Interim report from the Commission to the Council, the European Parliament, the Economic and Social Committee and the Committee of the Regions on the implementation of the programme of Community action on health promotion, education, information and training (1996-2000)
Date: 2000-03-22
Institutions: European Commission
Subjects: EU action, action programme, cooperation policy, health policy, public awareness campaign

COMMISSION OF THE EUROPEAN COMMUNITIES

Brussels, 22.03.2000
COM(2000)165 final

INTERIM REPORT FROM THE COMMISSION
TO THE COUNCIL, THE EUROPEAN PARLIAMENT,
THE ECONOMIC AND SOCIAL COMMITTEE AND
THE COMMITTEE OF THE REGIONS

on the implementation of the programme of Community action on health
promotion, education, information and training (1996-2000)

TABLE OF CONTENTS

Introduction ........................................................................................................................... 3

Consistency and complementarity.......................................................................................... 3

International co-operation ...................................................................................................... 4

Monitoring and Adjustments.................................................................................................. 4

Programme management........................................................................................................ 5

Observations of the Member States........................................................................................ 7

Effectiveness and the achievement of objectives .................................................................... 9

Budget Allocation for the Health Promotion Programme...................................................... 11

2

Introduction

Following the adoption of the programme of Community action on health promotion
by the European Parliament and the Council, the Commission, in accordance with
Article 7 of Decision N° 645/96/EC1, presents hereunder an interim report.

report,

the Commission highlights

the degree of consistency and
In this
complementarity reached between this plan and the other relevant Community
policies, programmes and initiatives, gives an overview on the international co-
operation in health promotion and also reports on the adjustments which are deemed
necessary as a consequence of the information gathered.

Based on answers to a questionnaire which was dispatched to the Member States
representatives in the programme committee the links to Member States' policies and
an impact on the development of health promotion in their countries have been drawn
up.

Furthermore the Commission presents first results of an evaluation which was carried
out by a group of independent experts, who under contract to the Commission
analysed the decision-making procedures of supported projects and the levels of
activity in the different priority areas in the three years 1996-1998. Within this part,
particular regard has been given to effectiveness and the achievement of the
objectives of the measures undertaken.

Consistency and complementarity

The Commission sought consistency and complementarity between its health
promotion and other Community policies, programmes and initiatives by a multitude
of efforts on different operational levels, in particular:

The implementation of the 4th Framework programme for research, technological
development and demonstration (1994 – 1998) of the European Communities was
closely followed by means of the inter-service consultations on publications of calls
for proposals and on adoption of projects for financing.

The preparation of the 5th Framework programme for
technological
development and demonstration (1998 – 2002) was actively followed by means of the
inter-service consultations on the draft proposal, and consultations on project
proposals, in order to ensure consistency and complementarity.

research,

Further, officials of the public health directorate were invited to all meetings of the
programme committees for the specific research programmes; likewise, officials from
the research directorates were invited to the meetings of the programme committee.

1

OJ EC L 95, 16.4.1996.

3

In the course of the implementation of the programmes, applicants seemed also to
have better understood the difference between health and health services research as
foreseen under the framework programmes for research and the health promotion
measures covered under this action plan.

International co-operation

Based on a mutual understanding of health promotion and its impact on people's
health and on infrastructural and environmental changes, the Commission has from
in
the beginning onward closely co-operated with other
particular with WHO. Thus, some conferences and international workshops on
specific issues have jointly been organised and the Commission Services significantly
contributed to the 4th World Health Conference on health promotion in Jakarta.

international bodies,

Monitoring and Adjustments

Monitoring of the specific actions has been performed mainly through a continuous
follow-up by the Commission Services of the contractual obligations of the projects
financed.

To improve the European added value as an important general objective,
the
Commission Services have embarked on a strategy to ask for enhanced networking of
applicants
to ensure better cross-border co-operation, e.g., as a means of
dissemination of best practice in Europe.

To cover areas of Community interest, which were not covered by specific actions
selected to date, following a thorough analysis of the active portfolio, the Commission
adopted annual work plans. In turn, the annual work plans aided in establishing
priorities for the next calls for proposals as well as in the selection of the newly
proposed actions.

4

To further improve transparency and simplify dissemination at the same time annual
reports have been produced for 19962, 19973 and 19984 by the Commission’s
Services, which give a comprehensive picture of the work of the respective unit of the
Commission’s services.

Following external suggestions and internal review of shortcomings the linkages
between the health promotion programme and other public health programmes have
been improved.

Programme management

Programme management since the first years of the implementation of the health
promotion programme has improved, but there are still opportunities for further
improvement.

This programme came into force end of March 1996. Thus, the creation of the formal
management infrastructure, including the setting up of the programme committee and
its rules of procedure and working practices, only occurred after
the formal
commencement of the programme.

There has been continuity in the management of public health actions by the
Commission, from the period prior to the establishment of the health promotion
programme, to the development of management practices of the new programme in its
first years.

Due to the late setting up of the formal management structure for the programmes, a
proper evaluation of the management can only be done in the second phase of the
evaluation. However, it is possible to make some preliminary comments at this stage
of the implementation. A more detailed evaluation of management will be undertaken
during the second phase of the evaluation.

A number of suggestions for further improving the timing and procedures for
processing and deciding on project applications have been established by the
independent experts:

– The Commission services should strive to increase the transparency of its
decision-making procedures and the timeliness of its communications to
the Health Promotion Committee.

2

3

4

Directorate Public Health and Safety at Work, Unit V/F/3, Community action programme on
Information, Education and Training, Projects subsidised in 1996,
health Promotion,
CE-V/3- 97-001-EN.
Directorate Public Health and Safety at Work, Unit V/F/3, Community action programme on
health Promotion,
Information, Education and Training, Projects subsidised in 1997,
CE-V/3-98-011-EN/FR/DE-C.
Directorate Public Health and Safety at Work, Unit V/F/3, Community action programme on
health Promotion, Information, Education and Training, Projects subsidised in 1998 by the
European Commission, CE-V/3-99-003-EN/FR-C.

5

– Extra efforts should be made to increase the participation of project

partners from Member States in Southern Europe.

– The guidelines should be revised to state that: (a) Projects with all 15
Member States will
(b) Under normal
receive highest priority;
circumstances, projects with fewer than eight Member States will not be
considered for funding, pilot projects investigating transfer of specific,
innovative methods to other Member States will be supported if they have
fewer than eight participants.

– The guidelines should specify that applicants will be required to
demonstrate the following aspects of project design and implementation:

• A sound, scientific methodology;

• In the case of quantitative studies, sample sizes should be representative
of the target population, large enough to yield meaningful results, and
matched across Member States for age, sex, socio-economic status;

• Analyses of the results should be appropriate to the information collected;

• Evaluation should be carried out;

• Dissemination of the findings should be arranged;

• Evidence of genuine collaboration between Member States must be

demonstrated.

– The guidelines should provide a clear set of instructions on the expected

structure and word length of the interim and final reports.

– Part One of the application form should contain a section that requires
specification of the parts of the budget to be allocated to evaluation and
dissemination. Part Two of the form should be revised and expanded to
include specific half-page sections for descriptions of
the design,
methodology, participants, analysis, evaluation and dissemination of
projects.

– Evaluation and dissemination of projects

should be significantly
improved. Evaluation and dissemination activities must be included in
applicants' description of tasks and written into contracts. If a project
evaluation has not been conducted and/or
if sufficient efforts to
disseminate the results have not been demonstrated, the final payment to
the contractor should be withheld.

For future actions in the area of health promotion they recommended:

– A Decision on future actions should establish an external and independent
advisory committee composed of high level experts in European health
promotion. The scientific advisory committee
the
should advise
the programme, make
Commission concerning the priorities

for

6

recommendations concerning funding, and evaluate the final reports of the
supported projects. The members of the advisory committee should be
paid fees set a level that is commensurate with their responsibilities and
their independence and impartiality should be assured.

– In future actions it should be made possible for projects to be funded for

two or more years without the need for re-application.

– Future actions should give greater priority to the role of socio-economic
conditions such as urbanisation, housing, unemployment and social
exclusion in the promotion of health, particularly for those living in
deprived areas.

– Future actions should give priority to research into lay people's health
beliefs in the light of different cultures, educational and socio-economic
groups so that European health promotion can be made more effective and
dissemination can be targeted appropriately at different segments of the
population.

As a result of all these suggestions, during the implementation the Commission has
continuously tried to keep abreast with procedural shortcomings and has adapted the
procedures and practices to the needs found by internal reviews and suggestions put
forward by applicants and external experts.

Observations of the Member States

A questionnaire was drawn up and dispatched to the Member States and EEA
countries that enabled the following focused reporting exercise:

Thirteen Member States and Iceland stated that the Programme had an
impact on the development of health promotion in their countries. Eight
Member States and Iceland stated that the Programme has contributed in one
way or another to national health promotion policy or developments (A, D,
DK, EL, IC, IRL, FIN, P, S). Only three countries (DK, NO, UK) stated that
the Programme had not had any impact on the development of health
promotion in their countries. Two of these three (UK and NO) stated that
their national health promotion policies were already well founded. Two of
the three countries (DK and NO) that stated that the Programme did not have
an impact on their national health promotion policies, however, did mention
some positive impact in particular settings.

The greatest impact was reported to be in projects related to specific settings
(such as schools, the workplace etc), with fourteen countries reporting that
there had been an impact. This is supported by other comments throughout
different parts of the questionnaire. Nine Member States (A, B, E, D, DK,
IRL, L, NL, P), Iceland and Norway mentioned the European health
promotion networks in a positive light. In addition to these eleven countries,
two other Member States (Greece and Finland) mentioned the transnational
collaboration that has resulted from the Programme and two others (France

7

and UK) stated that particular projects had or may have had a positive impact
in their countries. Thus, a total of fifteen Member States and countries
reported at least some added value from the Programme (albeit minimal in
one case).

Greece, Germany and Italy stated that it is too early or too difficult to assess
the impact of the Programme at the present time. France commented on the
difficulties of establishing networks and the lack of dissemination of the
Programme. This latter point was also mentioned by Sweden who also
referred to linguistic problems between professionals and lay people, and the
different structures and circumstances of the Member States. Seven countries
gave a positive reply to the question concerning practice. Only six countries
mentioned that health promotion interventions had an impact. Germany
implied that there is a lack of evaluated interventions. France also raised the
issue of the lack of evaluation of projects. Also,
in a preamble to its
questionnaire response, France stated that institutionalised health promotion
in the future should use well-thought out methodologies.

The impression given by the reports of the Member States and EEA countries
is that the Programme is already having a limited but positive impact on the
national policies of many Member States. In spite of the different cultures
and varying stages of development of health promotion in the Member States
and EEA countries, the majority reports that positive influences are already
in evidence. In particular, the European Health Promotion Networks are
attracting interest among the Member States.

The operational aspects of the Programme received considerable amounts of
criticism from the Member States. The majority of national representatives
on the Health Promotion Committee believe that there has been a lack of
transparency in Commission Services’ decision making procedures, that the
expertise of Committee Members has not been fully utilised, and that the
Committee has had too little influence on the process of project selection. A
few Member States reported that
improvements have recently occurred.
However there are good reasons for believing that the committee procedures
are not working well and that
the current
arrangements is required. Further efforts also need to be made to improve the
efficiency and effectiveness of communication between Commission
Services and the Health Promotion Committee.

some re-structuring of

Although the majority of Member States reported a positive impact of the
Programme, only four reported any new developments that had taken place
as a result of the Programme. However five more were aware of new
developments in specific areas. Seven Member States gave a positive reply
the usefulness of the occurred developments. Two Member
concerning,
in health
the Programme has extended an interest
States reported that
promotion to actors in the field of health. France commented that strategies
are needed for identifying and implementing pertinent models and also to
improve dissemination.

8

Effectiveness and the achievement of objectives

COVERAGE OF THE PROJECTS SUPPORTED

Given the kind of objectives laid down in this programme, the actual coverage by
specific actions following the first calls for proposals within the period of 1996 and
1997 showed some shortage as indicated by the independent experts:

The distribution of applications and expenditure varied significantly across
the five areas of activity. To date, areas B, C and A have received the most
expenditure and areas D and E have received the least expenditure. If the
Programme is to be fully implemented in all of the priority fields and achieve
its objectives in all areas, special efforts will be needed to distribute activity
levels more equally across the five priority areas. Activity E (Vocational
Training in Public Health and Health Promotion) appears to have been least
implemented to date with 15 small-scale projects using only 1.26 MECU of
Programme expenditure.

SUBSIDIARITY OF COMMUNITY ACTION

the opinion of Member States was invited through the
To ensure subsidiarity,
programme committee as laid down in the action programme. Thus, the necessary
support of Member States for implementation of actions selected in their countries
was encouraged. At the same time, the programme committee guaranteed the required
transparency of the European Commission’s actions towards the Member States. The
transparency towards the European Parliament was ensured by the prior transmission
to that Institution of reports and documents intended for the programme committee as
well as an annual list of projects financed.

EUROPEAN ADDED VALUE

There was one reservation that initially the European added value of projects was in
many instances under developed, but stress has been placed on the development of
network projects in order to resolve this shortcoming. This has been confirmed by the
independent experts and Member States' representatives, by stating:

There has already been moderately high Community added value in
comparison to the situation that would obtain if the Programme did not exist.
Some high ratings for the Community added value were awarded to projects
supported in 1996, especially in areas A, B, and C. The project leaders who
received funding were also fairly unanimous in asserting their belief in the
Community added value of the projects that they were running.

The majority of Member States' reported that the Programme had already
added Community value.

9

QUALITY OF HEALTH PROMOTION MEASURES

To ensure the highest possible standards for the quality of the actions selected, the
committee not only gave a favourable opinion on the annual work plans, but was also
consulted on the preparation of the calls for proposals, the selection of projects and
the follow-up of their implementation. Thus, the independent experts have already
identified projects supported in 1996, especially in the areas C, D and A which
"award some commendably high ratings".

IMPACT ON HEALTH PROMOTION IN MEMBER STATES

To ensure the highest possible impact on health promotion in Member States, the
Commission has gradually put more and more emphasis on projects, which were
carried out in all Member States and in the three EEA countries. Therefore, the
Commission supported the development of European networks with representatives in
all Member States and the EEA countries.

This successful development was confirmed by the independent experts by stating:

"Future action should prioritise the continued support of the European health
promotion networks that have made good progress within the 1996-2000
Programme".

These networks acted on specific issues such as mental health and evidence based
health promotion, in specific settings such as workplaces and schools and in favour of
specific target groups of the population such as disadvantaged people and children.
The efficiency and the impact of these projects were stated by the independent experts
and the Member States.

10

Budget Allocation for the Health Promotion Programme

1996

1997

1998

TOTAL

Area

A- Health promotion

strategies & structures

B- Specific prevention &

health
measures

promotion

Number
of
projects

7

18

Budget

Budget

Number
of
projects

Number
of
projects

912574.64

6

1252939.12

237314.66

10

1439257.00

C- Health information

9

1126822.69

D- Health education

12

1130736.10

E- Vocational training in

4

117435.46

public health and health
promotion

6

8

4

1252939.12

1524080.47

365328.74

Budget

847205.00

642521.00

Budget

Number
of
projects

15

32

3012718.76

2319092.66

67500.00

17

2447261.81

36687.76

23

2691504.33

201265.00

10

684029.18

2

4

2

3

2

TOTAL

50

3524883.55

34

5834544.45

13

1795178.76

97

11154606.76

11