The following text is from a speech by David Byrne, European Commissioner for Health and Consumer Protection entitled "EU health policy on a world stage". It defines the questions that need to be addressed in relation to a change in the Treaty Article on public health. The speech was given on 29 October 2002 at the European Policy Centre in Brussels.
David Byrne:
Early next year, I intend to publish a Communication on how Community health policy should develop to meet the challenges we face. This document will help to define policy goals, objectives, and priorities.
Allow me to set out some key areas where the Community can add value to what is done by Member States, international organisations and other actors in health. I will focus in particular on those areas with an international dimension.
Protection against threats
First, the EU must act to protect citizens against health threats. We already have in place a Community network on communicable diseases. But I am concerned that we are not fully prepared for epidemics of major communicable diseases, and other serious health threats, which require a rapid and co-ordinated reaction.
We lack fully effective and co-ordinated surveillance and response capacities. To rectify this situation, we have committed ourselves to creating a European Centre for Disease Control by 2005. This will bring together the expertise in Member States and will act as a reference and co-ordination point both in routine and in crisis situations.
We are also taking steps to address the threat of bioterrorism.(1)
Co-operation of national systems
A second priority to be featured in the forthcoming Communication is to see real progress on improving co-operation between national health systems across Europe. With our Member States, we need to work together to find ways to make our national health systems more open, transparent and effective. But in doing so, we need to ensure that our national health systems specific needs are fully respected, that their functioning is not disrupted. In short we need to support a sustainable future for our systems.
But in a world where there are queues of patients in one place, and empty beds in another, closer European co-operation between systems is an increasing reality. The movement of workers, patients, professionals and services will underline this trend in the new Europe of 25 members.
The organisation and delivery of health care remains in the hands of Member States. But the Courts are clarifying how this competence interfaces with the provision of cross-border services. Against this background, the Community can help by encouraging greater co-operation between Member States with a view to both improving patients’ quality of life, and supporting the financial sustainability of the systems within the context of the Treaties.
I am also determined to bring together health and other policies to ensure that we tackle health determinants with all the powers and instruments the Community has at its disposal. We will develop our work on health impact assessment, which will help to show how certain actions generate specific health outcomes. This needs to be complemented by strategies that combine actions in different policy areas.
I want to establish strong partnerships across the various Commission services in order to tackle the major health determinants. Developing links between trade and health policies, for example, is a key point in this context. I am of course aware of concerns in the health community about possible adverse effects of globalisation and trade liberalisation on health and health systems.
There is certainly more to be learned about how these two policy areas interact, and how individual health systems, especially in developing countries, are affected by international trade agreements. Perhaps we should ask ourselves what some of our own practices such as recruiting nurses and doctors in developing nations mean for the operation of health systems in these countries.
We should, however, acknowledge that important progress has been made in the international context to take account of health issues, for example, the arrangements to improve access to medicines for developing countries. But I must add here that I was appalled to read that some of these medicines have now re-appeared illegally on the EU market.
Empowerment and information
Finally, as regards the forthcoming health policy Communication, I take the view that the Community has an important role to play in the dissemination of health information and the empowerment of citizens - many of whom have already become active partners in managing their own health.
One key action is to improve health information and make it more widely available to ensure easy access to timely, accurate and authoritative information for patients, health professionals and authorities.
Another major action will be the establishment of a Community health portal. This will bring together accessible authoritative online information for patients and professionals alike. I want to see this up and running by 2004.
The empowerment of individuals is absolutely fundamental to this approach to enable individuals to make informed decisions as to how to protect their most crucial asset their own health. By ensuring easy access to timely, accurate and authoritative information, we can minimise the risk of citizens relying on partial, biased or misleading information and advice.
Health defines identity
I should pause here and say that I very much hope that I am not inadvertently giving the impression that developing the Community’s health agenda is a straightforward process. It isn’t. Universal access to affordable and decent health care is a defining feature of European social and political identity. It is part of what we are. It has been and remains driver of collective economic progress. And it is a defining feature of contemporary citizenship in Europe today.
Given its importance in the life of Europeans, it is not surprising that Member States have been defensive in defining the Community’s role. But following the Court’s definition of health services as services under the Treaties, a competence gap risks emerging where neither Member States not the Commission health actors are in a position to fully manage the situation.
We will quickly need to find new ways of managing these issues. Especially as the consequences of enlargement and globalisation, may well alter the balance of the equation.
Candidate Countries look to the Community for advice and help in rebuilding their national health systems, many of which are struggling to survive. It is vital that the new Europe of tomorrow, is one in which the essential European values of affordable universal access to decent services, is a reality in all 25 Member Services. There is much work to be done by Member States, by international organisations like the WHO, and indeed by the Community.
Many of the actions I have mentioned so far are possible under current community powers related to health. But it is evident that as part of the debate on future Community health policy we will have to re-examine the agreed ambition and legal basis of our work.
Changes to the Treaty
At the moment, of course, the European convention is reviewing the whole of the EU Treaty framework and structures. As far as health is concerned, important questions need to be addressed:
What powers does the Community need to address health problems that transcend borders, such as communicable diseases and environmental threats?
How can we ensure a proper balance between the operation of the single market and the functioning of national health systems?
How can we ensure clarity about what the European Union can and should do to protect and improve health?
As BSE has taught us, we need to be proactive rather than reactive when it comes to our citizens’ health. We are not interested in interfering in the running of national health systems. But there are many other open questions which European and international integration pose.
We need to achieve an effective and practical balance between the Community and Member States, founded on clear and unambiguous legal principles. It is in all our interests. This is certainly far from the case at present. For example, the Community cannot take vital public health action on anti-tobacco measures under the current Treaty Article on public health.
This must change. It is surely time to entrench firmly the health of our citizens into the new Treaty. So that we can continue to build the "Europe of Health" that our citizens demand, and that our citizens deserve.
(1) Several paragraphs from the speech are missing here. See full text on EU website under David Byrne’s speeches on Public Health.
