Protection of public health
1992: Maastricht Treaty ratified Article 129 gave the European Community its first responsibilities in health protection.
For the first time, health was recognised as being within the scope of the European Community activity, though certain limits were set as to the form the action could take. The task of the Community, acting together with Member States, was to contribute to "a high level of human health protection", particularly through preventative measures. The Article also stated "health protection requirements shall form a constituent part of the Community’s other policies".
The World Health Organization (WHO) established representation to the European Union in 1992.
The European Public Health Alliance (EPHA) was established in 1993.
Promoting health, especially food safety
1998: Amsterdam Treaty ratified
Article 152 extended EU competence to "promoting", in addition to "protecting", the health of EU citizens.
The new article called for community action to be directed towards "improving public health, preventing human illness and diseases and obviating sources of danger to human health" rather than simply "the prevention of diseases" (Maastricht Treaty).
In 1998, the BSE (bovine spongiform encephalitis) crisis was at its height. It played an important role in determining Europe’s strengthened role in public health in the Amsterdam Treaty. It also encouraged a future focus on food safety within DG Health and Consumer Protection, which was formed in 1999. Co-ordination in food safety led to the establishment of a European Food Safety Agency, which began operations in 2002.
EPHA’s focus has been on nutrition rather than food safety. In 1999, EPHA developed a declaration on Common Agricultural Policy (CAP) reform, recommending a shift away from production targets and towards improving nutrition and in favour of other health, social and environmental objectives.
Recognition of NGOs as important stakeholders
1999: WHO Environment and health process, and DG Trade
Official support for civil society involvement in WHO’s Environment and Health ministerial meetings was provided for the first time at the meeting in London in 1999. NGOs not only took part in the conference they also organised the concurrent "Healthy Planet Forum". EPHA was subsequently appointed to the organising committee of the European Environment and Health process.
The same year, DG Trade invited EPHA to be health adviser on the EU delegation to the World Trade Organization ministerial meeting in Seattle. EPHA also takes part in the DG Trade "Civil Society Dialogue", which started later the same year.
EPHA is also a member of the EU Health Policy Forum, officially launched in 2002.
Recognition of health inequalities
2001: "Tackling inequalities in health" report launched
An EU ministerial meeting under the Belgian presidency in December 2001 launched a report on health inequalities. This was recognised to be a turning point. In the first half of the 1990s, few European countries had been willing to admit that national policies could produce serious health and social injustices.
The first European Conference on health inequalities was organised by EPHA in 1994. It had recommended that health inequalities could be reduced by "input into policies on employment, education, nutritious food, housing and transport on the basis of availability and affordability, quality and equity".
Health on the environment agenda
2001: Environment sustainability and health, Sixth Environment Action Plan
Public concern over rising levels of chemicals and other man-made contaminants in the environment have been steadily rising during the 1990s. One of four action areas in the sixth environmental plan (2001-2010) aimed "to achieve a quality of the environment where the levels of man-made contaminants, including different types of radiation, do not give rise to significant impacts on, or risks to, human health."
The EU Strategy for Sustainable Development 2001 also included health as a priority.
EPHA launched an environment network in April 2003. The inaugural meeting of the EPHA Environment Network (EEN) attracted representatives from 40 non-governmental organisations.
Legislation on tobacco control
2002: Tobacco Products Directive and Tobacco Advertising Directive
Efforts to introduce legislation controlling the marketing of tobacco have had a rocky ride. In 1998, Germany and several tobacco companies successfully challenged the EU’s right to completely ban tobacco advertising. The European Court of Justice (ECJ) annulled the original Directive, but indicated the scope for more limited EU action. A revised and weaker Directive was subsequently adopted in March 2003. In the meantime, the Tobacco Products Directive of 2001 was also challenged in the ECJ, but emerged virtually unscathed and is now being transposed into national legislation by all Member States.
Rise of patients’ groups
2002: High-level reflection group on patient mobility established
Over the past few years, patients have emerged as key stakeholders in Europe. This has taken place in the context of the European Commission’s Pharmaceutical Directives review and the European court rulings in favour of the "free movement of patients" (e.g. Kohll and Dekker, 1998, and Smit-Peerbooms, 2001).
EPHA views the growing role of patients’ groups with some concern. By focusing on patients, the wider public health issues risk being overshadowed. Groups representing patients tend to concentrate on drug treatments for long-term conditions, such as HIV/AIDS and Alzheimer. The wider public health vision requires attention to addressing the underlying causes of ill health. All perspectives should be represented in the European debate determining public health priorities.
