Interview with Martin McKee, Professor of European Public Health and Research Director, European Observatory on Health Care Systems, London School of Hygiene and Tropical Medicine, London.
EPHA would like to see a stronger role for the European Union in public health and a clearly defined EU public health policy. Do you agree with this position?
McKee: There are many arguments for strengthening the role of the EU in public health, simply because so many threats to health act at a European, or even global level. The obvious example is tobacco. There, the tobacco industry has taken advantage of open borders within Europe and exploited differences within Europe, such as the weak position on tobacco control adopted by Germany.
Free trade and public health have faced tensions for centuries and there are many other areas where the EU will need to ensure that the balance between the goals of the internal market and health protection is set appropriately.
What do you see as the potential benefits of a significantly increased EU role in protecting the health of European citizens?
McKee: There are several benefits, which are well recognised by those involved. There are two that I would single out. First, facilitating a process of learning from each other, so helping the diffusion of good practice. The second is to give Europe a stronger role in global negotiations, especially at a time when there is a regime in power in Washington that is so opposed to effective action on the major threats to global health.
Has any "scoping" exercise been done to establish baseline data that would map morbidity and mortality trends for the major "burdens of disease". In particular, has attention been given to diseases and conditions that lead to potentially avoidable premature mortality such as poverty, social exclusion, diet, tobacco, alcohol, drugs and so on?
McKee: Yes. Refer to the WHO European Health Report published in September 2002.
The World Health Organization Health for All Strategy has introduced the setting of health targets and stimulated thinking on priority setting in health policy. Almost all European countries have taken the first developmental step in the process by giving a political commitment to the Strategy. Should the European Union be involved in encouraging policy development and practical steps?
McKee: There is a strong argument for the EU to develop health targets, not least because it is a means of monitoring its Treaty requirement to ensure that a high level of human health is integral to its policies. However, target setting and monitoring is a complex task, not least because of the weaknesses in systems for collecting health data in several Member States. In addition, we need to be careful that targets do not create perverse incentives, as they did in the USSR, or more recently, in the public sector in the UK. For example, the British NHS has had a series of scandals as hospitals either manipulated data or took steps to "lose" patients so that they could "achieve" targets.
EPHA would like to see change achieved through the introduction of effective health impact assessment and necessary changes at every step of the decision-making process, to ensure that health benefit becomes a primary concern of all policy development - "across the board". Would you agree with this approach?
McKee: Yes. However, this will require a major investment in both methodological development and in the acquisition and diffusion of skills in Health Impact Assessment (HIA), which are still extremely scarce. This once again highlights the consequences of generations of under-investment in the public health workforce in many countries.
How important do you consider the role of civil society to be in the promotion of public health in Europe?
McKee: We need to find more ways of involving NGOs in health policy and health promotion. In particular, they can have an important role in countering the effects of vested interests. On the other hand, we need to be careful that they themselves are not captured by vested interests, whether this is patient groups that are influenced unduly by the pharmaceutical industry or, much more sinister, the way tobacco companies have infiltrated all sorts of organisations in an attempt often successful to distort the agenda.
Does the European Union have a special role to play in terms of keeping citizens informed about their best health interests?
McKee: It is very difficult to see how it might do this. On the other hand, it would be good if national media gave more coverage to European issues, but with a greater degree of balance than has previously been the case.
Examples of Health Impact Assessment in Europe
The Netherlands: HIAs conducted by the National School of Public Health for the Health Ministry.
Sweden: HIA tool developed and used at local and regional (County Council) level.
UK: Commitment to HIA, publication of a checklist; Wales: introducing HIA as a tool in policy development.
Germany, e.g. used as a planning tool at regional level (Nordrhein-Westfalen).
Source: WHO network: European Centre for Health Policy, Brussels.
The European Observatory on Health Care Systems supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health care systems in Europe.
The Observatory is a partnership between WHO Regional Office for Europe, the Governments of Greece, Norway and Spain, the European Investment Bank, Open Society Institute, World Bank, London School of Economics and London School of Hygiene & Tropical Medicine.
Info:
Martin McKee
European Observatory on Health Care Systems
London School of Hygiene and Tropical Medicine
Keppel Street
London WC1E 7HT
United Kingdom
E-mail: martin.mckee@lshtm.ac.uk
