Director of Public Health at DG Health and Consumer Affairs (Sanco), Fernand Sauer describes the new programme for Community action in the field of public health (2003-2008).
In May 2000 the Commission put forward its proposal (1) for a new public health programme to replace the existing set of eight programmes and to unite these in a single, integrated horizontal scheme.
The proposal went through a lengthy co-decision procedure that ended successfully on 8 May 2002 with the agreement in conciliation of the European Parliament and the Council on the programme Decision. This agreement was then formally ratified by the Parliament and the Council, and the Decision (of 23 September 2002, No 1786/2002/EC) has recently been published in the Official Journal (OJ L 271 of 9 October 2002). It legally entered into force on the same day. The programme will come into effect on 1 January 2003 and run for six years. It will have a total budget of Euro 312 Million which represents a small increase on the Euro 300 Million we originally proposed.
A new approach
The new programme moves away from the fragmented, disease-oriented approach of the past, where resources were spread thinly over many one-off projects. Its intention is to focus on key priorities where real "added value" can be achieved. The programme will therefore be considerably more than the sum of the existing programmes.
It will be focused along three main strands of action enabling the EU to identify and tackle the major health problems it faces:
Improving health information and knowledge about people’s health, about health interventions and about the functioning of health systems;
Strengthening the rapid response capacity for co-ordinated reactions to major threats to health;
Targeting actions to promote health and prevention of diseases, by tackling the key underlying causes of ill health, related not only to personal life-styles, but also to other key determinants, such as economic and environmental factors.
The activities in the three areas will be inter-linked and mutually reinforcing, embodying an integrated approach towards achieving and maintaining better health. This is also reflected in the efforts we are making to achieve synergies with other Community policies. For example, the objectives of the programme may be implemented as joint actions by creating links with relevant Community programmes and actions. Moreover we shall also be looking closely at the health impact of other policies to ensure that there is a coherent and consistent approach to health across all Community policies and activities.
Linked to this is our effort to increase the openness and transparency of policy making. A key initiative in this context is the setting up an EU Health Forum as a consultative mechanism which gives stakeholder organisations the opportunity to make inputs into policy development and priority setting.
Implementation arrangements
During the co-decision procedure both the Council and the Parliament laid stress on the need for the programme to be effectively implemented to ensure that it achieved its objectives. In particular, the Decision now provides for setting up "structural arrangements". Apart from establishing the new programme committee, this means strengthening the Commission’s co-ordinating and technical capabilities by externalising some functions. The most likely option would be to set up an executive agency to carry out certain functions. But this will have to await the adoption of the Commission’s proposal for a Regulation on such agencies (2) and can not therefore begin until well into the life of the programme.
Another aspect of effective implementation is to ensure that the new programme is up and running straight away. We are therefore now preparing the necessary implementation documents, such as the draft work plan 2003 and the draft criteria for the selection of projects. These will be discussed with the members of the new programme committee at the end of November this year. An initial call for proposals for projects to begin in 2003 is also planned for November 2002. Stakeholders present at the last Health Policy Forum meeting were asked to send us their ideas for specific actions for the work plan, and a number, including EPHA, have already made very helpful suggestions.
Project characteristics
It is too early to talk about the detailed content of the work plan and project selection criteria. Nevertheless there are several points worth stressing:
First, we envisage that in addition to projects focusing on specific areas in each of the three programme strands, there will be a significant number of cross-cutting projects which involve elements in relation to all three strands. To give one example, it is easy to imagine that a project in the area of communicable diseases might have aspects involving information collection, responding to a particular threat and addressing underlying causal factors.
A second key point is that projects will have to be much more clearly linked to the needs of policy development, e.g. providing the essential information and analysis which is needed to design new legal instruments and other measures.
As for the design of projects, we expect that they will often be larger than in the past in order to ensure European added value and a measurable and sustainable contribution to public health. Some will probably involve all Member States and also Candidate Countries. We will also encourage multi-annual projects which will help ensure that there is sufficient time to plan the work carefully and to carry out all the tasks effectively. Finally, an emphasis will be placed on evaluation of outcomes and dissemination of results and findings.
In short, we are likely to see fewer, but larger, longer and better-focussed projects which will help to take forward the public health agenda in a positive way. The new public health programme has the potential to be an instrument of major importance in improving health. I have no doubt that EPHA and other NGOs and stakeholders will rise to the challenge and submit innovative proposals to ensure that the programme is as effective as possible.
Current public health programmes (until 2002):
Europe against cancer
AIDS and communicable diseases
Health promotion
Drugs prevention
Health monitoring
Rare diseases
Pollution-related diseases
Injury prevention
Activities outside the programmes:
A strategy on safety of blood and blood products
Network of surveillance and control of communicable diseases
Tobacco control
Reports and studies
Evaluation in progress:
The European Commission is in the process of evaluating their eight Community action programmes on public health. These were carried out between 1996-2002 and included EPHA - and several EPHA member projects. The call for tenders for an independent evaluationtenders for had a closing date of 13 September 2002.
Enlargement
I find the participation of the Candidate Countries in the programme from the very beginning of key importance. It provides them with an opportunity to get acquainted with Community policies and ways of working. Furthermore, it enables stakeholders in the Candidate Countries and Member States to get together, exchange and pool experience and knowledge and, on this basis, to work together on jointly identified priorities.
Countries of the Enlargement make their decisions
As stated in the main article, each accession country wishing to take part in the health programme has to conclude a "Memorandum of Understanding" with the Commission.
The ten countries that have officially confirmed that they want to participate in the Public Health Programme and conclude a Memorandum of Understanding to that effect are: Bulgaria, Cyprus, Estonia, Hungary, Latvia, Malta, Romania, the Slovak Republic, Slovenia and Turkey. Their contribution to the programme is calculated on the basis of national GDP. The Czech Republic and Lithuania have stated that they will not participate in the programme in 2003. Poland, which has expressed its intention to participate, has not yet formally replied. Those countries not participating are excluded from applying for programme-funded projects.
Information about how to apply for funding will be made available on the DG Sanco website. The terms are the same for accession countries (who have signed the Memorandum of Understanding)as for existing Member States. Issues concerning priorities for projects and rules for co-financing will be considered by the programme committee.
DG Sanco has provided information on the programme over the past two years, including at a workshop in July 2002 in Luxembourg to which two representatives from each candidate country were invited. Participants at the workshop were asked to disseminate information about the programme in their countries.
(1) COM (2000) 285 final of 16.05.2000. (2) COM (2000) 788 final and COM (2001) 808 final.
