# EUR-Lex - 52000AE1417 - EN

Avis juridique important

*|*

# 52000AE1417

**Opinion of the Economic and Social Committee on the "Proposal for a Decision of the European Parliament and of the Council adopting a programme of Community action in the field of public health (2001-2006)" **

*
Official Journal C 116 , 20/04/2001 P. 0075 - 0083 *

Opinion of the Economic and Social Committee on the "Proposal for a Decision of the European Parliament and of the Council adopting a programme of Community action in the field of public health (2001-2006)"

(2001/C 116/18)

On 12 July 2000 the Council decided to consult the Economic and Social Committee, under Article 152 of the Treaty establishing the European Community, on the above-mentioned proposal.

The Section for Employment, Social Affairs and Citizenship, which was responsible for preparing the Committee's work on the subject, adopted its opinion on 14 November 2000. The rapporteur was Mr Fuchs.

At its 377th plenary session of 29 and 30 November 2000 (meeting of 29 November), the Economic and Social Committee adopted the following opinion with 108 votes in favour and 4 abstentions.

1. Gist of the proposal

1.1. The Commission has issued a Communication to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions on the health strategy of the European Community, accompanied by a Proposal for a Decision of the European Parliament and of the Council adopting a programme of Community action in the field of public health (2001-2006). In putting forward this strategy, the Commission is seeking to enter a new phase in health policy development in order to add value to Member States' actions in this area and to play fully its part on the health front.

1.2. The European Community's new health strategy is designed to meet the expectations of the people of Europe and the challenge arising from longer life expectancy, technical progress, increased migration within the Union, enlargement of the Community and the Amsterdam Treaty's new public health provisions.

1.3. This health strategy follows on directly from the reorganisation of EU public health policy launched in the 1998 Commission Communication on the development of public health policy in the European Community(1). The strategy described in the communication and set out in the decision document highlights two main prongs of EU health policy:

1.3.1. Firstly, individual Member States are to be supported in their health-related activities by an action programme which focuses on three priorities: (i) improving health information and knowledge, (ii) responding more rapidly to health threats and (iii) addressing health determinants.

1.3.2. And secondly, all Community policies are to be assessed for their impact on human health, in line with the requirement laid down in Article 152 of the Amsterdam Treaty.

1.4. The substantive link between these two main aims is provided by a framework for action which is to coordinate existing schemes, draft guidelines and directives and recommendations. A coherent Community approach to health objectives is intended to boost the efficiency of the resources used.

1.5. The proposal for a European Parliament and Council decision adopting a programme of Community action in the field of public health establishes the legislative basis required to implement the European Community health strategy set out in the Commission communication. It also provides a framework for the allocation of financial resources to develop the action programmes over a total six-year period. The overall budget is EUR 300 million.

1.6. The resources may be used for contracts from the Commission and to subsidise projects. The idea is that the resources may be used flexibly (i.e. they can be switched between the priority areas).

1.7. The Commission has thus submitted formal proposals for a Community health policy, as announced in its preceding communication.

2. Previous ESC opinions on Community public health policy

2.1. In this context, it is worth bearing in mind previous Committee opinions(2) as they have had an influence on the broad lines of Community public health policy.

2.2. The Committee gave its views on the subject most recently in its 1998 opinion on the Commission communication on the development of public health policy in the European Community(3). In this opinion, the Committee repeatedly called for consideration to be given to the following points:

- Limited resources: The Committee has always considered that the financial allocation for each of the different programmes was insufficient to achieve their objectives.

- Consistency and complementarity: The Committee considers it essential to guarantee consistency and complementarity between relevant Community actions and programmes in the field of public health, in order to avoid any duplication of work and achieve efficient interaction between them. The Committee welcomes the steps taken so far to reorganise the European Commission, not least the banding-together of health and consumer protection issues. The present proposal is geared much more towards achieving a coherent approach than earlier action programmes and will - if the ideas set out in the paper are properly implemented - generate greater synergy between individual Union policies.

- Comitology: The Committee feels that a Commission committee should be established to assist the Commission both on the criteria and procedures for selecting and financing projects under the programme and on the evaluation procedure. Member States should consider the views of the various socio-economic partners and interests involved in public health policy. The policy strategy now on the table provides for the establishment both of a Commission advisory committee and a civil forum.

2.3. The Community's new health strategy takes up the Economic and Social Committee's repeated call for a more horizontal approach in the field of health protection; this is to carried out on the basis of the new Article 152 of the Amsterdam Treaty. In addition to the direct obligation to assess all Union policies for their impact on health, the aim is to coordinate existing schemes for establishing networks and observatories and drawing up guidelines, directives and recommendations. New measures are to be taken in the veterinary and phytosanitary fields which will help improve health-related environmental protection and food quality.

2.4. In its 1998 opinion on the development of public health policy, the Committee proposed, among other things, that a health strategy should include:

- specific, age-related issues (e.g. young and old groups) and particularly vulnerable categories (e.g. immigrant and other under-privileged sectors of the population);

- the link between health policy and the socio-economic dimension (e.g. employment);

- the "horizontality" of public health, which goes beyond social policy and should cover other areas such as the environment.

3. General comments

3.1. The Economic and Social Committee feels it is right to develop a strategic approach - if only because of the expiry of the previous programmes - and to submit a proposal to that effect. This is also a vital necessity following ratification of the Amsterdam Treaty. The ESC welcomes the proposal for a Decision of the European Parliament and of the Council adopting a programme of Community action in the field of public health.

3.2. The Committee notes that the 1998 proposal has been reworked and built upon following broad discussions between the Commission and the other Union institutions and bodies. The strategic approach has a twofold objective: (i) to support Member States' efforts on the health front and (ii) to gear all EU policies more closely to the requirements and protection of public health. It thus reflects the spirit of the Amsterdam Treaty. This approach also takes account of the legitimate calls voiced by the European public over the past few years for enhanced cross-border health protection within the EU.

3.3. The Economic and Social Committee endorses the outcome of the debate at the European Conference on health determinants in the European Union held in Evora on 15 and 16 March 2000. The EU Council's view in this regard is, among other things, that "the increasing differences in health status and health outcomes between and within Member States call for renewed and coordinated efforts at the national and Community level." The conclusions of the European Conference on medicinal products and public health held in Lisbon on 11 and 12 April 2000 also refer to the new public health strategy. The Council particularly urges the Commission "to promote cooperation and exchange of experience between Member States, using the full range of possibilities for action".

3.3.1. The Lisbon conference was convened specifically to analyse the new context for health policy arising from Article 152 of the Amsterdam Treaty. The ESC therefore welcomes the indication given in point 4 of the Commission document - "achieving an integrated health strategy" - that the programme will support all areas of pharmaceutical policy. It believes that this support is necessary in order to make up lost ground on aligning the various regulatory systems in force in the individual Member States, so as to counter the negative impact on the free movement of medicines in the EU.

3.3.2. It is important to promote the convergence of national health systems, so as both to defend the interests of patients in the individual Member States for whom the conditions of access to pharmaceuticals differ, and to eliminate the outstanding unfair privileges in the system that jeopardise the objective of improved public health by preventing sufficient resources from being channelled towards R& D; this funding is essential in order to secure a competitive backdrop for the genuinely innovative companies in this sector in the EU.

3.4. In its 1998 opinion, the Committee called for a strengthening of Community public health policy; this is now reflected in the proposal for a decision. The communication which precedes the proposed decision sets out the Commission's reasons for this course of action, i.e. the challenge facing Member States' health systems and its impact on public health across the Community. The Commission notes the increasing strain placed on Member States' health systems by longer life expectancy, rapid innovations in medical science and technology, increased migration and the emergence of new (or the resurgence of old) infectious diseases.

3.5. Public expectations of high-quality, universally accessible health care have also increased, placing further strain on Member States. The Commission argues that Community or cross-border problems are best resolved at Community level, and, while respecting the responsibilities of Member States, sees itself playing a coordinating and/or support role. The strategic new departure in EU public health policy goes beyond the predominantly single-issue approach of earlier Community schemes and sets out an integrated approach to European public health.

3.6. The EU's new health strategy thus represents a radical move away from an issue- and programme-driven public health policy towards a system-based approach. The downside, however, is also a loss of focus on ongoing problems. At least the priorities in tackling individual issues (such as cardiovascular diseases, cancer, dementia, drug addiction or communicable diseases) are to be switched from operationally oriented schemes to a comparative system-based approach.

3.7. On the one hand, this switch in the pattern of public health policy is logical and reflects the desire for coherence and efficiency. On the other, it involves considerable imponderables, since, particularly in terms of health information systems and addressing health determinants, the new methods to be introduced are still to some extent at the experimental stage (health technology assessments, schemes for measuring cost effectiveness and cost efficiency, medical guidelines and management, benchmarking), with no experience to draw on for their use on a broad scale.

3.8. The various types of traditional health monitoring practised in the Member States are once again the focus of attention as the result of an Icelandic scheme for both the establishment and commercial utilisation of a new electronic database containing individual health data and genetic information. On this front, therefore, it would make sense to work out guidelines for the ethically and scientifically justified use of individual health data in order to provide effective protection for citizens of the Member States.

3.9. Although the rationale behind these methods - which are all designed to give a more economic slant to medical practice - is understandable, past experience has also shown that approaches of this kind have not necessarily fostered developments in medicine, particularly medical equipment. The broad, uncritical adoption of such approaches may hamper the development of potential new treatments and impact badly on the medical equipment and pharmaceuticals industry.

3.10. To make the action programme more acceptable, the Economic and Social Committee recommends action to encourage the appropriate official bodies in the Member States, and the regional/local authorities, to engage in international cooperation and benchmarking on a voluntary basis. Merely juxtaposing figures in the form of mandatory performance comparisons or even ranking systems would simply demotivate participants. The Commission could clearly state that taking part in the action programme can be helpful in giving the various heath care sectors access to evidence-based knowledge and examples of best practice, and thus in making better use of ever-expanding medical knowledge.

3.11. The measures set out in the framework for action for bringing together various facets of public health policy are vital. The various networks, rules and bodies dealing with issues such as communicable diseases, prevention of drug dependency, smoking and the fight against tobacco consumption, organs and substances of human origin and blood and blood derivatives are to be linked and tailored towards the common achievement of public health objectives.

3.12. The new tasks in the veterinary and phytosanitary fields are fully consistent with this approach. The Committee also welcomes the proposal already on the table for the establishment of a food safety authority with a remit covering, among other things, the preparation of scientific opinions, the operation of rapid alert systems, communication with consumers and networking with national agencies and scientific bodies. Plant protection in particular should not only be considered in terms of safe food production, but should also be seen - and put into practice - as part of a health-related environment strategy. Linking the health strategy to other fields of Community action, e.g. telecommunications and IT programmes and statistics, will be useful in helping improve public health protection and in furthering the coordination of social protection systems.

3.13. In contrast to those sections of the action programme which have already been the subject of broad discussion and the coherent thrust of the other health-related policies which are to come under this framework for action, little is being done about monitoring or evaluating other Community policies or assessing their impact on human health. The Commission communication states that, from 2001, legislative proposals are to include an explanation of how health requirements have been addressed. The proposed decision, however, provides for no formal action to that effect.

3.14. The Committee also notes that the Commission evidently feels able to tackle the issue of addressing health requirements in all EU policies both without external evaluation and consultation, and without specifically designated staff. The Committee feels that this is somewhat unrealistic given the scale of the task, which touches on all Community policies.

3.15. The Economic and Social Committee welcomes the extension of the schemes both to the applicant states and also to associated and other countries. However, the practical methods for tackling the three priorities identified in the strands of action (particularly the benchmarking exercise) may generate a feeling among individual Member States, applicant states or associated countries that they are being pilloried rather than given support. It is thus important that the schemes focus rigorously on achieving health objectives. Any processing of material must also have a strictly practical, scientific purpose.

3.16. It is unclear whether the priority is to protect health or to push through market principles. This issue in particular will be of relevance in the ongoing development of national social and health system policies and should be discussed openly by the Commission. The fear is that both social protection and the "humanitarian" face of health care and social systems will quickly fall by the wayside if health issues are judged strictly in terms of their economic viability and social protection measures are assessed for their consistency with market rules. A more discriminating assessment of the interaction between the market and social systems in the European Community and a clear statement from the Commission on the need to protect health and social systems - from, inter alia, the market forces - would help boost public confidence. These difficulties are particularly in evidence in the pharmaceuticals sector. Mutual health insurance schemes, which operate according to the solidarity principle, are particularly concerned with and play an active role in these developments. The ESC backs solutions geared strictly to achieving a high level of health protection.

4. Specific comments

4.1. Overall aim and general objectives (Article 2)

The new strategy set out in the European Parliament decision is designed: (a) to improve health-related information and knowledge; (b) to facilitate a rapid and coordinated response to threats to health and (c) to take preventive action to minimise or eliminate health threats. The Economic and Social Committee regrets the failure to take up its suggestion that there be a fourth objective, namely the integration of health protection requirements into other Community policies and actions.

4.2. Community actions (Article 3 and the annex: Specific objectives and actions)

4.2.1. Improving health information and knowledge

4.2.1.1. Developing and operating a health monitoring system

4.2.1.1.1. The provision of information on the health situation in the Member States and - thus the Community in general - hinges on the availability of comparable data. In fact, such data hardly exist. Some organisations such as the OECD or the WHO do draw up comparative studies, but they usually do not use the same methods for collecting and interpreting data.

4.2.1.1.2. Moreover, the data used to analyse health services are invariably estimates; there is thus a margin of error which as a rule makes correlation difficult or completely impossible. This difficulty is exacerbated by the fact that the procedures for drawing up the assorted estimates vary, and also the study parameters in the different countries rarely match. It thus makes sense to adopt a common European approach, which can do much to improve data availability and - in particular - data comparability. For the success of this venture, it will be important always to make clear what the health monitoring objective is, in order to ensure collection of the data required to develop health protection. Any expansion of health monitoring should incorporate existing classifications and statistics.

4.2.1.1.3. To prevent a loss of public confidence in the Community as a result of the collection of health data, the Commission should strive to ensure that, under these schemes, no identifiable personal data are stored with government authorities or with bodies to which such authorities have access. Otherwise, there would be a danger of political misuse or direct intervention management and the involvement of health professionals would also be called into question. However, this is not an argument against the systematic approach proposed here, which can be fully implemented without individual data, using only aggregated anonymous information.

4.2.1.1.4. It is in itself a major challenge to reach agreement on a common set of indicators and then to undertake a comparison of health monitoring data relating to health systems which very much bear national traits. The data collected in this way are to be made available to the general public, health professionals and other stakeholders (via inventories and directories) and also to national, regional and local health authorities. Although this is a very ambitious programme, unique in the world, the question of its actual benefits remains, for the moment, theoretical.

4.2.1.1.5. Although the programme does make arrangements for monitoring how studies are carried out and for effective programme implementation, the question of actual impact on health care can only be answered on the basis of the indicators laid down in the particular study itself.

4.2.1.1.6. There is the risk that such indicator-based comparative schemes will result in Member States focusing public health activities on areas evaluated with the help of indicators, while neglecting other, unassessed fields ("window dressing"). Collateral effects such as a deterioration of care in other areas (not covered by indicators) or a slow-down - damaging in the long term - in the development of medical equipment cannot be measured using the approach set out above. New demands are thus placed on a broad-based quality assurance.

4.2.1.2. Developing and using mechanisms for analysis, advice, reporting, information and consultation

4.2.1.2.1. One of the ESC's earlier recommendations was for the establishment of an independent Commission advisory committee. The Commission's plan on that score is, among other things, to set up a European Health Forum as a consultative mechanism. The purpose of the forum is to give organisations representing patients, health professionals and other stakeholders the chance to make inputs into health policy and priority setting. It will provide a platform for consultations and discussions on a wide range of topics.

4.2.1.2.2. The Commission intends to launch a consultation later this year on the detailed functioning, organisation and composition of the forum.

4.2.1.2.3. The Commission will have to ask itself how it intends to establish such a forum as a real policy-building mechanism which does not contravene democratic principles or give rise to the suspicion that it is an inexpensive tool of "policy entrepreneurship". The Economic and Social Committee regrets the Commission's lack of precision on this issue.

4.2.1.2.4. Against the backdrop of the work programme launched by the Commission with a view to a white paper on European governance, the Economic and Social Committee endorses the view expressed by the Commission in the discussion of the opinion that the forum is to be given no formal status. It is not a matter of calling the authority, representativity and legitimacy of the Economic and Social Committee and the Committee of the Regions into question. The ESC is prepared to advise the Commission on the composition and structure of the forum as part of a formal consultation process. In this context, the ESC would also refer to the Committee of the Regions' opinion on the same issue(4) and its opinion of 13 April 2000 on the role of the local and regional authorities in the reform of European public health systems(5).

4.2.2. Responding rapidly to health threats

4.2.2.1. Enhancing the capacity to tackle communicable diseases Strengthening the capacity to tackle other health threats

4.2.2.1.1. So far, there has been insufficient coordination of national alert systems at Community level, as the events surrounding the food poisoning and food contamination cases of recent years have shown in particular. It is thus vital to set in place rapid response mechanisms for major health threats and to establish a rapid alert system.

4.2.2.1.2. It makes sense to link these and other specific policy areas such as ensuring the safety and quality of blood, organs and substances of human origin and strengthening the surveillance and control of communicable diseases; as the Commission proposes in the communication, such linkage should be extended to include health threats such as drug abuse, physical impacts on health and the prevention of accidents and injuries. Health professionals have a particular role to play here. They must be better able to tackle health requirements and health threats resulting from mobility, and in particular the cross-border movement of goods. The appropriate national bodies should take account of this aspect in the requirements for health professionals' initial, further and ongoing training.

4.2.2.1.3. However, the Committee has serious doubts about the need to establish a "Community incident investigation team". Such a team could not have the expertise to cover all possible outbreaks of disease; it would not have the right to take drastic action and would be impossible to keep usefully occupied. A more sensible option would be to set in place rapid advisory and support mechanisms in the form of "networks of expertise". Moreover, the cooperation generated by such an approach would also benefit "normal" care.

4.2.2.1.4. The Committee confirms the need to link the public health strategy with other existing actions and fields (network for the surveillance and control of communicable diseases, European Monitoring Centre for Drugs and Drug Addiction, smoking and tobacco control, organs and substances of human origin, blood and blood derivatives and veterinary and phytosanitary measures).

4.2.3. Addressing health determinants

4.2.3.1. Developing strategies and measures on lifestyle-related health determinants

4.2.3.1.1. The third strand of action addresses underlying health factors. These include in particular both positive and negative lifestyle factors, such as physical activity, a proper diet, stress, smoking, excessive alcohol consumption and drug abuse (including doping in sport), as well as major socio-economic factors.

4.2.3.1.2. The fact that the Commission communication targets action on young people is based on the belief that health behaviour is learnt primarily in childhood and adolescence. However, it should not be forgotten that adults can also change their behaviour and lifestyle. Health promotion is directed at everyone. The media and health professionals have a particular role to play. They must be continuously prepared for their tasks in health promotion and disease prevention.

4.2.3.2. Developing strategies and measures on socio-economic health determinants

4.2.3.2.1. In an earlier opinion, the Economic and Social Committee called for consideration to be given to specific, age-related issues (e.g. young and old groups) and particularly vulnerable categories (e.g. immigrant and other under-privileged sectors of the population). These factors may be classed as "socio-economic determinants". However, the strategy set out here deals more with systematic observation and data collection than the development of dedicated health advancement and promotion schemes in these areas.

4.2.3.2.2. The same is true of the link-up (called for by the Committee in the same opinion) between health policy and the socio-economic dimension (e.g. employment). Here too, the proposed programme may fall short of what is required, since, although it identifies and documents health problems and their link to socio-economic factors, the programme will probably not intervene by regulating how both these aspects interact.

4.2.3.2.3. Demands for health system convergence have grown markedly as a result of the increased migration of EU citizens as workers or tourists and fully open borders for the free movement of goods, services and capital. The ESC made known its views on this issue in its opinion of 27 January 2000 on the Proposal for a Council Regulation (EC) on coordination of social security systems(6).

4.2.3.2.4. With regard to cross-border health care delivery (cf. also ECJ judgements in the Kohll and Decker cases)(7), the Community should make arrangements which clearly reinforce people's rights, particularly vis-à-vis health insurers or other financing agencies such as (state) health administrations. Action is of course also needed in the fields of cross-border quality assurance (including quality of access) and cross-border service delivery and payment.

4.2.3.2.5. The Community could do much to gain public confidence here by demonstrating that citizens have a right to treatment abroad (and also to have it paid for by their home-country insurer), but also by ensuring that no-one is forced for economic reasons to travel to another country for treatment. Given this changed environment, health system convergence, but not harmonisation, must be stepped up considerably. The Economic and Social Committee would like to see the Commission give greater consideration to this ongoing development.

4.2.3.3. Developing strategies and measures on health determinants related to the environment

The inclusion of horizontal aspects of public health is in line with ESC recommendations(8). The proposal, however, gives no indication of what specific changes are to be made to cooperation by the Member States and the work of the Commission.

4.2.4. Carrying out the actions

The Commission recommends that provision be made both for the issuing of contracts (full financing) and the granting of subsidies.

The Economic and Social Committee is pleased that the Commission will strive to ensure that the public health programme is efficiently and effectively implemented and that, to this end, independent, external mid-term and ex post evaluations of the programme are submitted on the basis of indicators and work programmes. In this way, the Commission intends to assess the impact and efficiency of the resources used and to fine-tune the management of the programme. The issue of indicator-based assessment was addressed critically above.

4.3. Joint actions (Article 4)

The Economic and Social Committee is pleased to note that "as part of the effort to ensure a high level of health protection in the definition and implementation of all Community policies and activities, the measures of the programme may be implemented as joint actions with related Community programmes and actions". The Committee would point out, however, that this does not replace the requirement under Article 152 of the EC Treaty which states that "a high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities".

4.4. Consistency and complementarity (Article 6)

The Committee assumes that the committee referred to in Article 8(1) will also discuss proposals which do not stem directly from the public health sphere but which are of relevance to the objectives and actions of the programme.

4.5. Funding (Article 7)

The financial framework for the six years the programme is to run is set at EUR 300 million. This averages EUR 50 million a year. The Economic and Social Committee welcomes the funding rise. In contrast to earlier programmes, whose budgets were inflexible, the framework for action provides for the ongoing re-deployment of resources between the various strands. The Committee feels that dedicated funding is needed to ensure that all Community policies are geared to a high level of health protection. The Commission evidently also believes that it can tackle the work involved without specifically designated staff; the fear here is that, given their complexity, the tasks at hand will remain undone.

4.6. Participation of the EFTA/EEA countries, the associated central and eastern European countries, Cyprus, Malta and Turkey (Article 9)

The provisions about the inclusion of non-EU countries, especially the applicant states, remain vague, and these countries are not mentioned specifically in the financial statement.

4.7. International cooperation (Article 10)

This point addresses the issue of cooperation with international organisations (such as the OECD and the WHO). Such cooperation is to be stepped up - a welcome move to avoid duplication of work and the resultant waste of resources.

5. Summary

5.1. To sum up, while the Economic and Social Committee broadly welcomes the proposal, it would make the following points:

5.2. For the Commission, the communication on the health strategy of the European Community represents a change in policy direction, with a move away from priority-led, single-issue approaches towards a comprehensive, coherent strategy with two main strands: (i) to support national efforts on the health front; (ii) to coordinate other individual Union measures more closely and to assess other policies for their relevance to health.

5.3. The European Community's new health strategy is largely based on comparing health data. The Committee would propose that the appropriate bodies in the Member States and the regions cooperate on a voluntary basis in order to further such comparisons and promote health system development. It would be unfortunate if a ranking system were to have a demotivating effect.

5.4. The Economic and Social Committee therefore welcomes the Commission's efforts to provide comparable health data. This is a valuable contribution towards greater equality in health - and medical care.

The Committee hopes that Member States' health planning will be greatly assisted by taking account of care requirements.

5.5. The Economic and Social Committee regrets that there is no fourth strand in the action programme - and no formal proposals and resources - dealing with the Community analysis of health issues and their relevance for other policy areas.

5.6. The Commission is seeking to establish a European Health Forum as a consultative mechanism. It does not specify the profile such a body is to have and leaves open the issue of its composition. In its place, the Economic and Social Committee recommends that the official bodies responsible for health services, regional/local government and social stakeholders should be given adequate say and the chance to help frame the relevant schemes.

5.7. If all policy areas are in future to be assessed for their relevance to health, the Commission should make this a priority recommendation in the Proposal for a Decision of the European Parliament and of the Council adopting a programme of Community action in the field of public health (2001-2006).

Brussels, 29 November 2000.

The President

of the Economic and Social Committee

Göke Frerichs

(1) Cf. 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, COM(1998) 230 final.

(2) Cf. ESC opinions on: Communication on the framework for action in the field of public health, OJ C 388, 31.12.1994; Action programme to combat cancer, OJ C 393, 31.12.1994; Communication on a programme of Community action on health promotion, information, education and training, OJ C 102, 24.4.1995; Action programme on the prevention of drug dependence, OJ C 110, 2.5.1995; Programme of Community action on the prevention of AIDS and certain other communicable diseases, OJ C 133, 31.5.1995; Action programme on health monitoring, OJ C 174, 17.6.1996; The Bovine Spongiform Encephalopathy (BSE) crisis and its wide-ranging consequences for the EU (own-initiative opinion), OJ C 295, 7.10.1996; Network for the epidemiological surveillance and control of communicable diseases, OJ C 30, 30.1.1997; Communication from the Commission to the Council and the European Parliament on the present and proposed Community role in combating tobacco consumption, OJ C 296, 29.9.1997; Action programme on injury prevention, OJ C 19, 21.1.1998; Action programme on rare diseases, OJ C 19, 21.1.1998; Action programme on pollution-related diseases, OJ C 19, 21.1.1998; Communication on consumer health and food safety, OJ C 19, 21.1.1998; Proposal for a European Parliament and Council Regulation (EC) on orphan medicinal products, OJ C 101, 12.4.1999; Asbestos (own-initiative opinion), OJ C 138, 18.5.1999; Proposal for a Council Directive on the protection of workers from the risks related to exposure of carcinogens at work (Sixth individual Directive within the meaning of Article 16 (1) of Directive 89/391/EEC), OJ C 368, 20.12.1999; Proposal for a European Parliament and Council Directive on the Community code relating to medicinal products for human use (codified version), OJ C 368, 20.12.1999; Proposal for a Directive of the European Parliament and of the Council on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale of tobacco products, "recast version", OJ C 140, 18.5.2000.

(3) Cf. Opinion of the Economic and Social Committee 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, OJ C 407, 28.12.1998.

(4) Cf. Opinion of the Committee of the Regions on the Communication on the health strategy of the European Community - Proposal for a programme of Community action in the field of public health (2001-2006) (COM(2000) 285 final).

(5) Cf. Opinion of the Committee of the Regions of 13 April 2000 on the role of the local and regional authorities in the reform of European public health systems - CdR 416/99 fin.

(6) Cf. Opinion of the Economic and Social Committee on the Proposal for a Council Regulation (EC) on coordination of social security systems - OJ C 75, 15.3.2000.

(7) Cf. Judgement of the European Court of Justice No C-120/95 (28.4.1998), where Articles 30 and 36 of the EC Treaty preclude national rules under which a social security institution of a Member State refuses to reimburse to an insured person on a flat-rate basis the cost of a pair of spectacles with corrective lenses purchased from an optician established in another Member State, on the grounds that prior authorisation is required for the purchase of any medical products abroad ("free movement of goods"). Cf. Judgement of the European Court of Justice No C-158/96 (28.4.1998), where Articles 59 and 60 of the EC Treaty preclude national rules under which reimbursement, in accordance with the scale of the State of insurance, of the cost of dental treatment provided by an orthodontist established in another Member State is subject to authorisation by the insured person's social security institution ("free movement of services").

(8) Cf. Opinion of the Economic and Social Committee 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, OJ C 407, 28.12.1998.