The Public Health Programme was agreed by the EU Health Council on 26 June 2002. What can it achieve in terms of improvements in the health status of all EU citizens?
Lars Løkke Rasmussen: I see the new public health programme as an important supplement to the national activities to improve public health. In September, the Danish government launched a new programme for public health and health promotion for the period 2002-2010. It focuses action on the eight most common diseases including cancer, diabetes and cardiovascular diseases. The programme encourages institutions and organisations from a broad spectrum of society to work together for public health.
At the European Community level, the new public health programme has the same horizontal approach to improving the health status of all citizens. I think that the initiatives at EU level complement the national actions and thereby gives us an efficient instrument to improve public health for the citizens of the EU.
What role do non-governmental organisations play in national health policy development in Denmark, and how will they contribute to the Community health programme? Is there a formalised forum in Denmark for providing input from NGOs, for example, in looking at how other policies impact on health or improving patients’ rights?
Lars Løkke Rasmussen: A very important part in the implementation of the national programme is the establishment of a series of partnerships including the perspectives of three levels: the individual or family, the communities, and the government. NGOs are invited and expected to take part in the programmes and activities. The role of the government is to provide preconditions and support.
The Danish NGOs in the health promotion field have, in my opinion, good access to the political decision makers although we do not have formalised structures for their influence. Parallel to that the NGOs have very broad contact to the public health government institutions, and in tobacco, alcohol and accident prevention programmes the NGOs run several programmes in co-operation with government agencies.
Do you believe that there will be special benefits for accession countries deciding to join this programme?
Lars Løkke Rasmussen: First, I would like to say that I hope this question of voluntary membership only relates to a temporary situation. The ten candidate countries will hopefully become full members of the Community by 2004 and then also full partners to the public health programme.
When joining the programme the candidate countries will be able to apply for funding for projects to support their national health policies and to address specific national health problems. So yes, I believe that the EU public health programme provides benefits for every country participating.
What needs to be done to improve health that is beyond the scope of the public health programme? For example, do you consider that the EU should be playing a key role in the WHO’s initiative to develop a Framework Convention on Tobacco Control?
Lars Løkke Rasmussen: Smoking is one of the most serious risk factors to public health and action at national and EU level should be complemented by actions at global level (WHO). The EU countries consider the work on the WHO Framework Convention on Tobacco Control to be very important in the effort to improve public health. Besides the efforts to control the use of tobacco within the WHO framework convention, the EU countries are working with several initiatives on tobacco and the prevention of smoking. For instance, there is the Council recommendation on the prevention on smoking, the directive on tobacco advertising and the Commission’s campaign "feel free to say no".
The Danish presidency has played an important role in the pharmaceutical review. What is your position on DTCA (Direct To Consumer Advertising)?
Lars Løkke Rasmussen: During the Danish presidency the work on the pharmaceutical reform has concentrated on the Regulation (1), and in particular on the effort to ensure an effective procedure for the approval of new pharmaceutical products.
The question of direct to consumer advertising (DTCA) on pharmaceutical products has therefore not been discussed as this is regulated in the Directive. The negotiations are continuing on the basis of the result of the European Parliament’s first reading, which was published towards the end of October.
EPHA believes that the Common Agricultural Policy (CAP) should give more attention to ensuring the production of healthy food, and to sustaining healthy rural communities and environments. At present, only six out of the 15 EU countries produce enough fruit and vegetables to comply with WHO’s recommendation that we all eat five portions a day. Do you consider that EU agricultural support policies might usefully be oriented towards meeting citizens’ needs for a healthy diet?
This question was referred to the Danish Ministry of Food, Agriculture and Fisheries who responded as follows: Among the objectives that the agricultural and rural development policy in Europe should promote are production methods that support environmentally friendly, quality products, among these fruit and vegetables. In the light of this objective and others the Commission has put forward a communication "Mid-Term Review of the Common Agricultural Policy" which is now being discussed. From a Danish point of view it is important that food safety, food quality and environment are integrated elements of the Common Agricultural Policy. However, a continued fundamental element of the Common Agricultural Policy is the common market and trade between Member States not least because of differences in climate.
A Danish presidency conference on social inequalities in health will take place in Copenhagen in December. What do you consider are the best ways to reduce social inequalities in health? What should be the added-value of Community initiatives in this area?
Lars Løkke Rasmussen: As I see it there are two ways to reduce social inequalities in health. First, we need to extend our focus on the weakest groups in our general systems, such as health services and schools. Second, we must develop service activities for the weakest groups, as for example children of alcoholics, drug addicts, mentally ill, parents and so on.
In addition to the actions at national level, initiatives at the Community level can contribute to developing new experiences and methods, and support an exchange of experiences between the Member States.
The first exchange of experience in the "open coordination" process (aimed at sharing "best practices") was expected to address the development of health services and care for the elderly. Were there any particularly significant findings from this meeting?
This question on the application of the open method of coordination to health was referred to the Danish Ministry of Social Affairs who responded as follows: The current exchange of experience has focussed on child care facilities. There has not yet been a formal exchange of experience regarding health services or health care for the elderly.
The first meeting of the newly merged "Employment, Social Policy, Health and Consumer Affairs Council" has taken place under the Danish presidency. Does this move imply an expanded or a diminished role for health at the EU level?
Lars Løkke Rasmussen: The first meeting of the merged Council for Employment, Social Policy, Health and Consumer Affairs took place on 8 October 2002 in Luxembourg. Previous presidencies have raised the question of whether the Health Council should meet twice during each presidency. With the new council formation, this is now possible. In addition, at the recent meeting of the Council in Luxembourg, health ministers met to discuss the WHO Framework Convention on Tobacco Control. It will meet again on 2-3 December 2002.
The fact that health issues are now dealt with in the same council formation as employment, social policy and consumer affairs represents an opportunity for the European policymakers to integrate the actions and initiatives in the these policy areas. The problems and challenges that we are facing, especially regarding health, consumer affairs and social policy, are very often interrelated, and the new council formation gives us the possibility to co-ordinate our efforts and ensure a horizontal and integrated approach to common problems.
Health in Denmark
The health sector is primarily a public responsibility in Denmark with 81% of health care costs financed through taxation. Running the health services is mainly the responsibility of regional authorities, working closely with the Government and local authorities.
Policy: WHO’s "Health for All" strategy forms part of national health policy thinking and also helps guide health assistance to countries in Eastern Europe. The Public Health and Health Promotion plan (mentioned in the interview) involves the coordination of 10 ministries. It targets achievements in: 1) life expectancy and quality of life, and 2) equity in health.
EU level priorities: the Danish health ministry concentrates its efforts on Single Market issues (pharmaceuticals, medical devices and medical professions) as well as public health.
Information from: "Health in Denmark", website http://www.im.dk/publikationer/Healthcare/healthcare.pdf
Lifting children out of poverty: 80% of Danish children between the ages of six months and nine years have a place in a publicly supported day-care facility, according to the Ministry of Social Affairs. Figures compiled by the European Anti-Poverty Network show that the proportion of children living in poor households in the EU is lowest in Denmark (4%) and highest in the UK (26%).
Health impact assessment: The National Institute of Public Health, which is an independent institute under the Ministry of the Interior and Health, is carrying out work on health impact assessment. For further information please contact Mr. Finn Kamper-Jørgensen, email: fkj@si-folkesundhed.dk, institute website http://www.si-folkesundhed.dk
(1) One of several pieces of legislation comprising the EU pharmaceutical review process.
Interview completed on 30 October 2002.
Info
Ministry of the Interior and Health
Slotsholmsgade 10-12
1216 Copenhagen K
Denmark
Website: http://www.im.dk
