1. EU Internal market and health: a contradiction in terms? European Public Health Alliance Health and the internal market Presentation by Tamsin Rose, General Secretary, 8 September 2004 A network of 102 non governmental and not-for- profit organisations across Europe working on health and health-related issues. Our mission is to improve the health of European citizens and to increase their participation in EU policy- making

2. EU Internal market and health: a contradiction in terms? Structure of the presentation - Health status in Europe - Risk factors and health trends - Lifestyle factors and disease trends - EU role as a regulator - Some questions to debate

3. EU Internal market and health: a contradiction in terms? The good news Major improvement in health over 150 years. A doubling of life expectancy achieved by Hygiene: (water, air, food) Legislation, eg on safety seatbelts and helmets, control of pollutants Prevention: vaccination and screening Information and education Improved healthcare: technology and treatments

4. EU Internal market and health: a contradiction in terms? The bad news Much of current ill health and early death is preventable Extensive health inequalities New health threats (HIV, SARS, drug resistant TB) Demographic changes Rising healthcare costs

5. EU Internal market and health: a contradiction in terms? Is modern life killing us? Majority of deaths are lifestyle related Cardiovascular disease – improve diet, increase physical exercise, stop smoking, reduce alcohol consumption, reduce stress Cancer – as above but also tackle environmental pollutants (air, water, soil contamination, chemicals) Tobacco, alcohol, food, chemicals and consumer products are all goods regulated by the EU internal market

6. EU Internal market and health: a contradiction in terms? Consumer products – safe? Pesticide residue in fruit and vegetables Pthalates in childrens toys Flame-retardants in household furniture Chemicals in hair dyes, cosmetics and tattoo inks Anti-bacterial and microbicides in mattresses

7. EU Internal market and health: a contradiction in terms? What causes death and ill health?

8. EU Internal market and health: a contradiction in terms? Future expectations of health a b c Good Compromised Poor Now

9. EU Internal market and health: a contradiction in terms? Obesity – a clear example of manufactured risk Obesity has increased by 10-40 % in Europe in the last decade, in the UK it has doubled 75 % of salt in our diet comes from processed food Soft drinks are the leading source of added sugars in the US diet. Increase in diabetes and obesity has coincided with a 61 % leap in consumption by adults and a doubling of consumption by children between the late 70s and mid 90s. Uk evidence kids drink an average of 4.7 litres of soft drink per week, of which only 10% are fruit juice or water. Most alco-pops contain as many calories as sugary soft drinks, link between binge drinking and obesity Fat per 100g is a lot cheaper than other sources of energy

10. EU Internal market and health: a contradiction in terms? The context of food consumption 800 to 1 ratio : For every 1 pound spent on health education on promoting healthy diets, 800 is spent by the food industry 95 % of which are for products that encourage weight gain (confectionary, snacks, fast food.) Fruit industry spends only 2% on advertisements of the amount spent by snack industry Food advertisements were shown more frequently during children's programmes (45-58% of all advertisements) than during adult programming (21%). The overwhelming majority of the foods advertised during both adult (86%) and children's (95-99%) programmes were high in fat, sugar and/or salt.

11. EU Internal market and health: a contradiction in terms? Fireworks – a case study of regulating harmful products Minimum safety requirements for products Limit availability (points of sale) Limit accessibility (age limits) Limit visibility (bans on advertising) Warnings (on packets) Restrictions on use (timing, space) Public education campaigns Enforcement and policing Can we use this logic for tobacco, alcohol, unhealthy foods?

12. EU Internal market and health: a contradiction in terms? Sharing responsibilities The individual's challenge to live a healthy life, in the face of a rising gradient of societal pressure to live unhealthily. While ultimately individuals must meet this challenge themselves, government can play a role both by providing individuals with support as they climb, and by lowering the gradient against which they are climbing.

13. EU Internal market and health: a contradiction in terms? Some points to debate: Health as a human right but also as a duty to society What are we prepared to pay for quality healthcare systems Is poor health an acceptable price to pay for consumer choice How should corporate profits on unhealthy products be balanced with health costs