COMMON POLICIES

CONSUMER PROTECTION AND PUBLIC HEALTH

Public Health

LEGAL BASIS

The EC Treaty, whilst not introducing an EU health policy, nonetheless takes a number of steps in that direction. Article 152 stipulates that: ‘a high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities’ and that ‘by way of derogation from Article 37’ (CAP), the Council will adopt ‘measures in the veterinary and phytosanitary fields which have as their direct objective the protection of human health’. These measures, plus measures concerned with human blood and organ quality and incentive measures designed to protect and improve human health, are subject to qualified majority voting in the Council.

OBJECTIVES

Historically, EU health policy originated from health and safety provisions, and later developed as a result of free movement of people and goods in the internal market, which required coordination in public health. In harmonising measures to create the internal market, a high level of protection formed the basis for proposals in the field of health and safety.

Various factors, including the BSE crisis towards the end of the century, put health and consumer protection high on the political agenda. As a result, DGXXIV (renamed SANCO) was considerably reinforced.

ACHIEVEMENTS

A.  Early development

Despite the absence of a clear legal basis, public health policy had developed in several areas prior to the current Treaty. These included:

Medicines. Legislation introduced since 1965 sought to achieve high standards in medicine research and manufacturing; harmonisation of national drug licensing procedures; rules on advertising, labelling and distribution;

Research. Medical and public health research programmes date back to 1978, on subjects such as age, environment and lifestyle related health problems, radiation risks, and human genome analysis, with special focus on major diseases;

Mutual assistance. In the event of disaster and extremely serious illness.

The emergence of drug addiction, cancer and AIDS (among others) as major health issues, coupled with the increasingly free movement of patients and health professionals within the EU, pushed public health ever further onto the EU agenda. Major initiatives launched included the 1987 ‘Europe against Cancer’ and the 1991 ‘Europe against AIDS’ programmes. In addition, several key resolutions were adopted by the Council’s health ministers on health policy, health and the environment, and monitoring and surveillance of communicable diseases.

B.  Developments following the Maastricht Treaty

In November 1993 the Commission published a ‘Communication on the framework for action in the field of public health’, which identified eight areas for action.

1.  Health promotion

This Community action programme focused on promoting healthy lifestyles and behaviour, particularly in the areas of nutrition, alcohol consumption, tobacco and drugs, medicines and medication.

2.  Health monitoring

This programme based on cooperation is less than that proposed by Parliament, which wanted a specific budget and much tighter specifications for an EU, as opposed to Member-State, programme, including a centre for data collection.

3.  Cancer

The ‘Europe against Cancer’ programme ran until the end of 2002. New areas of activity include epidemiological studies to measure the impact of cancer on the population, and research collaboration and dissemination. In recognition of the strong link between cancer and lifestyles, a special part of the plan is dedicated to alcohol consumption, diet and, most importantly, smoking, both active and passive. This runs in conjunction with existing EU legislation on tobacco, which includes:

Council Resolution on banning of smoking in public places (1989);

two directives on labelling of tobacco products, with obligatory health warnings as well as tar and nicotine yields, and also banning oral tobacco products (1989, 1992) and a directive on the maximum tar yield of cigarettes (1990);

agreement was reached by the Council and Parliament on the text of a new directive to replace 98/43 (which was the object of a successful legal challenge) on the advertising and sponsorship of tobacco products. Together with the directive on television advertising of tobacco products, this directive will ban the advertising and sponsorship of tobacco products in the EU.

4.  Drugs

The only major scourge to be specifically mentioned in the EU Treaty, and recognised in the Commission’s Communication as a multi-faceted problem linked to social exclusion and unemployment. The EU set up a European Committee to Combat Drugs (CELAD) in 1990, and a European Monitoring Centre for Drugs and Drug Addiction (based in Lisbon) in 1995. The EU has also signed the UN Convention against illicit traffic in narcotics, as well as developing bilateral contacts with producer countries.

5.  AIDS and communicable diseases

The current programme comprises information, education and preventive measures to combat AIDS and other related communicable diseases. Emphasis is also placed on collaborative research, international cooperation and information pooling. The Commission has also proposed the creation of a network for the epidemiological surveillance and control of AIDS and other communicable diseases such as CJD.

6.  Injury prevention

This programme focuses on home and leisure accidents and targets children, adolescents and older people. Activities are complementary to those pursued in other fields such as consumer protection, transport, civil protection and the EHLASS programme.

7.  Pollution-related diseases

Many of the provisions of the fifth environmental action plan – on energy, transport and agriculture – will have a significant indirect health impact. The pollution-related diseases programme concentrates on improving data and risk perception as well as disease-specific actions for respiratory conditions and allergies.

8.  Rare diseases

This programme targets those diseases with a prevalence rate of less than five people per 10 000 EU population. It is intended to create an EU database and information exchange to improve early detection and identify possible ‘clusters’, as well as encouraging the setting-up of support groups.

9.  Other activities

Activities outside the eight programmes have included tobacco control, surveillance and control of communicable diseases, safety of blood and blood products and various reports and studies.

C.  Recent developments

1.  Evaluation of the current programmes

The eight programmes carried out between 1996 and 2002 were evaluated during 2003. During their lifetime the overall design of the programmes was criticised for being limited in effectiveness because of the dilution caused by its disease-by-disease approach. Calls were made for a more horizontal, inter-disciplinary approach concentrating on areas where EU action could produce ‘added value’.

2.  The 2003-2009 programme

In May 2000 the Commission put forward a proposal for a new programme to replace the existing eight programmes with a single, integrated, horizontal scheme. The proposal was adopted after a long codecision procedure and the final decision was published in October 2002. The scheme came into effect on 1 January 2003 to run for six years with a budget of €312 million. The new programme will focus on key priorities where a real difference can be made. It focuses on three strands of action:

a.  Mutual exchange of information

Knowledge about people’s health, health interventions and health system functioning. The inclusion of health system comparisons is a new element here since this had always been considered a purely national matter. In terms of organisation it still is, but systems have much to learn from each other and Court of Justice decisions on citizens seeking medical help in other Member States have increased the importance of this aspect, as has the fact that Member States face the same kinds of problems in providing health services to an increasingly elderly population.

b.  Strengthening rapid response capacity

It is now seen as essential for the EU to have a rapid response capacity to react to major health threats in a coordinated manner, especially given the threat of bioterrorism and the potential for worldwide epidemics in an age of rapid global transport making it easier for diseases to spread.

c.  Targeting actions to promote health and disease prevention

This is to be undertaken by tackling the key underlying causes of ill health relating to personal lifestyles and economic and environmental factors. This will entail, in particular, working closely with other EU policy areas such as environment, transport, agriculture and economic development.

In addition, it will mean closer consultation with all interested parties and greater openness and transparency in decision-making. A key initiative in this is the setting-up of an EU Health Forum as a consultative mechanism.

Provisions have been made for structural arrangements, establishing a new programme committee and strengthening the Commission’s coordinating and technical capabilities by externalising certain functions, and possibly by creating an Executive Agency for certain functions once a regulation on the establishment of such agencies has been adopted.

In addition to projects on specific areas of the three policy strands, there will be cross-cutting projects involving elements of all three. Projects will be much more clearly linked to policy development needs and will be larger than in the past to ensure added value at EU level and a measurable and sustainable contribution to public health. Some projects will involve all Member States and accession countries, whose inclusion in the programme from an early stage is seen as essential.

In recent years a number of initiatives have been taken to reinforce Community involvement in public health and consumer protection, notably the establishment of specialised agencies in these two areas. Developments include the setting-up of a European Food Safety Authority in Parma, Italy, and a European Centre for Disease Prevention and Control in Stockholm, Sweden. The latter was created by Regulation (EC) No 851/2004 of the European Parliament and of the Council of 21 April 2004 establishing a European Centre for disease prevention and control, published in the EU Official Journal on 30 April 2004.

ROLE OF THE EUROPEAN PARLIAMENT

Parliament has consistently promoted the establishment of a coherent public health policy. It has also actively sought to strengthen and promote health policy through numerous opinions and own-initiative reports on issues including:

radiation protection for patients undergoing medical treatment or diagnosis;

respect for life and care of the terminally ill;

a European charter for children in hospital;

research in biotechnology including organ transplants and surrogate motherhood;

safety and self-sufficiency in the EU’s supply of blood for transfusion and other medical purposes;

hormones;

drugs;

tobacco and smoking

breast cancer and women’s health in particular;

ionising radiation;

an EU health card – a European health card incorporating a microchip containing essential medical data which could be read by any doctor;

BSE and its aftermath and food safety and health risks;

biotechnology and its medical implications;

the rights of patients to seek medical assistance and care in other Member States.

In 2005 work was initiated leading to the approval by codecision (following a single reading) of a Programme of Community action in the field of health, 2007-2013 (COD/2005/0042A), based on a communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions on Healthier, safer, more confident citizens: a health and consumer protection strategy ((SEC(2005)425) and COM/2005/0115 final).