EPHA held a seminar on Monday 2 December 2002 aimed at discussing and developing a future policy path. Presentations focused on the right to health in Europe, the Peoples’ health charter and the "Open Method of Co-ordination". Participants agreed that the future health competence at the European level was a priority.
The Convention on the Future of Europe appears to be downgrading the importance of health. This is of concern because it could ultimately affect changes to the constitution by the Intergovernmental Conference later in 2003. The seminar addressed different approaches to raising the profile of health at the European level.
The right to health
Tamsin Rose, General Secretary, EPHA addressed the question of whether international treaties were useful in enforcing health rights. She highlighted Article 12 in the International Covenant on Economic, Social and Civil Rights (adopted 1966 and ratified in 1976) that defines the right of everyone to enjoy the "highest attainable standard of physical and mental health". It recommends four criteria for the assessment of health and healthcare quality in a given country: availability, accessibility, acceptability and quality.
Although the Covenant is legally binding, optimism about what could be achieved for health has waned since the 1960s. Article 152 of the Amsterdam Treaty and the EU Charter of the Fundamental Rights represent a step back. Rather than health being a right, the Amsterdam Treaty calls for: "A high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities."
Most people would like health higher up the agenda. In opinion polls, Europeans put health as one of five priority areas to be addressed by the EU. But with much of the decision-making left to the national level and only very limited resources allocated to public health, efforts are seriously constrained. If things are to change, citizens must be seen as important stakeholders. NGOs should be involved in advocacy on health rights, representation of the public interest, awareness raising, and monitoring and challenging violations.
EPHA’s goals must therefore be: a rights-based approach to health policy making; a greater health competence in the new EU Treaty; and, a reclamation of the right to the highest attainable standards rather than the lowest common denominator.
The full text of Tamsin Rose’s presentation (in Powerpoint format) is available on the EPHA website.
The People’s Charter
Christiane Fischer, People’s Health Assembly (PHA), introduced "The People’s Charter for Health: common visions of a healthier world". Signed at a meeting of 1,453 representatives from 92 countries gathering near Dhaka, Bangladesh in 2000, the Charter represents "an advocacy tool for addressing health and the underlying economic and social context".
Discussion in Bangladesh focused on defining the right to health and working out how it could become reality for every person. Dr Fischer said that the "People’s Charter for Health" is asking WHO to go back to its roots, especially the 1978 Alma Ata conference declaration on "Health For All". For this to happen, WHO needed to be strengthened and made more independent. The only organisation with real international power was WTO, due to the fact that it has an effective dispute settlement procedure. Trade law is often given more importance than human rights, Dr Fischer said: "Witness the case of patents on pharmaceuticals". The basic principle was clear: health is a priority that must be put before trade. WTO can, and should be, changed.
The "People’s Charter for Health" was distributed to participants ((http://phmovement.org/pdf/charter/phm-pch-english.pdf). Dr Fischer invited EPHA members to endorse the Charter and its principles: health is a human right, the broader determinants of health should be tackled (economic, social and political), and environmental challenges plus violence should be addressed. The Charter’s approach is people-centred and calls for people’s participation for a healthy world.
A discussion of the relative political strength in different forums followed. The technical briefings at the World Health Assembly in 2001 had questioned whether the growing role of public-private partnerships was unbalancing power at the World Health Assembly. At the EU level, thousands of industry lobbying groups were active but only a few hundred civil society NGOs. In such a context, the Charter would be massively resisted.
Dr Fischer belongs to Buko in Germany, one of the groups fictionalised in John le Carré’s story of the darker side of the pharmaceutical industry, "The Constant Gardener". Buko is a member of Health Action International. HAI-Europe is a member of EPHA.
"Open Method of Co-ordination"
Dennis Crowley, DG Employment and Social Affairs, explained the background to the Open Method of Co-ordination, which he said was providing a voice for social issues at the EU level.
The Amsterdam Treaty made employment a duty of the EU. Three Communications have defined the common challenges in relation to employment and social protection. These prompted the setting up of the Social Protection Committee in 1999. Mr Crowley is its secretary.
In March 2000, the Lisbon Summit called for a strategic vision for achieving "greater social cohesion" to be achieved over the next 10 years. Activities would include fighting poverty and social exclusion, and confronting an ageing Europe, including pensions and the quality and financial sustainability of health care and long-term care of the elderly population.
The Committee brings together representatives from social affairs ministries to discuss common challenges. Even though the Committee has no legal status since Member States have the competence in these areas, the need for co-ordination is recognised. In the "Open Method of Coordination" (OMC), Member States address a particular objective in relation to poverty, for example, and then work out what action is needed. Policy statements and national programmes are developed to achieve the goal in different policy areas. These documents provide much useful information and data for citizens.
Health care and long-term care of the elderly population is slowly being addressed. So far, a study is investigating issues such as accessibility, quality and financial sustainability. A questionnaire has been sent out and the results (to be published on the DG Employment and Social Affairs website) are likely to contain some useful political statements. But at this stage the process cannot be called OMC. It rather comprises an exchange of information. Member States do not feel they have identified a common challenge. However, the EU is touching every single legislative area related to health. In particular, health affects public spending where much co-ordination, common decisions and compulsory systems exist at the EU level. The need for a voice on social and health issues at EU level is clear, and the OMC could help in the process.
NGOs can get involved in the OMC consultations. But the key message was to keep up pressure at the national level. The OMC is a useful middle ground between national competences and EU law but it would need binding elements to be fully effective. Member States have the real decision-making power in health care.
Many participants expressed concern that the EU health competence is in danger of being weakened further and suggested that a campaign was needed to promote health rights.
Minutes of the meeting are available. Contact epha@epha.org.
