Resolution on the communication from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions on the development of public health policy in the European Community, 1999 O.J. (C 175) 135 (Mar. 10, 1999).
The European Parliament,
- having regard to the Commission communication COM(98)0230 - C4-0393/98,
- having regard to its resolution of 19 November 1993(1) on public health policy after Maastricht and to all European Parliamentary reports and resolutions subsequently adopted regarding and relevant to matters of public health,
- having regard to the Public Hearing of the Committee on the Environment, Public Health and Consumer Protection held in Brussels on 28 October 1998, and the preliminary working document (SACO 102) "European Union Health Policy on the Eve of the Millennium" published by the European Parliament Directorate General for Research,
- having regard to the Treaty of Amsterdam,
- having regard to the statement by Commission President Santer to the European Parliament on 18 February 1997 regarding "a Europe for health",
- having regard to the report of the Committee on the Environment, Public Health and Consumer Protection (A4-0082/1999),
A. whereas the Treaty of Amsterdam aims in Article 152(1) (ex Article 129 of the EC Treaty) to complement national public health policies and requires that a high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities, and also contains the specific expression in Article 152 (4) and (5) of the role of Member States in the delivery of health care,
B. having regard to the significant changes to demography, communications, lifestyles, age profiles, mobility, health care standards and social, economic and environmental health determinants affecting EU citizens during the period of the first Framework Programme for Public Health; seeking to learn from the experiences during that period regarding emerging diseases and health conditions, specifically transmissible diseases,
C. whereas not all of the recommendations of its abovementioned resolution of 19 November 1993 have been achieved, nor has there been sufficient follow-up undertaken in response to its resolutions of 17 April 1996(2) concerning the European health card, Alzheimer's disease, and blood safety and self-sufficiency in the European Community,
D. having regard to widespread concerns and criticism of aspects of the operation of the first Framework Programme in terms, inter alia of budgetary restrictions of programmes, limited resources available for management, lack of strategic coordination and evaluation, inconsistent integration of health in other policy areas and interinstitutional liaison; plus insufficient public and professional awareness of the Community public health roles despite strenuous and committed efforts by staff required to operate at distance from the main body of the relevant directorate,
E. whereas the health implications of Community policies potentially affect the work of virtually all directorates general of the Commission, many Community policies impact on the health of EU citizens either positively or negatively at international or regional levels, and the introduction of health and environmental impact assessments at all levels of decision making has become an integral part of those processes,
F. having regard to the well defined inequalities in public health, access to health care and freedom of movement for citizens including professional specialists across the Community, but also the targeted approach to socio-economic action which is an established feature of Community policies,
G. whereas the health services of all Member States are under growing financial pressure; whereas it is therefore desirable for the Commission and Council to encourage the setting of realistic, measurable, time-based and, where relevant, gender specific, health targets for tackling the most significant health risks and diseases,
H. whereas the emphasis of the Amsterdam Treaty is to direct action towards improving public health and addressing health determinants while a significant amount of information is maintained locally, regionally, nationally or internationally regarding epidemiology, demography etc. as well as evidence of practice methods,
I. having regard to the major contribution of international organisations such as the WHO, OECD, World Bank, other agencies and networks of non-governmental organisations, trades unions, educational establishments and regional authorities, and their significant role beyond the EU boundaries in health programmes in which the Community has a partnership and co-operation role,
J. whereas the process of enlargement of the EU currently being negotiated with candidate countries will potentially bring benefits and challenges for public heath in existing and applicant countries,
K. having regard to rulings of the European Court of Justice regarding the rights of citizens in respect of certain medical products and of the potential benefits of rapid development of new technologies and pharmaceutical products in the context of the single-market freedoms,
1. Calls for a positive interpretation by Council and Commission of the provisions of the Treaty of Amsterdam pertaining to public health, particularly Article 152, bearing in mind the status of health protection in the context of the EC Treaty and the principle of subsidiarity, which provides a good basis for sustainable development of the Community role as a partner in protection and improvement of the health of EU citizens while recognising the responsibilities of Member States for the organisation and delivery of health services and medical care; and hopes at the same time that a forthcoming revision of the Treaty will provide for greater involvement of the Community in matters relating to the health protection of EU citizens;
2. Welcomes the Commission Communication as a constructive contribution to the debate about that sustainable development; in particular prefers the option of a single strategic framework instrument with a single financial envelope, while stressing strongly the importance of maintaining the role of the Parliament in jointly determining the direction and budget of the framework and the essential meaningful evaluation processes which must be incorporated; and concurs that three strands will be appropriate within the framework, namely:
a) improving information for the development of public health,
b) reacting rapidly to threats to health,
c) tackling health determinants through health promotion and disease prevention; calls for the Commission to publish detailed and reasoned proposals as a matter of urgency once the Treaty is ratified, which set out a realistic number of measures achievable within each strand within the five year timescale of the framework;
3. Calls on the Commission to do further work on the impact of food on health as this is one of the main factors affecting health in the Union; therefore calls upon the Commission to participate in efforts by Member States and others to improve public information policy in this area;
4. Regrets that not all the recommendations of its abovementioned resolutions of 19 November 1993 and 17 April 1996 have been achieved and calls for an inter-institutional revision of the insufficient prioritisation of public health resources which will take into account the changing needs and expectations experienced during the first framework, in the context of proposals for improved strategic management of programmes and better allocation of resources within financial perspectives;
5. Reiterates that the Commission should appoint one of its members to be specifically responsible for a Directorate General for Health with sufficient capacity to include all aspects of public health policy, with appropriately enhanced resources including greater health related and country specific expertise, to be located in Brussels;
6. Calls for the core of the EU's efforts in public health to be the integration of health across all other policy areas and the integration of health impact assessment into health-determining areas of EU policy, with particular priority given to research, agriculture and food, transport, and socio-economic policies; in particular:
a) the Commission should strengthen reports on health integration to include health impact evaluation;
b) the Commission should include in its work programmes an indication of any proposals likely to impact on health;
c) the Commission and Member States should act urgently to strengthen coherent cooperation in local, regional, national and EU policies impacting on health, for example in regional funding programmes;
d) a study should be published within the first half of the framework on methods of health impact assessment potentially appropriate for use at various levels and seek implementation and interim evaluation by the conclusion of the framework;
7. Calls for a prime objective of Community action to be focused on fostering equality in health across the EU, to strengthen the regional approach regarding health, to seek greater coherence with socio-economic policies and programmes and urges the identification and introduction of targeted Health Priority Areas on evidence-based criteria in clear cooperation with Member States, regional authorities and non-governmental organisations and operating within the framework provisions; requests that the Commission uses early Health Integration Reports to focus on social inequalities, access to health related services, rights and responsibilities relating to freedom of movement for citizens, and opportunities for health professionals to train and practise to greatest effect;
8. Insists that transparency is vital within the horizontal framework strands and that clarity of definition of 'scourges' and priorities is essential; therefore requires the Commission to put forward clear proposals on targets, timescales, methods and strategies for action on each priority as a matter of urgency when the Amsterdam Treaty is ratified, allowing for flexibility in case of unforeseen developments, including continuing development and funding where appropriate of existing programmes; and including the major chronic diseases where the added value of action at European level can be beneficial;
9. Emphasises once again the importance of introducing a breakdown by sex of all relevant statistics concerning the public health situation and trends with a view to mapping out an effective public health policy;
10. Calls for the Commission and Council to maximise freedom of information regarding best practice, epidemiology, services, networks, risks and opportunities; and to maximise public, professional and legislative awareness of the work and added value of the Community role in health protection and improvement; specifically urges:
a) the Community to conduct a broader information campaign in cooperation with national and regional authorities and non-governmental organisations while avoiding provision of direct health education;
b) the greater involvement of non-governmental organisations and clearly identifiable and accountable social partners, citizens', carers' or patient representative bodies in the decision-making process;
c) the Commission to facilitate forums, including in partnership with the Parliament and Member States, where interfaces can be improved and developed with interested citizens and organisations and to assist maintenance of accessible networks for sharing information;
d) those forums to address transparently the major health related issues including health inequalities, freedom of movement, training for health workers, best practice and standards in health care, ethics, research and technologies;
11. Calls on the Commission to establish a framework for a dialogue between all stakeholders (governments, patients'organisations, pharmaceutical industry, trade unions etc....) on how to manage jointly the fast pace of change;
12. Calls for greater cooperation and communication between the EU institutions and international health-related organisations, particularly,
a) with UN agencies, specifically WHO, via collaborating centres and utilising expertise in Member States and agency centres;
b) with bodies such as OECD, the Council of Europe and the World Bank;
c) by developing the EU-US dialogue and seeking to integrate health policies into cooperation initiatives and agreements with other third countries and regional groupings;
d) in participation and negotiation with the WTO;
e) with developing countries and regions, particularly members of the ACP Joint Assembly, where EU partnership projects and programmes are instrumental in health protection and improvement, and where internal and external policy development must be cohesive;
f) with international and professional health and research networks;
13. Anticipating the publication of a Commission Communication relating to 'Health and Enlargement', expresses concern that the health status in most candidate countries is lower than EU Member States and that some threats to health are increasing; calls for
a) greater priority to be given by the Council and Commission to health related obligations and factors in negotiations with candidate countries with the aim of reinforcement of legislative functions regarding health in those countries;
b) development of better exchanges and links between NGOs, experts in relation to health care, information systems, etc.;
c) realistic assessment of potential problems and benefits as part of both the framework development and accession preparations;
14. Calls on the Council and Commission to consistently and coherently recognise, evaluate and respond positively to international developments such as new technologies and pharmaceuticals as well as the progress of the Single Market in the context of preparations for the next IGC; and thus encourages it to work with the Parliament to provide the visionary leadership and practical resources to meet the needs and expectations of EU citizens by designating the period 2000-2010 as the European Decade for Health;
15. Instructs its President to forward this resolution to the Commission and Council.