COMMON POSITION (EC) No 11/95 adopted by the Council on 2 June 1995 with a view to adopting a European Parliament and Council Decision of . . . adopting a programme of Community action on health promotion, information and training within the framework for action in the field of public health (1996 to 2000) (95/C 216/03)

THE EUROPEAN PARLIAMENT AND THE COUNCIL OF THE EUROPEAN UNION,

Having regard to the Treaty establishing the European Community, and in particular Article 129 thereof,

Having regard to the proposal from the Commission (1),

Having regard to the opinion of the Economic and Social Committee (2),

Having regard to the opinion of the Committee of the Regions (3),

Acting in accordance with the procedure referred to in Article 189b of the Treaty (4),

(1) Whereas, with reference to point (o) of Article 3 of the Treaty, Community action must include a contribution towards the achievement of a high level of health protection; whereas Article 129 of the Treaty expressly provides Community competence in this field in so far as the Community contributes to it by encouraging cooperation between Member States and, if necessary, by lending support to their action;

(2) Whereas the actions to be carried out need to be undertaken within the framework for action in the field of public health set out by the Commission and to take into account, as the Council requested in its resolution of 27 May 1993 (5), other actions undertaken by the Community in the field of public health or which have an impact on public health;

(3) Whereas the Council, in its resolution of 2 June 1994 (6), in response to the Commission communication of 29 March 1994 on a framework for action in the field of public health, included health promotion, education and training among the priority areas for Community action for which the Commission was invited to bring forward proposals for action;

(4) Whereas, in their resolution of 23 November 1988 concerning health education in schools (7), the Council and the Ministers of Education meeting within the Council emphasized that certain eating habits, the uncontrolled use of some chemical substances and medicines, drug abuse, smoking and environmental pollution have a harmful effect on health, also bearing in mind the related problems of safety and accident prevention;

(5) Whereas, in their resolution of 3 December 1990 concerning an action plan on nutrition and health (8), the Council and the Representatives of the Governments of the Member States meeting within the Council underlined that the promotion of a healthy lifestyle related to nutrition is vitally important to enable people to make the necessary choices for ensuring appropriate nutrition in keeping with individual needs;

(6) Whereas, in their conclusions of 13 November 1992 (9), in response to the Commission communication to the Council of 11 May 1992 on school health education (10), the Council and the Ministers for Health of the Member States meeting within the Council identified school as a vital setting for systematically developing a healthy lifestyle at an early age that will enable sickness and accidents to be reduced; whereas they considered that there were a variety of other settings such as local communities, homes, workplaces and hospitals, in which health promotion and health education had a central role; whereas they invited the Commission to strengthen cooperation between Member States in implementing effective health promotion and health education actions in the various settings;

(7) Whereas in its resolution (11) concerning public health, health promotion and health education, the European Parliament formulated a series of proposals for Community action in the field of accident prevention and prevention of cardiovascular diseases which are not currently the subject of Community programmes;

(8) Whereas, in its resolution of 2 June 1994 concerning cardiovascular diseases (12), the Council invited the Commission to examine actions to encourage their prevention and further study of the risk factors for such diseases;

(9) Whereas the results of the integrated approach as demonstrated in the Joint World Health Organization - Council of Europe - European Community Project entitled 'The European network of health promoting schools' are encouraging with respect to ways of implementing health promotion in particular settings;

(10) Whereas it is recognized that socio-economic conditions such as urbanization, housing, unemployment, and social exclusion have to be taken into consideration in the promotion of health, particularly for those living in deprived areas;

(11) Whereas health education and information are expressly mentioned in the provisions of the Treaty dealing with public health, and constitute a priority for Community action in public health;

(12) Whereas, Community action to support health promotion makes it possible by reason of the scale or effects of such action, to better achieve the objectives envisaged;

(13) Whereas cooperation with the competent international organizations and with non-member countries should be strengthened;

(14) Whereas a multiannual programme should be launched with clear objectives for Community action, and priority action should be selected to promote the health of all the citizens of the Community as well as appropriate mechanisms for the evaluation of such action;

(15) Whereas this programme has to contribute to the enhancement of awareness of health determinants and risk factors and encourage the development of an integrated approach to health promotion;

(16) Whereas, from the operational point of view, the activities undertaken in the past both in terms of the establishment of Community networks of non-governmental organizations and of the mobilization of all those involved in health promotion and education has to be safeguarded and developed;

(17) Whereas, however, possible duplication of effort has to be avoided by the promotion of the exchange of experience and by the joint development of basic information modules for the general public, for health education and for training members of the health professions;

(18) Whereas the objectives of this programme and the actions implementing it form part of the requirements concerning health protection referred to in the third subparagraph of Article 129 (1) of the Treaty and by virtue thereof form a constituent part of the Community's other policies;

(19) Whereas it is important that the Commission ensures implementation of this programme in close cooperation with the Member States; whereas, to that end, provision must be made for a procedure to ensure that Member States are fully involved in implementing the plan;

(20) Whereas agreement on a modus vivendi between the European Parliament, the Council and the Commission concerning measures implementing acts adopted in accordance with the procedure laid down in Article 189b of the EC Treaty was reached on 20 December 1994;

(21) Whereas this Decision lays down, for the entire duration of this programme, a financial framework constituting the principal point of reference, within the meaning of point 1 of the Declaration of the European Parliament, the Council and Commission of 6 March 1995, for the budgetary authority during the annual budgetary procedure;

(22) Whereas this programme must be of five-year duration in order to allow sufficient time for actions to be implemented to achieve the objectives set;

(23) Whereas in order to increase the value and impact of the action programme a continuous assessment of the measures undertaken should be carried out, with particular reference to their effectiveness and the achievement of objectives at both national and Community level, and the necessary adjustments should be made where appropriate,

HAVE DECIDED AS FOLLOWS:

Article 1

Establishment of the programme

1. A programme of Community action on health promotion, information, education and training, hereinafter referred to as 'the programme', is adopted for the period 1 January 1996 to 31 December 2000 within the framework for action in the field of public health.

2. The programme shall have as its objective to contribute towards ensuring a high level of health protection and shall comprise actions aimed at:

- encouraging the 'health promotion' approach in Member States' health policies by lending support to various cooperation measures (exchanges of experience, pilot projects, networks, etc.),

- encouraging the adoption of healthy lifestyles and behaviour,

- promoting awareness of risk factors and health-enhancing aspects,

- encouraging intersectoral and multidisciplinary approaches to health promotion, taking account of the socio-economic factors and the physical environment necessary for the health of the individual and the Community, especially for disadvantaged groups.

3. The actions to be implemented under the programme and their specific objectives are set out in the Annex under the following headings:

A. Health promotion strategies and structures

B. Specific prevention and health promotion measures

C. Health information

D. Health education

E. Vocational training in public health and health promotion

Article 2

Implementation

1. The Commission shall ensure the implementation, in close cooperation with the Member States, of the actions set out in the Annex in accordance with Article 5.

2. The Commission shall cooperate with institutions and organizations active in the field of health promotion, information, education and training.

3. Member States are called upon to take the necessary measures to coordinate and organize the implementation of the programme at national level.

Article 3

Budget

1. The total appropriation for implementation of the programme for the period referred to in Article 1 shall be ECU 30 million.

2. The annual appropriations shall be authorized by the budget authority within the limits of the financial perspective.

Article 4

Consistency and complementarity

The Commission and the Member States shall ensure that there is consistency and complementarity between Community actions to be implemented under the programme and other relevant Community programmes and initiatives, within the framework of public health action and particularly in the fields of education and vocational training (Socrates and Leonardo programmes), research (Biomed II) and health and safety at work.

Article 5

Committee

1. The Commission shall be assisted by a committee, hereinafter referred to as 'the committee', consisting of two members designated by each Member State and chaired by a representative of the Commission.

2. The representative of the Commission shall submit to the committee a draft of the measures to be taken, referring to:

(a) the committee's rules of procedure;

(b) an annual work programme indicating the priorities for action;

(c) the arrangements, criteria and procedures for selecting and financing projects under the programme, including those involving cooperation with international organizations competent in the field of public health, and participation of the countries mentioned in Article 6 (2);

(d) the evaluation procedure;

(e) the arrangements for dissemination and transfer of results;

(f) the arrangements for cooperating with the institutions and organizations referred to in Article 2 (2).

The committee shall deliver its opinion on the draft measures referred to above within a time limit which the chairman may lay down according to the urgency of the matter. The opinion shall be delivered by the majority laid down in Article 148 (2) of the Treaty in the case of decisions which the Council is required to adopt on a proposal from the Commission. The votes of the representatives of the Member States within the committee shall be weighted in the manner set out in that Article. The chairman shall not vote.

The Commission shall adopt measures which shall apply immediately. However, if these measures are not in accordance with the opinion of the committee, they shall be communicated by the Commission to the Council forthwith. In that event, the Commission shall defer application of the measures which it has decided upon for a period of two months from the date of such communication.

The Council, acting by a qualified majority, may take a different decision within the time limit referred to in the previous paragraph.

3. In addition, the Commission may consult the committee on any other matter concerning the implementation of the programme.

The representative of the Commission shall submit to the committee a draft of the measures to be taken. The committee shall deliver its opinion on the draft within a time limit which the chairman may lay down according to the urgency of the matter, if necessary by taking a vote.

The opinion shall be recorded in the minutes; in addition, each Member State shall have the right to ask to have its opinion recorded in the minutes.

The Commission shall take the utmost account of the opinion delivered by the committee. It shall inform the committee of the manner in which its opinion has been taken into account.

4. The representative of the Commission shall keep the committee regularly informed of:

- financial assistance granted under the programme (amount, duration, breakdown and beneficiaries),

- Commission proposals or Community initiatives and the implementation of programmes in other areas which are directly relevant to achievement of the objectives of the programme, with a view to ensuring the consistency and complementarity required pursuant to Article 4.

Article 6

International cooperation

1. In the course of implementing the programme, cooperation with non-member countries and with international organizations competent in the field of public health, in particular the World Health Organization and the Council of Europe, shall be encouraged and implemented in accordance with the procedure laid down pursuant to Article 5.

2. The programme shall be open to the participation of the associated countries of central and eastern Europe (CCEE) in accordance with the conditions agreed to in the Additional Protocols to the Association Agreements, to be concluded with those countries, concerning participation in Community programmes. The programme shall be open to the participation of Cyprus and Malta on the basis of additional appropriations in accordance with the same rules as apply to the EFTA countries following procedures to be agreed with the countries in question.

Article 7

Monitoring and evaluation

1. The Commission, taking into account the reports drawn up by the Member States and with the participation, where necessary, of independent experts, shall ensure that an evaluation is made of the actions undertaken.

2. The Commission shall submit to the European Parliament and the Council an interim report halfway through the programme and a final report on completion. The Commission shall incorporate into these reports the results of the evaluation. It shall also send the reports to the Economic and Social Committee and the Committee of the Regions.

Done at . . .

For the European Parliament

The President

For the Council

The President

(1) OJ No C 252, 9. 9. 1994, p. 3.

(2) OJ No C 102, 24. 4. 1995, p. 15.

(3) Opinion delivered on 16 November 1994 (not yet published in the Official Journal).

(4) Opinion of the European Parliament of 15 March 1995 (OJ No C 89, 10. 4. 1995), Council common position of . . . (not yet published in the Official Journal) and European Parliament Decision of . . . (not yet published in the Official Journal).

(5) OJ No C 174, 25. 6. 1993, p. 1.

(6) OJ No C 165, 17. 6. 1994, p. 1.

(7) OJ No C 3, 5. 1. 1989, p. 1.

(8) OJ No C 329, 31. 12. 1990, p. 1.

(9) OJ No C 326, 11. 12. 1992, p. 2.

(10) SEC(92) 476 final.

(11) PE 205-804 final.

(12) OJ No C 165, 17. 6. 1994, p. 3.

ANNEX

COMMUNITY ACTION PROGRAMME ON HEALTH PROMOTION (1996 to 2000)

A. Health promotion strategies and structures

Objective

To encourage the evaluation of the impact of policies and instruments on health promotion, and the development of a health promotion approach in the Member States by promoting the devising and assessment of health promotion strategies and dissemination of the best practices.

Actions

1. Surveys and comparative analyses of the impact of Community and national policies and instruments on health promotion and of health promotion structures and strategies and the assessment of the latter; activities to encourage and support cooperation between Member States on various strategic aspects of public health and health promotion.

2. Support for transnational networks of national, regional or local health promotion bodies, adopting an integrated approach (i.e. an approach covering the various determinants, contexts and population groups) and promotion of joint activities and projects.

B. Specific prevention and health promotion measures

Objective

To improve knowledge, particularly in conjunction with measures under the Biomed programme, of the situation and the problem of health promotion in relation to certain risk factors and health determinants and to certain disadvantaged social groups. Promote intersectoral and multidisciplinary approaches to health promotion geared to vulnerable or disadvantaged groups.

Actions

3. Support for integrated health promotion activities and projects relating to disadvantaged or vulnerable groups and particular areas, and incorporating the intersectoral dimension of health promotion.

4. Examination, in conjunction with the studies being carried out as part of the fight against cancer, of the role of balanced nutrition as a preventive measure and of nutrition in the etiology of diseases.

Support for information to the public to improve awareness of basic nutritional principles and of new techniques and methods of presenting and preparing foodstuffs.

5. Promotion of analysis, evaluation and exchange of experience and information and support for actions in respect of innovative measures for the prevention of cardiovascular and cerebrovascular diseases, taking account of the risk factors for such diseases.

6. Support for exchanges of experience and information concerning the rational use of medicines, in particular generic medicines and self-medication, in cooperation with general practitioners and pharmacists. Exchange of experience on providing the public with information on the use of medicines, in particular medicines available without prescription.

7. Promotion of examination, assessment and exchanges of experience and support for actions concerning measures to prevent alcohol abuse and the health and social consequences thereof.

C. Health information

Objective

To improve knowledge of mechanisms for devising health messages and assessing health information methods and encourage an exchange of information and documentation between professionals and those responsible for public health and health promotion policies.

Actions

8. Efforts to improve knowledge of the psychological, sociological and cultural mechanisms and the economic factors involved and of information methods to encourage the adoption of healthy lifestyles; support for the assessment of results and for dissemination of the best practices.

9. Surveys of public opinion on various aspects of health promotion (Eurobarometer survey) and support for the preparation and assessment of specific information campaigns including those coordinated at Community level or in several Member States.

10. Support for development of a European infrastructure, for example in the form of transnational networks, reference centres for information and documentation on public health and health promotion for use by professionals, administrators and decision-makers in the field of public health, and dissemination to interested parties of information on the Community's activities in this field.

D. Health education

Objective

To encourage greater integration of health education in schools; foster the development and dissemination of the best health education experiments and methods tailored to different contexts (e.g. school, work and leisure) and different types of public (e.g. children, adolescents and young adults and workers).

Actions

11. Exchanges of experiences between Member States concerning the development and distribution of appropriate health education programmes, teaching materials and modules. Support for demonstration projects and innovative experiments with the aim of promoting healthy lifestyles and responsible behaviour, including support for the European Network of Health Promoting Schools in cooperation with WHO and the Council of Europe.

12. Support for health education projects among young persons and adolescents who have left the school system in settings such as sport and leisure activities and socio-cultural activity centres and support for their evaluation.

13. Support for innovative means of providing continuing structured health education, involving distance teaching and information technologies, for adults and the elderly.

14. Support for health education measures in the workplace, particularly in relation to nutrition and the risks involved in tobacco and alcohol consumption, as well as factors such as mental health, including prevention of stress-related risks.

E. Vocational training in public health and health promotion

Objective

To help to familiarize the various categories of health staff, those who decide on and administer health policy or action and those in the front line of health promotion (e.g. teachers, educators, social workers) with knowledge, ideas and methods relating to public health, prevention, health promotion, information and health education.

Actions

15. Review and assessment of existing structures and training schemes in public health and health promotion and compilation of a European directory. Support for cooperation involving schools of public health, universities and bodies providing training in this area with a view to the development of common training courses and exchanges of students and teaching staff in conjunction with existing education and training schemes.

16. Promotion of cooperation between Member States on the content of training courses and training activities in the fields of public health and health promotion for professionals, administrators and decision-makers, emphasizing interdisciplinary approaches (including the social, economic, psychological and environmental aspects).

17. Support for training activities concerning health education in schools aimed at teachers, instructors and other staff concerned including development of modules, teaching aids and materials.

18. Encouragement and support for exchanges of experience with training health professionals in health promotion, prevention and the early detection of diseases, including cardiovascular diseases, and in identifying and controlling risk factors and situations including those linked to alcohol abuse.

STATEMENT OF THE COUNCIL'S REASONS

I. INTRODUCTION

1. On 22 August 1994 the Commission submitted a proposal, based on Article 129 of the EC Treaty, relating to a Decision adopting a programme of Community action on health promotion, information, education and training.

2. Opinions were delivered by the European Parliament on 15 March 1995 (1), by the Economic and Social Committee on 25 January 1995 (2) and by the Committee of the Regions on 16 November 1994 (3).

3. In the light of those opinions, the Commission submitted an amended proposal on 24 April 1995.

4. On 2 June 1995 the Council adopted its common position in accordance with Article 189b of the Treaty.

II. OBJECTIVE OF THE PROPOSAL

The proposed programme, which is regarded by the Commission and the Council as one of the priorities for action in the field of public health over the next five years, has a broader and more general scope than the other measures already implemented or proposed in this area.

Rather than being an action centred on the various aspects of one specific health problem (cancer, AIDS, etc.), it encompasses general fields and factors of prevention or pertinent aspects and approaches from the point of view health promotion, categorized under the following headings:

- Health information

- Health education

- Vocational training in public health and health promotion

- Specific prevention measures

- Health promotion strategies and structures

III. ANALYSIS OF THE COMMON POSITION

1. General remarks

In its common position the Council, while making a number of changes to the order and lay-out of the headings, has retained most of the substance of the proposed programme.

As regards the general elements of the programme (Articles) it has introduced, using an approach similar to that followed in other cases in this area (cancer, AIDS and other communicable diseases), certain amendments which it regarded as necessary in particular to clarify and strengthen the structures and conditions for implementing the programme.

2. Specific remarks

2.1. Amendments made by the Council to the amended Commission proposal

The main amendments made by the Council to the Commission proposal concern the following aspects:

(a) Establishment of the programme (Article 1)

The purpose of the amendments made is to specify the general objectives (paragraph 2) and the structure and specific objectives of the programme set out in the Annex (paragraph 3).

(b) Implementation (Article 2) and committee procedure (Article 5)

The main purpose of the amendments made to the provisions and procedures for implementing the programme is to:

- identify more clearly the respective roles and contributions of the various participants implementing the programme (Article 2),

- reconcile the requirement of flexibility in managing the programme with that of more active involvement of Member States in certain important decisions, by means of a mixed procedure: management committee procedure for the latter decisions and advisory committee procedure for other decisions (Article 5 (2) and (3) - in accordance with the interinstitutional modus vivendi referred to in recital 20),

- strengthen the requirement of transparency and effectiveness through regular information on financial asisstance granted and on activities in other areas which are directly relevant to achievement of the objectives of the programme, in accordance with Article 4 (Article 5 (4)).

(c) Total appropriation (Article 3 (1))

The Council has amended Article 3, in accordance with the ParliamentCouncil/Commission statement of 6 March 1995 on the inclusion of financial provisions in legislative acts, by entering in this Article the amount of the total appropriation to be earmarked for implementation of the programme. An appropriate recital (21) has also been added.

The figure adopted - ECU 30 million - represents a balance between the need to contribute to the initiation and development of activities in this area and the need to take into account the requirements of budgetary discipline.

(d) International cooperation (Article 6)

The Council has confined itself to adjustments to ensure that these provisions are consistent with the provision in Article 5 (2) (f) (paragraph 1) and with agreements in existence or being negotiated with the countries concerned (paragraph 2).

(e) Monitoring and evaluation

The amendments to the text do not alter its substance and are aimed solely at clarifying the conditions for monitoring in general and evaluation in particular.

(f) Annex

The main amendment made by the Council to the proposed text consists of changing the order of the headings and stating, for each of them, the specific objective (as indicated in Article 1 (3)).

2.2. European Parliament amendments

(a) Amendments taken over by the Commission

The Council has taken over - in some instances only partially or in another form - most of the amendments accepted as they stood, or in substance (4) or in part (5) by the Commission.

However, some were not taken over by the Council, which in particular:

- avoided referring, in the recitals, to specific aspects concerning the contents of the Annex (amendments 2, 4 and 6) or, in the enacting terms, to detailed procedures for implementing the programme (which are, moreover, covered by the procedure laid down in Article 5), (amendment 14),

- preferred not to introduce, in the list of measures in the programme, whose scope is very broad, very detailed and specific aspects - or methods of action - which it broadly regarded as covered in a more general form, inter alia by the specific objectives adopted for each of the main headings: amendment 21, in the context of heading D, amendment 34, in the context of heading B, amendments 38 and 39, more particularly in the context of heading C, and in particular point 8.

(b) Amendments not taken over by the Commission (6)

- In most instances the Council agreed with the reasons for the Commission's rejection of these amendments.

However, the Council has taken over the substance, in another form, of some of them, such as amendments 7 (see recital 18) and 15 (see Article 5 (4) and 7). It has also extended point 5 of the Annex (health education at the workplace - now point 14) along lines different from those followed by the Parliament in its amendment 23/50/46.

- In the case of amendments 10, 12 and 13, on which the Commission postponed adopting a position, the questions raised (committee procedure - Article 5 - and budget provisions - Article 3) have been resolved in the Council's common position in accordance with the interinstitutional agreements, as indicated in recitals 20 and 21.

CONCLUSIONS

The Council considers that the common position very largely meets the substance of the Parliament's wishes.

Although in some instances less specific, the formulation of the programme is sufficiently broad and open to make it possible to conduct a multiform, coherent and coordinated action within the framework laid down.

In particular, the Council has endeavoured to take the utmost account of the need to ensure, inter alia through appropriate implementing procedures, coordination and consistency between this programme and other programmes in the field of health, as well as in relation to other fields.

(1) OJ No C 89, 10. 4. 1995, p. 89.

(2) OJ No C 102, 24. 4. 1995, p. 15.

(3) Not yet published in the Official Journal.

(4) Amendments 2, 4, 6, 8, 9, 14, 16, 18, 19, 21, 25, 28, 30, 31, 37, 39, 47 and 48.

(5) Amendments 11, 34, 35, 36 and 38.

(6) Amendments 1, 5, 7, 15, 17, 20, 22, 23, 24, 26, 27, 29, 33, 40, 41, 43 and 44.