Which priorities has the Spanish Presidency chosen in the field of Public Health and why?
Celia Villalobos Talero: I would like to begin by making a clarification. In English, public health refers to the health of populations and to health services. In Spain, salaud publica refers only to tobacco and alcohol and the other factors relating to health status but it never includes health care services. I understand in answering your question that I include public health plus health structures.
My priorities are the Public Health Programme, the tobacco directive, the blood directive plus a new directive to be presented by the Commission on cells and tissues. This relates to the stem cell debate - but is nothing to do with the ethics. It is about maintaining the safety and quality of the cells and tissues. The proposal has been drawn up by the Commission with the help of a representative from the Spanish National Transplantation Centre working as an adviser.
Another major priority is the free movement of patients. This is a key political issue, which is why our meeting on this theme in Malaga was very well attended. All countries sent high-level participants, except Portugual (where elections were taking place), Greece and Luxembourg.
In which areas do you think the EU could do most to improve the health status of all EU citizens?
Celia Villalobos Talero: There is an enormous amount that could be done. The most important is to ensure that health is taken into consideration when drafting any other policy legislation. Legislation in social, economic, transport sectors, for example, all have an impact on health. The more this is taken into account, the better health status will be.
The free movement of patients may improve choice for citizens even if it does not improve the health status. Most health services in the European Union countries are of pretty good quality, but some citizens would like to have the opportunity to travel elsewhere for health care.
If the number of patients crossing borders for medical treatment increases so that major numbers are involved, Member States should begin to work together to agree quality of health care standards. This is not going to happen immediately but I think it will happen in the future.
The European Council which took place in March 2002 in Barcelona looked at a number of indicators to evaluate the implementation of the EU Sustainable Development Strategy. This strategy, agreed at the European Council in Gothenburg (June 2001), mentions public health as one of its four priority areas. Do you think public health should be put at the centre of a strategy of sustainable development? How do you think this could be achieved?
Celia Villalobos Talero: Indicators are not discussed in any detail at the political level. They are a technical discussion dealt with mainly by academics. Different indicators have different strengths and weaknesses. It would make sense to have an indicator on equality in access to health care, for example, but how to measure health status is left to the technical discussion.
The European Commission has recently proposed new legislation on pharmaceuticals. One of its proposals is to allow industry to disseminate information on "prescription only" medicines for the treatment of AIDS, asthma and chronic broncopulmonary disorders and diabetes. Given the experience in Spain with Baxter (1), do you think that the pharmaceutical industry is the most appropriate source of reliable and complete information on the medicines they produce?
Celia Villalobos Talero: Our first initiative has been to move the pharmaceutical dossiers from the Internal Market Council to the Health Council. We think that, since it is the ministries of health at the national level which are dealing with pharmaceutical policy, it is only logical that decisions taken in relation to pharmaceuticals at the European level should be dealt with by the health sector. This decision gives a higher political profile to health and places all the pharmaceutical dossiers where they should be.
We have the agreement of Greece and Italy that pharmaceutical issues will continue to be managed by the health sector under future presidencies. Denmark has yet to make its decision - but we do feel that this initiative has a future. It seems only right that decisions on pharmaceuticals will be made by the Health Council.
On the issue of prescription-only drug promotion, this was only a proposal of the G10 group. The G10 is an informal group providing advice to the Commission but what it has to say is not a formal proposal. Given the strong reaction that this proposal provoked, G10 has changed its initial proposal. The proposal to allow the advertising of drugs available only on prescription has not been accepted. It will not therefore be put for approval to the Health Council. (See page 17).
The Spanish Parliament has called upon the Spanish Government to follow up on the recent World Trade Organization amendment to the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS). (2) It has asked the EU presidency to find a way to ensure that even developing countries without manufacturing capacity will have access to essential medicines. How do you plan to proceed on this issue?
Celia Villalobos Talero: This is not an issue for the Health Council. Although they will ask for our opinion, it would be stepping on the toes of other councils if we became directly involved. TRIPS is a very important issue but it should be dealt with by only one voice from each government. Since it is about our relationship with the World Trade Organization (WTO), it is best left to the responsibility of those involved in the commerce and trade sector of EU Commissioner Pascal Lamy.
Given your reputation as a minister who is close to the citizen, how do you view the recently published White Paper on Governance? How do you think the European Union could be made to respond better to the expectations of the EU citizen?
Celia Villalobos Talero: I do not have a view on the paper itself. But certainly initiatives aimed at giving the citizen more voice, and involving citizens more in decision making, are positive. How to do it to ensure real representation of the citizen is very difficult. Patients provide a part of the voice of citizens, and they need to be listened to, but they do not represent society. Citizens’ interests are wider than those of patients, and this needs to be taken into account.
Interview completed on 21 March 2002.
References:
(1) Baxter is the manufacturer of dialysis equipment that caused several deaths in Spain and elsewhere. Company representatives denied all responsibility until the Spanish Government started investigations and eventually fined Baxter.
(2) This amendment allows certain drugs to be manufactured in developing countries through "compulsory licensing" (that is, exempt from patent and therefore cheaper). However, the current amendment does not make clear how developing countries with insufficient industrial capacity will gain access to these lower cost essential medicines.
