Health inequalities report adopted in the ENVI Committee - EPHA analysis of the vote.

The following EPHA amendments went through - the compromised amendment 5, the compromised amendments 10 and 11, and amendments 11, 29, 30, 149, 174, 183, 186, and 191. Also, some parts of EPHA’s amendments were included in some of the compromised amendments such as 1, 3, and 13.

Amendments proposed by a group of MEPs, including Edite Estrela, Philippe Juvin, Antonyia Parvanova, Milan Cabrnoch, Jiri Mastalka and Michail Tremopoulos introduced a very important dimension of health inequalities, namely link with poverty and social exclusion, health promotion and disease prevention, ageing population, early life development conditions, "health in all policies" approach, citizens’ lifestyles including health information and education, poor nutrition, tobacco and alcohol dependency, occupational health, among others.

In terms of the proposed actions and recommendations, it was suggested to:

 call on the Commission and Member States to press ahead with their efforts to tackle socio-economic inequalities, which would ultimately reduce some of the inequalities related to healthcare;

 call on the Member States to ensure that the most vulnerable groups, including undocumented migrants, are entitled to and are provided equitable access to healthcare;

 call on the Council and the Member States to evaluate and implement new measures to improve the effectiveness of their health expenditure, notably by investing in preventive healthcare, to restructure health care systems in order to provide equitable access to high-quality health care without discrimination throughout the EU, and encourage the Commission to study the use of existing European funds in order to further promote investment in health infrastructure, research and training and to promote and step up disease prevention;

 call on the Commission and the Member States to ensure that equitable access to healthcare and treatment options for older patients are included in their health policies and programmes and to make adequate access to healthcare and treatments for older people, a priority for 2012 EY for Active Ageing and Intergenerational Solidarity;

 encourage all the Member States to coordinate actions with regards to the qualification, training and mobility of health professionals, thus ensuring capacity and sustainability of the health infrastructure and workforce at both EU and national level;

 call on the Member States to promote public policies aiming at ensuring healthy life conditions for all infants, children and adolescents, including preconception, maternal care and actions to support parents and pregnant and breasfeeding women; in order to ensure healthy start to life for all newborn and avoid further health inequalities, thereby recognising the importance of investing in early child development as well as life course approaches;

 call on the Commission to foster the pooling of experience in connection with health education, healthy lifestyle promotion, prevention, early diagnosis and appropriate treatment in particular in relation to alcohol, tobacco, drugs, diet and obesity;

 call on the Member States to promote physical activity, good nutrition and "healthy schools" programmes targeted at children, notably in more disadvantaged areas;

 call on the Commission to ensure that the reduction of health inequalities and improved access to physical and mental health services are fully addressed and integrated into its current initiatives such as the Partnership on healthy and active ageing, the EU Platform against Poverty and Social Exclusion, and into future initiatives related to early child development, youth policies focusing on education, training and employment;

 call on the Commission to mainstream an approach based on the social, economic and environmental determinants of health and on ’equity and health in all policies’ in the development of all internal and external EU policy, especially with a view to achieving the MDGs, and in particular maternal health;

 call on the Member States to ensure all pregnant women and children, irrespective of their status, are entitled to and effectively benefit from social protection as defined in their national legislation;

 call on Member States to follow the WHO in recognising obesity as a chronic disease in order to provide access to obesity prevention programmes;

 call for better coordination between the EU agencies which have a major role to play in combating health inequalities, in particular between the European Foundation for the Improvement of Living and Working Conditions, the European Center for Disease Prevention and Control and the European Agency for Health and Safety at Work;

 call on the Commission to assist Member States in maling better use of Open Method of Coordination in order to support projects to address underlying factors of health inequalities;

 urge all the Member States to recognise the importance of health for the society and to look beyond a GDP-approach to measure societal, community and individual development;

 calls on the Commission to support actions financed under the current and future Public Health Programme to address social determinants of health;

 ask the Commission to consider the development of a proposal for a Council Recommendation, or any other appropriate Community initiative, aiming at encouraging and supporting the development by Member States of integrated national strategies, at national or regional level, for the reduction of health inequalities;

 call on the Commission to assess, in its progress reports, the effectiveness of intervention in the reduction of inequalities in health, and the improvement in health arising from the policies relating to the social, economic and environmental determinants of health;

 call on the Commission and Member States to support public information and awareness programmes and step up the dialogue with civil society, the social partners and NGOs regarding health and medical services.

In addition to these, the Committee on the Internal Market and Consumer Protection (Opinion drafted by Emma McClarkin, MEP) recommended to:

 stress that health inequalities in the EU represent a substantial burden to Member States and their healthcare systems and that the effective functioning of the internal market. With this regard, strong and coordinated public policies on prevention can contribute to improvements in this field;

 encourage Member States to develop partnerships in border regions in order to share costs of infrastructure and personnel, while limiting spatial inequalities with regard to health, particularly for equal access to state-of-the-art equipment;

 stress that countering socio-economic factors such as obesity or smoking, the accessibility of healthcare systems and effective diagnosis should be considered key aspects of measures against health inequality. In addition to that, the accessibility and affordability of pharmaceutical treatments should be regarded as a key aspect of individual citizens’ health. In this light, Member States should make sure that the Transparency Directive (89/105/EEC) is being properly implemented.

 stress that healthcare is not and should not be regarded as a general good or service;

 urge the Commission to promote best practices on pricing and reimbursement of medicines, including workable models for pharmaceutical price differentiation so as to optimise affordability and reduce inequalities in access to medicines;

 call on Member States to adapt their health systems to the needs of the most disadvantaged by developing methods for setting the fees charged by healthcare professionals which ensure access to care for all patients;

 ask the Commission to study the effects of decisions based on national and regional assessments of the effectiveness of medicines and medical devices on the internal market, including patient access, innovation in new products and medical practices, which are some of the main elements effecting health equality;

 urge the Commission to encourage Member States to offer reimbursements to patients and to reduce the inequalitiey in access to medication for the treatment of those conditions or illnesses, such as post-menopausal osteoporosis and Alzheimer’s Disease, which are not reimursable in certain Member States;

 consider that the implementation of the Directive on Patients’ Rights in Cross-Border Healthcare (2008/0142 (COD)) should be followed by impact assessments in order to measure as effectively as possible its consequences in combating health inequalities and to ensure that it maintains public protection and safeguards patient safety;

 note that high-quality and efficient cross-border healthcare requires increased transparency of information for the public, patients, regulators and healthcare providers on a wide range of issues, including patients’ rights, access to redress and the regulation of healthcare professionals;

 regret that the directive on cross-border healthcare was not accompanied by a legislative proposal on the mobility of healthcare professionals, taking into account the risk of a ’brain drain’ within the EU and call on the Commission to remedy it, possibly in the context of the future revision of the directive on professional qualifications (2005/36/EC);

 urge Member States to implement fully the exisitng Professional Qualifications Directive (2005/36/EC); encourage the Commission in its evaluation and review of the Directive to address the regulatory gaps that have the potential to harm patients and compromise a patient’s right to safe treatment;

 underline that health inequalities in the European Union will not be overcome without a common and overall strategy for the European health workforce, including coordinated policies for resource management, education and training, minimum quality and safety standards, and registration of professionals;

 urge the Commission, in its forthcoming legislative proposal on professional qualifications, to move towards a reinforced mechanism for the recognition of qualifications in the Member States;

 argue that open, competitive and well functioning markets may stimulate innovation, investment and research in the healthcare sector, and recognises that this must be accompanied by strong financial support for public research in order to further develop sustainable and effective healthcare models and to promote the development of new technologies and thier application in this field (eg. telemedicine), as well as a common health technology assessment methodology, all of which should benefit every citizen, including those from lower socio-economic backgrounds, whilst taking into account the ageing of the population;

 point out that increased innovation often leads to greater accessibility of treatment, which is particularly relevant for isolated or rural communities;

 take note that the work already done in the Internal Market and Consumer Protection Committee has helped to address certain aspects of health inequality in the EU; stress the importance of strictly monitoring the information which pharmaceutical firms provide to patients, particularly the most vulnerable and least well informed groups, and the need for an effective and independent system of pharmacovigilance.

The Committee on Women’s Rights and Gender Equality (Opinion drafted by Sylvie Guillaume, MEP) presented the following additional points to be included in the consolidated report:

 women often find themselves in precarious situations linked to their gender, way of life, religion, age, social status and financial solvency;

 gender and age inequalities in biomedical research and under-representation of women in clinical trials undermine patient care;

 the incidence of tobacco use among women, particularly young women, is rapidly rising with devastating consequences for their future health; in case of women, smoking is aggravayed by multiple disadvantages;

 violence against women is a widespread phenomenon in all countries and among all social classes and has a dramatic effect on th ephysical and emotional health of women and children;

 infertility is a medical condition recognised by the WHO which has a particular impact on women’s health, and it has been shown that the majority of women suffering from infertility also suffer from forms of depression;

 there is great inconsistency between member States in terms of access to fertility treatment;

 call on the EU and the Member States to include the health status of women and the question of ageing women as factors in gender mainstreaming and to use gender budgeting in their health policies, programmes and research;

 call on the EU and the Member States to mainstream gender into tobacco control, as recommended by the WHO-FCTC, and to introduce anti-smoking campaigns targeting young girls and women;

 call on the Member States to encourage and support medical and pharmaceutical research into illness that primarly affect women, with reference to all phases of their lives and not only thier reproductive years;

 call on the Member States to solve problems of inequality in access to healthcare that affect everyday life, in the areas of dental and opthamologic care;

 consider that the EU and the Member States should guarantee women easy access to methods of contraception and the right to safe abortion;

 urge the EU and the Member States to make mandatory the collection and analysis of comparable sex-disaggregated data and to conduct epidemiological studies and collect and produce comprehensive data, based on common, strictly defined indicators, in order to assess the impact of existing health policies and programmes on the health of women;

 call on the EU and the Member States rapidly to find ways of combating ethnic discrimination, particularly in certain Member States where Council Directive 2000/43/EC has not been implemented and where women from ethnic minorities have little or no social protection or access to healthcare;

 call to increase the number of women involved in the development of healthcare policies, programme planning and the provision of healthcare services;

 call on the EU and the Member States to recognise male violence against women as a public health issue;

 urge the EU and the Member States to focus on women’s human rights, notably in preventing, banning and prosecuting the forced sterilisation of women and female genital mutilation;

 call on the EU and the Member States to take the necessary measures, in relation to access to assisted reproductive technologies, to eliminate discrilination against women on the basis of marital status, age, sexual orientation or ethnic or cultural origins;

 consider that the EU and the Member States must support civil-society and women’s organisations that promote women’s human rights, including thier sexual and reproductive rights, the right to a healthy lifestyle and the right to work, with a view to ensuring that women have a voice on European and national health policy issues.