Congratulations for the WHO World No Tobacco Day 2013 Award for Hungary and serious public health concerns about the Hungarian legislation regarding penalising street homelessness
[English version] - Open letter to Hungarian Prime Minister Viktor ORBÁN
[Hungarian version] - Nyílt level ORBÁN Viktor, Magyarország Miniszterelnöke számára
Dear Prime Minister,
Firstly, I am writing to you to congratulate you for receiving the World No Tobacco Day 2013 award from the UN World Health Organisation’s Director-General Margaret Chan in recognition of your government’s non-smoking initiatives. As you mentioned in your speech, the evidence is shocking: Hungary is the world number one with relation to deaths caused by lung cancer. 90 % of deaths from lung cancer in Hungary can be attributed to smoking. In 2010, 20.470 Hungarians lost their lives as a result of smoking, and one person dies every 18 minutes because of smoking. In the case of deaths among people under 70, one third of men and 14 % of women die as a result of smoking. Hungary is still among the countries with the largest ratio of smokers, and in the 15-17 age group, one quarter of young men and one tenth of young women smoke daily.
This is a clear indication of a public health emergency and requires further action. The leading role of Hungary in respect to smoke-free legislation is crucial, especially in the light of the ongoing discussions on the revision of European legislation aiming at strengthening European tobacco control policy. Maintaining robust national smoke-free legislation is essential to guarantee a high level of health protection in Hungary which is Party to the UN Treaty – the WHO Framework Convention on Tobacco Control (FCTC)  May I assure you that the European public health community supports you and your government in your work on this important public health issue.
Secondly, I am writing to you in respect of the recently adopted national legislation about homelessness. On 8th October you pointed out that fighting smoking alone is not enough to reach a high level of population health in Hungary and – among others - you gave the importance of mental health, as an example. As you know, Hungary was hit very hard by the economic crisis,  and your government, has made huge efforts to mitigate its negative impacts. However, people living in deep poverty need urgent action and help, and this applies particularly to those who are the most vulnerable: the poor, the Hungarian Roma population, and especially Hungarian homeless people.
As I am sure you are aware, recent estimations from information in Hungary, there are about 11,000 places available at homeless shelters  and in Hungary, preliminary data from the census of 2011 show that there are at least 17,000 people who live in public spaces or in spaces unsuitable for housing (e.g. huts, cellars, storage rooms, etc.).
Homelessness has different dimensions such as rooflessness, houselessness, living in insecure housing and living in inadequate housing. According to the estimations, 1% of the Hungarian population, 100.000 people uses some form of homeless care services. In support of this, a recent survey conducted by the Ministry of the Interior also found that there is a shortage of places for the care of those living on the street in numerous cities in Hungary.
In light of the these facts, the European public health community has serious concerns about the recent modifications of both the Hungarian Constitution and the Hungarian Law on Infractions, which have made homelessness illegal and made possible to create homeless-free zones. Hungarian homeless people are extremely vulnerable, and such measures can be considered as punishment, may worsen their mental health situation and put the stigma of criminalisation on them.
Homelessness is a serious public health problem. Some people who are homeless, notably rough sleepers and long-term users of homeless shelters and hostels are particularly affected by multiple morbidity including problematic alcohol or drug dependence, mental health issues, physical health problems and high rates of premature mortality. Despite this substantial burden of illness, people who are homeless lack access to quality health care  .
Different types of homeless people have different needs and finding real solution for the roots of homelessness needs coordinated responses from all policy sectors. Addressing the social determinants putting people into homelessness is crucial: providing homeless people with minimum income, adequate housing, preventive health services as well as adequate health and social support are core elements of tackling the roots of homelessness.
There are available reliable scientific studies about homelessness in Hungary (1) (2), proposals for a Hungarian National Homeless Strategy , and existing Hungarian best practices that may be taken into consideration to develop and implement policy response to this significant public health challenge in Hungary. In light of the available policy responses to the issue of homelessness, on behalf of the European public health community, could you elaborate whether there are plans in place in Hungary to develop an adequate National Homeless Strategy which tackles the causes of homelessness as a public health problem and provides appropriate policy answers, given that we have grave concerns that criminalisation will exacerbate existing inequalities and will fail to resolve the problems.
EPHA Secretary General
© Source of the first photo: Botár Gergely – kormany.hu
© Source of the second photo and the logo of the article: A város mindenkié blog
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 The FCTC is the world’s first international public health treaty. It aims to protect present and future generations from the devastating health, environmental and socio-economic consequences of tobacco consumption and exposure to tobacco smoke through the adoption of evidence-based policies and legally binding obligations.
 Hungary received 25.1 billion US$ bailout from the EU and the IMF in 2008. Public health decreased from almost €4 billion to €1.2 billion- with a 40% cut in the pharmaceutical sub-budget and sickness benefits significantly decreased from 2009 to 2010, as of 1 August 2009.
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 FEANTSA (the European Federation of National Organisations working with the Homeless,) background document on Homelessness, Housing and Health, Health and Well-being for All – Holistic Health Services for People Who Are Homeless