Dineke Zeegers Paget, Executive Director of the European Public Health Association (EUPHA) believes that there is a vital need for strong guidance in public health at the European level and as such, nobody should be left behind
The 2017 Eurobarometer, published in April 2018, concludes that European citizens find having good health as the most essential factor for getting ahead in life (endorsed by 48% of the respondents).1 The Organisation for Economic Co-operation and Development (OECD) notes that there is a growing interest in the potential for preventive interventions to improve health status in OECD countries and to tackle remaining health inequalities.2 But in all the discussions going on at the moment – such as the upcoming European elections and discussions on the future of the European Union (EU) – the benefits of investing in health seem to disappear from sight. In the current discussions taking place, the questions about whether we need a dedicated Health Commissioner at EU level and a specific health programme are ones that are debated. However, this is not going in the direction we want to take.
Natasha Azzopardi Muscat, European Public Health Association (EUPHA) President from 2016-2020 is very clear that there is a role for health at European level: “EUPHA is calling for a renewed and updated health strategy that clearly places health priorities at the heart of EU policy. Europe has a role and responsibility to play not only in upholding the highest standards to protect the health of European citizens but also by exerting a normative political influence on the importance of health as a value binding people in the new world order.”3
European public health has advanced considerably since 1992, a year that marks the birth of European public health, with an article specifically dealing with public health adopted in the Maastricht Treaty. Article 129 calls for more collaboration between countries and community action for the prevention of diseases, in particular, the major health scourges, including drug dependence, by promoting research into their causes and their transmission, as well as health information and education.4 But since Maastricht, things have changed. First, public health practitioners are facing considerable challenges with the ageing population and the increase in migration. Second, the political landscape, the after-effects of the financial crisis and the new ways of communication are influencing the perception of public health. For instance, the measles eradication was so successful that people seem to have forgotten the illness, as well as the positive effects of vaccination and, are now increasingly hesitant to get vaccinated. This resulted in new measles outbreaks happening throughout Europe.
The political landscape has changed enormously over the past years and political disruptions cause uncertainty on many issues including health. For instance, the decision of the Italian government to reverse the decision to make childhood vaccination mandatory, the head of Italy’s national health research organisation, Prof Walter Ricciardi, being forced to quit because of the “anti-scientific” policies of the country’s populist government.5 The active campaigning for health after Brexit by Faculty of Public Health in the UK is another example.6 And the Austrian government abandoning a smoking ban in bars and restaurants set in motion by the previous government is the third example.7
Combine this time of political disruptions with the discussions on whether health should or should not be a priority in the EU and you have a volatile situation – inevitably requiring us to reconsider our approach to public health policies and politics. Several initiatives and actions to support the public health community to address the politics of public health have already been taken. In our recently published supplement to the European Journal of Public Health “How to Navigate Political Landscapes: Towards a Public Health Political Science”,8 we summarise key political science concepts to provide the public health community with tools and methods for how to integrate public health knowledge into the sphere of decision-making. In April 2018, several key European health-related nongovernmental organisations published a joint statement asking to do more for health at European level.9 The six asks formulated are self-explanatory:
- Establish strong leadership on health.
- Adopt EU-level legislation to prevent diseases.
- Develop a framework for tackling non-communicable diseases.
- Support national health systems with expertise and evidence.
- Empower citizens and patients.
- Assess the impact on the health of EU policies.
The EU should lead by example in this case, offering guidance, evidence and advice to all European countries to ensure that the health of Europeans is at the centre of everything. This will demand a joint effort from the public health community, from the EU and from politicians. As Natasha Azzopardi-Muscat states in her latest column:10
“At this point in which the EU is elaborating the future Multiannual Financial Framework (MFF), Horizon Europe as well as international aid and development programmes, we need to engage in discussion around the metrics and key performance indicators. These play a large role in determining where the efforts, investment and resources in Europe will be directed in the next decade. Health cannot be allowed to be left behind and EUPHA will be playing its part to ensure that nobody is allowed to forget this.”
2 Bennett, J. (2003), “Investment in Population Health in Five OECD Countries”, OECD Health Working Papers, No. 2, OECD Publishing, Paris, https://doi.org/10.1787/073776747532
3 https://academic.oup.com/eurpub/article/28/1/199/4811972 last accessed 25 January 2018.
Dineke Zeegers Paget
European Public Health Association (EUPHA)
Director of the EPH Conference Office
Tel: +31 30 2729 709
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