Public health
Public health policy has recently taken centre stage in EU policymaking with the COVID-19 pandemic, Parliament making cancer one of its areas of focus and the push towards a stronger European Health Union. The European Health Union initiative addresses immediate and future health concerns, building resilience against cross-border health threats, implementing the Beating Cancer Plan, advancing the Pharmaceutical Strategy for Europe and enhancing digital health.
Legal basis
Article 168 (public health), Article 114 (single market) and Article 153 (social policy) of the Treaty on the Functioning of the European Union (TFEU) and Article 35 of the Charter of Fundamental Rights of the European Union (the Charter).
Objectives
EU public health policy aims to:
- protect and improve the health of EU citizens;
- support the modernisation and digitalisation of health systems and infrastructure;
- improve the resilience of Europe’s health systems;
- better equip EU countries to prevent and address future pandemics.
Context
The Maastricht Treaty of 1992 created a clear legal basis for the adoption of health policy measures. Subsequently, the Amsterdam Treaty of 1997 strengthened these provisions, enabling the EU to adopt measures ensuring a high level of human health protection.
The emergence of major health issues, coupled with the free movement of patients and health professionals within the EU, and the socio-economic consequences of health issues, mean that public health has attained an ever more prominent position on the EU agenda. The setting up of specialised agencies such as the European Medicines Agency (EMA) and the European Centre for Disease Prevention and Control (ECDC) underlined the EU’s growing role in health policy. Agencies like the European Chemicals Agency (ECHA) and the European Food Safety Agency (EFSA) further contribute to strengthening European health policies. The EU4Health programme was adopted as a response to the COVID-19 pandemic and to reinforce crisis preparedness in the EU. The COVID-19 crisis generally intensified efforts, emphasising collective resilience and cross-border health security, driving the EU towards a robust European Health Union.
The general objectives of the European Health Union for 2021-2027 focus on immediate and enduring health concerns. These span from addressing the COVID-19 crisis, fortifying defences against cross-border health risks, implementing initiatives like Europe’s Beating Cancer Plan, the Pharmaceutical Strategy for Europe and advancing digital health. The EU will also persist in collaborating globally to tackle health challenges, including developing vaccines and tackling antimicrobial-resistant infections.
Achievements and current developments
A. Health in All Policies (HiAP)
The HiAP approach, formulated as an EU approach in 2006 and codified in Articles 9 and 168(1) TFEU and Article 35 of the Charter, responds to the cross-sectoral nature of public health issues and aims to integrate health aspects into all relevant policies so as to improve population health and health equity. For example, the ‘Farm to Fork’ strategy contributes to the production of not only sustainable, but also healthier food; the zero pollution action plan creates a cleaner and also healthier living space; the EU4Health Programme (2021-2027), together with other funds and programmes, helps address health issues from multiple perspectives. Several policies aim to prevent the damage to health from climate change, such as the increasing number of deaths due to heatwaves and natural disasters, and changing patterns of infection for water-borne diseases and diseases transmitted by insects, snails or other cold-blooded animals.
B. Disease prevention and health promotion
Prevention activities in the EU encompass a wide range of areas, including initiatives against cancer, communicable and non-communicable diseases (NCDs), vaccination and combating antimicrobial resistance (AMR).
Cancer is the second leading cause of death in the EU. Its impact extends beyond personal and familial spheres, affecting healthcare systems and overall economic productivity. Cancer is addressed at European level through several initiatives. Parliament set up a dedicated Special Committee on Beating Cancer (BECA) (2020-2022), which examined the measures that the EU could implement to combat cancer. Europe’s Beating Cancer Plan covers prevention, early diagnosis, treatment and follow-up, and represents the EU’s reaction to the increasing challenges in the field of cancer management. In September 2022 the Commission presented a new approach to support Member States’ efforts to boost the uptake of cancer screening. The objective of the plan is also to raise the participation rate in breast, colorectal and cervical cancer screenings to 90% of eligible individuals by 2050.
In December 2021, the Commission launched the ‘Healthier together – EU non-communicable diseases initiative’ to assist EU countries in reducing major NCD burdens and enhancing citizens’ well-being. It is estimated that more than 84 million people in the EU are struggling with mental health problems. The EU Joint Action on Mental Health and Well-being ran from 2013 to 2018, and created the European Framework for Action on Mental Health and Wellbeing, which contributes to the promotion of mental health. With suicide being the second main cause of death in the 15-29 age group, prevention, awareness, non-stigmatisation and access to help remain of key importance. On 13 September 2022, in a resolution concerning the effects of COVID-19 on young people, Parliament called on the Commission to establish a European Year of Mental Health. Cardiovascular disease represents the biggest cause of death in the EU. Drugs, alcohol and tobacco use are lifestyle factors with a serious impact on human health and the fight against them is a major issue in public health policy. The Tobacco Product Directive (Directive 2014/40/EU) and the Tobacco Tax Directive (Council Directive 2011/64/EU) were milestones in this fight. The use of drugs also generates costs for and harm to public health and safety. In December 2020, the Council approved the new 2021-2025 EU Drugs Strategy. The document establishes an overarching political framework and sets out strategic priorities for EU policy on illicit drugs under three main strands: drug supply reduction, drug demand reduction and addressing drug-related harm. Efforts to revise the 2006 EU Alcohol Strategy are currently stalled.
For communicable diseases and cross-border threats to health, the ECDC has put in place an Early Warning and Response System and the EU Health Security Committee coordinates the response to outbreaks and epidemics. Cooperation with the UN’s World Health Organization (WHO) is pivotal in these cases, as was seen with the outbreak of the COVID-19 pandemic in early 2020. Many ad hoc measures were adopted under urgency procedures (see the dedicated EUR-Lex webpage and the Commission coronavirus response webpage).
In 2022, the EMA’s mandate was extended and a new regulation on serious cross-border health threats extended the ECDC’s mandate and provided extra powers to the European Health Emergency Preparedness and Response Authority (HERA).
C. Societal changes, demographic transition
The 2023 Commission Report on Demographic Change explores challenges arising from ageing, population decline and reduced numbers of working-age individuals. Addressing the EU’s ageing population, ensuring a high quality of life in old age and sustainable healthcare systems are key challenges. In 2020, the WHO launched the Decade of Healthy Ageing, and in this context, the Commission published a green paper on ageing in January 2021.
In response to the challenges posed by the migration crises, the Action Plan on the Integration of Third-Country Nationalswas adopted in 2016. The action plan addresses, inter alia, health-related disadvantages experienced by migrants, including access to health services. In 2020, the Commission put forward the European Agenda for Migration and the New Pact on Migration and Asylum, which aim to further streamline European policies in this area.
Back in 2015, Parliament called for action to reduce childhood inequalities in areas such as health, and for the introduction of a Child Guarantee in the context of an EU plan to combat child poverty. In June 2021, the Commission’s proposal to establish a European Child Guarantee was adopted by the Council. As a first step, Member States submitted national plans outlining how they will implement the Child Guarantee up until 2030, to be reviewed every two years.
D. Medicines (2.2.5)
A medicinal product (medicine) is a substance or combination of substances that is used for the treatment or prevention of diseases in human beings. Directive 2001/83/EC and Regulation (EC) No 726/2004 lay down the requirements and procedures for marketing authorisation, as well as the rules for monitoring authorised products. Regulation (EU) 2019/1243 brought changes to this legislation, implementing particular actions aimed at guaranteeing the accessibility of medications and handling shortages across the EU. The EMA is responsible for facilitating development of medicines, evaluating marketing authorisations, monitoring the safety of medicines and providing information to healthcare professionals. Clinical trials investigate the effectiveness and safety of medicines in humans. Regulation (EU) No 536/2014, which took effect in January 2022, established harmonised rules for the authorisation and conduct of clinical trials in the EU.
As part of the ongoing revision of the general pharmaceutical legislation, the Commission presented its Pharmaceutical Package in April 2023 (approved by Parliament on 10 April 2024), aiming to make medicines more available, accessible and affordable. At the same time, it proposed a Council Recommendation to step up the fight against AMR, based on a One Health approach, which was adopted on 13 June 2023.
E. eHealth
The EU is in the middle of a digital transformation of healthcare systems. The digitalisation of health refers to the integration of digital technologies and information management systems into various aspects of the healthcare industry. It involves the use of electronic health records (EHRs), telemedicine, wearable devices, mobile apps, data analytics and other digital tools. The digitalisation of the healthcare sector forms part of the EU’s digital single market strategy, which aims at closer digital harmonisation between the EU Member States.
The eHealth Network is a voluntary network set up under Article 14 of Directive 2011/24/EU which provides a platform for Member States’ competent authorities dealing with eHealth. The 2018 Commission communication on the Digital Transformation of Health and Care in the Digital Single Market identifies as priorities secure access by citizens to their health data (including cross-border), personalised medicine and better research through shared EU data infrastructure and empowering citizens with digital tools for user feedback and person-centred care (mobile health solutions, personalised medicine). The eHealth Digital Service Infrastructure ensures the continuity of care for European citizens while they are travelling abroad in the EU. The May 2022 legislative proposal for a European Health Data Space (EHDS) seeks to empower EU citizens to control their health data, enabling cross-border use for research and innovation while ensuring data protection compliance. On 24 April 2024, Parliament approved the provisional agreement reached with the Council on the EHDS.
F. Health Technology Assessment (HTA)
HTA aims to offer evidence-based data on health technologies to ensure safe, effective, patient-focused and cost-efficient health policies. National authorities also use HTA findings to guide decisions about which technologies should be reimbursed at the domestic level. HTA assesses the added value of health technologies including medicines, medical devices and diagnostic tools, surgical procedures, as well as measures for disease prevention, diagnosis or treatment. A new regulation for assessing health technologies was adopted in December 2021 and will gradually apply as of January 2025.
Role of the European Parliament
Parliament has continuously promoted a consistent public health policy through numerous opinions, studies, debates and reports. In 2019, it adopted a more proactive agenda-setting role with its push to make beating cancer a top priority of EU health policy. During the COVID-19 crisis, Parliament took an active role in promoting a coordinated European response and underlined the need for stronger cooperation in the area of health to create a European Health Union.
The Committee for Environment, Public Health and Food Safety (ENVI) is Parliament’s main actor on health matters. In early 2023, the ENVI Committee set up a new permanent Subcommittee on Public Health (SANT) that will reinforce Parliament’s role in exercising scrutiny over EU health policies and promoting their development. Parliament also put the need for a more coordinated European approach to fighting cancer high on the political agenda in its current 9th legislative period, with the establishment of a Special Committee on Beating Cancer.
Parliament insisted on a standalone European health programme, securing support for EU4Health. It also scrutinises the implementation of the Recovery and Resilience Facility through dialogues, questions, studies and internal research, emphasising the importance of health reforms. Parliament has also consistently advocated for the advancement of mental well-being in EU policy formulation.
For more information on this topic, please see the websites of the Committee on the Environment, Public Health and Food Safety and the Subcommittee on Public Health.
Filip Karan / Christian Kurrer