The European Parliament’s Ageing and Health Intergroup debated on ’Mainstreaming Healthy Ageing in the Renewed Social Agenda.’ The debate took place on Tuesday 14 October and was co-chaired by Claude Moraes MEP and Lambert van Nistelrooij MEP.
Annika Mansnerus (AM), from the office of the Swedish Permanent representation to the EU, gave an introduction outlining the agenda for the debate, but also took the opportunity to give participants an insight into some of the plans for the forthcoming Swedish Presidency.
Anne-Sophie Parent, Director of the AGE-Platform, reminded participants that the Commission has proposed 2012 as the “Year of Active Ageing,” and wanted to know what the Swedish Presidency would be doing to prepare for that. AM said that it depended in part on the Commission, the majority of the work might fall on the Spanish Presidency.
Claude Moraes MEP (CM) introduced the main topic of the debate, Healthy Ageing. He pointed out that in July 2008, the Commission published its Social Agenda.
One of the many issues covered in this agenda was the issue of how to achieve healthy ageing. The floor was then passed to Isabel de la Mata (IDLM), speaking on behalf of DG SANCO. IDLM spoke on topics related to healthy ageing. The first issue she spoke on was the need to educate the public on the issue of ageing, and the second area she touched was the role of DG SANCO in meeting and improving the aims of the Social Agenda.
Under the first topic, IDLM emphasised that people in Europe are living longer. By 2050, there will be 75% more people over the age of 75. This represents both a problem and a challenge. It will be a problem if they arrive in bad health, but an asset if they arrive at this age in good health. She said that DG SANCO would concentrate on ensuring that people do arrive at this age in good health, with the aim of extending healthy-life expectancy and not merely life expectancy. Good health, she said, was the key to meeting the challenges of Europe’s demographic issues.
According to IDLM, healthy ageing is cross-cutting issue. A number of EU actions are relevant to the issue, such as the Social Agenda, the Proposed Directive on Cross-Border Healthcare, and the Health Strategy 2008-2013. The Health Strategy in particular, she noted, encourages a healthy diet, physical activity to all age groups, and the aim of reducing child obesity will help to reduce obesity-related diseases in the long run. Additionally, physical activity should be promoted amongst the elderly population.
IDLM noted that the consequences of unhealthy ageing are now being recognised by European governments, and she said that there is to be a meeting with the Spanish Permanent Representation to discuss the priorities for their presidency related to ageing.
Isabelle Moulon (IM) from European Medicines Evaluation Agency (EMEA), outlined the role of EMEA in providing Member States, the European Commission and European Parliament with evaluations of medicines, and scientific advice on new medicines. She stressed that elderly patients are a growing social group in the European Union, and the Commission had recognised the need to study their medical needs further. The International Conference on Harmonisation produced amended guidelines which will result in the adaptation of international requirements for clinical trials for the geriatric population. A conference will be held, incorporating workshops, to address the need to change initiatives on diseases affecting the elderly population. She then raised the issue of having a geriatrics’ working group at EMEA. It was decided that it would be better to deal with the issue at a global level, hence ICH. However, a specific website has been developed at EMEA, and a framework for interaction has also been developed to encourage the involvement of patients’ and consumer organisations in EMEA activities.
John Chave (JC), Secretary General of the Pharmacists Group to the European Union (PGEU) spoke on the issue of Information to Patients, and described its relationship to healthy ageing.
He highlighted the fundamental link between taking medicines and healthy ageing. One in four elderly patients are not taking their medicines correctly, and many are taking up to seven drugs at one time. There is therefore a need to inform patients, however the current revision of the directive is extremely controversial.
JC gave three main points regarding information to patients:
Patients need and deserve prime information on drugs. Not always about medicines, but all treatments options and information on healthy lifestyles.A huge amount of work is still to be done. This does not necessarily require a change in the law.
Member States need to map all sources of information that are already available. Communication was highlighted as vital for providing basic information. JC noted that patients receive information from a variety of sources, but primary source remains healthcare workers. There is a lack of time given to addressing the patients needs. However, there is also the need to move with times, and patients should be assured that the information they receive has been validated. They also need to be able to go back to healthcare workers with this new information to discuss their needs.
JC went on to point out that the controversy surrounding information to patients is linked to the idea of advertising. The pharmaceutical industry, he said, does not have a good track record for providing information to patients: the American experience gives cause for concern. It is difficult to ensure that pharmaceutical companies don’t breach the self publication law.
Mr. Chave wrapped up his contribution by insisting that all stakeholders come together to ensure that the information provided is validated.
After the speakers, the Chair invited questions from the floor.
IDLM underlined that prevention is better/cheaper than treatment. This needs to relayed to politicians in the form of statistics. In the framework of the Lisbon Agenda, making the health sector more competitive through prevention might be a good approach. Ministries of Health are seen as wasteful, but it would be better to see money spent on preventative care as an investment. The EU health community, she said, is focussed on producing studies and research papers under the topic of healthy living across all groups. Healthy ageing for the elderly must begin when people are young.
Anne-Sophie Parent asked why a target has not been set, such as increasing healthy life by one year, each year across Member States. IDLM cited the difficulty of getting different countries to agree on a healthy life target across different countries. She also reminded participants that any target would be an informal agreement, as we do not have the competency to introduce legislation. She suggested initiatives such as subsidies for healthier foods as another possible approach.
The second session was chaired by Lambert van Nistelrooij and the main topic of debate were: - Quality of long term care and the prevention of elder abuse – Jan Jarab, Cabinet Vladimir Spidla, Commissioner for Employment, Social affairs and Equal Opportunities;
Achieving the objectives of the renewed Social Agenda: the older people’s point of view – Anne-Sophie Parent, Director of the European Older People’s Platform (AGE);
Draft Directive on the application of patients rights in cross-border healthcare – Monika Kosinska, Secretary General of the European Public Health Alliance (EPHA);
Czech Presidency: Future actions and initiatives – Ms Zuzana Zajarosova, Czech Permanent Representation.
The last part of the article will go in depth on the presentation from Monika Kosinska (MK), Secretary General of European Public Health Alliance (EPHA).
MK started to explain that Member States and many EU legal and policy experts confidently assert that the EU has no competence in healthcare and that it therefore remains the realm of national governments. Cases that contradict this claim are, however, common. A 1998 case that appeared before the European court of justice was that of Mr Kohl, Kohl took his case to the ECJ under the EC treaty (defining the right of free movement of services) The ECJ ruled in Kohl’s favour and he was fully reimbursed for the cost of his treatment. Ten years on, the Commission has stepped in to fill this gap. The draft directive, adopted on 2 July 2008, gives the European parliament an opportunity to lead on behalf of European patients and citizens. The commission admits that there is no evidence that patient mobility benefits the overall health of a community. Critics have voiced concerns about the threat this poses to national sovereignty and the organisation of their healthcare. Supporters have lamented the fact that it does not go far enough.
With this draft, DG Sanco attempts to bring much-needed clarity to the court rulings. The commission’s impact assessment tells us that around 99 per cent of patients prefer to receive treatment at home. The remaining one per cent need to or elect to travel for healthcare. By providing European citizens with a legislative framework so that they can be aware of and exercise their rights without having to pay a visit to the European court of justice, the EU is delivering clarity and assistance to its citizens, or at least that one per cent.
The proposed directive does, however, provide much food for thought. Is it fair and just that reimbursement is the mechanism of choice for cross-border mobility? What of those who cannot afford that initial payment? We have 27 different sets of patients’ rights in Europe: surely a directive with patients’ rights as its focus should be strengthening these rights, not institutionalising disparities and creating different classes of citizens? The Commission admits that there is no evidence that patient mobility benefits the overall health of a community: how can the Parliament ensure it is representing the interests - and health - of the 99 per cent of European citizens who choose not to travel, as well as the one per cent who do?
The European parliament faces a huge challenge in protecting citizens and delivering a directive that is equitable and effective.
Europe’s job is to consider every citizen, even those far from the decision-making process, and health is one of the highest priorities for all Europeans, as surveys repeatedly show. This pro- posed directive is an essential piece of legislation and will spark a compelling debate, however, it carries with it some intrinsic issues that cannot be ignored. The health community is looking to the European parliament to strengthen the embryonic rights that this directive tentatively explores. At a time when citizens are increasingly disengaged from Europe, a strong voice from our democratic representatives could galvanise the electorate to action in June 2009.