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