Interview with David Byrne, European Commissioner for Health and Consumer Protection
Do you believe that the existing Treaty commitment, to ensure "a high level of human health protection" has been fully exploited? Could more have been done? Could you give positive and negative examples?
Byrne: The Treaty of Amsterdam, with its commitment that the EU should ensure a high level of health protection, entered into force on 1 May 1999 - just a few months before I started my mandate as Commissioner. Health protection has certainly been a very high priority of the European Commission since then. For example, when the present team of Commissioners took office in September 1999, overhauling EU food safety policy so as to ensure a high level of protection for consumers was a central plank in the programme we presented to the European Parliament.
I would see food safety policy as a good example of the EU integrating health protection into its other policies. In international trade negotiations, we resist attempts by some of our trading partners to get the EU to relax its food safety standards - even at the cost of the occasional trade dispute. When we harmonise food safety rules within the EU, we invariably harmonise to a high standard of protection. Animal health, animal welfare and food safety are central priorities of the EU’s agriculture policy.
Another excellent example of the EU pursuing a high level of health protection is our tobacco control legislation like the 2001 Tobacco Products Directive and the Tobacco Advertising Directive agreed by Parliament and Council in December last year.
Tobacco also brings me on to a negative example. In 2001 the Commission presented an EU Strategy for Sustainable Development that included a phasing out of EU financial support for tobacco growers. We have made some progress in at least putting the phasing out of tobacco subsidies on the agenda, but frankly there has been a lot of opposition in the European Parliament and Council of Ministers. Whatever the Treaty may say about health, politicians from countries that benefit from these subsidies fear their farmers will lose out and are fighting to preserve them.
Could we have done more? In an ideal world, yes. But in the real world - and bearing in mind that there are only about 100 officials in the Commission’s Public Health Directorate - I think we have done a pretty good job.
What are the main achievements of the eight programmes introduced gradually throughout the 1990s? Where is the EU "added value"?
Byrne: In the late 1980s there were very few European networks looking at health issues and not much of a "health lobby" in Brussels. By the end of the 1990s we had dozens of EU-wide health networks and a very vocal "health lobby" in Brussels. I believe the programmes introduced in the 1990s were instrumental in creating a public health community on EU-level as we know it today. That is a major achievement shared by all eight programmes.
Healthcare systems and health policy makers across the EU share many of the same challenges - for example, developing effective policies on drugs, alcohol, tobacco and nutrition, reducing inequalities in health and improving healthcare quality. When addressing these challenges, policy makers at national level are always very interested to know what has been done in other Member States, and what have been the results. If, by networking the health community, the EU can facilitate answering these questions then we have added value.
There are other numerous success stories within each of the eight old public health programmes. I will limit myself to listing just two. Work done under the Health Monitoring Programme and Europe Against Cancer demonstrated the value of high quality EU level health data. The European Network on Communicable Diseases that grew out of the AIDS and Communicable Diseases programme has established the importance of EU co-ordination in responding to health threats like the recent outbreak of the Severe Acute Respiratory Syndrome (SARS). These achievements will be built on and developed in the new programme.
Could these programmes have been run at all, without the support of civil society? What will be done to maintain NGO partnerships, in implementing the new programme? Specifically the programme decision mentions "promotion of co-ordination at European level of NGOs" but the 2003 work programme prioritises this activity in relation only to enlargement. How does the Commission plan to support European level NGOs?
Byrne: NGOs and civil society made an enormous contribution to the previous public health programmes and I am sure this will continue to be the case in the new programme. The structure of the programmes has always been based on the principles of partnership and co-financing. In other words, the EU covers part of the funding but project participants are also obliged to contribute resources. The Commission is aware that co-financing requirements can, in some cases, be a barrier to NGO participation in the programme. That is why, in the new programme, the Commission has relaxed the co-financing requirements and can now cover up to 80% of the cost of NGO led projects.
How will the benefits of the previous programmes, and the expectations they have created, be carried forward into the "three strand" approach now being introduced?
Byrne: One only has to look at the 2003 Work Plan to see that many of the priorities of the previous programmes are carried over into the new programme. For example, under the health determinants strand, the issues being looked at - such as nutrition, tobacco, alcohol, drugs, health and environment - are all ones that were worked on under the previous programmes. I have no doubt that many civil society organisations that were partners in the previous programmes will run projects under the new programme. However, the Commission’s financial rules require projects to be selected on a competitive basis following a public call for proposals. We cannot "ring fence" funding for particular organisations just because we have an established relationship with them.
What key outcomes are you hoping to achieve by 2005 and 2008 (i.e., the mid-point and end-point of the new programme)?
Byrne: The new programme will have a number of concrete outcomes, for example in the areas of putting in place a comprehensive information system for citizens, health professionals and health authorities and in increasing the EU’s capacity to respond to health threats. By the mid-point of the programme I am confident major advances will have been made towards these objectives with for example, the establishment of a health portal, and the creation of a European Centre for Disease Prevention and Control.
Multiple factors affect our health as individuals. Does the Community take proper account of the impact of policy proposals - across the board - on the health of its citizens? How can effective health impact assessments be built into the EU’s decision-making processes?
Byrne: It is precisely because so many factors affect our health that health impact assessment is so difficult. Enhancing our understanding of health impact, and developing effective health impact assessment methodologies, is a priority in this year’s work plan for the Public Health Action Programme. I am confident that, as the Programme proceeds, this work will yield useful results.
How does the Commission co-ordinate health concerns given that there are so many critical areas, e.g. agriculture, pharmaceuticals, equitable access to cross-border health care, mutual recognition of professional qualifications and so on?
Byrne: The Commission has a working group with officials drawn from across its Directorates General that aims to integrate health priorities into all initiatives likely to be of significance to health. My Directorate-General also has the Health Policy Forum to give it input from civil society on health issues and, as I have already said, we are developing methodologies for conducting health impact assessments on policies.
Further upstream, all Commission proposals are subject to a system of "inter-service consultation" whereby each Directorate-General gets to comment on them before they are finalised. And at the very end of the line, the Commissioners have to approve all proposals. My civil servants or I can raise health concerns at both these stages.
What restructuring of SANCO’s Public Health Unit do you anticipate in the near future to meet the challenges ahead? What are the most demanding challenges facing the Unit in the immediate future?
Byrne: Health is a topic that is moving up the political agenda in the European Union. We need to ensure that this rising importance is matched by adequate capacity and expertise in the Commission. One practical problem the Commission has to face is that its Public Health Directorate is based in Luxembourg whereas the other policy-driven services are based in Brussels - just like the Consumer Protection Directorate which, together with the public health part, forms the Directorate-General for which I am responsible. We have now reached an agreement with the Luxembourg government that will enable us to introduce a new structure for the Public Health Directorate in response to current challenges. In particular, it will allow us to strengthen our work in relation to health in other policies by basing some officials in Brussels, where they can more effectively interact with colleagues in other parts of the Commission. The Public Health Directorate will continue to be present in Luxembourg, from where staff will ensure that the actions of the new programme are effectively implemented.
How do you feel that civil society organisations can best support public health in Europe during the next ten years?
Byrne: Continue to organise and network at European level! Civil society organisations working on tobacco control have been very effective in promoting their agenda in the EU. They have done this by building European organisations, learning how EU politics works and investing the time and effort needed to have an impact. I am sure civil society organisations can and will have a major impact on other health issues if they organise themselves effectively at EU level and make a sustained effort over a number of years.
Interview completed 24 April 2003.
