At the end of April, the European Commission finally announced its long-overdue plan to counterbalance the harmful impacts of austerity policies and deep cuts to health services, care and education. The package of documents constituting the Pillar are, at first glance, remarkable. Rhetorically it is a great example of Health in all Policies. For the first time, the Juncker Commission – after almost three years of ignoring health as not a “big thing” – has put health centre stage. In the reflection document presenting the rationale for the package by Commissioners Marianne Thyssen (Employment, Social Affairs and Inclusion) and Valdis Dombrovskis (Euro and Social Dialogue), health is finally given the attention it so badly needs.
The Health department of the Commission (DG SANTE) has done a very good job of painting the EU’s added value of social and health policies, programmes, funding and research and anchoring wellbeing and access concerns. It’s a very clear case for the EU doing more, not less, for health and especially prevention, guaranteeing to healthcare for all and recognising the urgent need to invest in health and quickly increase the health and care workforce. Indeed, 70% of Europeans want Europe to do more for health, according to the latest Eurobarometer survey.
The reflection paper puts some focus on deaths from chronic diseases and recognises that healthy life years are not increasing according to the target set in the Lisbon Strategy of adding 2 healthy life years by 2020, saying “almost 50 million people in the EU-27 suffer from chronic diseases and nearly half a million people of working age die prematurely from these every year. Those deaths are avoidable through more effective public health and prevention policies, or more timely and effective healthcare.” We would add that chronic diseases are also having an increasing impact on children and young people, as well as those over working age, who the Commission must not forget in their employment-centric assessment. But it’s too early to get excited that the Commission has finally recognised the societal and economic costs of Europe-wide challenges posed by alcohol, mental illness, obesity and environment-related diseases, without checking whether the package will lead to real differences for people’s daily lives.
So when will people feel the benefit of the new Pillar of Social Rights? The package is regrettably empty of any concrete suggestions on how or when the twenty principles will become reality.
A statement of rights and principles is welcome but not good enough. The Pillar will initially apply only to Eurozone countries, others are invited to opt in. This means that countries with some of the weakest social protection systems, greatest threats to fundamental rights and highest barriers for vulnerable groups are excused from the Pillar. This risks further divisions, some countries falling further behind, and people continuing to suffer from today’s race to the bottom on rights and protections across Europe. Plans for monitoring via a scoreboard and the European Semester sound vague. Conditions will have to be made crystal clear – via EU funds – if the Pillar is to be taken at all seriously. Real leverage is lacking so far. It will be up to the European Parliament to make the link.
Likewise, the Commission will need to lead by example, by referring to the rights and protections of the Pillar when developing all other EU policies. This sounds like a commitment to put a longstanding Treaty principle into practice; social and health impact assessments will now be carried out routinely and must guide policy decisions. This means, for example, that future economic, fiscal or trade policy proposals will have to be checked against how they will impact on access to healthcare, housing, water, sanitation or other essential services, child poverty, work-life balance, inclusion of people with disabilities and all the other principles.
To date, the impact assessment and ‘fitness check’ process for policies has had a very strong focus on assessing the costs for business, and not at all on fitness for purpose for protecting people’s rights, access to essential services or achievement of social or health benefits. If the Commission really is serious about a social ‘Triple-A’, as President Juncker says, the ideology around impact assessment will have to be rebalanced. If so, that means an immediate shift from business-as-usual which still produces proposals which undermine health and social goals.
It is clear that social standards cannot be uncoupled from the single market – a healthy population is a prerequisite for a healthy economy, while many of the common health threats we face such as antimicrobial resistance, obesity or alcohol harm, cannot be tackled alone.
The focus is now on putting into action. How will the proposals be supported by the European Parliament and the Council? EPHA is ready to engage, and calls on the Commission to work with civil society across Europe to translate the words into practical actions to begin to make the vision of a social Europe a reality for all.
Watch Nina Renshaw (EPHA) address the Committee on the Environment, Public Health and Food Safety – meeting 25/04/2017 (PM)
Address starts at minute 16:55.