Opinion of the Economic and Social Committee on the 'Proposal for a European Parliament and Council Decision adopting a programme of Community action on health monitoring in the context of the framework for action in the field of public health` ()

(96/C 174/02)

On 12 March 1996 the Council decided to consult the Economic and Social Committee, under Article 129 of the Treaty establishing the European Community, on the above-mentioned proposal.

The Section for Protection of the Environment, Public Health and Consumer Affairs, which was responsible for preparing the Committee's work on the subject, adopted its Opinion on 5 March 1996. The Rapporteur was Mr Lemmetty.

At its 334th Plenary Session (meeting of 27 March 1996), the Economic and Social Committee adopted the following Opinion by a large majority with one dissenting vote.

1. ESC Opinions on public health - a review

1.1. During the past years the Committee has produced a number of Opinions in the field of public health. In line with Article 129 of the Maastricht Treaty, the Committee has called, on several occasions, for closer coordination and cooperation between individual Member States and between the Community and international organizations. Better coordination would make it possible to compare achievements in the field of public health in order to find best possible practices and to gain European 'added value` for the benefit of citizens of Member States.

1.2. In its Opinion on the framework programme, the ESC stated that public health policy should not be viewed in a restricted sense, only concerned about disease prevention, but, instead, it should be viewed as health promotion based on a horizontal, interdisciplinary approach, involving cooperation between the various disciplines. Furthermore, the Committee called on the Council to give the Commission a mandate to make a global, horizontal analysis of public health ().

1.3. The importance of valid and available information has been emphasized in various Opinions. The Committee has stressed, for instance, the importance of exchanging information between Member States with a view to reducing differences of approach. Furthermore, relevant and accurate data about the state of public health, and about more detailed indicators would serve as a basis for future decision-making in the health sector both at the Community level and in Member States, with whom responsibility and decision-making in most cases rest.

1.4. In its Opinion on health promotion, information, education and training (CES 50/95) the ESC urged the Commission to set up an 'appropriate structure for processing health data and indicators in order to provide a clearer picture of the various factors, lifestyles, individual behaviour, and environmental and socio-economic conditions, and provide a database which can be accessed by Member States and other health promotion bodies, working in close cooperation with Eurostat` ().

1.5. The Committee has also recommended that a suitable link should be made between health policy and the socio-economic dimension, in terms of solidarity, competitiveness and employment, in the framework of a 'social Europe` and the 'Citizens' Europe`, particularly by stepping up the horizontal approach to the subject (work, employment, urban living environment, housing, farming policy, consumption, environment, etc.) ().

1.6. The Committee has consistently attached importance to cooperation between Member States and stressed the principle of subsidiarity.

1.7. Hence, referring to the abovementioned arguments, the Committee warmly welcomes the new Commission proposal to adopt a Community action programme on health monitoring. After all, the main aim is to guarantee a high level of health protection to all European citizens.

2. Main contents of the proposal

2.1. The Commission proposes a five-year programme for the development of a high-quality health monitoring system. The system is to provide the Community and Member States with indicators and data for supporting their efforts in the public health field, and to facilitate the planning, monitoring and evaluation of Community programmes and actions, in compliance with the principle of subsidiarity.

2.2. The Community health monitoring programme would also involve the development of a network for the purpose of collection and dissemination of health data and indicators, using the possibilities offered by telematics, and the development of a capacity to undertake the analysis of health data and the production of reports, reviews and other health information material.

2.3. The programme will involve:

a) Establishment of Community health indicators;

b) Development of a Community-wide network for sharing health data;

c) Analyses and reporting.

2.4. The Commission proposal states that the choice of Community health indicators will provide the necessary means for monitoring health status in the Community and the factors affecting it and for the planning, monitoring and evaluation of Community programmes and actions. It will also provide Member States with health-related information to support the development of health policy.

3. General comments

3.1. The ESC feels that the Commission's proposed Decision and the Communication which backs it up is founded on a realistic and sound base. The aims and principles of the proposal can be endorsed.

3.2. The matter is an important one. The proposed health monitoring programme is necessary if the EU is to carry out its remit on public health. The preparatory work has been done with care and is well informed. The action proposed is wholly justified.

3.3. The chief problem, both at national and international level, has proved to be the lack of sufficiently comprehensive health indicators designed to gauge the impact of health policy measures, and poor comparability.

3.4. The development and implementation of new indicators is possibly the most important result of the programme. The ESC feels that the programme should place even more emphasis on this development stage.

3.5. The ESC also feels that the Commission's views on the principles underlying a health monitoring system are correct:

- use should be made of ready-made systems and existing data;

- any duplication or overlap of work should be avoided;

- no unnecessary or unjustified burdens should be imposed on Member States;

- there should be a cost/benefit assessment;

- the system must be as flexible as possible.

3.5.1. In particular, the ESC would like to emphasize the Commission's cooperation with the WHO (World Health Organization), OECD (Organization for Economic Cooperation and Development) and EMCDDA (European Monitoring Centre for Drugs and Drug Addiction). The Commission should also consider the scope for cooperation with other European agencies, such as the European Environment Agency, the European Agency for Health and Safety at Work and the European Foundation for the Improvement of Living and Working Conditions. Comparable data is needed from other countries, as well as from EU Member States.

3.5.2. As regards participation by third countries and associated countries, the Committee would welcome the inclusion in the Decision of a mention of cooperation, based on agreements, with all Mediterranean countries.

3.6. In the same way cooperation with the Member States is important if the work is to gain added value. The analysis and interpretation of the data collected is a demanding task involving a large amount of research and expertise. Use should also be made of specialist institutions and experts in the Member States, and part of the meagre budgetary resources proposed could for example be used to fund their participation and contribution to the work.

3.7. The Committee notes with satisfaction that according to Article 7 of the proposal the Commission is also to send reports to the Economic and Social Committee. This will serve to strengthen the established practice applying to all public health programmes.

4. Community health indicators

4.1. According to the Commission proposal, establishing health indicators involves both identifying and analyzing existing indicators and selecting and/or creating Community health indicators and defining them. In the development stage consideration should be given to past and current research and development work, both that done by Member States at their own expense and that funded by the EU in various Community countries.

4.2. According to the proposal, the Commission would be assisted by a committee composed of two representatives from each Member State. The Committee considers it very important that the expertise available in Member States and in Community committees handling health and safety statistics should be utilized in the preparatory work on the selection of 'domains` and 'headings` for indicators. In particular, the ESC stresses the importance of consulting the Advisory Committee on Safety, Hygiene and Health Protection at Work.

4.3. The Committee notes that an important part of the programme listing domains and headings for indicators appears in Annex A to the Communication. Although the list is general and preliminary, the Committee proposes that it be annexed to the proposal, so that the proposal would contain data on domains for indicators.

4.4. Some preliminary general comments on Annex A to the Communication are called for here. The following should be emphasized when the list is being developed:

- the concept of health and the factors determining it should be broad enough so that the data reflects both professional assessments and people's own views;

- the concept of health should cover community level and individual level health determinants as well as actual illnesses and disabilities. The inclusion of these data would help to promote health. Thus socio-economic factors, as well as those connected with work and the environment, should also be considered as affecting health. Consequently, health habits, including eating habits, should be taken into account;

- one of the Community's priority areas is consumer protection. As far as the consumer is concerned, among the essential areas are the quality, provision and financing of health services and equitable availability of services. The Commission Communication refers indirectly to these, in dealing with the feasibility and cost-effectiveness of developing statistics on data protection in the public health sector. Patients' rights and putting these into practice are also an important consideration.

5. Data collection and dissemination of information

5.1. The ESC emphasizes that the rules on data protection with regard to individuals must be properly observed both when establishing the indicators and collecting data.

5.2. In addition to existing sources of information, separate studies are needed, some of which could be carried out annually depending on what they are measuring, while others would be done much less frequently. These studies should be developed in the various Member States to form part of an ongoing health information system and there should be collaboration to ensure that the main procedures used in these studies are as appropriate and comparable as possible.

6. Analyzing and sharing data

6.1. The preferred trend would be for data sharing to be developed using electronic data networks but other methods should be used as well. Use should also be made of other corresponding projects.

6.2. The formulation, collection, analysis and interpretation of health indicators will require networking between Member States and specialist institutions.

7. Links with other Community policies and areas of action

7.1. The Commission Communication lists a number of areas of Community policy which are linked to the present proposal.

7.1.1. In particular, the Committee attaches importance to cooperation in the field of health and safety at work, which would enable an indication to be obtained of the extent of occupational diseases and accidents at work.

7.1.2. In addition, under the statistical framework programme 1993-1997, Eurostat produces valuable statistical data in areas such as health and safety, employment, living conditions and social protection, which are fields of priority action under the sectoral programmes for social policy, economic and social cohesion and consumer protection. In 1994, a Consumer Household Panel Survey was launched covering, for instance, demographics, income, labour force participation, education, housing and certain health aspects.

7.1.3. The Commission proposal on support for the telematic interchange of data between administrations (IDA) provides for three projects in the field of health.

7.1.4. The Committee also refers to health-care actions under the third and fourth framework programmes for research and technological development. The establishment of a European Clearing House on Health Outcomes should also be considered.

8. Conclusions and evaluations

8.1. The ESC considers the Commission proposal to be important and endorses it.

8.2. The ESC emphasizes the importance of establishing and maintaining health indicators and feels it is important that data users are involved at the development stage.

8.3. It could be difficult to fit all the indicators needed for general monitoring of public health and health policy into the same framework as those required at present for certain current EU policies concerning the public health service. It might be better in future to develop these in tandem only where appropriate and to allow separate development where necessary.

8.4. The ESC draws attention to the size of the appropriation for the programme. The appropriation for the collection and dissemination of data is too small considering the importance of the matter for the health policies of Member States and the European Union. In view of the fundamental importance of the programme, more funds should be provided.

Done at Brussels, 27 March 1996.

The President

of the Economic and Social Committee

Carlos FERRER

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