1. Public health and the EU
Francesco Longu
Communications Officer
European Public Health Alliance
Brussels, 15 September 2005

2. Presentation outline
What is EPHA? How does it work?
How is responsibility for health issues covered at EU level?
What do the EU current treaties say about public health?
Does health need to be addressed at EU level?
Q&A

3. About EPHA
A network of 116 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
The alliance comprises 107 different organisations from 21 countries in the wider European region. The key criteria for membership of EPHA are to be a non government or not-for-profit organisation and be committed to improving the health status of European citizens.
EPHA was established ten years ago with the mission statement you can read here. At that time, to many people the word "health" was applied only to health services. The idea that governmental or EU policy could influence citizens’ health status through action on the determinants of health was new to most people, in the institutions as well as among NGOs. Similarly, "public health" was routinely equated with public health services, and then in some people’s minds again with health-care organisations such as hospitals, that were in the public rather than the private sector.
The time was ripe for this in terms of the state of European legislation. The Single European Act, which was already in force, specified "a high level of health protection" in the setting of standards governing trade within the single market. This was important, as it could prevent "a race to the bottom", in which the cheapest producers would succeed in under- cutting and thus driving out the higher-quality ones (a battle which is still being fought internationally, in relation to the World Trade Organization).
Secondly, negotiations were in progress for the Maastricht Treaty, the first European treaty to have an article on health, and which contained the sentence, "Health protection requirements shall form a constituent part of the Community’s other policies". This unequivocally gave Europe a legal competence in health, and the focus was on health determinants; health services were explicitly excluded from European Union competence.
I am particularly happy of being here today, as in fact the first EPHA small secretariat was set up in spring 1993, actually with the help and support of ECAS.

4. EPHA members (1/3) EPHA has two categories of membership:
Full members are Non-Governmental Organisations (NGOs) active in the public health sector. Full members have two votes at the Annual General Assembly
Associate members are other not-for-profit organisations, professional bodies, academic institutions and local or regional authorities. Associate members have one vote at the Annual General Assembly
EPHA membership fees are based on the income of the member organisation
Our membership is currently divided into two main categories, full members and associate members. The key criteria for membership of EPHA are to be a non government or not-for-profit organisation and be committed to improving the health status of European citizens. Members vote differently at the AGA but all receive the same amount of membership services.
For NGOs in new Member States of the EU (eg Poland, Hungary, Slovenia etc), membership fees are being phased in over a 3 year period. The EPHA Executive Committee can, on a case-by-case basis, waive the membership fees for NGOs in NIS and South East Europe.

5. EPHA members (2/3) Health advocates Disease specific patient groups
Academic researchers
Health professionals (e.g. doctors, nurses and pharmacists)
Consumer groups
Environment organisations
Development organisations
The separation between full and associate members is the official classification as written in EPHA statutes. But EPHA members can also be classified according to their work area and, as we will see in a minute, according to their level of action.

6. EPHA members (3/3) International networks European networks
National organisations
Complete list of EPHA members:
Group examples:
International AIDS Vaccine Initiative (Netherlands)
International Babyfood Action Network (IBFAN) (Luxembourg)
International Diabetes Federation - European Region (Belgium)
2. Association of European Cancer Leagues (Belgium)
European Respiratory Society (Switzerland)
Mental Health Europe (Belgium)
3. Actis - Norwegian Policy Network on Alcohol and Drugs (Norway)
The Meningitis Trust (United Kingdom)
The Netherlands Institute for Care and Welfare – NIZW/IC (Netherlands)

7. EPHA organisational structure (1/3)
The Annual General Assembly
> Convened once a year (extraordinary meetings are possible)
> Discusses the broad policy of EPHA
> Elects the Executive Committee
> Members vote according to their membership category
> May include consultation meetings and/or training seminars for members
EPHA is a membership and advocacy based organisation. As such, the AGA is the key governing body of EPHA.
The Annual General Assembly (AGA)
The European Public Health Alliance is an international not-for-profit association registered in Belgium (identification number: 5567/94, Annex to Moniteur Belge). According to the statutes, the Annual General Assembly convenes the membership once a year to discuss the broad policy of the organisation.
The AGA elects an Executive Committee to oversee the work of the organisation. Consultation meetings and seminars are also organised with member organisations during the year as appropriate.

8. EPHA organisational structure (2/3)
The Executive Committee
> Seven people elected for a two-year period - gender equality and balance between NGOs and professionals are required
> Sets out the annual work programme
> Sets priorities and targets for EPHA
> Reviews EPHA financial management and annual accounts
> Supervises the EPHA Secretariat and appoints the appropriate staff
The Executive Committee
Members of the Executive Committee are elected for a 2 year mandate. There is currently a 4:3 proportion between men and women and between NGOs and health professionals. The role of the Executive Committee is to:
supervise the EPHA Secretariat
set out the annual work programme of the organisation
set priorities and targets
review EPHA financial management and scrutiny of annual accounts
appoint the appropriate staff.
Executive Committee members also provide expert public health, policy and management advice to the secretariat on an ongoing basis. The members of the Executive Committee for the period are:
Janice Cave, Royal Society for the Prevention of Accidents, United Kingdom
Florence Berteletti Kemp, EUROCARE, Belgium
Pim de Graaf, The Netherlands Institute for Care and Welfare - NIZW/IC
Owen Metcalfe, The Institute of Public Health in Ireland
Flora Giorgio, Pharmaceutical Group of the European Union, Belgium
Joanne Vincenten, European Consumer Safety Association, The Netherlands
Stephen Gordon, European Council for Classical Homeopathy, United Kingdom

9. EPHA organisational structure (3/3)
The EPHA Secretariat
> Manages the “day to day” work of EPHA
> Ensures that the full work programme of the organisation is carried out efficiently and effectively
> Actively contributes to the development of good organisational practice
> Currently five staff members, located in Brussels
Working Groups
Policy Coordination Meetings
WG and PCM - more later.

10. EPHA membership benefits
Electronic Newsletter
Health Alerts
Members Only section of our website
Newslists
Daily information help desk
Visibility in EU policy making circles
Support for advocacy work
Representation and participation at European and international fora

11. How does EPHA work? (1/2) Advocacy:
> Working groups. At present there are five ongoing working groups on the following subjects: Alcohol, Food and Nutrition, Health and Environment, Health and Enlargement, and Pharmaceuticals
> Policy Co-ordination Meetings. Meeting every two months in Brussels, this group is open to all EPHA members. Contributions to the meeting are also received via
Information exchange
Membership services
Our job is to maintain a flow of information about the EU institutions to our members and from the grassroots organisations back to policy makers in Europe. We strengthen the ability of individual NGOs to understand Europe and how to make a difference at EU level. We also offer a platform for single-issue groups or organisations to come together to develop joint advocacy and campaigns. Working through the umbrella of EPHA offers NGOs a greater impact and political weight.
Working groups can be set up following members’ requests or at the suggestion of the secretariat.
The aim of PCM is to share information, discuss EU health policy developments and create policy positions and strategies for EPHA and its members. The minutes of these meetings are available on the "members only" section of the EPHA website.
Mention EEN.

12. How does EPHA work? (2/2) Lobbying: > EU institutions Networking:
> Other health NGOs
> Other thematic NGOs
Tracking policy issues:
> Day to day analysis
> Mailings - Briefings

13. What does EPHA stand for?
Health protection as a goal in all EU policy-making - e.g. health impact assessments for all proposed legislation
Involvement of citizens in decision-making related to their own health
Equal access to good quality healthcare for all EU citizens
Addressing health inequalities
Ensuring that EU internal and external policies actually contribute towards better health
We believe that the health of EU citizens should be the prime goal of all EU policy-making and that people want, and need, to be consulted and involved in decision-making related to their health.
Social inequalities lead to equivalent inequalities in health which reinforces the social exclusion and poverty of disadvantaged groups. This must be addressed with concrete measures at national and EU level.
Good quality healthcare should be accessible to all EU citizens, wherever they live. In urban or rural areas, healthcare should not be a lottery but a basic right.
EPHA believes that Europe, with its values of social democracy, bears a responsibility to ensure that external policies such as trade, external relations and development aid are designed to improve and promote health. This is crucial because the burden of ill health in developing countries falls disproportionately on the poor and on women. The World Health Organisation’s Macro-Economic Commission on Health recently reported that investment in public health created measurable and clear economic benefits.

14. What are the goals of EPHA?
Develop key consultative role for civil society as partners in health
Promoting healthy public policies throughout EU activities
EU Policy to be based on the highest common denominator rather than lowest.
EPHA’s goals are to join with other key stakeholders and groups to ensure that the European Convention leads to a strengthening of the EU competence in public health. We want the EU to have the right to initiate legislation for the sole purpose of protecting health rather than needing an internal market justification.
EPHA is campaigning to ensure that health is at the heart of the process of defining indicators on sustainable development. This would mean that each Spring Summit of the EU would focus on improving the health status of citizens.
We want health in Europe to be based around the highest standards rather than the lowest common denominator.

15. Health in the European Commission (1/2)
DG Health and Consumer Protection
DG Environment
DG Employment and Social Affairs
DG Internal Market and Services
DG Competition
DG Agriculture
DG Development
DG Education and Culture

16. Health in the European Commission (2/2)
DG Trade
DG Research
DG Information Society
DG Transport
DG Enterprise
DG Tax and Customs
EMEA, ECDC, EFSA, European Agency for Safety and Health at Work

17. Health in the European Parliament
Committees
Environment, Public Health and Food Safety* (ENVI)
Industry, Research and Energy (ITRE)
Internal Market and Consumer Protection* (IMCO)
Employment and Social Affairs (EMPL)
Inter-group on health

18. What does the EU treaty state?
Article 152 of the Amsterdam Treaty states:
“A high level of health protection shall be ensured in the definition and implementation of all Community policies and activities”
But the EU must respect Member State responsibilities for organisation and delivery of health care
The legal basis for the EU, the Amsterdam Treaty has one article, number 152, devoted to ensuring a high level of health in all EU policies.
But the principle of subsidiarity needs to be respected and Member States are responsible for the organisation and delivery of their health systems and health care. The diversity of approaches to healthcare across Europe means that it is unlikely that there will ever be harmonisation of systems.
Until now, Member States have not permitted the EU to have a role in healthcare policy which remains strictly a national government domain,

19. What does the new Constitutional Treaty state?
Article 179 – Public Health as coordinating, complimentary or supporting action
“Action by the Union, which shall complement national policies, shall be directed towards improving public health, preventing human illness and diseases, and obviating sources of danger to physical and mental health”.
“The Union shall complement the Member States' action in reducing drugs-related health damage, including information and prevention”.
“Union action shall respect the responsibilities of the Member States for the definition of their health policy and for the organisation and delivery of health services and medical care. The responsibilities of the Member States shall include the management of health services and medical care and the allocation of the resources assigned to them”.
Article goes on to mention “the protection of public health regarding tobacco and the abuse of alcohol”.

20. What EU rights to health exist?
“Everyone has the right of access to preventive healthcare and the right to benefit from medical treatment under the conditions established by national law and practices”
Charter of Fundamental Rights of the EU, Adopted in Nice, 12/2000
In practical terms this means the right to be treated by a doctor. It does not cover issues such as ‘quality’ and ‘timeliness’ of care. It is less ambitious than the WHO definition of health and the UN Convention on Cultural, Economic and Social Rights.

21. Why health needs to be addressed at EU level
Many EU policies have an impact – direct or indirect – on the health of EU citizens
Implementation of internal market legislation is de-facto creating policy on health related issues
The European Commissioner has greater powers to promote animal welfare than to protect human health
EPHA believes the only way to fulfill the objective of Article 152 is to strengthen the legal basis for health to be addressed more comprehensively at European level.
A study by the European Healthcare Managers Association concluded that between 1958 and 1998 some 233 directives, regulations or decisions by the European Court of Justice connected to the internal market had a potential impact on Member State health systems.
EU Member States are beginning to appreciate that in the absence of a coherent pan-European policy on health, it will be the internal market legislation and economic forces that drive EU initiatives. There is increasing willingness to consider allowing EU coordination and activity on health issues.
The Health Council in February discussed the implications of free movement of patients and healthcare services on national governments’ abilities to manage their health systems with a view to creating a coordinated pan-European approach.

22. European Public Health Alliance
39-41 Rue d’Arlon
B-1000 Brussels
Belgium
Tel:
Fax: