The 2013 annual growth survey marked a step change by identifying the duality of providing access to high-quality healthcare and the efficient use of public resources. This allowed for country specific recommendations (CSRs) that prioritised efficiency in the healthcare sector, strengthening primary care and a shift towards community care. However, further efficiency and cost savings could be achieved through the rational use of medicines, greater transparency in health service pricing, better health promotion and disease prevention and ensuring a balanced mix of staff skills and preparation for future staff needs. This is crucial given the upcoming findings from the reflection processes on Sustainable Health Systems and Chronic Disease (3), which the European public health community expects to feed into the drafting of the national reform programmes and the CSRs.

We know that 77% of disease burden is largely preventable, hence the follow up to the Annual Growth Survey must address the underlying causes of the high costs of healthcare. In order to measure progress in achieving better health outcomes, better monitoring mechanisms need to be put in place,” argued Ms Monika Kosińska, EPHA Secretary General (4). The Social Scoreboard included in the draft Joint Employment report is a step forward, as it would facilitate the uptake of social considerations within the European Semester (5) and enhance cooperation between Finance Ministries and Ministries of Health and Social Affairs Ministers with the end result the country-specific recommendations fit for purpose. However the Social Scoreboard should be more closely linked to the Annual Growth Survey. The European Parliament resolution adopted by the Employment and Social Affairs Committee offers a glimpse of hope, with MEPs from across different parties asking for indicators to measure access to healthcare, homelessness, child poverty, and decent work, all of which should have a gender dimension. (6)

As part of the revamped economic governance rules (known as the Two Pack), this year marks the first time the Commission will publish its opinions on euro area countries’ draft budget plans for 2014. (7) The “Investing in Health paper” that accompanied the Social Investment package points out that disease prevention and health promotion, is regarded as an investment that yields a handsome rate of return but only 3% of current health expenditure is allocated to public health and prevention programmes in areas such as immunization, smoking, alcohol drinking, nutrition and physical activity. (8) “ A more effective approach is needed to achieve sustainable public finances. EU economic governance process cannot be used a fig leaf for national governments to take away funding from value-for-money, evidence based programmes. ” said Ms Kosińska.

There needs to be an introduction of consumption taxes for products high in salt, sugar and fat coupled with subsidies for healthier options and action to ensure these options are available to tackle the underlying causes of widely-spread health issues in our society: Alarming rates of obesity and diabetes as well as the enormous health consequences of smoking and an abusive consumption of alcohol amongst millions of Europeans could be greatly diminished by adopting fiscal measures (so-called sin taxes as well as health subsidies) across the board.

EPHA encourages the Council of the EU and the European Commission to engage civil society to ensure initiatives are implemented properly at national level and to monitor the impacts on vulnerable groups.

***Notes to editors***

- 1. The Annual Growth Survey will set out general economic and social priorities for the EU for the coming year. The AGS is a roadmap for member states to follow when drawing up future budgets and reform plans, and sets the scene for the specific recommendations the Commission makes to member states each spring.

- 2. The 2014 Annual Growth Survey notes: "a widespread need to strengthen the efficiency and financial sustainability of social protection systems, notably pensions and healthcare systems while enhancing their effectiveness and adequacy in meeting social needs and ensuring essential social safety nets." The 2014 Annual Growth Survey no longer includes transparency in health service pricing.

- 3. In 2010, the Council of Ministers committed itself to undergo a reflection process on chronic disease and on modern, responsive and sustainable health systems (concluding December 2013). The final report on the reflection process on chronic disease found “Within Member States, there is an urgent need to change the imbalance between prevention and care in health budgets. Investing in prevention will help to avoid paying for treatment in the future.”

- 4. The European Region is the most affected by noncommunicable diseases (NCDs)compared to other regions and their prevalence is increasing. The impact of the major NCDs (diabetes, cardiovascular diseases, cancer, chronic respiratory diseases and mental disorders) is equally alarming: taken together, these five conditions account for an estimated 86% of the deaths and 77% of the disease burden in the Region.

- 5. The Commission Communication on the Social Dimension of the EMU stated “A proposal for a scoreboard should be ready to be analysed in time for the 2014 European semester (so in mid-November 2013)”. The draft Joint Employment Report will be endorsed by the EU’s Council of Employment and Social Affairs Ministers and will be then presented to the European Council in order to feed into the European Semester process and surveillance.

- 6. Members of the Employment and Social Affairs Committee adopted a motion for a resolution that called for the inclusion of supplementary indicators child poverty,access to health care, homelessness and a decent work index. the resolution will be debated and voted during the November plenary session.

- 7. This year marks the first time the Commission will publish its opinions on euro area countries’ draft budget plans for 2014. This is a feature of new economic governance rules (known as the Two Pack), which came into force in May 2013 and which allow for closer coordination of euro area budgets and economic policies.

- 8. On 20 February, the European Commission releaseda Staff working paper on Investing in Health accompanying the Social Investment Package for Growth and Cohesion.

• Contact information

Javier Delgado Rivera, EPHA Communications Coordinator at or +32(0) 2 230 3076

Last modified on November 13 2013.