvantaged group representatives, and also ordinary people in Europe worried about their health.
There are many fora and ways to express that: maybe the most recent voice coming from public interest civil society was a joint statement calling for health prioritisation but it was a significant event in early July, which brought together representatives of the European public health community, the Patient Access Partnership (PACT) conference around the future of health in the EU.

“Unified and understandable advocacy messages can open the doors to other sectors impacting on health.”
PACT Secretary General Stanimir Hasardzhiev

A recurrent theme was related to the current EU-level health competency; while often perceived as weak, it remains highly relevant. Facilitating the sharing of experiences and mutual learning while assuring appropriate coordination and direction can and will be beneficial. Moreover, existing tools and instruments, such as the European Semester Process and Horizon Europe, can be put to better use to ensure a health dimension in other EU-level policies. However, in order to truly achieve a multi-sectoral approach to health, the priorities of other sectors will need to be identified as the health aspects of these priorities can provide useful entry points for cooperation. Participants also agreed on the need to appoint a Vice-President for Health in the next Commission, who would be responsible for assessing the impact of EU-level policy development on the health of citizens and propose pro-active health policy measures. See my take-aways on that here:

The same old, same old again?

Big on the big things, small on the small things. This was the motto of the Juncker-Timmermans co-led Commission which desperately failed. Look at what kind of response did Europe give to the Sustainable development process? After 3 years intensive consultation, the outcome is a Chrismas three documents, identifying 3 potential options. Which includes everything and nothing. It is not exagerated to say that the old Commission failed on the big things and ignored the small things (not to mention that it is questionable, if they identified the ‘right’ big things).

How to pretend acting but do nothing?

The EU is very good at pretending that it answers calls but in fact it just delivers what was initially planned under a different label.
This is what happened to the Sustainable Development Goals (SDGs). I remember when I was part of one of my advocacy achievements, the first successful European Citizens Initiative (ECI) Right to water in 2014, the Commission was obliged to give an answer. They organised a press conference about it, and there was a hearing in the Parliament, as well.

Finally, the Commission services delivered finally a list of ongoing actions in the area of access to drinking water and presented it as an ‘answer to the ECI’. All the listed actions would have happened anyway regardless of the ECI.

I have the bad feeling witnessing the same with the Sustainable Development Goals. Let’s take the example of the goal which is closest to health: ‘Goal 3. Ensure healthy lives and promote well-being for all at all ages’. If you go to the Commission website about the 17 SDGs you can see the various actions the EU is doing. This is the same for health: under SGD 3 you can see an impressive list of actions ‘the EU is doing to implement SDG 3‘ You can also hear that ‘SDGs are mainstreamed in the EU work’. Well, I am always suspicious when I am hearing sentences like that. Mainstreaming can be indeed meaningful but often it just means window dressing: let’s re-group the ongoing EU actions and present them, as if they would have done to achieve the SDGs. I don’t know…

Just to add that what the EU really did was to add the SDG responsibility to the portfolio of Vice-President Timmermans who launched a consultation process, set up a Multistakeholder platform but the outcome…
In its final product A Sustainable Europe by 2030, the EU was only able to identify 3 scenarios which if you look at are the same: business and usual and limited added value.

“An overarching EU SDGs strategy to guide all actions by the EU and Member States

Here, the SDGs are endorsed at the highest EU political level, underpinning future policies and activities. EU institutions and Member States, including regional and local authorities, would work closer together to ensure better coordination. An implementation process will be set up to monitor progress, setting milestones to deliver on by 2030.

Continued mainstreaming of the SDGs in all relevant EU policies by the Commission, but not enforcing Member States’ action

The SDGs will continue to inspire the Commission’s political decision-making and guide the development of the post-EU2020 growth strategy, while not excluding other political priorities, and not forcing the work of Member States to reach the SDGs collectively and EU-wide. This approach would leave more freedom to Member States, including regional and local authorities, to decide whether and how they adjust their work to deliver on the SDGs.

Putting enhanced focus on external action while consolidating current sustainability ambition at EU level

The EU is a frontrunner on the SDGs in many ways. It could build on this experience by making more improvements and assisting other countries around the world to help make further progress. The EU could decide to promote its environmental, social and governance standards more strongly through trade agreements and multilateral negotiations. The EU could also work even closer together with international organisations in pursuit of the same goals.”


Avoid the illusion of impact and the illusion of no-impact

As we now have a President elect, my earlier open letter has now a target. While not expecting a clear and concrete answer to my questions, I can honestly and realistically hope that the new Commission will not make the same mistake again it did with the earlier petitions or the SDGs but will take the demand of European people and health stakeholders seriously and will do something SMART about health finally!

PS: SMART stands for Specific, Measurable, Achievable, Realistic and Time-bound.

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