Nearly seven months from the end of its mandate, the current European Commission held its last major event "Health in Europe, making it fairer" in the field of public health on 18 March 2014. The conference focused on the current inequalities in health to make progress towards integrating discriminated and stigmatized social groups. The aim was to share good practices in promoting equity and combatting discrimination including health promotion, prevention and treatment.
The European Public Health Alliance (EPHA) and the European Patient Forum (EPF) issued a joint press release on the day of the conference: [Joint press release] Ball is in Council’s court to end health discrimination
In the European Union, the gap between the rich and the poor and between social groups has widened substantially over the last few years. The economic crisis has contributed to limited access to health care services for the most vulnerable people, disrupting European citizens’ lives. The most deprived people are not sufficiently visible in policies and their concerns are not heard. Additionally, the alarming social gradient in areas such as tobacco use, harmful consumption of drugs and alcohol and poor nutrition cannot be denied. Immigrants face substantial problems while settling in European countries and fighting with administrative obstacles. Instead of a patient centred approach, European countries still follow a paternalistic care provision. People with HIV/Aids are not integrated sufficiently in the health system and are instead confronted with discrimination and co-infections such as tuberculosis. Public health professionals speak about a chronic disease epidemic, which is on the rise in Europe. 
Following Paola Testori Coggi’s welcome speech, Vice-president and Commissioner Viviane Reding, Health Commissioner Tonio Borg, and the Greek and Latvian Ministers of Health (Adonis Georgiadis and Ingrida Circene) delivered opening remarks and addressed how important the issue of inequalities and discrimination in health is.
Viviane Reding highlighted that the right to healthcare went beyond many different policy areas. Equal access to healthcare is a shared value throughout the European Union. She highlighted that there is 10 years difference in life expectancy between Roma and non Roma which is unacceptable.
Health Commissioner Tonio Borg pointed out that the fight against discrimination and stigma in health had been the flagship of his mandate. "Discrimination in healthcare is an indication of poverty." - he said. He mentioned that we still had not achieved a union in the field of health. He added that discrimination is a public health issue and simply complaining about the impacts of austerity measures is not enough: the public health community should convince Finance Ministers about the results of cuts on population health. He made a specific reference to the recently adopted Tobacco Products Directive stressing that "Tobacco should taste like tobacco and smell like tobacco."
As EPHA highlighted in its previous communication, in Europe around 700,000 people die every year from smoking-related causes and close to 13 million suffer from smoking-related diseases such as cancer, cardiovascular diseases or Chronic Obstructive Pulmonary Disease (COPD).
Adonis Georgiadis, Minister of Health in Greece claimed that "a lot has been done in the past and we have to see what our successes were." However, inequalities should be diminished and important values such as equity need to be fundamental. Current challenges included the economic crisis in Greece and the uptake of important and increasing technologies into health systems.
In Ingrida Circene, Minister of Health in Latvia had the view that "health is a value itself". Unfortunately, prevention often does not "target the most vulnerable groups and health expenditure on prevention is very low at just 3%". Despite these failures, however, she said that "success on prevention control was the tobacco control for vulnerable people".
How to promote fairness in health? Special focus on impact of austerity on population health, especially on vulnerable groups
During the second half of the morning, people from different backgrounds brought up their own perspectives on fairness in health.
MEP Lívia Járóka (HU, EPP) in her video message focused on the health of Roma, highlighting that isolated Roma communities are left out of vaccination programmes and disease prevention measures. She also outlined the situation of Roma, as regards eye health, pulmonary diseases and the lack of access to appropriate water services.
A professional’s point of view was provided though Michel Roland (President of Doctors of the World, Belgium), who reminded participants that stigmatisation in screening processes is counter-productive and inefficient. He also mentioned that healthcare professionals should not only take medical determinants into account, but also the social determinants of health (such as employment, living conditions and environment) while working with patients.
As regards the patients’ perspective, Robert Johnstone, from the European Patients Forum (EPF) highlighted that barriers still threaten universal access to health which is a prerequisite to effective public health policies. He underlined that high quality healthcare was a fundamental right. Patients across Europe still continue facing discrimination, stigma and unfair treatment. Mr. Johnstone mentioned that treating people unequally constituted a huge cost to the society. According to him, patient-centred healthcare is key and decision-making must ensure that patients’ view is meaningfully taken into account in health policy.
MEP Jean Lambert (UK, Group of the Greens/European Free Alliance) emphasised the downward pressure in the access of health care in Greece and she mentioned the increasing unemployment rates and how this affects access to health care. However, Greece is not the only country facing these difficulties. "We need to give antidiscrimination legislation a horizontal dimension and make sure it becomes practice" - she said.
The afternoon was devoted to three parallel sessions which took place simultaneously:
- "Equity in addressing chronic diseases". Cancer, alcohol, tobacco, diet and exercise have strong connection to chronic diseases: the WHO European region is the region most affected by chronic diseases and this is a trend which is likely to increase due to demographic trends. The stigma on chronic disease patients is present in the whole system and they receive insufficient support. "General prevention is absolutely the way to go, but there may be a few devils in the details: The more equal a society is, the better the health outcome" highlighted Susanne Lřgstrup from the European Heart Network (EHN). "People shouldn’t be punished because they were born on one side of Europe" highlighted MEP Alojz Peterle (EPP, SI) former Prime Minister and a former cancer patient.
Speakers from the floor highlighted, that as regards chronic diseases and discrimination, it is important to take into account the impacts on mental health. The public health community should talk to the representatives of other sectors (e.g. housing) who were missing from the conference.
This session was chaired by Commissioner Borg who highlighted that on 14 March 2014, the Commission launched a renewed EU Action Plan on HIV/AIDS lasting until 2016, which has a special focus on discrimination. People diagnosed with HIV/AIDS, including lesbian, gay, bisexual, transgender and intersex (LGBTI) people still experience many discriminations, included unintentional discriminations. They suffer from mockery and are not taken seriously due to their sexual orientation. Treating everyone with dignity is essential, as well as adopting a patient-centred approach in policy-making. There is a crucial need to ensure that medicines are accessible and affordable. Prevention, where possible should be even more encouraged. Civil society asked for HIV-AIDS issues to be discussed in the Council of Health Ministers. In addition, ten years after the adoption of the Dublin Declaration on the Partnership to Fight HIV/AIDS in Europe and Central Asia, a new commitment is needed. Financial support to NGOs working on HIV/AIDS should continue.
"Health of people in vulnerable situations".
The interactive debate about "Health of People in Vulnerable Situations" was driven by people from diverse backgrounds. A migrant talked about the social exclusion he experienced: "I saw a Europe of exclusion, even though health is a human right." It was also elaborated on in how far legislation can improve the situations for migrants, children, elderly, Roma, people with disabilities and other vulnerable social groups. Stigma cannot be inclusively related to particular social groups- it is a problem across society. Service providers may also face stigmatisation while working with vulnerable people. A wide range of examples for social exclusion was provided. All in all, the discussion revealed that inequalities are still present even though people have multiple identities. Good practices are already happening, but change is needed on an individual as well as on a system level.
In his closing remarks, Martin Seychell (Deputy Director General at SANCO) said that "We all have a role to play in fairness, tolerance and respect: this cannot be delegated to others." In her closing remarks, Isabel de la Mata highlighted that a final report encompassing the discussions and the proposals which have been brought up during the conference would be released.
Over 400 participants were representatives of Member States, members of civil society and NGOs as well as professional groups, academics, and EU institutions. As stated by Commissioner Tonio Borg, it was " an opportunity, not just to exchange information, but also, more importantly, to share our views and concerns and table ideas for the future ".
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