1. Moving towards 2020 – priorities for Public Health for the years 2013-20

2. Health in the MFF
THE CHALLENGES
- increasingly challenging demographic context threating the sustainability of health systems
- fragile economic recovery limiting the resources available for investment in healthcare
- increase of health inequalities between/within Member States
- increase in chronic diseases prevalence
- pandemics and emerging cross-border health threats
- rapid development of health technologies
Commission proposal for the Health for Growth Programme
Adopted in November 2011
7 years, proposed budget of €446 million
Other Programmes for health: Horizon 2020, Structural funds

3. The future Health Programme, a tool for investing in health, aligned with
the Europe 2020 Strategy for an intelligent, sustainable and inclusive growth, and
the EU Health Strategy " Together for Health" and its shared principles and objectives
Taking forward work already started in the current Health Programme , and supporting EU health legislation including legislation on medicinal products and medical devices

4. The scope and objectives of the Programme
1) Promote health, prevent disease and foster supportive environments for healthy lifestyles
2) Protect citizens from serious cross-border health threats
3) Contribute to innovative, efficient and sustainable health systems
4) Facilitate access to better and safer healthcare for Union citizens
Negotiations are still on going; the content of this presentation does not preempt the final text of the Programme Regulation expected to be adopted by the end of 2013

5. Major chronic diseases
Health systems
Environment
Mental Health
Cancer
Lack of physical activity
Musculo-skeletal Diseases
Neuro- degenerative Diseases
Genetic Background
Obesity
Over nutrition
The good news is actually that most of the diseases that people suffer from
are preventable.
We know that smoking, alcohol-related harm, eating an unhealthy diet,
the lack of physical activity can lead to chronic health problems,
in particular later in life.
Tobacco Alcohol
cardiovascular disease
Diabetes
Chronic obstructive pulmonary disease
Social factors
Communicable diseases

6. DALYs: WHO-EURO (projections for 2015)‏
WHO considers the rise in chronic diseases an epidemic and estimates that
this epidemic will claim the lives of 52 million people in the European Region
by It is important to mention that up to 80% of healthcare costs are spent
on chronic diseases.
This corresponds to €700 billion in the European Union and this number is
expected to increase in the coming years .
About 97% of health budgets are presently spent on treatment, while only 3%
is invested in prevention.
Therefore, the challenge of chronic diseases must be addressed at all relevant
levels – from communities to policy makers – and across policy fields.
Disease burden in the WHO-EURO Region, Projections for DALYs: Standard DALYs (3% discounting, age weights) - Baseline scenario. Source: WHO

7. Economic impact of chronic diseases
In 2011, public health expenditure amounted to 15% of total government expenditure, according to Eurostat. Health is the second biggest sector of spending after Social protection (which includes pensions, unemployment and other social benefits), and before General public services
Chronic diseases are responsible for 78% of health care expenditure in Europe. To give an example, the management of diabetes and related complications accounted for 89 billion Euros only in 2011 across Europe.

8. EU work on chronic diseases
Action on risk factors and health determinants
Nutrition and physical activity strategy
Alcohol related harm strategy
Tobacco legislation and campaigns
EU strategy on health inequalities
Disease specific initiatives
Cancer, Alzheimer…
Health systems
European Innovation Partnership on active and healthy ageing
Reflection process on sustainable health systems
Reflection process on Chronic disease
Support through financial mechanisms (EU Health Programme, Research)

9. Disease Specific Actions
CVD: The EC supported the European Society of Cardiology and the European Heart Network, to develop the first European Heart Health Charter designed to prevent CVD)
Cancer: Guidelines on screening, European Partnership for Action Against Cancer
Mental health: European Pact for Mental Health and Well-being
HIV/AIDS: EC Communication on HIV/AIDS (2009) and accompanying action plan
Health workforce: Joint action for the EU workforce for health
European initiative on Alzheimer’s disease and other dementias
Large range of Health Programme funded activities
Moreover, we have some disease specific actions such as our work on cancer, rare diseases, on Alzheimer’, and on HIV/AIDS, which also contribute to address chronic diseases

10. screening early diagnosis Independent living & active ageing
European response – an example initiative European Innovation partnership on Active and Healthy Ageing
crosscutting, connecting & engaging stakeholders across sectors, from private & public sector
specific actions
Improving prescriptions and adherence to treatment
Better management of health: preventing falls
Preventing functional decline & frailty
Integrated care for chronic conditions, inc. telecare
ICT solutions for independent living & active ageing
Age-friendly cities and environments
Pillar I
Prevention
screening early diagnosis
Pillar II
Care & cure
Pillar III
Independent living & active ageing
+2 HLY by 2020
Triple win for Europe
health & quality of life of European citizens
growth & expansion of EU industry
long-term sustainability & efficiency health and social care systems
CONTRIBUTION FROM 02

11. Issues to be considered
Issues and challenges
Balance of prevention (3%) and treatment (97%)
Demographic change: ageing
Innovation – new technologies and processes
Role of the EU and added value
Address risk factors – building on established action
A role in better prevention? Support Member States in modernising health systems?
Develop the evidence base, improve information, collect and exchange good practice

12. EU Chronic Disease Reflection Process
Consultation of stakeholders (80 submissions); HPF input (May 2012)
Interim report agreed with the Council's Senior Level Working Party on Public Health in September 2012
 Identified 2 main priorities for EU action on chronic diseases:
- Prevention & health promotion
- Disease management with an emphasis on patient empowerment.

13. EU Chronic Disease Reflection Process first outputs
Joint action on chronic diseases
Collection, validation and dissemination of good practises to address chronic conditions
Diabetes: a case study on barriers to prevention, screening and treatment of diabetes and improvement of cooperation among Member States to act on diabetes 
Development of common guidance and methodologies for care pathways for multimorbid patients
Study on empowering patients with chronic diseases

14. The reflection process on chronic diseases: next steps
Report discussed in Council Senior Level Working party, 8 October 2013 – Input into Health Council considerations
Risk factor and disease specific action will continue
Innovative preventive actions based on social media, behavioural science and new technologies
Innovation Partnership
More streamlined health information
More efficient use of EU funding and policies in the context of the chronic disease prevention and management
EU summit on chronic diseases in 2014

15. Further challenges – Some thoughts
Make health promotion more effective
Targeted
New insights – behavioural economics
New technologies
Better win-win and integration across policies
Link better health promotion/prevention/screening
Health integrated services (health/social, hospitals/community, public/private)
Healthy ageing, involvement in the second half of life
Many future challenges are there to be faced. How to make health promotion more effective, how to link better health promotion with prevention and screening, how to create health integrated services and last but not least how to make healthy ageing a reality. We have different options for efficiently addressing these challenges, but we believe that only a constant discussion and a more close dialogue and joint approaches with Member States and stakeholders will make the future steps really meaningful for Health Promotion in Europe.

16. Increase of disability benefit claims due to mental disorders
Percentage of new disability benefit claims per year for mental disorders for selected European countries (OECD, 2011)

17. Joint Action on Mental Health and Well-being including Work Package "Mental Health at the Workplace"
Co-financed from EU-Health Programme and by participating Member States (associated partners), 26 Member States plus Iceland and Norway
Joint Action lead: Portugal (coordinator: Prof José Miguel Caldas de Almeida, NOVA University of Lisbon), Duration: three years ( ), financial volume: € 3 million (EU 50%)
Objective: to establish a common framework for action on mental health, and to:
Assess scientific knowledge
Analyse situations in participating Member States
Identify and exchange good practices
Develop policy recommendations

18. Study for DG SANCO into "Economic benefits of workplace mental health promotion and mental disorder prevention interventions" (Matrix Insight UK)
The study's results suggest that the net economic benefits generated by such programmes can range between €0.81 to €13.62 for every €1 of expenditure in the programme.
The net economic benefits (reduced costs and lost output) generated by these programmes range from -€3 billion to €135 billion.
From the perspective of employers, some of the interventions do not generate sufficient benefits to outweigh the costs.
Measures put in place to combat the impact of mental health disorders in the labour market do not fall under one specific public department; rather they are a collaborative effort between departments and government agencies.
Study available as download under: mh_promotion_en.pdf 18

19. The Strategy for Europe on Nutrition, Overweight and Obesity-related Health Issues
The Strategy relies on a voluntary, partnership based approach using two key tools of implementation:
The High Level Group for Nutrition and Physical Activity (HLG): Member States coordinated activities
Facts:
More than half (52%) of the adult population in the European Union are overweight or obese.
The rate of obesity has more than doubled over the past 20 years in most EU countries for which data are available.
On average 1 in 3 children in the EU aged 6-9 years old are overweight or obese.
Main purpose of the Strategy: To contribute to the reduction of the risks associated with poor nutrition and limited physical activity in the European Union
The Strategy promotes action in six priority areas: better informed consumers, making the healthy option available, encouraging physical activity, focus on vulnerable groups, develop the evidence base, develop monitoring systems.
High Level Group: One of the first priorities: Salt Reduction of a minimum of 16 % over 4 years - Helped to increase dialogue between governments and the industry. Since June 2012: Also focus on saturated fat.
Platform: Since 2005 a multistakeholder approach, 33 EU Platform members: Industry – including primary production, Public Health NGOs, Health Professionals, Consumer Groups – Voluntary commitments
The EU Platform for Action on Diet, Physical Activity and Health: EU Stakeholder commitments
efficient action on dietary and physical activity habits requires a concerted response across society.

20. Physical activity promotion
Health-enhancing physical activity is a priority of the Strategy for Europe on Nutrition, Overweight and Obesity-related Health Issues
The EU Physical Activity Guidelines (2008)
Recommending a minimum of 60 minutes of daily moderate-intensity physical activity for children and young people.
30 Platform commitments in the area of physical activity
'Now We Move' campaign is an excellent way of raising awareness about the health benefits of sports and physical activity (7-13 October 2013)
Facts: It is worrying that only one in five children in the age group report taking regular moderate to vigorous exercise. It is also of concern that rates of physical activity tend to drop amongst children in this age group in most European countries.
Health-enhancing physical activity is at the heart of the Strategy and a number of actions have been launched through the Health Programme, the EU Platform and through other EU policies.
The EU Physical Activity Guidelines recommend that children and young people undertake a minimum of 60 minutes of moderate intensity physical activity every day.
EU Platform members actively promote physical activity through individual commitments. For example, the European Association of Communications Agencies (EACA) and the European Cyclists' Federation (ECF) promote and encourage cycling to work as a way incorporating exercise into people's daily lives. The International Sport and Culture Association (ISCA) is another good example. They promote physical activity through the MOVE forum and by coordinating the 2013 MOVE week, where people of all ages can participate in variety of sport and physical activity initiatives across Europe.
MOVE Week: Monday October 7 to Sunday October 13, 2013: The European MOVE WEEK is an annual Europe-wide campaign week promoting sport and physical activity and their positive impact on European societies.

21. Physical activity promotion (II)
The Commission proposal for a Council Recommendation on health-enhancing physical activity (HEPA) - In order to address the high rates of physical inactivity in Europe
Milestone: the first ever Recommendation in the field of sport.
One key element of the proposal is a monitoring framework to help Member States to trace developments and identify trends regarding their national efforts to promote sport and physical activity.
Council will start discussing the Recommendation and could possibly adopt it in 2013.
The newly adopted Commission proposal for a Council Recommendation on health-enhancing physical activity also addresses the high rates of physical inactivity in Europe.

22. Health and work place
Workplace health is a priority in the Strategy for Europe on Nutrition, Overweight and Obesity-related Health Issues.
18 Platform commitments on health at workplace.
Research projects funded by EU Health Programme on Obesity and workplace – e.g. the FOOD project.
The Nutrition Strategy states: "Businesses can also support the development of healthy lifestyles in the workplace. Together with employee organisations, they should also develop proposals/guidelines for ways in which companies of different sizes can introduce simple, cost-effective measures to promote healthy lifestyles of employees." .
Research projects funded by EU Health Programme on Obesity and workplace; e.g. the FOOD project (Fighting Obesity through Offer and Demand) dealt - among others - with health promotion at the workplace and at changing bad habits and lifestyles of the employees during their lunch break in the period

23. Next steps
More inter-Commission coordinated action with other DGs and cooperation with services
Evaluation of the Strategy results:
Greater focus on physical activity
A careful consideration of the effects of actions on lower socio-economic groups
High level Group: Action Plan on childhood obesity
Platform: monitoring working group to improve the reporting of the commitments
Strategy evaluation: Evaluation results were based on findings of the external contractor PHEIAC (Public Health Evaluation and Impact Assessment Consortium) and are based on desk research, surveys, and interviews.
Findings stressed continued coordination at the EU-level by the Commission is needed to increase policy developments and actions, both at EU and national levels
The Commission, through DG SANCO, has successfully integrated Nutrition Obesity and Physical Activity concerns into EU policies where the implications were relatively clear, such as agricultural policies
EU co-funding for schemes and programmes to pursue Nutrition Obesity and Physical Activity-related objectives has been effective and should continue
More should be done in the area of physical activity and health inequalities.
Action Plan: Following the fruitful discussions on childhood obesity in the Informal Health Council in Dublin in March 2013, the High Level Group will reflect on the initiatives it will develop in addition to the already launched food reformulation frameworks to better target childhood obesity. The Action Plan is currently being drafted and meetings in a High Level Group Working Group are planned for October and November The final Action Plan is planned to be presented at the High Level Group meeting 25 November Mention the importance of tangible contributions by stakeholders to the action plan on childhood obesity.
Fall 2013: A Platform working group will work on developing a reporting system that is effective, without being a burden to the members.
The Commission is firmly committed to promoting healthy lifestyles, including physical activity, among the European citizens. We support all EU Member States, who through the High Level Group, have recently committed to step up their efforts in targeting children, following a call for action by the Irish Presidency of the EU. However, we cannot rely solely on policy makers to encourage healthy lifestyles and reverse the obesity trend. All stakeholders including industry, schools, NGOs and the media, have a role to play.

24. Alcohol and Health – the European Union Strategy
Hazardous and harmful alcohol consumption: a key health determinant
7,5% of all ill health and 195,000 early deaths per year in EU
In year olds: 25% of male deaths and 10% of female deaths related to alcohol
Risk factor in some 60 acute or chronic diseases
Monetary costs of alcohol related harm in the EU estimated at €155bn in 2010
Harmful alcohol consumption causes more than 60 different diseases and conditions, including intentional and unintentional injuries, drink-driving fatalities, cancer, etc.
The tangible costs of alcohol related harm in the EU (including direct costs through health care, policing, traffic accident damage and crime as well as productivity losses through absenteeism, unemployment and early death) were estimated to amount to 125 billion Euro in 2003.
Here are the common priority themes identified in the EU alcohol strategy and endorsed by Member States, other Institutions, and a wide range of stakeholders who have joined in voluntary action.
As a result of the Strategy, alcohol now has a solid place on the EU health agenda. There is broad consensus that the alcohol-related harm is a substantial health and societal challenge. The Commission recognises this, as do the Member States, and it is this consensus which enables us to work towards reducing harm.

25. The three pillars of the strategy
- European Alcohol and Health Forum
- Committee on National Alcohol Policy and Action
- Work across other policies
The way forward:
- Strategy still running
- Joint Action to support Member States to take forward work on common priorities in line with the EU alcohol strategy
The implementation of the alcohol strategy at EU level rests on three “pillars”:
The European Alcohol and Health Forum – a new structure set up by the Commission to mobilise action by stakeholders to reduce alcohol related harm. Involve public health and consumer NGOs, alcohol industry, retailers and servers, advertisers and the media. 70 members with more than 250 commitments to action.
The Committee on National Alcohol Policy and Action (CNAPA) comprises Member States' representatives and is an instrument for further coordination of Member States' policies to reduce alcohol related harm.
Work across other EU policies in areas where we can find synergy. This includes e.g. drink driving, and the protection of minors with regard to alcohol marketing. Important to note is also the collaboration with the WHO which includes a common survey of trends in alcohol consumption, harm and policies in Member States.
The strategy is still running and the Commission continues its work within the strategy.
The Joint Action aims to strengthen Member States' capacity to reduce harmful alcohol consumption and related harm, thereby improve EU citizens' health and reduce costs to health systems and the society.
The JA engages MS to address factors that slow down progress in tackling alcohol related harm and that cannot be effectively dealt with at MS level.

26. Alcohol and the work place
Priority theme in the strategy
Two projects under the EU Health Programme in :
FASE project
EWA project (still running)
Absenteeism and unemployment caused by alcohol is estimated to cost the EU 11,3 and 17,6 million euros each year. Alcohol Strategy has prevention of alcohol-related harm among adults and reduce the negative impact on the workplace as one of the priorities. The commission aim to contribute to the reduction of alcohol-related harm at the workplace and promote workplace related actions. The main instruments to cooperate and communicate with Member States and stakeholders are CNAPA and EAHF. Alcohol and workplace has been a theme in the meeting of these institutions.
A science group under the Forum have issued two opinions, one on the negative impact of harmful and hazardous alcohol consumption on the workplace.
Furthermore, alcohol and workplace has been subject to two projects that have received funding under the EU health programme in , the FASE project (Focus on Alcohol Safe Environment, included focus on best practises in workplace) and the EWA project (European Workplace and Alcohol, main aim is to engage with workplaces to raise awareness and bring change that leads to safer consumption and thus alcohol-related reduce absenteeism and injuries. Still running.)

27. European Agency for Safety and Health at Work
Promoting good health is an integral part of the smart and inclusive growth objectives of Europe Keeping people healthy and active for longer has a positive impact on productivity and competitiveness. Healthy and safe working conditions has a positive impact on productivity and competitiveness.

28. Workplace health and safety - Priorities for research
Work organisation and health
Effort - reward imbalance
Locus of control
How to incentivise employers
Implementation (focus on SMEs)

29. Workplace health and safety - Priorities for research
Adapting work to the meet the needs of an ageing population,  people with chronic disease
Emerging risks – new technologies, biological hazards, complex human-machine interfaces

30. Council Recommendation on seasonal influenza (2009/1019/EU)
MS are encouraged
To take measures in order to reach by 2015 a vaccination rate of 75 % for older people
To improve vaccination coverage among healthcare workers
To analyse the reasons why some people do not wish to receive vaccination
To foster education, training, and information exchange on seasonal influenza and vaccination

31. Proposed steps of improvement at the EU level
To strengthen coordination of initiatives related to the socioeonomic impact of seasonal influenza vaccination in order to demonstrate the cost-effectiveness of this preventive intervention
To strengthen coordination of research initiatives in order to identify reasons for vaccination refusal and develop mechanisms that can improve coverage of seasonal influenza vaccination, also among healthcare workers
To strengthen initiatives to improve the qualtiy of the seasonal influenza vaccine as the quality of the vaccine is a basic argument against vaccination

32. Proposed improvement at the MS level
To engage with healthcare workers more directly and actively on critical vaccination issues, fostering education, training and information exchange, particularly focusing on strengthening the role of health care professionals in advocating vaccination.

33. HproImmune (Promotion of Immunisation for Health professionals in Europe)
HproImmune is a three-year project funded by EAHC, launched in September The three-year budget is € 603,900.
To promote vaccination coverage of healthcare workers for Vaccine Preventable Diseases (VPDs) in different healthcare settings.
To add to European knowledge about the effects of immunisation practices among healthcare workers on the development of successful immunisation activities in public and private healthcare sectors.

34. HproImmune (Promotion of Immunisation for Health professionals in Europe)
To increase awareness among healthcare workers and policymakers about the importance of vaccinations against Vaccine Preventable Diseases (VPDs) and contribute to the development of informed national strategy goals for increasing vaccination coverage among healthcare workers, especially for seasonal influenza.
Key output of the project is a comprehensive toolkit for the promotion of immunisation among healthcare workers. It is designed to help increase vaccine coverage rates and improve reslilience and the response capacity of the European health sector.