The Belgian presidency of the European Union, which ended in December 2001, made a considerable contribution to raising the issue of inequalities in health. But health minister, Magda Aelvoet ended her term of office expressing a sense of frustration over how little could be achieved.
Sitting around the table at a Ministerial meeting in December 2001, participants were reminded that ten years ago a discussion about how to tackle inequalities in health would not have been possible. The infamous Black report on Inequalities in Health was all but ignored by the British government when it was published in 1980. Governments in other European countries have been similarly reluctant to accept that national economic and social policy can produce serious health and social injustices.
Fortunately, the European Commission has been able to play a positive role. Over the past few years, it has addressed health inequalities as a priority. It has done this by concentrating on some of the issues that create the problems, such as nutrition and alcohol policies. It has also focused on some of the hardest hit groups, such as adolescents, migrants, women, older people, and the disabled. In 1998, the Commission funded a project on health inequalities proposed by the European Network of Health Promotion Agencies (ENHPA). When the project report became available, the Belgian presidency responded with interest to its findings and a statement was made to the Health Council of November 2001 on the basis of its conclusions.
During the Belgian presidency, common EU indicators for social inclusion in the European Union have also been agreed, and these include "poor health related with low income" as one of seven lead indicators. In addition, an international conference on measuring poverty in Europe was held in September 2001.
However, the ministerial roundtable in December brought greatest attention to the issue. It was well-attended by the health community, addressed by David Byrne, European Commissioner for Health and Consumer Protection and livened by the strong advocacy for a reduction in health inequalities by several ministers including the Belgian health minister Magda Aelvoet. Hopes for the future grew when Horst Kloppenburg from the European Commission intervened to give a verbal commitment to the continuation of support to the ENHPA project. The next stage would be the "marketing" of the study findings and recommendations to countries throughout Europe.
Working against the tide
But a sense of frustration among participants remained. European policy was sometimes increasing inequality. For example, regional aid has increased the gap between rich and poor regions within Greece and Spain despite increasing average income per capita in the two countries. (1) In the health care sector, encouragement for cross-border travel for medical treatment is more likely to benefit wealthy, well-travelled people. (2)
Those involved in the "Tacking inequalities in health" study said many health care professionals feel powerless when confronted with housing, unemployment or other social problems, which they could not possibly solve on their own. (3) Working directly with patients it becomes obvious that other sectors have to be involved if the problems and injustices are to be resolved.
Ms Aelvoet recognised the limits of what health ministries can achieve. "The only approach we can take is to integrate activities into the work of other Councils", she said. Her priorities are agriculture and environment. But she feels that a change in EU competence with regard to health is needed. "Health requires its own set of rules because it is not a service like any other," she told the December meeting.
Looking ahead, the Danes have agreed to take up the issue of health inequalities during their presidency in July-December 2002. Meanwhile, the Commission’s project would continue, and efforts would be made to integrate health priorities into the work of other Councils.
References:
(1) The EU’s regional aid, What’s ours is ours, The Economist, 24 May 2001
(2) GPs concerned over plans to send patients to Europe, BMJ2001;323:712 (29 September)
(3) Communication from Catherine Ancion, Project co-ordinator, Tackling inequalities in health, Vlaams Instituut Voor Gezondheidspromotie (VIG)
