Opinion of the Committee of the Regions 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)"
Date: 2000-12-13
Institutions: European Committee of the Regions
Subjects: action programme, cross-border cooperation, health legislation, information network, public health

16.5.2001

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Official Journal of the European Communities

C 144/43

Opinion of the Committee of the Regions 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 health strategy
of the European Community’, and

— 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 144/13)

THE COMMITTEE OF THE REGIONS,

having regard to the Communication from the Commission 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; and the Commission 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)
[COM(2000) 285 final — 2000/0119 (COD)];

having regard to the proposal for a Decision of the European Parliament and of the Council extending
certain programmes of Community action in the field of public health [COM(2000) 448 final —
2000/0192 (COD)];

having regard to its Bureau’s decision of 13 June 2000 to instruct Commission 5 for Social Policy, Public
Health, Consumer Protection, Research and Tourism to prepare the Committee’s work on the subject;

having regard to its opinion on the Communication from the Commission on the development of public
health policy in the European Community (COM(98) 230 final) (CdR 156/98 fin) (1) adopted at the
plenary session of 18-19 November 1998 (rapporteur: Ian S. Hudghton);

having regard to its opinion on the Role of the local and regional authorities in the reform of European
public health systems (CdR 416/99 fin) (2) adopted at the plenary session of 12-13 April 2000 [rapporteur:
Tilman Tögel (DE/PSE)];

having regard to its draft opinion (CdR 236/2000 rev. 2) adopted by Commission 5 on 23 October 2000
[rapporteurs: Roger Kaliff (SV/PSE) and Bente Nielsen (DK/PSE)],

adopted the following opinion unanimously at its 36th plenary session on 13 and 14 December 2000
(meeting of 13 December).

Introduction

Committee of the Regions’ views and recommendations

The Committee of the Regions welcomes the Commission
proposal on a health strategy and a programme of Community
action in the field of public health. The Committee of the
Regions believes that the EU must launch a public health
offensive, based on the proposal for a health strategy. The
Committee of the Regions looks positively on the Com-
mission’s drive for greater coordination and continuity in
Community policy in the field of public health, in order to
achieve the objectives laid down in Article 3 (p) of the EC
Treaty, and in implementation of the new Article 152. The
Committee is particularly pleased to see that the Commission
places great emphasis on the need for a high level of health
protection within the Community.

(1) OJ C 51, 22.2.1999, p. 53.
(2) OJ C 226, 8.8.2000, p. 79.

General

1.
The Committee of the Regions would point out that the
proposed health strategy must not lead to a widening of EU
competence to include health and medical care. A clear line
must be drawn between Community and Member State
responsibilities. Any moves towards harmonisation must be
ruled out, and Member States must have sole competence
for managing health and medical care, using their own
organisational and funding systems. The subsidiarity principle
must be respected and any Community level measures must
bring clear value added to Member State action.

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2.
The Committee of the Regions would stress the import-
ance of cross-border cooperation between regions, munici-
palities, towns and Member States. It is extremely important
that the EU should use new support structures and practical
initiatives to help encourage cross-border cooperation. This
would promote development within the Community and in
the field of health. The Committee of the Regions’ comments
regarding future decisions affecting local and regional authority
competence in health matters should, in particular, be taken
on board.

3.
The conditions for good health are created at grassroots
level. In many Member States local and regional authorities
(hereafter ‘regions’) are responsible for public health issues and
health and medical policy. The Committee of the Regions and
the regions responsible for these policy areas wish to partici-
pate in and contribute to the development drive, and must be
guaranteed a say in Community health policy. The Committee
of
it will be involved in the
implementation of the health strategy, e.g. in choosing indi-
cators and in the planned health strategy evaluation. It also
takes for granted that the committee which is to assist the
include representatives of the local and
Commission will
regional level.

the Regions assumes that

The health strategy

4.
The Committee of the Regions would stress that health
discrepancies within the population are amongst the biggest
challenges facing many of the Member States and the Com-
munity. This will most probably become even clearer when
the applicant countries join the Community. While the
proposed health strategy is
indeed comprehensive and
ambitious, it would nevertheless benefit from greater clarity of
focus. The Committee of the Regions would therefore suggest
that the Commission should focus on health imbalances and
hammer out a broad strategy objective. This could be worded
as follows: ‘The overall objective should be to reduce health
risks and health discrepancies in the European Union. Health
standards in the various countries and population groups
should ultimately approach the best in the EU’. The Treaty
must clearly be respected when the objective is followed up
and achieved.

Community, and an investigation should be launched into
how the EU and the applicant countries themselves can
improve health standards in those countries. In addition to the
approximation criteria, attention should focus on solving the
public health problems of the applicant countries.

6.
Cooperation with international organisations such as the
WHO, OECD, etc., should be intensified. It is important that
Community measures should complement rather than overlap
with the WHO’s work.

7.1.
The Committee of the Regions welcomes the proposal’s
focus on the impact of different policy areas on public health.
The EU is the common body in Europe which has the
competence and ability to impact on a range of health
determinants. The Community remit to ensure a high level of
health protection in different policy areas is of major import-
ance. This applies in particular to Community policies which
have a clear impact on public health, e.g. agricultural policy,
employment policy, introduction of the single currency and
the eastward expansion of the Community. Other important
policy areas are education, mobility, the working environment
and consumer policy.

It is essential that health impact assessment (HIA)
7.2.
models be developed for use in the EU decision-making
process.

Initially,

7.3.
it would be worthwhile introducing HIA
models in some areas of agricultural policy. It is not just
agricultural policy models which need to be examined —
employment policy should also come under the spotlight.
Attention should be paid to possible ways of promoting the
provision of training for healthcare professionals on an inter-
regional basis and promoting mobility of these professionals
between regions. As the age of the population rises, the need
for public health increases.

5.
The consequences of enlargement and increased inter-
nationalisation will be significant in the Europe of the future,
and the health strategy must make this clear. Health standards
in the applicant countries and in many countries bordering
the EU are lower. Per capita expenditure on health is lower, as
is the average age. This could affect health standards in the

8.
The Committee of the Regions believes that the oppor-
tunities for informed discussion afforded by the European
Health Forum can provide value added for European public
health. This will require democratic input from both the
national and the regional level, together with viable rules. It is
important
to create a forum for mutual discussion and
exchanges of experience — along the lines of the existing
Social Forum and the Consumer Policy Forum — rather than
a policy or legislative instrument. The European Health

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Forum Gastein, which brings national, regional and local
representatives together with doctors and other health pro-
fessionals, has been a positive experience.

Since prescription and consumer patterns differ from country
to country, it is important that information systems should
reflect national circumstances.

The public health programme

9.1.
The Committee of the Regions believes that previous
public health programmes should be extended until the new
one enters into force.

The Committee of

the Regions also believes that
9.2.
specific funds should be allocated for the applicant countries,
which have special needs, in order to enable the applicant
states to work with public health problems in their countries.

10.1.
The Committee of the Regions believes that infor-
mation technology is of considerable importance in the area
of public health, and calls on the Commission to take account
of the impact of IT on public health operating models and
structures. Quick access to the latest disease prevention
measures is of great significance.
IT can be particularly
beneficial
in sparsely populated areas where distances are
considerable.

The Committee of the Regions believes it is important
10.2.
to be able to learn from each other and to have access to
quality, comparable data. With regard to the drive to establish
a health monitoring system, attention must be paid to ensuring
that it is the level of health protection which is assessed, and
not the health system itself. It is the sole responsibility of the
Member States to draw conclusions from comparative data,
and to implement measures.

12.
The Committee of the Regions feels that the proposed
programme priorities should be more clearly defined, and that
mental health issues should be addressed in greater depth.

12.1.
The Committee of the Regions believes that Objec-
tive 1 of the proposed programme, ‘Improving health infor-
mation and knowledge’,
should focus more clearly on
important indicators for health promotion and prevention of
disease. Working to achieve good health is a major priority.
This responsibility should not be diluted by making medical
care an EU competence.

The Committee of the Regions endorses the measures
12.2.
proposed under Objective 2,
‘Responding rapidly to health
threats’, since this is an important part of the Commission’s
work, and it stresses the EU’s coordinating role in this area.

12.3.
The Committee of the Regions believes that Objec-
tive 3, ‘Addressing health determinants’, should be a priority
issue in order to ensure there is sufficient Community interest
in, and scope for, long-term public health issues at Community
level. It is particularly important to intervene in health issues
in the applicant countries. The Objective needs to be outlined
clearly and new priorities must be established. For example, of
the total EUR 287 million allocated for the programme, only
EUR 6 million has been earmarked to address health risks
from tobacco, EUR 7 million for nutritional determinants, and
EUR 3 million for physical activity; these are all key health
determinants.

10.3.
The Committee of the Regions recommends setting
up an information system in conjunction with other players in
the field. Collation and comparison of healthcare data is
already carried out by the OECD and the WHO, whose systems
the EU could build on. The case for a stand-alone EU system
must be investigated thoroughly, and there must be clear
benefits in terms of value added.

13. Moreover,
the Regions suggests
that, in order to promote health in the future Europe, the
Commission should:

the Committee of

— produce a European report on ‘Investing in Health in
Europe’, similar to the World Bank report, in order to
analyse the cost of ill-health in socio-economic terms,
and the benefits of investing in health;

10.4.
a way as to protect personal integrity.

Any EU health data system must be designed in such

— produce regular reports on expected health trends in
order to counter new threats to public health in the
Community and in the applicant countries;

11.
The Committee of the Regions looks positively on
generation of knowledge and exchanges of experience in the
field of medicines. Common rules for marketing and public
information are desirable.

— launch an ethical discussion on basic evaluation in the
field of health, given that different policy areas have
repercussions for health and that the Community has
many diverse health initiatives;

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— to stimulate

education of healthcare
personnel to European standards and to promote the

actively the

Brussels, 13 December 2000.

mobility of healthcare personnel between European
regions.

The President

of the Committee of the Regions

Jos CHABERT