European Public Health Alliance

[Joint Press Statement] Access to medicines in Europe: The EU cannot save banks while sacrificing people's health

Javier Delgado Rivera — 2013-05-17T09:03:09Z

Brussels, 17 May – In a seminar hosted yesterday by the Group of the Progressive Alliance of Socialists & Democrats (S&D) in the European Parliament and the Member of the European Parliament (MEP) Alejandro Cercas (S&D, Spain), six MEPs from various political groups (1) along with representatives of governments, leading academics, researches and public health organisations (2) met to raise awareness about one of the most alarming issues that European healthcare systems face – the increasingly inadequate public access to medicines and its dire consequences. Speakers were brought together to discuss solutions that help make drugs accessible, affordable and available to the public.

Austerity policies are having a profound impact on the ability of many European public health systems to provide many of the necessary biomedical products for their citizens and residents. "European governments are using the current economic crisis to cut public spending across the board; decades of social justice are being swept away in a matter of a few years. What also raises eyebrows is the sense of arbitrarily that comes with the cuts - lifesaving medicines should have never made it into any cut list. Healthcare systems should be at the very bottom of the austerity list, not as a default option," said MEP Alejandro Cercas (S&D, Spain).

In her intervention, MEP Maria do Céu Patrão Neves (EPP, Portugal) put forward a proposal to ease the current scarcity of medicines in Europe. "Research and innovation will make the production of medicines increasingly sustainable and affordable, bringing prices down so people for whom medicines have become a luxury regain the lifesaving access today denied. In addition, a decisive and smart boost to research and innovation of medicines will help make them more effective, widening the diseases they covered.“

In her intervention, MEP Antonyia Parvanova (ALDE, Bulgaria) stressed how the European Parliament is becoming a battlefield between public interests and big pharma companies. "As the Parliament is debating three key directives related to public health -clinical trials, medical devices and price transparency- EU policy-makers must show that they are on the side of the people by putting their interests ahead of the industry's profits," said Ms Parvanova.

On his side, MEP Nikos Chrysogelos (Greens/EFA, Greece) highlighted the need to make a better use of his country's dwindling health budget. "In Greece, as in many other EU countries, improved efficiency should be a priority when adopting measures that fix all what is broken in our healthcare. The setup of Greece's health system is deeply unfair in the way it allocates resources. If we are to rebuild a sustainable and capable healthcare model, thorough cost-benefit assessments are to be made the norm. Otherwise, the dire state of access to medicines in these times of crisis would only worsen."

MEP Marian Harkin (ALDE, Ireland) pointed to the excessively high cost of drugs in her native Ireland. “In spite of having several big pharma firms based in the country, the cost of many drugs in Ireland is up to three times the price paid in other European countries. Even if, to a large extent, the Irish healthcare system still functions reasonably well, the exceptional price of medicines is a huge burden on the individual and on the healthcare system that needs to be lifted."

When talking about the problems faced by Romania, MEP Minodora Cliveti (S&D, Romania) said that "in Romania there are problems related to access to medicines for uninsured individuals, and problems arising from the fact that in 2011 the conservative Romanian Government shut down 67 hospitals. These events have diminished peoples' access both to quality healthcare and to the drugs they need to stay healthy – not to mention the Romanian citizens who do not receive quality healthcare when working in other countries of the EU."

Medicines shortages: curbing a damaging trend

Three elements determine whether or not a person obtains the medicine he needs; access, affordability and availability (3). As Europe's population ages and the prevalence of non-communicable diseases goes up, the presence of these three factors increasingly translates into the difference between a healthy individual and a chronically-ill patient.

“The failure to consider the health consequences of austerity policies is preventing people from receiving essential medicines. Medicines are growing less affordable and increasingly hard to access for many. In particular, it has hit communities who are already affected by the crisis and the cuts and are struggling to put food on the table, let alone to pay for the medicines they need,” said Monika Kosińska, Secretary General of the European Public Health Alliance (EPHA).

Referring to the Spanish case, Joan Rovira, from the Department of Economic Theory at University of Barcelona, said that “disguising it as fiscal discipline, the Spanish government is shifting from a universal health system to a model where coverage is linked to employment. It recklessly excludes disadvantaged groups, like undocumented immigrants from receiving timely and adequate healthcare. As a result, the growing incidence of infectious diseases, like AIDS, will no doubt lead to increased health care costs.“

Further below you can read an extended version of this press statement (with additional quotes).

Notes to editors

(1) Alejandro Cercas (S&D, Spain)[ [key note speech, in Spanish]; Maria do Céu Patrão Neves (EPP, Portugal); Antonyia Parvanova (ALDE, Bulgaria); Nikos Chrysogelos (Greens/EFA, Greece); Marian Harkin (ALDE, Ireland); Minodora Cliveti (S&D, Romania)

(2) European Public health Alliance (EPHA); the European Association of Hospital Pharmacists (EAHP); Transatlantic Consumer Dialogue (TACD); European AIDS Treatment Group (EATG); Health Action International Europe (HAI Europe); Pharmaceutical Group of the European Union (PGEU).

(3) [EPHA Briefing] Access to Medicines in Europe in Times of Austerity discusses the topic of access to medicines in the context of the economic crisis and considers three determinants; affordability and availability, in terms of access to medicines, and innovation in terms of developing new methods of assuring best possible health outcomes.

Contact information

Javier Delgado Rivera, EPHA Communications Coordinator at javier@epha.org or +32(0) 2 230 3076.

Addittional quotes

Medicines shortages are not only spreading to every corner of the EU - they are also emerging in a growing number of medicines. “Evidence from the Pharmaceutical Group of the European Union (PGEU) members suggests that the problem affect countries from all corners of the EU and a wide variety of medicines. A number of PGEU members reports that the problem has got worse in the last 12 months. While the causes of shortages are attributable to a number of factors, including pricing policies and manufacturers' issues, it is essential that patients are informed about actual and possible shortages and the likely duration of the problem. Additionally, stakeholders need to work together to make sure that this is the case,” said John Chave, Secretary General, Pharmaceutical Group of the EU.

Raminta Stuikyte, from the European AIDS Treatment Group, talked about the case of HIV/AIDS. " Cutting on HIV/AIDS prevention, shrinking budgets for medical tests and compromising treatments are not helping European governments fix their economic unbalances. If EU Member States are serious about streamlining their health systems, they would be better off by shifting the focus from measures that undermine people's health to policies that address their healthcare underlining flaws, like the high price of certain life saving medicines."

Roberto Frontini, President of the European Association of Hospital Pharmacists (EAHP), stressed the upsetting scale of the lack of adequate drugs. “EAHP's recent pan-European survey on medicines shortages clearly demonstrates that the shortages problem does not respect national borders and is affecting virtually every hospital in Europe. Immense amounts of hospital pharmacists' time are being diverted from other elements of patient care to simply source medicines. With the evidence strongly suggesting the problem is becoming worse, doing nothing is no longer an option. Swift action is required.”

Over the course of the conference, it became clear that the EU would have to adopt a fresh policy approach that includes a better coordination among Member States and other stakeholders. For instance Horizon2020 provides a key opportunity to shape the legal framework governing EU funded research in a way that broad societal objectives are better fulfilled.

Talking about the enhanced role that the EU is urged to play, Tessel Mellema, from the Health Action International (HAI) Europe, highlighted that “the EU should step in and take the lead in the development of new models of biomedical innovation that promote both needs-driven innovation and affordable access to R&D outcomes. Pharma companies have gradually shifted their business model from focusing on therapeutic innovation, towards marketing, wider patenting, increased litigation against competitors and the development of ‘me too' medicines of little therapeutic advantage. In the cases where new drugs deliver innovative therapeutic value, prices are sometimes too high for today's shrinking health budgets.”

Several speakers agreed that national competent authorities should be placed in a stronger position to be able to negotiate prices when procuring medicines with the aim of facilitating the access by patients to high quality, efficient, safe, essential medicines.

According to David Hammerstein, from the Trans-Atlantic Consumer Dialogue, “the EU pharmaceutical model is dominated by massive marketing costs, poor results in innovation and very high prices artificially maintained.“

As Mr Hammerstein put it, “the current economic crisis has made the situation untenable. A European policy better equipped to fulfill public healthcare needs would include: a closer coordination among European countries in the public procurement of medicines; more flexible rules on Intellectual Property Rights (IPR) and anti-monopoly legislation both to promote generic competition and to boost imports; rules for social conditionality in the use of scientific results publicly funded; and a stricter regulation on transparency to better evaluate the real efficacy and safety of pharmaceuticals.“

[2013 Patients' Rights Day] Putting patients in the driver's seat

Sascha Marschang, EPHA — 2013-05-16T15:41:29Z

On the occasion of 2013 Patients' Rights Day (May 15) EPHA would like to stress that, although much progress has been made, there is still a lot of scope for health systems to benefit from an obvious, yet commonly underutilized and underestimated resource: patients themselves.

As patients and consumers of health services - and we all fall into this category throughout our lives - we build up an enormous amount of knowledge over the years that takes various forms. Some individuals, frequently those suffering from chronic conditions or rare diseases, seek out like-minded communities in order to share their feelings, obtain comfort and learn about their diseases in detail: they become experts in their own right. Others may never become particularly knowledgeable about their pathology, and may not even wish to do so, however nonetheless they learn subjectively about their feelings, and over time find out what 'works' for them and what makes them feel uncomfortable, whether this is a treatment method, a drug, or a new medical device. This collective knowledge has huge potential to become a source for effective health decision making.

While mobility in Europe is becoming more intense, and both health professionals and patients are moving around in order to seek and access what they perceive to be the 'right fit' for them, the issue of cross-border patients' rights is becoming particularly important. The Directive's transposition is still underway till October 2013, but growing concerns have been raised about new administrative burdens that are complicating cross-border healthcare delivery rather than facilitating it, especially for patients living in two countries or wishing to access healthcare services in a third country where they neither live nor work, but also due to new restrictions to access owing to austerity measures.

Moreover, making use of eHealth services still confronts patients with a potentially complex puzzle as the legal rules of the country of the provider apply, and these are commonly unknown to most patients. There is also a good degree of uncertainty as eHealth services are governed by a number of Directives at the crossroads of eCommerce, Medical Devices and cross-border patients' rights (to name but a few), depending on their exact nature. It will thus be important to establish more clarity so patients can exercise their rights without having to worry, and innovation can be harnessed where it should be, i.e. to facilitate these forms of exchanges.

But patients' rights is not only about obtaining health services: it is also about making one's voice heard and about becoming an integral part of the design, implementation and evaluation of health services- it is a political process. As taxpayers and benefactors, patients must be consulted and involved at every step of the way, and policy makers should ensure that decisions are being taken in a transparent and inclusive manner to ensure that innovation is driven by people and better health outcomes instead of profit margins and the prospect of economic growth. Everybody - governments, industry, health providers, insurers, researchers but also civil society - has a role in ensuring that patients know what is going on. It is not only a matter of accountability and good governance, but also a question of legitimacy. Simply stating that one is acting in patients' best interest is not enough for patients have the right to know who is speaking on their behalf and why.

As technology is developing at lightning speed, treatments become more personalised thanks to advances in research, and health systems grapple with the combined challenges of demographic change and multiple morbidities, patients' views will matter even more. There is no doubt that some very innovative technological and non-technological solutions exist to fully include them, however it must be clear that these can only obtain critical mass if they are being accepted by patients; economic growth will follow. And acceptance can best be gained by listening to, educating and learning from patients, whether this is in the design process for new mobile health (mHealth) applications for smartphones or in the health technology assessment process.

Moreover, the notion of informed and empowered patients can only be realised if patients are given the tools and the data to know more about themselves, their conditions and health systems. The more data is publicly available - while fully respecting legal rules governing privacy, confidentiality and data protection - the more 'in charge' will people feel about their own health.

EPHA related articles

[EPHA Briefing] Access to Medicines in Europe in Times of Austerity

Magdalena Krupiarz — 2013-05-14T08:46:47Z

When discussing the topic of access to medicines in the context of the economic crisis we have to consider three determinants: affordability and availability, in terms of access to medicines, and innovation in terms of developing new methods of assuring best possible health outcomes.

AFFORDABILILTY

Usually, health expenditures are mostly covered by public funding and supplemented by private spending. The economic crisis has forced public expending to be cut making patient co-payment increase [1] On average public pharmaceutical expenditure has gone up in the EU by 76% between 2000 and 2009. This rate will likely slow down as a consequence of austerity budgets. In order to protect patients and ensure transparency and on time management, each country has to comply with the Transparency in Medicine Pricing Directive.

Some of the pharmaceutical policies adopted by Member States over the last few years are:

The Polish case

Recent study from the University of Cambridge has found that an increasing number of drugs are being recommended for reimbursement in Poland, even though more than 50% of the medicines were not deemed cost-effective at their current pricing. The study argues that some of the world's biggest pharmaceutical companies, as well as politicians, are exercising influence over the drug evaluation programme in Poland. The Polish Agency for Health Technology Assessment (AHTAPol), found that for recommended drugs, the evidence supporting their cost-effectiveness was “not credible” in more than 25% of cases, and was missing or lacking in more than 50% of cases.

AVAILABILITY

As an effect of the changes in pharmaceutical polices, the availability of medicines has also been undermined. Medicines shortage was reported in all responders to a survey performed by the Pharmaceutical Group of the European Union. Prevalence of medicine shortage varies between member states.

The case of Spain

Spain has a wide range of pharmaceutical policies that depict different scenarios in a single country. In order to reduce pharmaceutical bills policies around four major axis were introduced:

1. Increase diligence in market entry and use of generic drugs- cut the price of generics by 30%, while original medicines and orphan medicines were discounted by 7.5% and 4% respectively on the pharmacy retail price.
2. Increases in co-payments- the patient would pay for 40% of the value of the drugs prescribed by their GP.
3. Medicines coverage- 471 medicines were excluded from public coverage, meaning the cost was fully borne by the patient; the price of these medicines increased by 50%, with some of them showing increases up to 184%.
4. Exclusion of certain groups from coverage- undocumented migrants and citizens over 26 years old, who have not been able to enter the labour market, will be excluded from receiving public care and accessing essential and preventive healthcare services.

The case of Greece

Greece is currently struggling with unpaid bills for drugs imports, which is causing shortages of some critical medicines. Greek authorities have forbidden the parallel export of drugs while threatening to fine drug companies that do not provide their products. At the same time, health advocates have proposed that the Greek government overturn patent protection on costly medicines and import them from low-cost generic producers to ease the burden on the country's medical system.

INNOVATION

The current situation in the pharmaceutical industry may suggest that today's innovation model is unsustainable. Pharmaceutical companies in the EU spend 23% of their turnover on marketing while only 17% on Research & Development (R&D). The EU needs to look with an open mind at new approaches to innovation and at the promising developments in the area of incentives as Brussels enhances its financing of R&D. The EU should consider innovative proposals, particularly those that de-link R&D costs from the price of final products, and become a key player in the development of new sustainable models of biomedical innovation and public knowledge goods.

[EPHA BRIEFING] Access to Medicines in Europe in Times of Austerity

Related EPHA articles

[1] 5 Observatorio Portugues dos Sistemas de Saude. Crise & saúde. Um país em sofrimento. Relatorio da Primavera. Lisbon, 2012)

[eHealth week] eHealth innovation must be driven by full inclusion

Javier Delgado Rivera — 2013-05-13T12:00:35Z

13 May, Brussels -The motto of the 2013 eHealth week (13-15 May), which kicks off today, is ‘Delivering Innovative Healthcare and Well-being'. According to the European Commission, eHealth Week aims to encourage continuous investment in health IT in an effort to improve patient care and get a handle on rising medical costs.

An integral part of this year's eHealth Week is the High Level eHealth Conference, organised by the Irish Presidency and the European Commission. This event will feature discussions on the economic and societal value of eHealth, how it can contribute to health system reform and help mitigate the impacts of ageing populations, rises in chronic diseases, shrinking healthcare budgets and growing patient expectations.

eHealth week aims to demonstrate how innovation can unlock eHealth's potential to face the challenges of health systems across Europe.

ReadEPHA briefing on eHealth

EPHA would like to underline that, given the vast disparities of access to technology and the increasing difficulties that many people have in accessing health services and essential medicines, eHealth innovation must be driven by the ambition to improve inclusion and health outcomes, while avoiding the exacerbation of existing health inequalities.

As long as the digital divide remains a distinct reality in Europe, and technology development outpaces take-up amongst many segments of society, eHealth will remain a somewhat idealistic notion that requires a more focused debate.

If the eHealth Action Plan 2012-2020 is implemented wisely, eHealth can contribute to achieving cost effectiveness and patient empowerment in healthcare delivery.

However, the investments required to build up the necessary infrastructure, achieve interoperability and to train different categories of users, including patients and health professionals, must not occur at the expense of improving access offline, especially in the face of the ongoing economic crisis and the harsh impacts of austerity measures being felt in many parts of Europe.

To know more:

Speech: Exploiting the potential of eHealth - By Neelie Kroes, Vice-President of the European Commission responsible for the Digital Agenda

European Commission memo - Digital Agenda: Kroes & Borg welcome recognition of the contribution ICT can make in reforming health systems

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[Water is a Human Right campaign] First ever European Citizens Initiative to make it !

Javier Delgado Rivera — 2013-05-07T07:58:52Z

Brussels, 7 May - The first ever European Citizens Initiative (ECI) – Water is a Human Right! – has collected over 1.5 million signatures across Europe. Eight countries have just passed the minimum number of signatures required.

The European Citizens' Initiative ‘Water is a Human Right!' is a pan-European initiative calling for the European Union (EU) to guarantee clean drinking water and quality sanitation for everyone living in Europe.

EPHA, one of the campaign partners, congratulates the European Federation of Public Service Unions (EPSU), which is leading the campaign, for taking this initiative to the next level.

Extracts from the campaign's press statement:

Jan Willem Goudriaan, vice-president of the Citizens Committee said: “Our European Citizens Initiative has managed to create a truly European debate about water and sanitation and the challenge to ensure that millions of Europeans have access to this basic Human Right. The financial and economic crisis and the pro-privatisation drive have galvanized millions of Europeans to rally to support our efforts to keep water and sanitation out of the internal market rules.”

“On Europe Day and in the year of European citizenship together we have made history. We expect that politicians across Europe will listen to the voice of citizens affirming water as a Human Right, as the United Nations did in 2010. We want to thank the more than 140 organisations that have helped us as well as the thousands of citizens that have made this European Citizens' Initiative a success,” added Mr. Goudriaan.

[Full press statement] Right2water: First ever European Citizens Initiative to make it!

SIGN NOW - support the campaign

Find out more:

EPHA article: Water is a Human Right campaign

Website - Water and sanitation are a human right!

Using Twitter; Follow the European Citizens Initiative – Water is a Human Right at @right2water or its hashtag #right2water

EPHA related articles

Water is a Human Right campaign - Sign online!
World Water Day: Join the campaign to defend our right to water and sanitation
Water as a public health good
How will water shape the 21st century?
Resources on water and health
European Commission new Innovation Partnership on Water still treats water as a commodity
EPHA Statement on the World Water Day 2012: “Access to water and sanitation is a human right, not an ordinary commodity”
Civil society unites on water policy
Report findings - an inefficient use of water resources in Europe
A Decade of "Water for Life" launched on world water day

[EPHA position paper] Reforming Health Systems in Times of Austerity

Leonardo Palumbo, EPHA — 2013-05-06T15:30:59Z

As a consequence of the current economic crisis many changes have been introduced to health systems on national levels to reduce expenditure and to introduce more cost-effective methods. However, the health community urges decision makers to ensure that all changes introduced are in accordance with European Health System Values which are:

Universality meaning that no-one is barred access to health care;
Solidarity is closely linked to the financial arrangement of our national health systems and the need to ensure accessibility for all;
Equity relates to equal access according to need, regardless of ethnicity, gender, age, social status or ability to pay;
Access to good quality care

The health community urges decision makers to ensure the right to health for all regardless of social status, geographic location or ethnic origin. Our vision is equal access for all to national immunisation schemes, paediatric care and that all pregnant women have equal access to pre and post natal care. Our request is for a coherent EU public health policy for the prevention and treatment of diseases. We encourage the European Commission to make full use of its role as coordinator of best practices and guardian of the Treaty to protect health systems and social protection mechanisms during these times of austerity.

In most countries the focus is on the reduction of healthcare spending on the supply side, through budget cuts, shrinking care ‘packages' and the increasing involvement of the private sector. Unfortunately, needs on the demand side are at the same time increasing, due to the growth of non-communicable diseases, an ageing population and higher expectations of patients. This might cause a situation where demand exceeds supply and health systems are not fit for purpose. In some European countries costs have shifted from public spending to private spending.

Some countries attempted to lower expenditure through reductions in the salaries of health professionals, (salary freezes, reducing rates of salary increases). These policies may exacerbate wage imbalances across countries, increasing health worker migration in Europe and other regions, and adding to problems of human resource shortages. This runs the risk of undermining quality and efficiency in the health system, while not achieving financial sustainability. This also highlights the importance of the health sector as an economic motor.

Reforms to health systems should focuses on cost-effectiveness, expenditure and sustainability with clear links to better patient safety, higher quality care and accessibility, in line with EU values for health systems. Effectiveness in the health care sector refers to the extent to which the health system attains its chosen objectives. Health promotion and preventative measures should be prioritised. We recommend that:

Reforms should be evidence-based and policy makers should consider novel sources of funding for health
Investing in healthand preserving budgets for disease prevention and health promotion should entail a greater financial reallocation for these measures. EPHA regrets the fact that 97% of health budgets are earmarked for the treatment of disease and only 3% for investment in prevention, at a time when the cost of treating and managing non-communicable diseases is increasing
Health Ministries and health actors should be consulted on non-health policies that directly affect the social and commercial determinants of health.
Civil society organisations advocating for investment in public health and health systems should undertake a rapid programme of training on EU Economic Governance so that they can engage actively in national debates about economic policy
Changes made to health systems and healthcare provision should be based on the overarching values of universality, access to good quality care, equity, and solidarity.
In times of crisis investments in health systems should continue; significant reductions in healthcare budgets risk creating new inefficiencies, undermining access and quality of care, and damaging health outcomes. The impacts of health system reforms on health outcomes should be monitored at the EU-level and a Health Impact Assessment conducted on policy responses to the economic crisis and cost-containment measures.

EPHA Position Paper- Reforming Health Systems in Times of Austerity

[EPHA's 20th anniversary series] There is no time like the present

Javier Delgado Rivera — 2013-05-03T13:34:56Z

While generally speaking, political change in Brussels tends to be tremendously slow, twenty years are a sufficiently long period of time to have witnessed some crucial changes in the continent's public health sphere.

At the time of EPHA's inception in 1993, Article 129 of the Maastricht Treaty had just equipped the European Commission with a limited but important legal coordinating role in the field of public health with a focus on prevention, health promotion and protection. Over time this expanded mandate contributed to the creation of a new policy architecture for health, including the creation of the EU Directorate General for Health & Consumers (DG SANCO) in 1999, the setting up of specialised EU Agencies (e.g. like the European Medicines Agency (EMA) or the European Centre for Disease Prevention and Control (ECDC) and the introduction of the Community Action Programmes for Public Health in 2003.

Despite this, the principal obstacle to further European health system harmonisation remains firmly in place – the Article 168 of the Lisbon Treaty, which maintains that the competence to organise health systems remains with the member states, and leaves the EU with coordinating powers on certain issues with a cross-border impact. There is nonetheless a growing interest in creating a level playing field concerning the scope, access and quality of national healthcare services. This is underpinned by growing patient expectations and increased mobility across the continent, now enshrined in the Cross-border Patients' Rights Directive.

Calls for eradicating health inequalities across Europe are becoming especially urgent in reaction to the ongoing economic crisis, amplified by the effects of austerity measures that are calling into question long-standing health system functions and values, including the very meaning of European solidarity. While problems related to accessing medicines and healthcare services are particularly pronounced in the countries most strongly affected by the crisis, all of Europe is plagued by structural problems. The need for health system reform is being felt everywhere and many countries have followed the dispiriting trend of cutting health services and salaries. Combined with the serious challenges faced by all EU health systems – including demographic change, health professional shortages and the rise of chronic diseases - they emphasise the need to finally ensure that sustainable investments, employment opportunities and innovations are encouraged in health. Ironically, health represents a top concern for people living in the EU, but its economic importance has so far not been fully recognised.

- eHealth - healthcare with a taste of XXI century -

While health system managers and decision makers are searching for novel ways to realise cost savings and gain efficiencies, one area where health and innovation are coming together in relative harmony is eHealth. The potential of delivering health services electronically has been widely discussed, and services such as telecare, telehealth, and electronic patient records are already routine in many member states. Apart from cost savings derived from more timely and efficient communication, reduction of errors, and other benefits, eHealth enables better prevention and remote monitoring and empowers patients to take charge of their own health data.

Yet problems related to interoperability, data protection and user-friendliness have mired the enthusiasm around eHealth that reigned at the turn of the Millennium, both for patients and health professionals. Now the challenge for eHealth is not to replicate the mistakes made in the physical world – such as exacerbating existing health inequalities by providing certain services only to the most skilled, literate and financially advantaged users. As eHealth is increasingly being transmitted via mobile devices, which are less costly and more integrated into many users' lives, there is a prospect that vulnerable groups can also be reached and informed more easily through accessible and even “fun” applications.

The need for face-to-face contact with health professionals will, however, not go away, as patients, no matter how personalised their treatments are, will wish to communicate and put into context online information. Hence eHealth is best deployed as an efficacious complement rather than a full replacement.

While the reflection process over the future of European health systems and healthcare developments is ongoing and likely to spark further controversy, Europe's concerns about health protection have remained a constant over the last two decades. Beginning with the global HIV and AIDS pandemic, and followed by other health crises such as BSE (1996) and the H1N1 influenza pandemic (2009), there has been a realisation that communicable diseases and other health threats do not respect national borders. In particular, the lessons learnt from the H1N1 outbreak have led to the creation of an ambitious health security package at EU level, which includes measures for joint procurement of vaccines, placing European solidarity back at the heart of the debate. This discussion is also particularly timely in light of what has been identified as Europe's biggest current public health threat, antimicrobial resistance.

EPHA will make every effort to bring forward the debate and in the spirit of solidarity look towards the future of public health. With this goal in mind, the theme of EPHA's 2013 Annual Conference will be inclusive growth and the response to the economic crisis. The conference is part of EPHA's work on the impact of economic governance on health and health systems. EPHA hopes to facilitate a dialogue on how to tackle injustice and inequalities, the added value of innovation in the future of health systems, and how to create efficient societies and health systems.

Encouragingly enough, in collaboration with international organisations such as the WHO and the OECD, the scope of health issues discussed at European level – civil dialogue with civil society organisations having been inscribed into the Lisbon Treaty and the Charter of Fundamental Rights – has expanded significantly. Looking at recent dossiers launched by the Commission –which are co-legislated with the Parliament and the Council of the European Union-, the issues dealt with range from clinical trials to medical devices, and from health professional qualifications to data protection. It is proof that there are numerous areas where the EU can make a difference by fostering a level playing field for public health that people living in Europe deserve, no matter how they feel about European politics and identity in general.

Author: Sascha Marschang, EPHA's Policy Coordinator for Health Systems (s.marschang(at)epha.org)

Thinking of attending EPHA 4th Annual Conference on 4-5 September 2013 in Brussels? Take a look at the Save the Date.

EPHA Leaflet

(© Photo source. European Commission: Health - Digital Technologies)

[Joint media reaction] Minimum Alcohol Price: Scottish High Court on the side of public health

Javier Delgado Rivera — 2013-05-03T10:52:10Z

Brussels, 3 May – Today, the Scottish Government has won a case on Minimum Unit Pricing (MUP) for alcohol (1) in the Scottish High Court - the first legally-binding minimum price on alcohol within the EU. Now the alcohol industry will have 21 days to decide whether it has grounds for appeal.

MUP sets a floor price below which alcohol cannot be legally sold and unlike taxation, MUP prices alcoholic beverages based on their strength.

Alcohol misuse hits the poor badly, most of whom rely on cheap alcohol to maintain their habit. Hazardous drinkers tend to belong to vulnerable socio-economic groups and bear the brunt of alcohol-related harm in terms of its social and health impact.

The measure is expected to reduce binge drinking in Scotland (2), and to have a positive impact on the region's health and crime levels.

“This move by the Scottish High Court is a recognition of the baseless – and undemocratic - attempt by the alcohol industry to prevent an elected government from protecting the health of its population,” said Monika Kosińska, Secretary General of the European Public health Alliance (EPHA). “It is heartening to see the Scottish government prevail in this landmark case, and hopefully the alcohol industry will refrain from wasting more taxpayers money in delaying this process further,” concluded Ms Kosińska.

“I am delighted at the decision of the Scottish courts to support minimum unit pricing. This decision sends out a strong message to the drinks industry that the health community is not prepared to be steamrollered when the health of the public is at stake,” said Sir Ian Gilmore, Royal College of Physicians (RCP) special advisor on alcohol. “Scotland has a proud history of leading the way in UK public health with measures like the ban on smoking in public places, and we hope that the strong line the Scottish government has taken will also strengthen the resolve of Westminster on this issue,“ pointed out Sir Ian Gilmore.

Notes to editors

(1) In May 2012, the Scottish Parliament passed legislation to introduce a MUP for alcohol that was originally due to come into force in Scotland in 2013. However, it has been put on hold as the Scottish measure was legally challenged by the Scottish Whisky Association and the European wine and spirits producers.

(2) Last week, in an event in MUP in Brussels, Alex Neil, the Scottish Cabinet Secretary for Health and Well-being said that “alcohol misuse is costing Scotland too much and we firmly believe that minimum pricing is a key measure in our overall strategy to reduce consumption and alcohol related harm. We are perfectly clear that taxation would not – and cannot – deliver the targeted impact on heavy drinkers that is so vital. We remain absolutely committed to introducing minimum pricing in Scotland.”

About

European Public health Alliance (EPHA)is a change agent – Europe's leading NGO advocating for better health. We are a dynamic member-led organisation, made up of public health NGOs, patient groups, health professionals, and disease groups working together to improve health and strengthen the voice of public health in Europe.

The Royal College of Physicians is a British professional body of doctors of general medicine and its subspecialties. It was the first medical institution in England to become a Royal College, and the first Royal College in the UK and Ireland for physicians. The college has been continuously active in improving practice medicine since 1506, primarily though training and qualifying new physicians.

Contact information

Javier Delgado Rivera, EPHA Communications Coordinator at javier@epha.org or +32(0) 2 230 3076.

Fundamental Rights to Promote Public Health

Zoltán Massay-Kosubek — 2013-05-02T15:15:54Z

The Fundamental Rights Agency (FRA) has organised the 6th Fundamental Rights Platform (FRP), its flagship event to meet with civil society representatives working on fundamental rights. The European Public Health Alliance (EPHA) participated in the event for the first time, bringing the public health community's voice in substantive discussions about Fundamental Rights.

What about Fundamental Rights?

Fundamental Rights are rights that are recognised and guaranteed by international legal documents. Fundamental rights set out minimum standards to ensure that everybody is treated with dignity, regardless of status, sex, age, race or any other factor. Although the EU member states have a long tradition of promoting fundamental rights, and the EU itself is built on these values, they only became legally binding 50 years after the signing of the Treaty of Rome.

Are Fundamental Rights at the heart of the European Project?

The European project was started in the aftermath of the Second World War with the aim of maintaining peace in Europe. Although the Council of Europe developed a unique European human rights protection system through the case law of the European Court of Human Rights (ECHR) which interprets the European Convention of Human Rights, the European Union remained mainly an economic integration dominated by the common market. However, although the Treaty of Maastricht in 1993 extended the community method to other important policy areas, (such as public health which motivated the creation of EPHA), the Human Rights dimension of the EU remained underdeveloped.

The Charter of Fundamental Rights of the European Union

Recognising the importance of Fundamental Rights, the European Convention (1999-2000) drafted the Charter of Fundamental Rights of the European Union which was proclaimed on 7 December 2000 by the European Parliament, the Council of Ministers and the European Commission. However it only became legally binding after the coming into force of the Treaty of Lisbon on 1 December 2009.

The Charter lists the rights that the EU Institutions and member states must respect when they develop and implement EU law and policy. The rights outlined in the Charter are divided into six groups (Dignity, Freedoms, Equality, Solidarity, Citizens' rights, Justice).

Is the Fundamental Rights Agency (FRA) the Guardian of the EU Charter?

The European Union Agency for Fundamental Rights (FRA) was set up by the Council Regulation (EC) No 168/2007 as an independent EU Agency to monitor the promotion of fundamental rights. Although it can assist the EU by collecting and analysing "objective, reliable and comparable information and data", its mandate is clearly restricted by the founding regulation: "assistance and expertise on fundamental rights to the relevant authorities of the Community and its member states."

So, instead of being a guardian, the FRA's role can be considered more as a facilitator, bringing the fundamental rights based approach into the EU decision making procedures.

The Fundamental Rights Platform (FRP) is the bridge between civil society and the FRA

The Fundamental Rights Platform (FRP) meeting is the flagship event of the European Union Agency for Fundamental Rights (FRA). The 6th FRP meeting on 24-26 April in Vienna brought together over 200 civil society organisations working on a variety of fundamental rights issues across the European Union

Snapshot on the Programme of the 6th Fundamental Rights Platform (FRP) meeting

The keynote speaker was MEP Kinga Göncz (S&D, HU), vice chair of the LIBE committee about the Rights and Citizenship Programme (2014-2020).

As regards Session I (25 April), the panel debate about the proposal for a directive implementing the principle of equal treatment between persons irrespective of religion or belief, age or sexual orientation (equal treatment directive - COM(2008)426 of July 2, 2008) explored the possibility of re-launching the blocked directive with the presence of the rapporteur MEP Raül Romeva i Rueda (ES, the Greens)and Mr. O'Brian, Chair of the Council Working Party.

Concerning session II (26 April) about victims of hate crime: challenges and promising practices for victim support, this panel debate highlighted some of the promising practices in the field and invited participants to explore together, how national and EU institutions can best support the efforts of civil society in providing help to victims of hate crime.

The 'Harvesting letter' of the 6th FRP meeting compiled by FRA together with members of the FRP Advisory Panel gives an overview about the main outcomes of the FRP. Moreover, it indicates the date of the 7th FRP: 10-11 april 2014.

Relevance of the 6th FRP for the public health community

The European Public Health Alliance (EPHA), as a change agent advocating for better health, was recognised as participant of the FRP due to its commitment, expertise, proven experience and capacity with regard to the protection and promotion of fundamental rights.

EPHA developed the European Charter for Health Equity, which reaffirms the commitment to the values of well-being, solidarity, social justice, promotion of fundamental rights and gender equity.

EPHA has engaged in many activities for the protection and promotion of fundamental rights among others, in the field of children, Roma minorities, disabled and patients' right, violence against women, right to water, to clean and safe environment, sexual and reproductive health and rights.

In 2012, the EPHA Annual Conference was dedicated to the issue of the impact of austerity measures on health systems and services in the EU, the consequences of the crisis on population health, inequalities and social justice.

As a first step, EPHA actively participated in the 6th FRP and will make sure in the future by following the Health in All Policies (HIAP) approach that Fundamental Rights will be taken seriously in all decisions affecting our health.

Please contact Zoltán Massay-Kosubek, EPHA Policy coordinator for Policy coherence at zoltan@epha.org

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European Year of Citizens: Are Roma people European citizens like any others?

Zoltán Massay-Kosubek — 2013-05-02T15:13:09Z

The ''citizenship gap'' between Roma and non-Roma was taken up by a conference organised by the European Roma Information Office (ERIO) at the European Economic and Social Committee on 22 April 2013.

The International Romani Day 8 April is a good day to remember what happened recently to members of the Roma community in Europe. In France alone, about 10,000 Roma were sent back to Romania and Bulgaria in 2009. The following year, at least another 8,300 Roma were concerned with expulsion and dismantlement of camps. Forced expulsion is completely wrong and a frustrated reaction which focuses on the symptom and not on the real roots of a serious social problem.

Basic facts about Roma

The Roma are Europe's largest ethnic minority with about 10 to 12 million people living on the continent. For decades, if not centuries, they have been on the receiving end of racism, discrimination and social exclusion. More often than not, they live in abject poverty and lack proper access to healthcare and decent housing.

According to World Bank estimations, the vast majority of working-age Roma lack sufficient education to participate in the labour market. Besides the devastating social effects of this labour divide, European countries are losing hundreds of millions of Euros annually in productivity and in fiscal contributions.

Does Europe recognise the importance of integrating its Roma communities?

The EU mandate on promoting Roma rights take a few steps in the right direction. The European Commission regularly organises European Roma Summits, which provide the opportunity to discuss Roma issues at the highest decision-making level with EU, national and regional authorities and with the involvement of civil society. As European Commission President Barroso underlined last July, these events represent "a unique opportunity for getting the problems of the Roma higher on the agenda than ever before".

A long way off: from Roma Summits to an EU Framework for Roma

In April 2011, the European Commission adopted an EU Framework for national Roma integration strategies. This framework seeks to make a tangible difference to Roma people's lives.

At least the Member States accepted the call: they made unprecedented political commitments on Roma integration as stipulated by the Council conclusions of May and June 2011.

What is the EU Roma Framework about?

In this framework, all Member States were expected to present to the European Commission a national strategy for Roma inclusion, or sets of policy measures within their social inclusion policies, for improving the situation of Roma people.

The European Commission assessed these strategies and published its conclusions in its Communication "National Roma Integration Strategies: a first step in the implementation of the EU Framework " , adopted on 21 May 2012.

The national strategies are available on-line.

Roma integration is not a tick-box exercise!

While at first glance, this process looks promising, it is important to underline that rhetoric alone is not enough. The successful integration of Roma communities in Europe requires real, effective action by countries themselves; the EU framework is crystal clear in this regard. Although the EU "encourages Member States to make further commitments", "it does not replace Member States' primary responsibility in this regard."

And this is just the point: Roma integration entails further commitments, resources and effective action. It is not a tick-box exercise! By merely completing annual National Roma Strategies on paper, Member States are far from fulfilling their real obligation - to stimulate effective and real inclusion of Roma minorities into society.

Second class citizens?

The event ''Are Roma people European citizens like any others?'' took place in the context of the European Year of Citizens and highlighted that one of the fundamental prerequisites for active citizenship - sense of belonging - is not something that can easily be achieved through supra-national EU citizenship alone. Although many Roma are now EU passport holders, their way of life often transcends national borders and opportunities are being sought wherever they present themselves, with many multinational families. The limits of the ''right to live and work anywhere in the EU'' were also pointed out in a number of national contexts as residency and other rights, including access to healthcare and social benefits, are directly tied to employment status, and permanent work contracts are hard to obtain for non-qualified migrants such as many individuals of Roma origin. Without employment, the fate of Roma communities in Western Europe is often completely arbitrary and comparable to that of undocumented migrants.

Representatives of Roma organisations based in Belgium and elsewhere in Europe (Spain, Germany, France, etc.) also pointed out that EU recommendations address tend to address non-Roma political decision makers which decreases their meaning for Roma advocates. Moreover, day-to-day administrative hurdles complicate Roma integration, combined with institutionalised racism. Since many of the administrators dealing with Roma funds in the Member States also do not have a direct stake, trust and respect between Roma and non-Roma are real concerns that need to be worked on across Europe and in different contexts, given the diversity of this population.

Two speakers from the European Commission, Alexander Vajda of DG Justice and Joachim Ott of DG Communication (Citizens' Programme) talked about the different levels of action the EU is engaged in to improve the situation, especially in the context of the ongoing economic crisis. This is backed up by the Communication referred to above, the setting up of national Roma contact points and the need for more targeted deployment and monitoring of European Structural Funds, which are currently very much underused not only in Romania.

The way a society acts towards its minorities is the true indicator of its values. As long as all the determination and pledges remain confined to the boundaries of a declaration -no matter how official it is- the Roma will be the focus of our debates only once a year: on International Roma Day...

Please contact Zoltán Massay-Kosubek, EPHA Policy Coordinator for Policy Coherence at zoltan@epha.org

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