Verbatim report of proceedings

Thursday, 16 March 2006 - Strasbourg

5. Community action programme in the field of health (2007-2013) (debate)

  President. The next item is the report (A6-0030/2006) by Mr Trakatellis, on behalf of the Committee on the Environment, Public Health and Food Safety, on the proposal for a decision of the European Parliament and of the Council establishing a Programme of Community Action in the field of Health and Consumer Protection 2007-2013 – Health aspects [COM(2005)0115 – C6-0097/2005 – 2005/0042A(COD)].

  Markos Kyprianou, Μember of the Commission. (EL) Mr President, I should like, first of all, to thank the rapporteur, Mr Trakatellis, for his excellent work in preparing this report. However, I should also like to thank the members of the two committees for their excellent work in studying and examining this programme. I am truly delighted at the large number of both speakers and proposals submitted on this programme. Similarly, I want to say as of now that I could not in fact, under different circumstances, disagree with the substance of the proposals made.

We may, as regards the split into two programmes, have different approaches, but the recommendations add to the actions under the programme, extend its scope and make it more effective, so that it covers more sectors. In addition – and this is equally important – not only is provision made for the resources sought by the Commission in order to support the programme, but also its budget has been further increased.

Unfortunately, however, under present circumstances – and I refer here in particular to economic circumstances – we must be careful and – to use a word which I do not particularly like – 'realistic'. The most serious issue which is pending at the moment is the closure of discussions on the financial perspective and Parliament has an important role to play here. At this point, I would highlight the support and positive positions of Parliament and the Commission on the financial strengthening of the programme.

It is a fact that, if the compromise achieved in the European Council in December is maintained, this will mean considerable cutbacks to the programme. President Barroso has already sent the relevant letter to President Borrell, in which he points out that, if the arrangement stays as it was in December, the health and consumer protection sector not only will not have sufficient resources, but also this sector will have fewer financial resources in 2007 than it had in 2006. In other words, there will be less money for the Europe of the 25 and 27 Member States than there was for the Europe of the 15. I believe, as President Barroso also points out in his letter, that this approach cannot be justified, especially at a time when we want to bring Europe close to its citizens. That is why President Borrell is asked for Parliament to make one more effort to cooperate in this sector.

The Commission proposal for the programme is also reflected in the relevant budget. If, however, the considerable reduction to which I referred earlier ultimately comes about, this will mean that numerous actions and numerous sectors of the proposal will have to be abandoned, because there is no point in allocating small amounts to numerous sectors in such a way that, in essence, no sector is supported effectively.

That is why the whole programme needs to be reassessed, priorities need to be set and the actions, initiatives and sectors covered need to be reduced considerably, so that we can cover effectively even just the few sectors selected.

Of course, I would like to hope that, in the debates which follow, this situation will be remedied and it will be understood that this was perhaps a mistake and that, given the huge political significance both of the issue of health and of the issue of consumer protection, even just some small amounts will at least be added to the programme.

As far as the question of splitting the programme is concerned, I understand the positions expressed. I know that both committees would prefer there to be separate programmes, I understand the arguments and I understand the concerns. We, however, continue in essence to consider that there are benefits if a joint programme is maintained. Better use can be made of resources. However, in all events, until the matter of the financial perspective has been cleared up, the Commission is not in a position to take a final decision on the extent to which it does or does not accept the split. That is why, at the present stage, the Commission will reject the amendments which promote the split into two programmes and, once we have the final outcome of the debate on the financial perspective, then we shall re-examine the matter. Parliament has made its position clear and we have noted that.

I will not go into other details due to lack of time. I had the pleasure of discussing the programme with the competent committee. I merely wish to emphasise, because there is no time and there are a great many amendments, that the Commission's position on each of the amendments will be circulated in writing and I would be obliged if it could be included in the Minutes of this debate⁽¹⁾. However, I would insist on the fact that the amendments which are being rejected are not being rejected due to disagreement in substance with their tenet. I would remind you, of course, that many of them are being accepted, but those which are being rejected are mainly not being accepted because of the need for there to be, on the one hand, some priorities within the framework of the financial situation and, on the other hand, because of issues of subsidiarity, in other words so that we do not intervene in the competences of the Member States and, of course, so that we do not overlap and do not repeat actions which are covered by other Community policies and actions.

To close, I should like to thank you once again and I shall follow the debate by the Members with a great deal of interest.

  Antonios Trakatellis (PPE-DE), rapporteur. – (EL) Mr President, the problem of bird 'flu was – I am sure you will agree – an opportunity for the Union and the Member States to act in a coordinated and effective manner, by strengthening citizens' confidence and feeling of security. However, it also provided further proof of the value which Community action has in the field of public health.

That is why I consider the timing of this debate to be the right time to support the present report, including the increased financing which is the necessary basis for achieving the objectives, objectives which, like the basic lines of action, safeguard the continuation and, at the same time, the development of the previous programme. This is achieved by a combination of objectives and actions, such as the protection of citizens from health threats from physical, chemical or biological sources, infectious diseases and so forth. We need a common defence system and a coordinated response at European level for possible pandemics, as the topical issue of bird 'flu proves.

The promotion of policies which result in a healthier lifestyle – health determinants. We owe it to our children, to future generations, to work for the adoption of lifestyle standards, taking serious account of health determinants: proper eating habits, stopping smoking, social and economic conditions that do not result in excessive stress.

Disease prevention cannot but be based primarily on addressing health determinants which demonstrably affect physical and mental health.

Helping to reduce the incidence of morbidity and mortality for major diseases and injuries is a further line of action which also requires coordinated and joint action.

Improving the effectiveness and efficacy of health systems: we need to examine jointly the health systems of the Member States in order to safeguard their compatibility, as this will allow them to perform better for the citizens of Europe.

Better information and knowledge, on the one hand, in order to develop health and, on the other hand, in order to incorporate the objectives of policies applied in the health sectors in other policies must be available to everyone, both those employed in the health professions and simple citizens.

Better medical practice which not only constitutes the most effective means of combating diseases, but also restricts further losses to our health. It is obvious that the criterion for evaluating treatments cannot be the financial cost and must be effectiveness, which also works out cheaper in the long run.

In addition, emphasis is placed on actions such as the effect of the environment on health and the collection of data relating to low birth rates, low fertility and sterility, which are developing into a scourge for aging European communities, which are already under threat from the demographic problem. The collection of data and the development of strategies for patient mobility, the further development of the electronic health card, mechanisms for the promotion of organ transplants, cooperation between the Commission and the Member States and with international organisations such as the World Health Organisation and the European Centre for Disease Prevention and Control, are needed for there to be exchanges of opinions and for the promotion of health actions. The Member States are also being called on to play an important role, given that a large proportion of the data comes from them.

The element of coordination of the programme is, I think, material and instrumental to its success and certainly the open method of coordination can contribute to issues of subsidiarity through the strengthening of strategies in the health and healthcare sector, such as patient mobility.

Ladies and gentlemen, I could continue with an endless catalogue of prevention and care issues. However, I am certain that the need for a coordinated intervention that will combine joint action at European level with the facility and ability of the Member States to improve their efficiency now constitutes common ground. This truly ambitious aspiration is served by the proposed second programme. It is more integral and, given also the experience which we have acquired, I believe that it will return comparatively better results.

From this point of view, I believe that Amendment 64, which recommends a higher amount, because the programme is now fuller than and different from that tabled by the Commission, is needed because, without financing, the best programmes will not bring about any results. Consequently, as rapporteur, I cannot encourage you enough to vote in favour of Amendment 64 and I believe that, in doing so, you will send a message of decisiveness to the Council and a message of hope to the European citizens that we too really are concerned with and interested in the health of the citizens of Europe.

  Anders Samuelsen (ALDE), draftsman of the opinion of the Committee on Budgets. – (DA) Mr President, I wish to begin by thanking Mr Trakatellis on the sterling work he has done on the matter we are debating today. This is most certainly one of the areas for which real grass-roots support may be secured. There is a lot of talk about there being a rather defensive approach to European cooperation at the moment, especially after the votes in the Netherlands and France on the Constitutional Treaty. All investigations show, however, that it is very difficult to find grass-roots opposition to cross-border cooperation on precisely the areas we are debating today. It is, of course, therefore also important for me to emphasise that we support the work done so far. We support the attempt to split the two programmes up, and we are in favour of securing as substantial funding for the programmes as it is reasonably possible to obtain.

I would particularly emphasise that the report includes a proposal from the Committee on Budgets, designed to ensure that the Commission can grant core funding on a two-year basis by means of network partnership conventions. The idea is to make sure that as few resources as possible are expended on bureaucracy and that most go into increased efforts in those areas about which we are in agreement. With that, I should like once again to thank Mr Trakatellis for his considerable efforts. I hope that we really will succeed in sending a clear signal to Europeans that the EU can make a difference of benefit to us all in this area.

  John Bowis, on behalf of the PPE-DE Group. – Mr President, I warmly commend my colleague’s report and indeed I welcome what he and the Commissioner said in their opening statements about the budget. I think that is something Parliament needs to listen to. At the moment we have an absurd budget of 0.15 cents per EU citizen – that is the total we spend each year on health in this European Union – and yet we have so many health threats, health challenges and health opportunities.

This week I met with iatrogenic patients. The Commissioner and my honourable friend the rapporteur will understand what that means, because it is Greek, but for other colleagues it means patients who have suffered severe disability or severe health problems as a result of accidents in hospital. It is one of the patient-safety issues on our agenda and was rightly put there during the British Presidency.

We face the challenge of an ageing population, with people living longer – mainly healthy – lives, but then becoming frail in older age and facing all the neuro-degenerative disease challenges that brings. We now have a drugs bill for Parkinson’s disease higher than the drugs bill for cancer.

We need to raise standards, and we raise standards in the European Union by describing good standards, not prescribing them. That is the way forward; it is not very expensive; we have done it on cancer screening, starting with the Irish Presidency and continuing with the Austrian Presidency. We are calling for that on diabetes, particularly type 2 diabetes, and the Commission itself is calling for something along those lines for mental health, one of the biggest challenges of our time. One in three of us will probably, at some point in our lives, have cause for concern, and indeed thanks are due if we have managed to make headway in that field.

But the budget is a concern. One of the greatest threats at the moment is the flu pandemic. One of the greatest needs is the establishment of the effective running of the European Centre for Disease Control. One of the problems, as we have heard directly from that board, is that it is under-resourced, under-financed and will not be able to do its job properly if the pandemic hits in the coming months, or even years. That must be a priority for us, but it must not be a priority which destroys the rest of our health work. We must devote time and energy and some resources to getting right the opportunities that are coming through the European courts for patient mobility. We need to concentrate on all those ranges of disease where there is public concern, whether it is heart or respiratory, rheumatological or brain disease.

We also need to think of the entire range of medical science, including those newest areas, like complementary medicine, which can play their part. I recently benefited from a course of acupuncture to remove the pain of sciatica and can guarantee and vouch for the effectiveness of at least one type of complementary treatment. I also commend that element of this report to the House.

  Linda McAvan, on behalf of the PSE Group. – Mr President, firstly I want to join those who are congratulating Mr Trakatellis for his work and for the open and cooperative way in which he has conducted the drafting of this report.

We all know that the EU has limited powers and limited resources, maybe even smaller resources than we would hope, to carry out work in field of health. It is, therefore, important that we focus our work on areas where the EU can add value and make a real difference. That is why the PSE Group has tried to ensure that we have real focus in the health programme.

We need a health programme that forms part of a health strategy for the European Union. At the moment we have a lot of ad-hoc initiatives, often coming from Presidencies, on this or that condition. That is not good enough: we need a strategy and we need to define what the strategy should cover. For my part I say it should include trans-border health threats; we have heard about those, we know about the flu pandemic. Secondly, it should include patient health mobility issues: with more and more people travelling, we have got to get the health card right. I get a lot of casework from people who still have problems with their health card. Then there are people travelling, who want health care abroad with the E112. We have to stop letting the Court make the rules about healthcare; the legislators have to make the healthcare rules. Thirdly, there is the area of cooperation, of exchange of good practice on tackling health determinants. As Mr Trakatellis said, that is extremely important. We get a lot of lobbying on this from organisations asking us to include in the programme actions on one or other disease or condition. The PSE Group does not support including a list of conditions in the report, because we feel we should be focusing on the health determinants. We do not want to create a hierarchy of diseases and conditions, because many of these diseases and conditions are terrible for those who have them.

Keeping this sharp focus on health in the health programme is not going to be easy. We need only look at the number of amendments tabled for plenary – nearly 200 – and at the many competing demands that are being made. However, unless we have focus in the programme, unless we can show that the EU is adding value and not just making a series of declarations at summits or conferences, it will be very difficult to convince the Council and the public of the need for an increased budget.

So, it is over to the Commission. I hope it will come forward with a health strategy, I hope we will have focus in a future health programme. We will be voting for Amendment 64; we think it is very important to send a signal that healthcare matters. We know the public is sceptical about Europe, but if people see us acting on things they care about, they might feel friendlier towards Europe.

I very much hope we will defend a good budget but also keep an eye on focus in the programme.

  Holger Krahmer, on behalf of the ALDE Group. – (DE) Mr President, Commissioner, ladies and gentlemen, health policy falls essentially within the competence of the Member States. There is a good reason for that. Health systems are paid for out of contributions and taxes, and the various systems are geared to specific needs. Moreover, the principle of subsidiarity applies for the field of health services and medical care.

Article 152 of the EU Treaty requires Member States to ensure a high level of health protection. The EU can also take measures in support of Member States’ policies. I sometimes get the impression that the Commission and some of our fellow Members, too, would prefer to compete with national policies on health. We have the same problem with health policy as also constantly recurs in other fields: Europe is suffering from being unable to do the important things it ought to be concerned with. The upshot is that the EU embraces many areas of policy which, if in doubt, would be better dealt with by the Member States and interferes assiduously in their affairs.

That does not of course mean that Europe should keep its hands off health policy. Rather, the EU must concentrate on things that have real European added value, and here I can pick up directly what the previous speaker was saying: Europe should take action primarily on cross-border questions that one Member State is unable to deal with alone. Top priority must be given to improving the exchange of information and to closer cooperation in coordinating the fight against epidemics and infectious diseases. The health risks resulting from bird flu show the urgency of cross-border coordination of measures.

The same goes for HIV and Aids, a major problem in the new Member States in particular, and one which is increasingly being forgotten and neglected even though infection rates are rising.

The EU should set stronger priorities for fighting disease. My group has tabled amendments on this, for which I would again like to canvas your support. The focus should be on the most important widespread diseases, such as diabetes, cancer and cardiovascular diseases; that is where the EU’s measures and scarce resources must be concentrated.

We should not take it upon ourselves to make a shopping list. In Committee, we discussed at length what diseases and what preventive measures should have priority in the action programme. Let us be consistent in our demands here. Parliament’s December 2005 resolution on the work programme calls explicitly for measures to combat diabetes, cancer and cardiovascular diseases. The terms of the proposal for the Commission action programme were too general, too broad. It is time for us to set political priorities and concentrate on the most widespread diseases.

I would also like to say a few words about the budget and the funding of NGOs. My Group supports the rapporteur’s proposal that the budget for the action programme be increased to EUR 1.2 billion. If we are serious about the priorities we are setting with this programme, we will of course need the resources to match. Patients’ associations and non-governmental organisations are playing an increasingly important role, which justifies them receiving EU support. When funding NGOs, however, we must ensure there are strict criteria and transparency. It cannot be acceptable that some organisations – as happens in the environmental field – are so lavishly endowed that they can pay for Brussels offices as though they were subsidiaries of the EU Commission.

  Hiltrud Breyer, on behalf of the Verts/ALE Group. – (DE) Mr President, the Group of the Greens/European Free Alliance quite clearly supports an independent, well-funded health programme.

Health heads the European public’s wish list, and we must give a very clear sign today that health policy is also a priority for us in the European Parliament, in the European Union, too. Services and systems are of course organised at national level, but we must discuss the objectives of health policy internationally and jointly in Europe. If a billion euros a year are spent subsidising tobacco, then health policy must be worth the same amount.

On the financing of NGOs, we in the Group of the Greens are quite clear that only NGOs that are independent of industry should be funded. Sadly, we have a very large number of NGOs that are in the pay of the pharmaceutical industry and are its mouthpiece, their only purpose being to advertise over-expensive medicines. That is not what we want. We want to support NGOs that are independent. And, Mr Krahmer, it is a contradiction to say they must not get state funding as well. What else are they to get? Are they really to be financed by the pharmaceutical industry and kept on a leash? We do not want that! Of course these NGOs also need funding to pay for their public relations work.

Support for complementary and alternative medicine is quite central for us. I am pleased that there have already been positive experiences with it. We have millions of people in the European Union who have had very positive experiences with complementary and alternative medicine, not forgetting environmental medicine. It is therefore discriminatory of the European Union to pay no attention to this field of medicine, which does not yet have even a shadowy existence.

If the Commission is serious when it proclaims in Lisbon that we are an innovative society, then we must use the knowledge and innovation of alternative and complementary medicine, develop it and make it available to the people of the European Union. That is really quite central and I think the Commission has staked far too much on the interests of the big pharmaceutical companies alone with its demand for blockbuster drugs. That cannot be allowed to continue. We must not go in for covert industrial and pharmaceutical research here, but our aim must be to really get innovation moving. Complementary and alternative medicine must of course have its place there.

My final point is this. We all again expressly ask that there really should be no discrimination, no genetic selection. We would therefore like to press Mr Trakatellis once again to accept our amendment as an additional clause in which we quite clearly say: work in this field should only continue postnatally and only where therapies are also available.

  Adamos Adamou, on behalf of the GUE/NGL Group. – (EL) Mr President, ladies and gentlemen, Mr Trakatellis, I must congratulate you on the truly excellent job which you have done on such a complicated issue and agree with you on many counts, especially as regards the increase in the financing framework for the programme.

Nonetheless, I cannot agree with your wish that certain diseases, which are the big killers, should not be named and certainly they are not shopping lists, as Mr Krahmer said.

Cancer: one in four deaths is due to cancer. One in three European citizens will suffer from some form of cancer during their lifetime.

Cardiac diseases: first cause of death.

Rheumatism: over 150 diseases and syndromes. One in five Europeans are in permanent therapy for rheumatism or arthritis. Rheumatism is the second most frequent cause of visits to the doctor. In most countries, 20% of primary care is for people suffering from rheumatism. Then there are other diseases, such as diabetes and mental illness.

Given that the diseases which I have mentioned affect such a large proportion of the European population, and are so directly linked to the quality of life of Europeans, I am of the opinion that they should be included by name in the programme in question. Consequently, I have tabled the relevant amendment on behalf of my group – Amendment 156 – which I should like to ask you to support.

It is a fact that the rich members of our society enjoy direct and easy access, not only as regards information on health matters, but also as regards access to health services. They are well informed of the dangers and threats as regards health matters and have the facility to consult doctors regularly and in time.

By contrast, those in financial difficulty do not have direct and easy access to information and it is almost certain that they will have to wait a long time for medical care. Consequently, we need to make a huge effort to include the needs of these groups and the organisations that represent them in our health systems. We must take account of their experiences, so that we can create specially designed health systems which meet the needs of the Europeans who are victims of discrimination and receive poor treatment. That is why the relevant amendment has been tabled – Amendment 157 – which I again call on you to support and, to close, I wish once again to congratulate Mr Trakatellis on the truly excellent job he has done.

  Johannes Blokland, on behalf of the IND/DEM Group. – (NL) Mr President, first of all, I should like to thank Mr Trakatellis for his work on this dossier. His commitment to improving public health in Europe is commendable. Whilst I can support the gist of the report, I should nevertheless like to make three observations.

Firstly, with regard to the budget, Amendment 64 increases it substantially, albeit only indicatively. In my view, this amendment does not belong in this report, since the level of the budget is not decided upon today, but depends on the outcome of the negotiations on financial perspectives.

Secondly, I should like to speak out in favour of Amendment 148 of the Group of the European People’s Party (Christian Democrats) and European Democrats. Genetic screening can be a valuable addition to the present diagnostic techniques, but only if it is used in an ethically responsible manner. We must, for example, prevent insurance companies from excluding certain people from their policies on the basis of genetic profiling.

Lastly, I should like to draw the Commissioner’s attention to the very bureaucratic manner in which the research budget is now shared out. It has come to my notice that a single application can cost as much as a few thousand euros. Also, applicants are left in the dark as to the criteria on which basis they will eventually be tested and as to the basis on which applications can be granted or turned down. Moreover, whilst the Commission is very strict on the applicants when they exceed deadlines, there are no repercussions when the Commission postpones a decision. Needless to say, this leads to much frustration.

I suggest we introduce a preliminary procedure in which applications are tested on a limited number of points. Full applications would then be requested only of the projects that have real chances of success. This will reduce the work pressure in the Commission and can also considerably reduce the burden on the part of the applicants. I should like to hear a reaction from the Commissioner on this.

  Liam Aylward, on behalf of the UEN Group. – Mr President, public health in each country is crucial to the citizens and is clearly a matter for each Member State. One of the great advantages, however, of being a Member State of the European Union is having access to other Member States’ cooperation and knowledge base. It matters in any field and, in this case, if public health, by reason of its scale or effects, can be better achieved through the cooperation of Member States, then this should be encouraged.

The Irish Government continues to aim for top-quality healthcare for its citizens, including appropriate, prompt and safe healthcare in the right setting: healthcare provided in a way that is fair to patients, taxpayers and health professionals. It aims to provide professional staff ready for the job, training, equipment and support for promoting healthier living in a healthier environment.

In this age, in Ireland and across the European Union, we have major health challenges to tackle: cardiovascular disease, neuropsychiatric disorders, cancer, digestive diseases, respiratory diseases, sense organ disorders, obesity and diabetes, to mention a few. No one country can tackle this alone. The European Union, through the experience of its Member States and experts and by virtue of this proposal, which has been greatly improved by the Committee on the Environment, Public Health and Food Safety, is rising to the challenge of assisting Member States in public health. I also wish to compliment Mr Trakatellis on his contribution in this report.

Communications, education, access to modern methods, application of sound medical advice and bridging gaps in the issue of public health at Member State level are vital.

Further, and more specifically, I welcome the amendments regarding the inclusion of alternative medicine in the programme. Better knowledge about complementary and alternative medicine can provide an important contribution to the ability of citizens to make better informed and responsible choices regarding their health.

  Andreas Mölzer (NI). – (DE) Mr President, many of the diseases that people in Europe suffer from today are more or less directly related to our lifestyle. One only has to think, for example, of the increase in nutrition-related diseases or in those caused by lack of exercise. The approach of promoting strategies for a healthier lifestyle is therefore certainly an important one. Their success will be doubtful, however, if some EUR 1.4 billion are put into an information system on health issues that serves only to exchange health reports. Most of the diseases people suffer from, even here in Europe, are not caused by a lack of available information.

The truth is that health starts with your attitude to life. Every child knows that people who take plenty of exercise and eat sparingly but naturally stay healthier. People have known for a long time what is harmful to health without it being written on cigarette packets, beer and wine, sweets or finished products; that is imposing on people and taking decisions for them, when they want to make their own judgments.

Such supposedly deterrent measures are of doubtful success and I do not believe the public wants them. As you may know, 66% of respondents in a survey were in favour of promoting health-conscious behaviour, by discounting insurance contributions for having regular medical check-ups, for example. We ought to move more in that promising direction. What is more, one thing is perfectly clear: preventing disease would also reduce the financial burden on our health system.

  Ria Oomen-Ruijten (PPE-DE). – (NL) Mr President, good health is always at the top of the European public’s wish list. If Europe can contribute to this, then that is very legitimate, and that is, in fact, what we have to do, for the Treaty requires of us that we guarantee a high level of public health.

I should like to congratulate the rapporteur on the programme. He has been open to the justified wishes of his fellow Members, and the Commission has tabled a sound programme, which Parliament did, however, tweak in a few areas. If I may start with one of those improvements, it is now expressly stipulated that the Member States must cooperate in making the purchase and supply of health care easier.

I come from a border region with university hospitals in Maastricht, Liège and Aachen. Standing on top of the Vaalser Berg – which stands just over 300 m tall, so we Limburgers call it a mountain – you can almost make out the three academic top hospitals. Surely it would make sense, also putting cost before benefit, if those regions joined forces, thus making sure that those top facilities did not grind to a standstill, and costing us all a great deal of money.

I am therefore pleased with the extended programme that included those cross-border options. That is the first point I wanted to make. The second point is about health systems that are under pressure everywhere, partly due to demography and partly because we need more, and also often therefore more expensive, facilities. Every Member State is adapting their care systems. Why do we need to re-invent the wheel everywhere? Why can we not learn from each other? Attention should go to that area too.

With regard to funding, cost must go before benefit. With bird flu, it is not if, but a matter of when. When I see – and Mr Bowis has echoed this sentiment – that the management team in Stockholm for contagious diseases asserts that ‘it cannot function at a time when a disaster of that kind strikes’, then I think we have to draw up fresh agreements with each other, and I hope that is exactly what the Commission will do.

I also believe it to be important that this programme should extend into complementary alternative care and provision, and that more should be done for diseases such as cancer, diabetes and Parkinson’s.

  Evangelia Tzampazi (PSE). – (EL) Mr President, allow me to congratulate Mr Trakatellis on his willingness to cooperate.

The Community action plan in the field of health is an important text, in that it aims to safeguard effective prevention, improved health services and a better quality of life for everyone, something that is our primary political objective.

The basic priority of the programme is to combat inequalities in health by strengthening existing networks in the field of public health.

As far as people with disabilities are concerned, we need to take account of the fact that a disability is not an illness or an inability; it is a different state of health that needs to be taken into account when processing and applying all Community policies and programmes. It is hugely important to develop strategies and exchange best practices in the aim of promoting the health of people with disabilities and providing reliable information in forms accessible to the disabled, who are one of the target groups of the programme. We also need to safeguard equal access to the corresponding medical and pharmaceutical systems.

Another basic priority is to safeguard the added value of Community actions in relation to national actions for health, in order to strengthen transnational cooperation in innovative sectors, such as telematics in medicine. For people with disabilities, these actions can forge new paths which will allow them to seek improved quality of life and timely and suitable access to health services while, at the same time, they will help to rationalise spending in the field of health.

  Georgs Andrejevs (ALDE). – (LV) Mr President, ladies and gentlemen, first of all I would like to congratulate my colleague, Mr Trakatellis, on his fine report. In the Commission’s new Community action programme in the field of health and consumer protection for 2007–2013 the Commission has emphasised the European Union’s important role in reducing the number of illnesses, that is – and I would emphasise this – in the field of serious diseases. Cardiovascular diseases, as we all know, are without a shadow of a doubt one of the main causes of death in Europe. Each year two million European Union residents die as a direct result of these diseases. The decisions taken by the Council during the Irish Presidency were – and continue to be – a good start in our efforts to prevent cardiovascular diseases. I therefore believe, like many others of my colleagues here, that in this legislative document cardiovascular diseases ought definitely to be mentioned too. We should call a spade a spade. I would therefore like to call on my fellow Members to support Amendments 142 and 143, which make it clear what can be considered to be the main diseases in Europe, against which we must work together by putting in place prevention, screening and treatment. Thank you, Mr President.

  Caroline Lucas (Verts/ALE). – Mr President, I warmly welcome Mr Trakatellis’s report. I thank and congratulate him for his excellent work on it. I also want to add my voice to those who deplore the reduced funding for the area concerned. My group will support Amendment 64. In fact my group originally proposed an even higher level of funding, as you may recall.

I should like to highlight, once again, one of the key issues that has already been raised and on which my group has tabled an amendment, namely the contribution of complementary and alternative medicine. Over 100 million EU citizens are already using complementary medicine and its popularity is growing rapidly. Improving people’s knowledge about complementary and alternative medicine can be an important way of enabling them to make more responsible and better informed choices about their health. Therefore, I believe it is vital that we bring that area of medicine out of the ghetto and into the mainstream and recognise the very real benefits it can bring.

Heightened public awareness of the dangers of chemicals in the food chain, growing resistance to antibiotics through over-use and concern about the side-effects of some conventional drugs are all contributing to a massive re-think about the way we live and how we seek to regain our health. Complementary medicines with a holistic and person-centred approach are attracting an ever-widening public. It is important to acknowledge that as a phenomenon. Yet there is still a huge disparity between public demand for those medicines and the negligible amount of funding for research in that field. It is vital that we close that gap.

I strongly support those amendments which refer to the seriousness of environmental pollution as a risk to health and a major source of concern for European citizens. That needs to be addressed urgently as part of a preventive healthcare strategy.

As Mrs Breyer has already set out, our group believes that the participation of civil society is vitally important to the formulation and implementation of European health policy. I welcome the proposed increase in funding to enable its greater involvement, as I do the criteria outlined in Amendment 53, which makes clear the need for independence from industry, commercial and business interests.

Amendment 141, by the Liberals, however, muddies the water and takes away precisely the legal certainty that Amendment 53 sets out. For that reason I would urge colleagues to reject it.

  Bairbre de Brún (GUE/NGL). – (The speaker spoke Irish)

Mr President, current fears regarding any possible mutation of bird flu means that the public is aware of the need for a joined-up strategy in relation to communicable diseases. At the same time, we need to recognise that non-communicable diseases are by far the greatest causes of the burden of disease and we need to put our resources where they will be most effective.

I also ask the House to support the amendment that calls for the involvement of disadvantaged communities in the shaping of future health policies. We cannot hope to tackle the inequalities in health without the active input of those whose life experience makes them experts in this field.

I also support the inclusion of complementary and alternative medicine in the action supported by the programme and I strongly support health as a separate programme from consumer protection.

The Community action programme in health has the potential to support the mainstreaming of health in all Community policies. The EU is in a unique position to complement the work undertaken in Member States, to study the impact of other policies on health, to promote access to information, to improve the early detection evaluation and communication of risks and to make recommendations on best practice.

(The speaker spoke Irish)

  Urszula Krupa (IND/DEM). – (PL) Mr President, as a doctor I would like to draw particular attention to the fact that modern science is seeking the psychological basis of the majority of diseases defined as psychosomatic, ranging from obesity to circulatory problems and high blood pressure, as well as autoimmune diseases and tumours, and that a knowledge-based society, and particularly the legislators in the European Union, should be informed of this.

Community polities can also play an important role in the prevention of diseases and the protection of public health, not just in respect of those diseases defined as diseases of civilisation, but also of mental illness. There does, however, need to be a change in lifestyle from a liberal model that does not observe any ethical principles, to a lifestyle based on ethical and moral values, as mental order and mental integration help to prevent personal underdevelopment due to mental illness and all forms of dependence, including nicotine, alcohol and drug addiction and other self-destructive forms of addiction.

Vast financial resources are being poured merely into remedying the effects of such dependence, but these are simply wasted due to the lack of legal restrictions. There is a similar problem with consumer protection, which is sometimes nothing but high-sounding phrases because of the predominance of wealthy monopolies on the market which look after their own interests and pour vast resources into advertising. The flood of such manipulative information should be countered, at the very least by ensuring that EU slogans about protecting basic rights become a reality.

  Irena Belohorská (NI). – (SK) Ladies and gentlemen, I too would like to thank Mr Trakatellis for an excellent report. I fully support his idea of splitting it into two parts, one dealing with health promotion and the other with promoting consumer protection in 2007–2013. I too have contributed several amendments to this report, and I am glad that some of them have been adopted, in particular the amendment concerning the new Member States, which is the most important one to me.

There are some striking differences between the healthcare systems of the EU Member States. The new Member States seem to be in an inferior position in this regard, as they face major healthcare challenges and have little funding available for improving the situation. Insufficient spending on healthcare is a major obstacle to the development of these states and to the growth of the European Union as a whole. It is necessary to increase awareness of the possibility of financing healthcare programmes from EU structural funds. For the new Member States, this information could be a source of hope, providing an opportunity to raise the quality of services.

It is unfortunate that, in accordance with the subsidiarity principle, the healthcare sector does not fall under the purview of the European Union and is therefore subject to national legislation. I appreciate the effort to include the protection of patient safety in the report. The difficulties faced by EU citizens in accessing healthcare services while abroad constitute an obstacle to free movement. It is necessary to define more clearly the ambiguous regulations on reimbursements for medical services, as European citizens are finding the present-day provisions and rulings of the European Court of Justice unclear and difficult to understand. It might benefit patients if a database were to be set up with information on healthcare service providers in the other Member States. It would definitely improve the situation for patients, and would possibly eliminate long waiting lists for some services.

The mass media are also in a position to contribute to improving the health status of the population. It would be a good idea to replace various ‘reality shows’ with programmes that use an attractive format to highlight nutrition-related issues, the neglect of which may ultimately contribute to the onset of obesity, cardiovascular disease and cancer. Encouraging the mass media to focus on healthcare issues is also important in terms of state security at the moment, because of the threat of possible attacks in the form of bioterrorism. In case of an epidemic, the public would be better informed about the basic strategies for containing the spread of disease. It is necessary to focus more and allocate larger budgets to healthcare, as we know that it will be impossible to attain the Lisbon Strategy goals without having a healthy population.

  Thomas Ulmer (PPE-DE). – (DE) Mr President, Commissioner, ladies and gentlemen, first of all I would like to extend my sincere thanks to Mr Trakatellis for the excellent cooperation and his excellent report.

The three common core EU policy objectives in the fields of health and consumer protection are clearly brought out: to protect the public from risks and hazards over which the individual has no control and which cannot be effectively or completely dealt with by individual Member States. The focus is quite clear. Strengthening people’s ability to make decisions affecting their health – in this connection, a Commission initiative aimed at reducing the restrictions in the pharmaceutical industry’s information policy is also commendable. Thirdly, the incorporation of health policy into the other areas of Community policy.

In the field of health, this report introduces three new core subjects that relate to the new challenges of our time: the response to threats – taking as an example the epidemics that are at present very much in our minds with bird flu. Secondly, the prevention of diseases and patterns of behaviour – citing here only smoking, obesity, addictions and lack of exercise as examples. Thirdly, the necessary cooperation between national health authorities, where there is surely still room for improvement at many levels. I see no undermining of subsidiarity here, but on the contrary greater cooperation, effects of synergy and a strengthening of subsidiarity.

I believe the separation into consumer protection and health protection to be important and correct, since they are two fields of policy with different bases in law, which means they also entail different EU powers within the Community. Personally, I find all that we are wanting to do with 1.5 billion in seven years astonishing. I hope that a lot of it will be achieved. Let us only bear in mind that statutory social insurance has a turnover of EUR 180 billion a year in the Federal Republic of Germany alone.

I support Amendment 64 on expanding the financial framework. I believe it is the minimum if we are to do any meaningful work at all. Compared to what the Community spends in seven years on subsidising the cultivation of tobacco, this amount is still vanishingly small. It amounts to only about one fifth of tobacco subsidies.

We certainly cannot satisfy every desire of Europe’s citizens and institutions in a framework programme. We have tried to be as fair and balanced as possible. I see this as a great opportunity to take Europe a bit further into the midst of the citizens again through joint public relations work.

IN THE CHAIR: MR ONESTA
Vice-President

  Dorette Corbey (PSE). – (NL) Mr President, Commissioner, ladies and gentlemen, first of all, I should like to extend warm congratulations to Mr Trakatellis. His expertise on health is a considerable asset to our debate. Health is an important political topic, but is, first and foremost, a national concern. It is justified that Europe should devote attention to health, but Europe should only stir into action if there is a clearly added value to be had. Nevertheless, Commissioner, I expect a great deal from your policy.

First of all, I hope that you will actively encourage your fellow-Commissioners to adopt healthy policies. Have a look at agricultural subsidies through the eyes of health. Should we really continue to subsidise fat, sugar and tobacco? I would prefer us to opt in favour of vegetables and fruit. Alternatively, Commissioner, I invite you to plant yourself in the middle of the scrap between DG Industry and DG Environment on air quality, chemicals and plead strongly in favour of health. This will not cost any money and is one of the biggest favours you can do the European citizens.

Secondly, I would urge you to engage in the battle against inequality, and I would echo what Mrs Belohorská said in this connection. Access to adequate treatment for the citizens of Europe is very lopsided. Cancer patients have considerably higher chances of survival in some countries than in others. Methods of treatment differ, access to health is unequal. The patients’ knowledge of their diseases differs in each country. Prevention does not have the attention it deserves in all countries.

I would invite the Commissioner to pool knowledge. Member States, hospitals, patient associations and treatment providers can all learn from each other. Combine prevention and treatment. I would urge you, above all, not to collate statistics on the general health situation, but rather collect very practical information on the most important diseases, including cancer, rheumatism, diabetes, lung disorders and naturally heart and vascular diseases, and then assess where improvements can be made. You may be able to set up knowledge centres and networks that can be a valuable source of information for the treatment provider and patient alike. In that way, the European Union can make a worthwhile contribution.

I would finally like to urge you all to sign Declaration No. 1, which is about diabetes, and has been tabled by various Members of this House. We already have 260 signatures, and we need 80 more, so please let us have yours.

  Frédérique Ries (ALDE). – (FR) Mr President, Commissioner, health and consumer protection are two fields − as is shown repeatedly by each successive Eurobarometer − for which the people demand more of Europe, and therefore I must thank our two rapporteurs, Mr Trakatellis and, for this afternoon, Mrs Thyssen, who had the good sense to propose to us the splitting of the two programmes.

Having made this opening remark, I should like to join all those who are with Mr Trakatellis, with you, Commissioner, and with a number of others, who have expressed their support for an ambitious Health programme, even though, as we well know, we will not obtain the billion and a half euros we asked for, and will not reach that very symbolic threshold of the percentage of the European budget. Ultimately, then, we shall have to make cuts, painful sacrifices. That is why I believe it is important to concentrate our efforts on the five to seven diseases that are the main causes of mortality in Europe. We must, therefore, take into account what the WHO tells us and support Amendment 142, proposed by the Group of the Alliance of Liberals and Democrats for Europe, and not be afraid to specify certain diseases and work twice as hard at the prevention, for example, of cardio-vascular diseases and various cancers, because being ambitious does not mean trying to do too many things at once.

Our citizens want Europe to be effective and transparent. We must not fail them by spreading resources too thinly. They are asking us also to be responsive and to reassure them, especially today. It would not be right, therefore, to leave the European Centre for Disease Prevention and Control in Stockholm without a decent budget. Let us remember, after all, that it was launched in 2005 following the lightning spread of SARS two years ago. It is therefore very much in our interest to see the ECDC fulfil its purpose now that avian influenza has arrived in our continent.

So, in conclusion, Commissioner, I have a question for you and, likewise, for the Council. How are you going to fund the health and environment action plan and reconcile it with this new public health programme? Europe must, we know, equip itself with the means of combating environmental pollution, which affects the most vulnerable among us, pregnant women and children. Protecting the very youngest among us is also the way to give every chance to the Europe of tomorrow.

  Carl Schlyter (Verts/ALE). – (SV) Mr President, I should like to thank both Mr Trakatellis and Mr Kyprianou, who have done a sterling job. We are, however, in an absurd situation in which we spend five times more money on tobacco subsidies than on promoting public health, that is to say five times more money on ruining people’s health than on improving it.

What I like is the fact that this report focuses on preventive work. Resources are so limited that they are only sufficient for the purposes of cooperation, sharing good examples and disseminating information. However, it is at national level that the big money is to be found and where the bulk of the work will take place. What I think is good about the European Parliament’s changes is Amendment 53, the importance of which I want to emphasise. Since there is so little money, it should not go to organisations that lobby, openly or otherwise, on behalf of the pharmaceutical industry. It is good that there would be careful monitoring to ensure that that did not happen.

We have not so far mentioned Amendments 92 and 144, which deal with gender equality. I think that this is an important aspect, which we must consider. Too large a portion of the available money goes to men and men’s health care and too little to women’s health care. However, it is in the relationship between public health and trade that Europe can make the biggest contribution in this area. The Treaty’s articles on public health are scarcely applied at all to trade policy. Where is the health dimension in alcohol policy? The same applies to chemicals and pesticides. It is in these areas that the really big efforts must be made.

Commissioner, you can make an initial contribution to bringing about that more comprehensive view by not approving the eight new pesticides that are coming on the scene and that are biopersistent, endocrine disruptive and class 2 carcinogenic – a wordy enumeration of the perfect reasons for banning chemicals. You can take the opportunity to do so now.

  Kathy Sinnott (IND/DEM). – Mr President, I congratulate Mr Trakatellis on the report. It is important to reaffirm that health is a national competence. However, it is appropriate for the EU to encourage health-promoting lifestyles and at least require minimum health service standards in the various countries. That is especially so in a country like mine, Ireland, which has the strongest economy in Europe while its health service is inadequate and people are put at risk because they cannot get the basic health services they need.

Diabetes is a good example of a disease that is under-funded in my wealthy constituency. We have half a diabetic nurse post to cater for 250 people, when there should be one for 50 people in order to be effective. Other experiences in the Irish health system have informed my reading of this report. On human organs, tissue and blood, I will request an oral amendment to include the concept of traceability. Our hepatitis C scandals in Ireland illustrated the medical dangers of not being able to trace sources of contamination. In the Irish organ retention scandal, dead children were routinely stripped of organs without the knowledge or consent of their families, illustrating the ethical necessity of traceability to ensure that human products are obtained legitimately.

To conclude, Europe has a role to play in promoting health. However, I do not think EU funds should be used to promote profit-making health industries; they have plenty of funds to promote themselves.

  Zuzana Roithová (PPE-DE). – (CS) I warmly applaud the work that Mr Trakatellis, rapporteur and Group of the European People’s Party (Christian Democrats) and European Democrats member, has devoted to preparing this report, in which Parliament has had its say. The citizens and healthcare professionals also welcome the new action plan before us in this debate. Most importantly, according to the report, politicians and healthcare managers will work together to mark out the path for solving problems that cut across Member State borders. The report paves the way for a modern strategy, especially as regards the coordination of activities, but unfortunately, after the Council radically amended the EU budget, this is not accompanied by adequate funding from European sources. Much remains for the Union to do, and in particular those tasks that individual Member States are not capable of accomplishing themselves. This is not only a matter of combating serious infectious diseases that cut across borders, such as AIDS and influenza, but also of combating the spread of drug addiction and lifestyle diseases. The European Centre for Disease Prevention and Control was set up for this very purpose, in conjunction with the national reference laboratories. Budget cuts are not good news and are indicative of shortcomings in the priorities of the EU’s political elite and of some MEPs.

I should at this point like to highlight a further problem. Modern medicine provides people with a longer, higher-quality life, but this comes at an ever-higher cost – some 60 to 90% of the public purse. The higher the proportion of Community funding for healthcare services, the less responsibility individual citizens take for their health. It is also the case that the more the state regulates, the further the law reduces personal responsibility on the part of individuals. Evidence of this can be found in countries that experienced centrally run and completely regulated healthcare, in which decisions on patients’ health, prevention and treatment – and in turn on the cost of that treatment – were taken without the patient being involved. Although specific reforms have been made, they have brought about a less effective system and more expensive services; old ideas and habits die hard among patients, doctors and politicians. I should therefore like to say that programmes intended to help health service clients to be better informed, and to help system compatibility, should not under any circumstances be cut. These resources pay for themselves many times over.

I have further qualms about the effectiveness of certain regulations – supposedly crucial to the protection of health and the environment – that we have foolishly adopted. I fear that sometimes the aim is to please certain industrial pressure groups and not enough money is spent on the citizens’ health. I therefore call on the Commission to devote a larger proportion of the budget to analysis based on empirical evidence. In this way, our decision-making on regulations can be more responsible, and we can become aware of the true impact on public health, the economic cost, and in turn, the impact on the European economy. For this reason I also support Amendment 64.

  Anne Ferreira (PSE). – (FR) Mr President, Commissioner, ladies and gentlemen, firstly I should like, as other Members have done, to express my approval of the decision not to merge the health and consumer protection areas of the Community action plan within the field of health and consumer protection.

Quite apart from the different nature of the European Union’s competences in these two fields, health policy cannot be regarded as a consumer good.

Although I support the introduction of ‘e-Health’, this must not be used to provide a covert means of testing out an information policy.

I thank Mr Trakatellis for proposing a considerable increase in the budget allocation for this programme, an increase that is necessary if we are to see our objectives and actions brought to a successful conclusion. More funding would have been preferable in view of the challenges to be faced, but we shall already have cause for a certain satisfaction if the Council agrees to increase the funding allocations for health within the context of the financial perspective for 2007–2013.

I wish to emphasise two priorities. Firstly, we must improve cooperation and coordination in the field of health in order to respond more rapidly to cross-border health threats. Had that been the case, we should have been able now to avoid the extent of the spread of the chikungunya epidemic. This ought to prompt the European Union, the Member States and the pharmaceutical laboratories to establish a system for monitoring and for research into these kinds of disease, which may be rare in terms of world population but are catastrophic at a local level.

My second priority is this: to achieve the objective of a better standard of health for all Europeans, we must take into account the impact of environmental and social living conditions on health. In order to treat certain illnesses better we have to address the causes. Everyone knows that people who are vulnerable and socially excluded are more prone than others to certain diseases. We have to help the weakest.

If the Member States made rapid progress in these two areas, our people would feel a little more protected by the European Union.

  Marios Matsakis (ALDE). – Mr President, I congratulate Mr Trakatellis on his report, which was excellent as expected. An important aspect of the EU's health problem is protection against disease through prevention. The three main preventable curses affecting human health – tobacco, excessive alcohol and poor nutrition – are responsible for the premature deaths of millions of European citizens every year. Tobacco especially is thought to be implicated in the cause of death of one in every three smokers. Smoking kills far more people than drug addiction, road traffic accidents and HIV infection all put together. So, with tobacco being such a big killer, are we really doing enough to help our citizens get rid of this self-destructive habit? I think not quite enough.

First, we continue to subsidise tobacco growing in the EU. Surely this is unwise, as has been mentioned by many colleagues already. Second, we allow the ever-more powerful multinational tobacco manufacturers to lobby and influence important decision-making centres freely; they certainly freely lobby MEPs. Third, we lag behind in implementing an effective information strategy. For instance, we put scary warnings on cigarette packets which nobody takes any notice of any more, whereas the tobacco companies pay for movie star idols to smoke on screen.

We have no structured anti-smoking teaching programmes in our schools. We build expensive hospital departments to treat patients suffering from serious diseases caused by smoking, and yet we tolerate many doctors working in such departments giving the worst possible example by smoking in public themselves. Many Member States pay for expensive departments for smoking-related diseases, but they do not pay for smokers to go on anti-smoking programmes before they become ill. Finally, many Member States still leave passive smokers at the mercy of smokers, be it at work or in places of entertainment.

Now that we have a strongly anti-smoking Health Commissioner it is perhaps time to wage a truly full-scale war on the tobacco giants of death and be reasonably optimistic of winning.

  Avril Doyle (PPE-DE). – Mr President, let me start by saying that I agree with absolutely every word the last speaker said; I shall not repeat it all, but well done! I should like to thank Mr Trakatellis for an excellent report and I also thank the Commissioner for being so honest with us here this morning and stating that this Community action plan on health already needs to be reviewed if it is to be effective, so that we can prioritise areas, because of – and I use his words – ‘the accounting muddle’. All I can say about that is that it is an embarrassment!

The EC Treaty states that ‘a high level of human health protection should be ensured in the definition and implementation of all Community policies’. This report is an important first step in making our citizens’ right to health protection, enshrined in the Charter of Fundamental Rights, a reality.

While health is a Member State competence, the European Community can add value and complement the activities of Member States through urgently needed coordination and collation of best practice models so that we can learn from each other and create centres of excellence. By mainstreaming health into all EU policies, by conducting extended health impact assessments and evaluations on all EU legislation and by promoting healthy lifestyles, the EU can provide the necessary platform for joined-up thinking across its Member States.

According to the World Health Organisation, in 2000, for the first time in history, the number of overweight people in the world equalled those who were underweight – more than one billion overweight, 300 million of whom are obese – with the huge implications this has for morbidity. In this respect, it is imperative that we encourage a preventive approach and I welcome a number of recent Commission initiatives in this area.

The broader behavioural, social and environmental factors that determine health can be optimally addressed at Community level through a holistic, as opposed to fragmented, approach. Complementary and alternative medicines, where scientifically substantiated, must be included in any Community action programme in the field of health.

The European Community is optimally positioned to combat transnational health problems, such as the threat posed by epidemics of infectious diseases and food-related incidences. BSE, SARS and the recent avian influenza concerns have all, to our cost, underlined the imperative of having proactive, pre-emptive coordinated action in the area of health.

The proliferation of EU agencies in the field of health – the European Centre for Disease Prevention and Control, the European Food Safety Authority and others – is a very welcome and necessary development in tackling these health threats. However, these bodies cannot function without a clear Community-level policy and the necessary designated financial resources to underpin them. If the money is not secured in the budget and a preventive approach cannot be taken, the consequences, financial and otherwise, may be much greater. Less money from an EU of 25 than from an EU of 15 is not acceptable and is, frankly, irresponsible.

Could the Commissioner tell us where our health services directive is and when we will have a draft proposal?

  Karin Jöns (PSE). – (DE) Mr President, Commissioner, ladies and gentlemen, I, too, would like to sincerely thank Mr Trakatellis for his excellent report. It is in fact very difficult to do the greatest possible justice to all legitimate interests here while at the same time remaining cogent. I therefore regret, for example, that cancer is no longer explicitly mentioned as a priority in the new health action programme.

You are more than right, however, Mr Trakatellis, to point out in your report that there must of course also be sufficient resources for all the objectives we have set ourselves. At present we are a long way from that, however, not to mention the fact that we shall today be rejecting the Commission proposal for a joint action programme for health and consumer protection as totally unacceptable.

In health policy, too, the public wants more protection from Europe, not less. Health policy takes fourth place among the European policy priorities you mention. That itself makes it a matter of urgency that health should be given its own action programme again.

I cannot understand how even the Commission could propose such a low budget allocation or how the Council could cut it still further. We are therefore trying to remedy two cardinal errors here today. We want two separate programmes, and we want more money. I am saying that primarily to the Council. If the further reduction you want were to become reality, it would mean we only had one third of the previous funding for what will be 27 states. That would mean, however, that we would be completely unable to provide primary and secondary prevention of certain diseases or the urgently necessary protection against the risks of disease occasioned by globalisation.

  Frederika Brepoels (PPE-DE). – (NL) Mr President, Commissioner, ladies and gentlemen, I too should, of course, like to start by congratulating Mr Trakatellis not only on his sterling report, but, above all, on the way in which he always had time for all Members, who were keen that their concerns should eventually be reflected in the report. It is a very important report, because it formulates the Community action programmes in terms of public health for the next six years, which cannot be fleshed out by the individual Member States. I think it is safe to say that the rapporteur has successfully managed to combine all relevant and specific aspects in such a vast, and at the same time sensitive, area as public health.

I am particularly delighted that for the first time, it is possible to include complementary and alternative medicine in the actions, as a result of which the public can make more informed and responsible choices in connection with their own health. I am all too aware that alternative methods of medicine are all too often greeted with jeers, but the many people who derive benefit from them claim otherwise, of course. Nevertheless, the Commission has quoted a figure according to which no less than 30% of the population and some hundreds of thousands of doctors and therapists demand these alternative methods.

Better knowledge of complementary medicine will be a major step forward for public health, and so I wholeheartedly endorse the tackling of the problem of the shortage of organs on an EU-wide scale. Both the setting up of common platforms for donors and recipients, and the development of activities to improve safety and the quality of organs can help in this throughout the EU.

As a member of the Committee on the Environment, Public Health and Food Safety, I should, above all, like to stress that health is affected by environmental factors. All too often, people remain oblivious, for example, to the impact of exposure to certain toxic substances. Providing clear information, backed by scientific research, could go a long way in preventing much suffering and also avoid misunderstandings.

The action programme provides specific measures in the area of prevention, detection and raising awareness as well as in terms of information about serious diseases. As a member of MAC, ‘MEPs against Cancer’, recently set up at the heart of Parliament, I can do no other than applaud these concrete steps. There is one thing, however, that I, like many other Members, find hard to digest.

For as long as no agreement is reached about the financial perspectives for the next period, discussion of this action programme will remain merely academic. Even so, the need is considerable, the ambitions even more so, and Parliament will therefore need, in the next few months, to ensure that the necessary funds are actually made available.

(Applause)

  Lidia Joanna Geringer de Oedenberg (PSE). – (PL) Mr President, even though healthcare services fall within the competence of the Member States, the European Union should make the best possible use of its opportunities to supplement actions taken at national level in the interests of the entire Community. It is for this reason intolerable that in future years the EU budget will cut spending in areas that affect the quality of life of its inhabitants, including in particular healthcare.

The European Union can and must contribute towards protecting the health and safety of its citizens, particularly since the recent enlargement has increased the imbalance between Member States as regards healthcare. The marked disparities in citizens’ average life expectancy, health and access to healthcare are closely related to the level of development of individual Member States.

New healthcare programmes with an overall aim of improving the health of citizens and ensuring prevention in the broad sense of the word ought to level out these imbalances. High standards of healthcare should be the aim of all EU politicians. Efforts should now in particular be taken to reduce inequality of access to and quality of healthcare in Member States by introducing comparable standards and securing greater transparency of national healthcare systems. The new programme could prove particularly helpful in the case of cross-border public health threats, as it would make it possible to implement common strategies and actions to protect health and safety and to eliminate any threats, and to promote healthcare-related economic interests of citizens and reduce the cost of healthcare to citizens. Better information exchange on available medical services and the opportunity for having costs reimbursed on the territory of the European Union will also lead to the promotion of patient and healthcare specialist mobility, as the author of this very important report, Mr Trakatellis, correctly pointed out.

  Christofer Fjellner (PPE-DE). – (SV) Mr President, I have expressed quite a few views on the Commission’s health programme and kicked up a bit of a fuss. I do think, however, that it is really commendable, and I therefore wish to thank not only Mr Kyprianou but also Mr Trakatellis.

It has been self-evident to me that health is primarily an issue for the Member States, and I am delighted that the majority in this Chamber are of the same view. What we do at EU level needs to provide clear added value to patients. There are three aspects of this subject that I have been involved in and fought for and that I particularly want to emphasise today. First of all, there is the point of departure for this report, which is, and always must be, that the individual’s own commitment to his or her own health is what is most important. Where health care and work in the public health field are concerned, we politicians must always regard people, even if they happen to be ill, as adults with rights and duties, including the right to control their own lives and health care. We must never forget that active involvement in our own health is always the best medicine. That is precisely what is so unfortunate about the fact that the Social Democrats wish to remove the wordings designed to promote just such active involvement in our own health.

As Members of the European Parliament, we must also facilitate movement within and between countries so that everyone can seek the treatment and care they themselves most believe in. At present, those who enjoy least freedom of movement in the EU are those who need it most, that is to say the patients. For them, Europe’s borders become little Berlin Walls standing in the way of their ability to obtain treatment. For them, freedom of movement may be a matter of life or death. We must not believe that the most important aspects of the good society can be regulated and organised using the planned economy, which has so clearly proved to be the economic model most destructive of creativity and sound housekeeping. We must have more freedom of choice and of movement.

We must also make efforts to ensure that we as decision-makers, together with those who implement the decisions and, in particular, those who use health services obtain better access to information from those services. We must be able to compare results and not only, as at present, costs. These developments are needed not only so that we might learn from each other but also so that users might take advantage of the freedom of movement and of choice given to them by the European Court of Justice. These developments would be to the advantage of European patients.

Up until about the time of the Second World War, people coming into contact with health services were victims. More often than not, they were healthier before the doctor was called than after. Through the development of treatment methods and the advent of drugs, we have become patients in our health care systems. I am, however, convinced that, within the not too distant future, we shall be health care consumers, and that is a shift in perspective that we must help bring about: victims yesterday, patients today and health care consumers tomorrow. That would be a fantastic development that I believe would make us not only healthier but also freer.

  David Casa (PPE-DE). – (MT) I also wish to join my colleagues in thanking Mr Trakatellis for the excellent piece of work we have before us today. It is every government’s priority to establish a health system, for the health sector is of relevance to everybody without exception. It is a sector without frontiers, and one that is at the heart of every country. The Charter of Fundamental Human Rights sets all this out and emphasises that the European Union should give the health sector the necessary attention and priority. The European Union is duty-bound to intervene by establishing objectives for improving the public health system, helping prevent contagious diseases and trying to eliminate every risk that might endanger the health of the Community. It is therefore very important that we look at the Community action programme in the field of health in an objective and distinctive way that focuses exclusively on this particular sector. We cannot agree to have just one programme serving two different sectors, however these may be related to each other. Otherwise, what is essential might, I am afraid, be lost, and more harm than good might be done. What I am saying applies also to the consumer protection programme, which is in itself a complex subject to which separate attention needs to be given. We want to see a programme that, on the one hand, brings the health systems of the various countries closer together and, on the other hand, helps every country achieve its own individual aims. I cannot neglect also to mention the particular importance that needs to be given to cases of persons suffering from chronic diseases or from disabilities. We have to make sure that they are not marginalised and, over and above that, that they also enjoy a high standard of living. Those with difficulties should have the opportunity to benefit from assistance that makes their lives easier, as well as from research programmes to improve the conditions under which they live. We should also bear in mind the important role played by those who take care of people with difficulties, and we should have programmes whereby those who provide care are given the necessary training to carry out their duties more efficiently. We have a programme that will be an important tool enabling patients to benefit from the best treatment and medicines. We have a programme that will educate Europeans and help them make better choices in the interests of their health. This programme will help reduce the imbalances in health care that exist from one EU country to another, so that every country enjoys a higher level of services. Yes, we have a challenge before us, a challenge that must lead to our achieving effective prevention, a more efficient health service and a better quality of life.

  Péter Olajos (PPE-DE). – (HU) Mr President, firstly, I would like to thank Mr Trakatellis for his excellent and thorough work.

Health is our most important asset, and therefore it is good that the European Union, too, addresses this issue. I agree with the words of Mr Fjellner, and as an MEP from a new Member State, I am pleased that the areas of health protection and consumer protection have been separated, as in our country, these two areas face entirely different problems.

A long life is not sufficient; it is equally important that we stay healthy for as long as possible. Therefore, I consider it particularly positive that the programme focuses on extending the healthy life expectancy of citizens, because enjoying good health for as long as possible is crucial to the welfare of European citizens.

In light of the demographic challenges we currently face, this also has a great significance for the sustainability of social care systems. This is a particularly important task in Hungary, where healthy life expectancy is ten years shorter than in the older Member States of the European Union. Therefore, the new programme must include special efforts to reduce the differences between the health levels of European Union citizens.

Our most important task is to ensure prevention, which is also a priority of this programme. This was the reason why I suggested in my amendment proposal that the programme should focus on the health of children and young people, because a healthy lifestyle adopted early in life is decisive in the prevention of problems that may occur later.

Finally, I would like to call attention to the fact that every cent we spend on improving the health of our citizens will bring a multiple return. We could hardly find a more profitable investment for the money of European taxpayers than health. Therefore, I hope that the appropriate financial resources required for the successful implementation of the programme tabled before us will also be available.

Once more, I would like to say thank you, on behalf of all of us, to Mr Trakatellis for his thorough work, and I do hope that everything contained in this programme will be implemented.

  Richard Seeber (PPE-DE). – (DE) Mr President, I would like to add my thanks to those already expressed to Mr Trakatellis, he has really worked very hard. I would also like to express my thanks to the Commissioner, however, because the Commission is also working very hard, especially in the closely related field of bird flu.

Health is certainly the field of greatest interest to us all and of course also to our citizens. We do of course find that life expectancy has risen tremendously over the years. There are figures to show that life expectancy has been increasing steadily by two and a half years per decade since 1840. That of course also brings new challenges for our health and social systems. It means that while we are living longer, we also need to ensure – especially from the political and medical side – that the expectancy of a healthy life becomes longer and that people do not only get older but also healthier.

We are faced with new challenges. Some of them have already been mentioned, such as bird flu, which could mutate into a pandemic and present Europe with problems such as it has not experienced before. We need to be well prepared for this if we are to be able to take the right action in good time. I would also like to point out that problems surrounding Aids, cancer, diabetes and cardiovascular disease must remain on the agenda because they still represent major risks for our citizens.

We must also be clear that the Member States are of course basically responsible for health. We on the European side need to think, however, where we can actually contribute this much vaunted European added value, where we can do something from Europe that will help our citizens to live longer healthy lives. This cross-border factor is certainly one area. Diseases do not stop at borders.

Knowledge is certainly another factor. I would like to mention another figure here. Medical knowledge in particular has increased tremendously, and it does of course entail costs. If we were to take the level of knowledge of Bismarck’s day and apply it to our own, then only 1% of our health budgets would be taken up. The remaining 99% relates to knowledge that was gained later. That also means, of course, that health costs money. I therefore back the rapporteur’s call for EUR 1.5 billion from the European Union very strongly. We cannot adopt lavish health programmes and not make the necessary money available.

Another point is the whole area of provision. As I have already said, people are getting older. That also means that healthy lifestyles and provision will increase. More importantly, a lot of research needs to be done here in order to put our health budgets on a sound footing in the long term.

Over all, we are on the right road, but we must not close our eyes to the challenges that lie ahead.

  Markos Kyprianou, Member of the Commission. Mr President, I should like to thank the Members for a very interesting debate. I will make a few brief comments.

First of all, on the issue of the agencies, I totally agree that both the ECDC and EISS are very important policies, but they should not be at the cost of the other health policies. Unless we have increased financing, we will be faced with the impossible choice of either funding fully the two agencies and doing absolutely nothing else, or splitting the money, which I am not sure would be of benefit either. That is an important issue.

With regard to funding, I should like to thank the Members for their support. Given the way that we work in the Union in the area of health, which involves mostly non-legislative initiatives, more money is required. When you legislate, it is much easier to send the proposals that have been adopted and expect Member States to implement them. But when you want to take other initiatives of coordination, of recommendations, or of exchange of best practices, then you need more money. I agree that we will not expand into the competence of the Member States. We will emphasise and target areas where we can have European added value by taking action at European level. That is in fact what the programme is doing.

Health services fall within the competence of Member States. There is no question about that. But in a Union of solidarity, I do not believe we can accept the health inequalities that exist today in the European Union, where we have a life expectancy variation of more than ten years from one Member State to the other.

Patient mobility is an important issue. It is a reality that we have to deal with. We will produce proposals in that respect. But the target should be that patients be offered a high level of treatment where they live, where their families are, where they speak the language. That can be achieved through programmes of centres of reference, exchange of best practices, coordinating Member States, coordinating healthcare systems and working together and achieving the highest level of service. I repeat: that would not interfere with the issues of competence and subsidiarity.

We are working not only with ‘blockbusting’ medicine; on the contrary, I would like to remind you that there is provision in the programme for rare diseases, which is also followed by orphan drugs. We are promoting that area as well.

As regards tobacco, I could not agree more, and I would be very happy if we ever have the opportunity to have a specific debate on the tobacco area. The issue of subsidies is correct, but I would also like to add that subsidies will eventually be phased out and that is a decision which has already been taken, but the tobacco fund that we financed in European-level campaigns gets money through those subsidies. Once the subsidies finish, we will have no more money left for Europe-wide campaigns on tobacco, so that, again, is an impossible situation and I hope we come up with a solution in the near future.

As regards alcohol, I would like to remind you that by the end of this year, or some time after the summer, we will produce the Community strategy proposal for a European strategy on alcohol. I have noted the comments made about pesticides.

On financing, I would like to address Mrs Doyle: I raise an accounting error – or, at least, I hope it is an accounting error – because I cannot really believe that it was intentionally decided to reduce the funding of health and consumer protection. I hope in the overall arrangement that somebody noticed the impact that compromise would have on those two specific areas, which means it can be corrected. If it was intentional, then I very much regret that and I cannot say much more than that.

On the issue of complementary medicine, I have noted the comments made. We feel that this is more of an area of subsidiarity. The Commission proposal does not deal with specific medicine as such.

Regarding environment and health – I am addressing Mrs Ries – we already have measures under the current programme and they will continue under a new programme especially as regards environmental determinants on health.

Coming to the various diseases, I can assure you that cancer is our priority among other diseases, but we have included a new strand which provides for the reduction of disease burden, but we believed that in a seven-year programme we needed more flexibility, so we do not list specific diseases; however, that can be done through different decisions that can be taken in the course of the programme. By listing some diseases, you effectively exclude others, so we wanted a more flexible approach on this.

I would also like to remind the Members that I will be bringing forward a proposal on the health strategy, which will be more detailed and will elaborate on the programme based on the funding that we will eventually obtain; so there will be a fully-fledged, broader strategy and that will be done together with the stakeholders and citizens.

In conclusion, I would like once again to thank Mr Trakatellis for the excellent job he has done, as well as the members of the committee. I thank you again for your support in this very important policy area.

(Applause)

  President. – The debate is closed.

We all thank Mr Trakatellis, once again, for his excellent work.

The vote will take place today at voting time.

Annex - Position of the Commission

Trakatellis report (A6-0030/2006)

The Commission can accept Amendments 4, 6, 7, 8, 9, 11, 12, 13, 17, 20, 21, 22, 24, 25, 30, 34, 35, 36, 44, 51, 55, 59, 60, 61, 65, 66, 69, 70, 72, 78, 80, 84, 85, 86, 88, 99, 100, 101, 102, 103, 106, 108, 111, 113, 119, 120, 122, 123, 124, 126, 132, 135, 139, 146 and 149.

Amendments 16, 31, 32, 56, 57 and 90 can be accepted in part.

Amendments 10, 14, 23, 26, 27, 28, 29, 39, 46, 50, 63, 67, 71, 73, 79, 81, 91, 110, 115, 116, 118 and 137 can be accepted subject to modifications.

The Commission cannot accept Amendments 5, 33, 47, 54, 58, 64, 68, 82, 83, 89, 95, 96, 98, 104, 105, 112, 128, 130, 141, 142, 143, 145, 147, 148, 150, 151, 152, 153, 154, 155, 156 and 157.

The Commission rejects mainly on grounds of split or resources Amendments 1, 2, 3, 15, 18, 19, 37, 38, 40, 41, 42, 43, 45, 48, 49, 52, 53, 62, 74, 75, 76, 77, 87, 92, 93, 94, 97, 107, 109, 114, 117, 121, 125, 127, 129, 131, 133, 134, 136, 138, 140 and 144.

(Amendments underlined are new amendments tabled by political groups on 8 March 2005.)

(1) Commission position on Parliament's amendments: see Minutes.