The European Public Health Alliance (EPHA) has been very concerned about signs that the Convention on the Future of Europe is proposing a downgrading of health from a "shared responsibility" to a "supporting responsibility" in the future EU treaty. We therefore welcome the fact that the Greek presidency is seeking a broadening of the EU health competence. Could you tell us more about the exact position the Greek presidency is taking on this issue?
Costas Stefanis: Health should be a prominent component of the new EU treaty. The Greek presidency is working towards achieving a consensus amongst the Member States so that we can conclude on treaty articles. Our aim is to formulate a framework for policy development that will protect and improve the health of European citizens.
At this stage, since we hold the presidency of the European Union and therefore are responsible for the negotiations, it would not be appropriate to express further views on the particular wording of the future treaty articles.
The emerging reality makes the provisions of article 152 of the treaty seem rather limited in scope, or areas of application. This calls for a re-examination of the appropriate remit of EU level health policy and its relationship to national policies regarding health care systems. It seems more and more accepted that the application of the subsidiarity principle may not be the most appropriate action in some areas, such as where the single market operation and patient mobility have created new dynamics for an EU level policy in regard to health care finance or provision.
The Greek presidency organised a major meeting in Athens at the end of February where the WHO European region’s framework food programme was presented addressing the contribution of poor nutrition to the overall health burden. Greece is recognised as having one of the best diets in Europe and is therefore well placed to host such a meeting. Will this event result in nutrition finally becoming a public health priority for the Community? Can we expect the announcement of a European nutrition strategy in the near future?
Stefanis: In the context of the Greek presidency, two meetings in relation to nutrition took place in Athens. In the first one, national nutrition experts from more than 50 European countries were brought together and discussed regional co-operation in support of the WHO global strategy on diet, physical activity and health.
The second one was aimed at discussing Nutrition in the European Union, in view of EU Enlargement. Three themes dominated the meeting:
The Public Health Nutrition situation in the accession countries, in view of EU enlargement
The impact of Agricultural Policy on the implementation of Nutritional Policy
The need for improving nutrition education in medical schools.
In Greece, nutritional guidelines based on the traditional Greek diet have been set and a Nutrition Policy Committee is working towards the development of the key strategy to tackle these nutrition-related issues.
At the EU level, several ongoing activities are related to nutrition and supported through the EU Directorates. DG SANCO (the health and consumer protection Directorate General) is taking the lead in terms of public health nutrition and we consider that in the near future an intersectoral approach for nutrition policy will be developed at the EU level.
What is your position on the European Commission’s proposal to allow drug companies to provide information to consumers on prescription medicines to treat AIDS, asthma and diabetes? The European Parliament and many public health advocates believe the proposal will result in DTCA in Europe. Do you agree, and what is your position on DTCA?
Stefanis: The European Parliament has already expressed its views on direct to consumer advertising (DTCA) on pharmaceutical products with an overwhelming majority against it. I fully agree with the Parliament’s position on this issue.
Mental health is high on your agenda. It is a problem with important social aspects. For example, 80% of people with long-term mental illness are unemployed. Do you think that the Mental Health Conference on Stigma and Social Exclusion in Athens at the end of March enhanced collaboration on health and social policy (between DG SANCO and DG Employment)? Will they be able to capture the essence of the health and the social dimension?
Stefanis: It is understood that people with mental illness have to face, apart from their health problems, the consequences of stigmatisation, which usually leads to social exclusion and unemployment. Consequently, the World Health Organization correctly considers the issue of stigma to have serious consequences for mental health. Thus, it is clear that there is an interrelationship between mental illness and stigma.
From the above, it appears that our responsibility is not only to introduce therapeutic methods to fight mental health illnesses, but also to raise awareness about stigma and discrimination towards persons with mental disorders in order to minimise the social consequences that arise.
Perhaps most importantly, action can be taken at the European level to promote awareness and understanding of mental health. This may help to create an impetus for a change in attitudes, and in the long-term help to alleviate the level of stigma and social exclusion that can hamper individuals in all aspects of daily life. Action might also be taken to further build up and share knowledge on effective interventions in different European settings, and in particular to consider their broad socio-economic impact not only in the health care sector but also elsewhere, such as in social care, education and employment.
At the Athens Conference "Mental Illness and Stigma in Europe", we discussed precisely these issues. Based on its conclusions, as the current EU presidency, we are promoting proposals pertinent to this important issue for adaptation at the Minister’s Council for health, social protection, and employment. Therefore, health and social policy collaboration between DG SANCO and DG Employment will be enhanced as our proposals incorporate both the health and the social dimension.
European NGOs are pleased to note that the Greek presidency is seeking a strong and positive outcome on the WHO’s tobacco treaty. How to you anticipate the EU will be able to reach an agreed position, for example on advertising, to support this outcome?
Stefanis: Smoking is one of the most serious risk factors to public health. Therefore, measures should be taken within the WHO framework convention to control advertising and the use of tobacco.
In our capacity during the current Presidency of the Health Council, we have devoted considerable time and effort to the co-ordination of a common position, which I do hope will be adopted by the Ministers Council.
An agreement on the tobacco convention in May in the WHO General Assembly will not signify the end of our initiatives rather it will mark the beginning of activities to fight more vigorously the use of tobacco.
While it is Community policy to reduce the harm to health resulting from tobacco, the EU continues to provide subsidies to tobacco farmers. Would you care to comment on the inconsistency of the European policy on tobacco and health? As a Health Minister, do you feel you should support the phasing out these subsidies?
Stefanis: There is a need to develop a comprehensive European policy on tobacco. This would include developing health promotion activities and tobacco prevention programmes under the Public Health Directorate of the European Commission.
The EU produces limited amounts of tobacco, mainly by small family enterprises. Tobacco is cultivated in less developed regions of the EU. It is therefore imperative to face changes related to subsidies with a global approach. Measures taken in this direction should include public awareness alongside other actions that will enable current tobacco producers to shift their production towards other activities.
What should be the role of NGO’s at the European level, particularly in relation to health? Does the Health Ministry in Greece have a process whereby it consults with civil society?
Stefanis: The role of NGO’s and stakeholders are to support the programme of Public Health by voicing their preferences and expectations. We must not forget that it is the civil society organisations and their members that finally are on the receiving end of the effectiveness and outcomes of the Public Health programmes. This is obviously recognised by our Ministry, especially in the field of health and social welfare. One of our priorities during the Greek presidency is for the NGO’s to participate in our actions and events.
In relation to the consultation process with the civil society representatives, we always seek their views and submit constructive proposals whenever we plan for developments or reforms on the various health and social policy issues.
Interview completed on 15 April 2003.
