What is the future of Public Health Policy within the European Union?

The future of Public Health Policy within the European Union (EU) institutions is currently attracting considerable debate. Since achieving a mandate for public health under the Maastricht Treaty in 1993, the EU has been responsible for implementing important public health policies, for example in the area of tobacco control. Much more however remains to be achieved.¹ As the commercial and political determinants of health become increasingly shaped at supra-national levels, there is a clear and pressing need and role for an EU that is actively and visibly at the forefront promoting improvement for the health of European citizens. The EU has a vital role to play in enabling and supporting all Member States to reach the targets set by the Sustainable Development Goals—the vast majority of which will improve health—and assisting other countries with Sustainable Development Goal implementation. The goals are interconnected and provide strong support for health in all policies, also at EU level: the European Commission is commitment to mainstream them into their own priorities.

Earlier this year Europeans celebrated 60 years since the Treaty of Rome established the four freedoms as pillars of the EU, embracing the promotion of its peoples’ well-being as one of its key aims. Quality-of-life for European citizens has improved significantly over the past decades and today European citizens can expect to live around 80 years on average with most of their life being spent in good health. There is no doubt that this reflects the economic and social development that has been enabled by the EU. Yet gains in life expectancy are slowing or even stagnating in some EU Member States and in many EU countries virtually no healthy life years have been gained in our current decade. It is increasingly clear that many people in Europe are struggling to live decently, while health inequalities within and between Member States are widening.

EUPHA, along with a large number of European health organizations, adopted the Vienna Declaration at the European Public Health Conference in November 2016.² This reviewed the many new challenges facing public health and highlighted the renewed impetus needed for measures to improve health and well-being of European citizens for the 21st century. Reflecting on those challenges, EuroHealthNet developed a 10-step framework to rejuvenate health promotion approaches within the context of the UN Agenda 2030.³

There now appears to be a growing consensus that at a time when the determinants of health (or ill-health), have become globalized, the effort to tackle these unhealthy influences, which lead to much chronic illness and disability, must equally lie at a supra national level. All European countries face challenges related to demographic change, sustainability of health systems, migration and climate change and have more in common with each other in terms of unhealthy diets, overconsumption of alcohol, tobacco use and inactivity.

In March 2017, the European Commission published a White Paper on the Future of Europe as an opportunity to reflect on the direction that the EU might take in the coming years.⁴ While the White Paper outlined different scenarios for the possible development of the EU in the years to come this paper has also raised serious concern in public health circles that public health risks being further sidelined from the European agenda. The future of public health research and policy is at stake. The Council and the European Parliament now need to respond and a citizens’ consultation process has been launched. We look forward to seeing a response that places health and wellbeing of European citizens as a foremost policy objective for the EU in the future.

The call within the White Paper for the EU to lead the way in addressing policy on climate change is commendable. However, suggesting public health as an example of an area where the EU should consider doing less in the same paper is a prime example of policy inconsistency. A health in all policies approach is enshrined in the European Treaty and this should be the way forward. Health is an outcome, it is a European value. Furthermore, health contributes to strengthen economic development and social cohesion and can serve to further bind and bring together the diverse European communities.

The European Pillar of Social Rights⁵ presents an important opportunity to address complex public health issues. Each of the 20 principles of the Pillar can have an important role in reducing health inequalities. The inclusion of the right to access health services as a component in the proposed Social Pillar builds on the EU’s Charter of Fundamental Rights, yet has been met with reservations by some Member States.

As the EU institutions have embarked on a process to reengage with European citizens, doing more in the area of health together at a European level should be the undisputed way forward. Policy decisions that impact on health matter enormously to voters. A recent Eurobarometer survey bears this out: 70% of EU citizens want the EU to do more in health and social security.⁶

The EU is at a crossroads. It is hoped that the path taken will be one that strengthens its remit in relation to communicable diseases and broadens its remit in addressing other public health priorities, including non-communicable diseases. Most importantly, the EU must step up to its Treaty obligation to promote well-being, protect health in all policies and start using its legal mandate to the fullest extent to protect and improve health, including ironing out inconsistencies such as health-harmful subsidies, in other policy areas.

Finally, public health and health systems research must remain at the top of the agenda in order to enable European solutions, informed by evidence, to assist policy-making in these challenging times. As the debate on a new EU framework programme for Research and Development is taking shape, our organizations are ready to share our knowledge agenda, so we can really invest in the healthy European future we want.⁷

Conflicts of interest: None declared.