The Sustainable Development Goals (SDGs) were launched in 2015 with the ambition to end poverty, tackle climate change and fight inequalities, while promising to “leave no-one behind”. Three years on, where does Europe stand? What are the main challenges in achieving the health-related SDGs, and what is the Commission’s plan to ensure Europe remains on track for 2030?
Current European health challenges
The Lancet’s Global Burden of Disease study provides an in-depth annual assessment of countries’ progress towards achieving health SDGs. In the latest report released in 2017, the biggest gaps for European countries were seen in relation to Non-Communicable Diseases (NCDs) including mental health, cardiovascular disease, and diabetes, as well as their associated risk factors: smoking prevalence, alcohol use, and obesity. The study also critically revises the measurement of a key indicator on Universal Health Coverage (UHC) to include personal healthcare access and quality of care for NCDs, with results showing clear inequalities between and within member states.
Health and Europe
While the organization and delivery of healthcare services is a national competence of Member States, the potential for added value of EU action on health in relation to the SDGs is clear. The European institutions are uniquely placed to coordinate action to address the key commercial drivers of the NCD epidemic such as unhealthy diets, tobacco and alcohol, within the Single Market. Moreover, coordinated action on NCDs will help address the challenges to national health system sustainability, and subsequent threat to countries’ achieving UHC, that an increasing chronic disease burden coupled with an ageing European population poses.
The Commission and the SDGs
Given that the EU, as well as national governments, have signed up to the SDGs, it is worth reflecting on why international goal setting might be useful. Goals can define common priorities, promote social mobilization to allow individuals, organisations and governments to work together to identify new solutions, as well as create peer pressure, ensuring accountability. But it is clear that goal-setting alone is insufficient for success. Targets need to be accompanied by good policy design, governance structures, and adequate financing in order to achieve results.
So how does Europe measure up in relation to these factors?
Despite pressure from the European Council, the Commission is yet to develop any specific or measurable SDG implementation strategy. However, in 2016 the Commission began the process of developing the European Pillar of Social Rights, as part of President Juncker’s imitative to achieve a “Social Triple A”. The framework, consisting of 20 principles to support fair and accessible labour markets, social welfare and health systems, was unanimously endorsed by all EU institutions in November 2017. While it has no legal basis, the Commission stated that the EPSR will promote mainstreaming of the social priorities it comprises in EU competencies, with the European Semester as a principal vehicle for doing so. Although not explicitly designed for this purpose, the Commission considers the EPSR a key tool for attaining the SDGs. However, the indicators monitored as part of the Social Scorecard, which aims to monitor EPSR implementation, focus on high-level health outcomes and healthcare coverage, failing to capture efforts in health promotion and disease prevention. Moreover, in the latest round of Country Specific Recommendations as part of the European Semester, there was no relationship between the Social Scorecard headline health indicator of ‘self-reported unmet need’ and health recommendations issued; only one of the countries with ‘critical’ levels of unmet need received a health recommendation. Thus it remains unclear whether the EPSR, in terms of content as well as implementation, is fit for purpose as a principal policy framework for SDG delivery.
Governance and monitoring
2018 saw the Commission set up a Multi-Stakeholder Platform (MSP) to support and advise the Commission on SDG implementation, as well as to promote exchange of best practice between different stakeholders. EPHA was selected as a platform member, along with 29 other representatives from civil society, NGOs and the private sector. The MSP is responsible for producing recommendations for input into the Reflection Paper to be completed by the Commission in December 2018, to assess SDG progress and steer post-2020 policy. The Commission has stated that the Reflection Paper will also form an important basis for reporting to the UN High level political Forum, the global monitoring platform for SDG progress, in 2019. However, given the final paper will be drafted by the Commission, it remains to be seen whether it will contain what is needed for ensuring the best chance at SDG delivery; namely, a detailed roadmap for SDG implementation, supported by monitoring mechanisms ensuring accountability for failure to achieve targets, and robust systems for mainstreaming sustainability at all levels of decision-making.
Following extensive campaigning, the EU health programme was not integrated into the Single Market part of the Multi-Annual Financial Framework proposals released in May but stayed as a stand-alone Health Strand within the ESF+ proposal, with a slightly reduced amount (-8%) compared to the 449 million euros allocated between 2014-2020. While this represents a small win in terms of ensuring a continued dedicated EU health budget, it is clear that EU health spending needs to shift from small-scale funding of discrete projects within the health sector, to address the key societal determinants of Europe’s health challenges and to support large scale health promotion efforts.
Faced with threats to health as a standalone priority following Juncker’s fifth scenario, as well as in response to concerns over the future of DG Santé, EPHA and the European Patient’s Forum’s #EU4Health campaign is calling for stronger EU action on Health. Only through tackling common challenges in a coordinated way, with strong EU leadership, can we hope to achieve the health SDGs in Europe.
Public Health Registrar