Editorials |
The future of public health in the European Union
Ilmo Keskimäki
President, Society for Social Medicine Finland
President Elect European Public Health Association
Correspondence: Ilmo Keskimäki, MD, PhD. Director of Division, Health Services Research, STAKES National Research and Development Centre for Welfare and Health P.O. Box 220, 00531 Helsinki, Finland, tel: +358 9 3967 2256; fax: +358 9 3967 2278; e-mail: ilmo.keskimaki{at}stakes.fi
The role of the European Union (EU) in influencing health policy in its member states has a long history. In 1951, the treaty on the European Coal and Steel Community comprised articles on occupational safety and health. Since then the scope of the health policy activities of the community and its followers has broadened considerably. In principle, the EU has a strong legal basis to take health into account in its activities. The Union's Amsterdam Treaty from 1997 states ambitiously that ‘A high level of human health protection shall be assured in the definition and implementation of all community policies and activities’. This gives a good ground for the recent initiative ‘Health in All Policies’ by the Finnish Government (see the accompanying editorial by Puska in this issue). As public health research highlights: virtually all societal decisions have implications for health. Unfortunately, these implications have not been recognised widely enough in the EU and, in practice, health has not belonged to the hard core of its policymaking.1
The European Commission has, nevertheless, recently increased its activities in health policy. Last year, the Health and Consumer Protection Directorate General (DG SANCO) issued a discussion document2 on operational aspects of health policy strategy which the Commission is planning to adopt this year. The Commission has also organised an open consultation on its actions on health services.3 Besides DG SANCO, other directorates have tackled issues directly relevant for public health. The Employment, Social Affairs and Equal Opportunities DG have just published a discussion paper on inequalities in health and access to health care.4
Drawing from this growing interest in health policy and acceptance of its links to other policies, European decision makers have increasingly realised the association between health and wealth. ‘Wealth brings health’ is a common wisdom but there is a reverse causation as well.5 In its current strategy, that is, the ‘Lisbon Agenda’ in EU slang, the EU aims to develop a knowledge-based economy and to strengthen employment, economic reform and social cohesion. It is clear that these goals cannot be reached without improving physical and mental health in the member countries and decreasing health disparities between and within them. Considering the values of public health it may sound unethical to ground health protection and health promotion on economic objectives. For us, public health people, health and its even distribution represent a normative value, not a means to achieve other goals. Personally, I am inclined to think that we may have to accept to compromise with economic policymakers, and admit that we can find a common good cause here.
More action on health is incompatible with the unacceptably weak institutional position of health policy in the EU.6 To give an example: the Union’s 2007 budget allocates 
40 million for the public health programme, while 36.9 billion will be disbursed as direct aids to farmers. My aim is not to criticise the support to farmers which may have a strong social policy rationale in many countries, but to argue that the capacity to tackle health challenges in the EU should be strengthened. This capacity is needed to guarantee that the EU is truly able to adopt the commitment of the Amsterdam Treaty on a high level of health protection. This is even more vital in a situation in which the increasing economical and political integration of the Union countries is narrowing national options to define health policy. Moreover, in many cases, national policies are not effective to respond to public health challenges becoming increasingly globalized. The consequences of global warming, infectious diseases, and environmental pollution as well as drugs, tobacco, alcohol or the epidemic of obesity—just to mention few collective threats—do not respect national borders. There is a genuine added value to act together and a need for common measures in order to tackle these challenges.7
A strengthened basis of health policy in the European Commission is not sufficient, however. Whether the structures to formulate and implement health policy in the EU are weak or strong, these structures need support from the national level. We, public health people in the member countries, should see ourselves as stakeholders in EU public health and health policy. We should understand that influencing policy making at the EU level is an effective way to impact on public health at home and in our neighbouring countries. Public health institutes, academic departments, and professional and scientific associations should accept this responsibility. In the current Europe, supporting the development of EU health policy and public health activities is part of their duties. Their expertise is needed to assure that policies to be adopted are evidence-based and effective. The future of European public health is in our hands.
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 Top References |
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1 Ollila E, Lahtinen E, Melkas T, et al. Towards a healthier future. In: Health in All Policies. Prospects and Potentials—Ståhl T, Wismar M, Ollila E, et al, eds. (2006) Helsinki: Ministry of Social Affairs and Health.
2 European Commission. Health and Consumer Protection Directorate-General. Health in Europe: A Strategic Approach. Discussion Document for a Health Strategy. http://ec.europa.eu/health/ph_overview/Documents/strategy_discussion_en.pdf.
3 Communication from the Commission. Consultation regarding Community action on health services. Commission of the European Communities. Brussels: 26 September 2006.
4 European Commission. Employment, Social Affairs and Equal Opportunities Directorate-General. Inequalities in health outcomes and access to care. Discussion paper for the Social Protection Committee. April 2007.
5 Suhrcke M, McKee M, Sauto Arce R, et al. The Contribution of Health to the Economy in the European Union. (2005) Luxembourg: Office for Official Publications of the European Communities.
6 Koivusalo M. Moving health higher up the European agenda. Ståhl T, Wismar M, Ollila E, et al, eds. (2006) Ministry of Social Affairs and Health. Health in All Policies. Prospects and Potentials. Helsinki.
7 Brundtland GH. Public health challenges in a globalizing world. Eur J Public Health (2005) 15(1):3–5.
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