Commission staff working document - Global health – responding to the challenges of globalisation - Accompanying document to the Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions - The EU Role in Global Health {COM(2010) 128} {SEC(2010) 381} {SEC(2010) 382}
Date: 2010-03-31
Institutions: European Commission
Subjects: EU policy, developing countries, development policy, equal treatment, health policy, international affairs, medical research, public health, right to health

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EUROPEAN COMMISSION 

Brussels, 31.3.2010 
SEC(2010) 380 final 

COMMISSION STAFF WORKING DOCUMENT 

Global health – responding to the challenges of globalisation 

Accompanying document to the  

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

The EU Role in Global Health 

{COM(2010) 128} 
{SEC(2010) 381} 
{SEC(2010) 382} 

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COMMISSION STAFF WORKING DOCUMENT 

Global health – responding to the challenges of globalisation 

TABLE OF CONTENTS 

Introduction ................................................................................................................................ 2 

1. 

The global state of play in Health – what change is needed and why?........................ 4 

1.1. 

Five challenges calling for Action ............................................................................... 5 

Health has become a question of politics, security and economics. .......................................... 5 

1.1.1.  Lack of coordination / fragmentation of health policies and programmes .................. 5 

1.1.2.  Global Health challenges ............................................................................................. 5 

1.1.3.  Development needs ...................................................................................................... 7 

1.1.4.  Globalisation ................................................................................................................ 8 

2. 

3. 

Global Health - Role of the Commission..................................................................... 9 

A Global Health Policy and Strategy ........................................................................... 9 

3.1. 

Four principles underpinning EU action on global health ......................................... 10 

Principle 1: A strategy based on shared health values ............................................................. 10 

3.1.1.  Principle 2: Health Is Wealth ..................................................................................... 12 

3.1.2.  Principle 3: Health in All Policies (HIAP)................................................................. 12 

3.1.3.  Principle 4: Strengthening the EU's Voice in Global Health ..................................... 12 

3.2. 

Three areas of EU added value in addressing global health challenges .................... 13 

Objective 1: Fostering Good Health in a changing world........................................................ 13 

3.2.1.  Objective 2: Protecting Citizens from Health Threats ............................................... 13 

3.2.2.  Objective 3: Supporting Health Professionals, Dynamic Health Systems and new 

Technologies .............................................................................................................. 13 

4. 

4.1. 

4.2. 

4.3. 

4.4. 

Seven Pillars for Action ............................................................................................. 14 

Development: the crucial role of ensuring that coherence for development addresses 
global health challenges ............................................................................................. 15 

Promotion of Fundamental Rights and Public Goods................................................ 19 

Research/Knowledge Management............................................................................ 20 

Cooperation, Coordination, Export of Knowledge and Experience .......................... 22 

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4.5. 

4.6. 

4.7. 

5. 

6. 

Foreign Policy, Governance....................................................................................... 23 

Security ...................................................................................................................... 25 

Response to Globalisation (Markets/Services) .......................................................... 27 

Benefits of Cooperation for Global Health  at EU and Global Level ........................ 28 

Outcomes for Global Health ...................................................................................... 29 

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Introduction 

This  Commission  Staff  Working  Document 
the 
Communication  on  the  EU  role  in  Global  Health  by  describing  in  further  detail  those 
policy areas and actions impinging on global health where the EU is already active. 

to  complement 

intended 

is 

Four  main  drivers  of  change  and  trends  are  identified  and  need  to  be  addressed  in  the 
coming  years,  namely  globalisation,  changing  society,  confidence  and  governance. 
Strengthening the EU's voice in global health is a key principle underlying the EU Health 
Strategy  2008  –  2013,  it  is  therefore  necessary  that  work  takes  place  at  a  strategic  and 
global level, using a cross-sectoral strategy that ensures coherence of relevant EU internal 
and  external  actions  related  to  global  health  and  developing  new  partnerships  and 
approaches  as  appropriate.  The  expected  benefits  to  citizens  in  the  EU  and  globally 
include  a  more  efficient  and  targeted  use  of  public  resources  to  save  lives  and  improve 
health,  a  democratic  and  inclusive  governance  and  better  coherence  among  actors  and 
across  policies  in  the  area  of  health  as  well  as  increased  health  security  for  them  in  the 
broader global context. 

The  Commission  Communication  and  related  working  documents  are  intended  to 
contribute  to  international  discussions  in  this  area  -  an  area  currently  suffering  from 
fragmentation and lack of leadership. 

This should also enhance EU visibility, presence, status and influence on the world stage.  

1.  THE GLOBAL STATE OF PLAY IN HEALTH – WHAT CHANGE IS NEEDED AND WHY? 

Globalisation  and  changes  in  societies  around  the  world  are  altering  the  global  health 
landscape  to  the  point  where  the  existing  governance  and  framework  is  no  longer 
sufficient to ensure the confidence of citizens in their future health and wellbeing.  

The  shortcomings  of  the  now-outdated  view  of  global  health  as  a  purely  development 
issue was highlighted over the last decade by SARS and the threat of pandemic influenza, 
and even more recently with the Influenza A (H1N1) pandemic. Over the past 15 years, 
decisions  had  to  be  made  about  how  to  react  to  cholera  in  Zimbabwe,  plague  in  India, 
Ebola in Zaire, mad cow disease in Europe, anthrax in the United States, AIDS throughout 
the world and the annual waves of influenza, among others. Therefore, when it comes to 
public health preparedness the EU must think global and not local. And for that reason EU 
policies and views on global health should always be up to date. Diseases and their causes 
do not respect political borders, and health cannot be dealt within a European vacuum.  

A  lack  of  global  leadership  and  uneven  levels  of  national  commitment  and  aligned 
cooperation has fragmented the field, bringing in a variety of new actors, mechanisms and 
agendas that the existing framework has difficulty adjusting to. Thus public health can no 
longer  be  pursued  just  at  the  national  level.  It  needs  renewed  global  institutions, 
mechanisms and funding for security, development and global public goods. 

The health sector can no longer deal with emerging challenges on its own. It needs multi-
sectoral  action  and  broad  public  and  private  partnerships  at  national  and  international 
levels. Neither can health still be seen as a purely professional and technical endeavour; it 
needs the strong voice and support of civil society and of political leaders to address the 

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issues at stake. The financial and workforce-related pressures on health systems to deliver 
quality care to ageing populations are also universal, and can only be addressed with better 
international collaboration. 

1.1. Five challenges calling for Action 

Health has become a question of politics, security and economics. 

Globally, it can be argued that improved health at the population level will depend not so 
much  on  new  discoveries  or  on  technological  advances  as  it  will  on  working  towards 
achieving greater social justice and equity. The 2008 WHO Report on Social Determinants 
provides  ample  evidence  that  progress  requires  social  and  economic  redistribution 
mechanisms which may also require changes in power balances. In the area of access to 
medicines,  during  trade  negotiations,  some  developed  countries  have  been  accused  of 
putting their own economic interests before the health needs of developing countries. The 
lack of agreement in the WHO on the sharing of avian influenza virus strains because of 
disagreements on access to benefits is yet another example where politics seems to trump 
health.   

1.1.1.  Lack of coordination / fragmentation of health policies and programmes 

•  The multitude of policy fields influencing global health (development, trade, research, 
employment, social systems, finance, education…) poses a particular challenge for the 
formulation and implementation of a consistent cross government global health policy 
(both within and between countries). 

•  The multitude of players and activities (countries, organisations for cooperation among 
industrial countries, organisations of middle-income countries, regional organisations, 
NGOs, UN bodies) that have entered the global health arena are a welcome sign of the 
strong  interest  in  the  area  but  they  can  also  mask  the  reality  that  in  many  countries 
there are problems at national level in delivering healthcare to the citizens and that in 
some cases the sheer number of actors involved in a country  can even be an obstacle 
to progress.  

•  The  substantial  increase  in  the  number  of  donors  and  in  funding  is  a  positive 
development but global coordination and strategic direction is lacking, and   this may 
have an negative impact on the effectiveness of aid 

•  Coordination is insufficient at global level and what is really needed is leadership. The 
UN,  and  particularly  WHO,  has  not  been  able  to  fill  this  role  in  an  era  of  increased 
interdependence and multilateralism. The private sector and NGOs have moved in to 
fill  a  vacuum  with  the  result  that  global  health  (as  a  notion,  objective,  and  tool  of 
action) now lacks clear definition and direction.  

1.1.2.  Global Health challenges 

Global  health  challenges  affecting  all  worlds'  citizens  relate 
to  health  risks 
(communicable,  lifestyle,  trade),  health  resources  (mainly  medicines  and  human 
resources) and the effects of climate change and the financial and food crisis. 

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•  Health risks: 

o  There  is  a  need  to  protect  populations  from  communicable  diseases  such  as 
HIV/AIDS,  SARS,  Avian  Influenza,  Influenza  A  (H1N1),  zoonoses,  food 
poisoning and so on. Given that many of these diseases are of zoonotic nature, 
it is necessary to implement global and national surveillance systems covering 
animal and human health to assure early prediction, detection and mitigation of 
these  health  threats.  Special  health  issues  (e.g.  antimicrobial  resistance  and 
nosocomial infections) also need to be addressed so as to ensure full protection 
of the population. The International Health Regulations (2005) provide a legal 
framework  to  the  international  community  to  prevent  and  respond  to  acute 
public health risks that have the potential to cross borders and threaten people 
worldwide.  However,  the  capacities  of  developing  and  enforcing  these  legal 
frameworks are uneven. 

o  Lifestyle-related  health  determinants  –  Globalization  fuels  certain  risk  factors 
such as inadequate diets, low levels of physical activity, tobacco consumption 
and alcohol abuse. These are increasingly important contributors to avoidable 
morbidity and mortality on a global level. Global concerted action is required 
to limit the negative health effects of those lifestyle-risk factors. 

o  Globalisation of markets requires evidence-based safety norms for food, feed, 
and products. The high standards expected by EU citizens require coordination 
with WTO rules. Structures to control and test food, feed, and other products 
need to be strengthened in order to assure that agreed norms are respected and 
that Public Health aspects are taken into account. It also ensures the safety for 
food, feed and products at a global scale. 

•  Health resources: 

o  Health  professionals  tend  to  follow  market  forces  towards  better  salaries  and 
conditions,  to  the  detriment  of  poorer  countries.  There  is  a  difficult  balance 
between the rights of free movement, quality of life and career development of 
health workers, with the States' responsibility to guarantee the right to access of 
the  population  to  quality  health  care.  Brain  drain  to  the  private  sector,  to 
international organizations and to third countries, undermines the capacities of 
national  public  health  services  which  aim  to  bring  about  equitable  and 
universal  coverage  of  health  services.  A  voluntary  code  for  recruitment  of 
health professionals will offer an opportunity for an EU vision and voice in a 
more equitable distribution of health workers in the EU and worldwide, while 
respecting  their  individual  rights.  Migration  policies  also  affect  the  health  of 
migrants, which is often undermined by policies which restrict their access to 
basic social services including health promotion and care.  

o  A  long-term  supply  of  effective  and  affordable  vital  health  products  is  of 
critical importance and requires action at global level. New drugs and vaccines 
subject  to  patent-rights  risk  being  unattainable  for  a  large  proportion  of  the 
world's population due to high costs. The lack of effective drugs and vaccines 
for  neglected  diseases  or  new  effective  antibiotics  in  the  context  of 

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antimicrobial  resistance  are  of  particular  concern  at  global  level.  These 
challenges  require  coordinated  actions  to  ensure  the  access  to  existing  and 
shared  knowledge  for  R&D,  and  for  the  development  of  new  pharmaceutical 
and  diagnostic  tools  according  to  global  needs.  In  addition,  the  world  market 
for  counterfeit  and  substandard  drugs,  which  is  increasing  at  a  rapid  rate,  is 
problematic for both developing and developed countries. 

•  Effects of global crises:  

o  Neither the causes nor the effects of climate change are shared equitably but all 
need  to  work  jointly  towards  a  solution.  Changes  in  the  climate  will  affect 
availability of food and water, and other direct consequences for health and in 
some  developing  countries  undermine  already  fragile  health  systems.  Global 
actions  to  respond  to  the  climate  change  need  to  include  adaptation  and 
mitigation policies and actions in the health sector. 

o  The  current  economic  crisis  poses  a  substantial  threat  to  health  funding  from 
EU  Member  States,  making  it  more  important  than  ever  that  existing  ODA 
commitments  in  the  development  field  be  honoured.  The  financial  crisis  has 
caused global unemployment to rise and triggered investments in health to fall 
and health actors must ensure that health issues remain a prominent matter on 
the  global  arena  so  to  ensure  that  the  financial  crisis  does  not  bring  about  a 
social disaster.  

o  The  threat  of  a  food  crisis  for  health  is  not  to  be  underestimated.  The  World 
Bank  estimates  that  it  ranks  amongst  the  top  three  global  crises,  next  to  an 
influenza pandemic and climate change. Health issues are heavily attributed to 
poor  nutrition,  which  in  turn  reflects  the  large  disparities  in  excess  and 
shortage.  It  requires  global  analysis,  monitoring  and  actions  related  to  global 
food security and multi-sectorial health strategies under a global action plan. 

1.1.3.  Development needs 

Several  of  the  Millennium  Development  Goals  (MDGs),  including  those  in  the  health 
field,  are  not  being  met  and  developing  countries  fear  that  the  economic  crisis  will 
encourage  donors  to  renege  on  their  development  aid  commitments.  This  is  not  just  a 
problem of developing countries – many countries in the WHO European Region are also 
behind schedule on meeting the MDG targets.  

Improving health conditions in developing countries is essential to reduce poverty and to 
achieve  the  health-related  MDGs.  To  help  these  countries  meet  global  development 
challenges  in  the  field  of  health,  the  EU  is  taking  action  at  different  levels  aimed  at 
promoting  access  to  health  care  for  the  poor  and  other  disadvantaged  groups;  achieving 
universal  access  to  prevention,  treatment,  care  and  support  for  the  main  poverty-related, 
neglected and emerging diseases; and strengthening countries' ability to train, support and 
retain  healthcare  personnel.  Other  priority  issues  in  the  field  of  health  include  nutrition, 
water and sanitation, information and education for healthier behaviour. However, in the 
last  decade  integrated  approaches  to  health  care  have  proved  to  be  more  effective  and 
sustainable, and support is being progressively redirected from specific and single disease 
interventions to developing and strengthening more comprehensive health systems. 

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A  variety  of  approaches  have  been  put  into  practice  by  the  EU  for  delivering  effective 
development  assistance  and  improved  health  outcomes  in  developing  countries.  While 
country level approaches remain the focus of EU's health interventions under the European 
Development  Fund,  the  Development  Cooperation  Instrument  and  the  European 
Neighbourhood Policy Instrument, the EU has engaged at the global and regional level in 
areas  where  it  can  add  particular  value.  In  this  context,  an  Africa-EU  Partnership  was 
endorsed by the EU-Africa summit in December 2007 to serve as a forum for intensified 
continent-to-continent  policy  dialogue,  cooperation  and  joint  action  at  all  levels,  with  a 
view  to  achieving  the  MDGs  in  all  African  countries.  EU  geographically-based 
instruments are supplemented by thematic development programmes such as "Investing in 
people", which focus on strengthening the country approach by contributing to global or 
regional initiatives and improving access to global goods for public health. 

1.1.4.  Globalisation 

Globalisation is conducive to many positive developments on health, such as the increase 
in  opportunities  for  cross-border  health-related  transactions,  trans-national  cooperation, 
support, and knowledge sharing - for example the development of medicines, vaccines and 
medical devices, which in turn allows for the development of new forms of treatment and 
prevention.  Access  to  medical  information  and  treatment  has  also  been  significantly 
improved. 

On the other hand, the interdependence produced by globalisation has turned health into 
an increasingly important challenge and responsibility for foreign policy and governance 
at all levels. It can give rise to, or increase, potential threats to health. Health problems and 
diseases  can  spread  more  rapidly;  increased  migration  may  strain  the  capacity  of  health 
services, from both incoming patients and outgoing health professionals; and inequalities 
in  access  to  medical  progress  may  rise.  In  developing  countries  in  particular  this  would 
result  from  pressures  on  public  expenditures;  increased  prices  for  newly-developed 
medical  drugs  and  devices  due  to  more  stringent  international  property  rights  rules;  low 
research and development expenditures on many tropical diseases; donor focus on disease-
specific  programmes  rather  than  on  health  system  strengthening;  and  lack  of  priority 
assigned to health by some of the countries themselves. 

As  any  other  workforce,  the  health  workforce  is  influenced  by  globalisation.  There  are 
also  difficulties  in  many  poor  countries  to  retain  medical  staff,  which  are  attracted  by 
higher salaries in rich countries. 

Significant work needs to be done to address the draw back of globalisation on global 
health  without  losing  the  benefits  of  an  increasingly  more  open  world.  There  is 
therefore  an  urgent  need  to  find  shared  values  and  approaches  in  the  area  of  global 
health that would be embodied in relations between countries. Recognition of the need 
for policy coherence, strategic direction and a common value base in global health is 
beginning to emerge at the level of countries. A few European countries are beginning 
to  address  global  health  more  consistently  at  national  level  by  mapping  many  global 
health activities across all government departments, establishing new mechanisms for 
coordination  within  government  and  developing  a  ‘national  global  health  strategy’, 
frequently on the initiative of the international departments in the Ministries of Health. 
The  financial  crisis  has  also  pushed  foreign  security  policy-makers  to  set  a  clear 

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agenda for moving at least global health security higher up the foreign policy agenda. 
However,  foreign  policy  and  global  health  are  not  only  relevant  to  national  health 
security and development. Health and foreign policy are also crucial for alliances and 
for trade issues. In all these areas, health and governance are intrinsically entwined. 

2.  GLOBAL HEALTH - ROLE OF THE COMMISSION 

Priority-setting  for  global  health  action  still  lacks  a  coherent  approach  between  EU 
Member  States,  between  European  organisations  and  between  different  parts  of  the 
EU. It is often still more issue-based and responsive rather than defined by long-term 
investments 
infrastructures,  action  on  health  determinants  and 
in  health 
intergenerational health sustainability.  

Although  the  organisation  and  delivery  of  health  services  remains  primarily  a 
responsibility of the Member States, the EU also holds a range of responsibilities in the 
field  of  global  health.  The  EU's  role  is  to  complement  national  policies  although  in 
some specific areas it has explicit authority to legislate (early warning and response to 
communicable  diseases,  quality  and  safety  of  substances  of  human  origin,  organs, 
blood  and  blood  derivatives,  food  and  product  safety,  veterinary  and  plant  health 
measures directly aimed at public health). It also has a Treaty obligation in Article 168 
to  "foster  cooperation  with  third  countries  and  the  competent  international 
organisations in the sphere of public health". 

It  is  also  explicitly  recognised  in  the  2008-2013  Health  Strategy  that  the  EU  and  its 
Member  States  "can  create  better  health  outcomes  for  EU  citizens  and  for  others 
through  sustained  collective  leadership  in  global  health".  With  an  overarching, 
coherent  and  comprehensive  approach  to  global  health,  the  Commission  can  provide 
real  added  value,  and  speaking  with  one  voice  in  international  and  global  health 
questions will underline the EU's strength as a credible player in this field. 

3.  A GLOBAL HEALTH POLICY AND STRATEGY 

The  future  challenges  confronting  the  EU  in  health,  consumer  and  food  policies  were 
identified  at  a  high-level  conference  organised  by  the  European  Commission  on  29-30 
October 2008 ("Delivering for Tomorrow's European Consumers"). The main four drivers of 
change and trends that were identified were globalisation, changing society, confidence and 
governance.  

Globalisation: 

•  There is a need to reaffirm the EU position on the global scene, to better promote 
EU policies and  influence standard setting as well as respond  effectively to global 
risks. 

•  As  regards  preparedness  for  unpredictable  disasters  (e.g.  pandemics,  natural 
disasters), the EU crisis preparedness tools is being reinforced and a prevention-led 
approach  is  being  strengthened  in  the  different  policy  areas  to  minimise  risks  as 
much as possible.  

•  There is an ongoing effort to reinforce EU relevance at global level with regards to 
EU normative functions of standard setting (e.g for food, pharmaceuticals, medical 
devices etc). 

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Changing Society: 

•  There is a growing need to examine more closely and include social and health 

inequalities in policy delivery. 

•  Sustainability is a real challenge not only for the future, but to be acted upon today. 
•  Consumers  are  increasingly  in  control  of  their  communications  agenda  than  in  the 

past. 

Confidence:  

•  The  Commission  faces  the  challenge  of  obtaining  public  acceptance  if  it  is  to 
become  more  entrepreneurial  as  well  as  Member  State  acceptance  if  it  is  to 
implement a process whereby delivery is more closely monitored to achieve quality.  

Governance: 

• 

Implementing  a  common  culture  of  working  together  whereby  cooperation  and 
tolerance  are  ensured  is  a  challenge  but  needs  to  be  further  developed.  The 
Commission must be in a position to clarify why and how to improve global health 
governance. It must identify the benefits to global health of an enhanced EU role in 
global  health  governance.  It  is  important  to  assess  the  benefits  and  identify 
mechanisms  needed  to  ensure  a  more  participative  and  accountable  global  health 
governance. 

3.1. Four principles underpinning EU action on global health 

EU principles for global health policy have been set out in the EU's Health Strategy adopted 
in 2007 ("Together for Health: A Strategic Approach for the EU 2008-2013"). The principles 
include  taking  a  value-driven  approach,  recognising  the  links  between  health  and  economic 
prosperity, integrating health in all policies, and strengthening the EU's voice in global health. 
The  strategic  themes  are  Fostering  Good  Health  in  an  Ageing  Europe,  Protecting  Citizens 
from Health Threats, and Dynamic Health Systems and New Technologies.  

The Strategy also focuses on the importance of coordination between the EU and its Member 
States  and  other  countries  and  international  organizations  which  would  help  to  foster  good 
health in the EU and beyond and strengthen the EU's voice on global health issues.  

Principle 1: A strategy based on shared health values 

The  EU  aims  not  only  to  provide  a  well  functioning  internal  market  for  goods,  capital  and 
services;  it  also  supports  social  justice  and  respect  for  fundamental  rights  in  line  with  the 
Charter of Fundamental Rights of the EU with particular attention to children's rights1 , and 
therefore  its  internal  and  external  actions  should  strive  to  support  these  values.  This  is 
particularly important in the field of health, which is a key element in individual and social 
wellbeing. EU action to support the objectives of the EU Health Strategy should therefore be 

1 

OJ C  303/7, 14.12.2007, p.1. In particular, the following rights such as human dignity, integrity of the person, health care, non-
discrimination,  equality  between  women  and  men  and  rights  of  the  child  are  at  stake.  In  accordance  with  the  Commission's 
Communication  Towards  an  EU  Strategy  on  the  Rights  of  the  Child,  all  EU  internal  and  external  actions  should  be  fully 
compatible  with  the  principles  and  provisions  of  the  UN  Convention  on  the  Rights  of  the  Child.  Article  24  UNCRC  obliges 
Member States to recognize the right of the child to the enjoyment of highest attainable standard of health and to facilities for the 
treatment of illness and rehabilitation of health. 

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built on fundamental rights relating to health with particular attention to children's rights and 
health  as  a  global  public  good.  They  should  make  concrete  common  values  such  as 
participation  and  empowerment  of  citizens,  transparency,  and  the  overarching  values  of 
universality,  non-discrimination,  access  to  good  quality  care,  equity  and  solidarity2.  The 
Council  has  also  invited  the  Commission  to  take  into  account  and  integrate  the  gender 
dimension3. 

Equity  and  solidarity  are  of  importance  between  and  within  Member  States  and  regions  in 
terms  of  life  expectancy,  health  status  and  access  to  high  quality  health  services.  Issues  at 
stake  include  differences  in  health  outcomes,  differences  in  access  to  treatment  and  care, 
differences  in  health  between  different  groups  within  countries,  such  as  between  rich  and 
poor,  or  between  male  and  female.  Working  across  different  sectors  is  vital  for  reducing 
health  inequalities,  and  tackling  inequalities  in  the  economic,  social,  environmental,  genetic 
and behavioural determinants of health. A recent Communication addresses health inequities 
in the EU4.  

The  Commission  regards  the  extent  of  the  health  inequalities  between  people  living  in 
different parts of the EU and between socially advantaged and disadvantaged EU citizens as a 
challenge to the EU's commitments to solidarity, social and economic cohesion, human rights 
and  equality  of  opportunity.  At  the  EU  level,  the  Commission  plays  an  important  role  in 
raising  awareness,  promoting  and  assisting  the  exchange  of  information  and  knowledge 
between  the  concerned  Member  States,  identifying  and  spreading  good  practices  and  in 
facilitating the design of tailored made policies for the specific issues prevailing in Member 
States  and/or  special  social  groups.  It  also  monitors  and  evaluates  the  progress  in  the 
application of such policies.  

The same factors apply to equity and solidarity between EU and other regions of the world. 
For  example,  the  differences  with  sub-Saharan  Africa  are  striking.  Progress  towards  health 
MDGs  is  off  track  in  over  50  developing  countries,  especially  in  sub-Saharan  Africa  and  is 
almost  stagnant  in  reducing  maternal  mortality  rates  (MDG  5)5.  The  general  failure  to 
progress in the health MDGs is a reflection of the high burden of disease globally6, especially 
in  developing  countries.  Over  60  million  persons  die  every  year  prematurely,  most  of  them 
due  to  social  and  environmental  factors  and  low  or  absent  access  to  adequate  health  care7. 
Nine million of them are children below the age of five8. The difference of life expectancy in 
the world has been widening, with the richer top billion enjoying an average life expectancy 

2 

3 
4 

5 
6 

7 
8 

Council  Conclusions  on  Common  Values  and  Principles  in  European  Union  Health  Systems  (2006/C 
146/01) 
Council Conclusions on Women's Health (2006/C 146/02) 

"Solidarity in health: Reducing health inequalities in the EU", Communication from the Commission to 
the  European  Parliament,  the  Council,  the  European  Economic  and  Social  Committee  and  the 
Committee of the Regions, COM(2009)567, Brussels, 20 October 2009. 

The Millennium Development Goals Report 2009:  http://www.undp.org/mdg/basics_ontrack.shtml 
Burden  of  disease  is  measured  by  Disability  Life  Adjusted  years,  comprising  the  health  years  lost  to 
premature deaths and to the degrees of disability during disease. 
The global burden of disease: 2004 update.WHO. 
The State of the World’s Children 2009. UNICEF 

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close to 80 years, which is twice the life expectancy of those living in the poorest billion9. At 
the  same  time,  half  of  the  loss  in  potential  healthy  and  productive  life  is  due  to  disability 
caused  by  acute  and  chronic  diseases,  with  a  30%  higher  burden  of  disease  on  the  limited 
lifespan of the poorer (even though on average they are younger). Altogether the exposure to 
risks for ill health and the inadequate access to health care translate to a loss of 20% of the 
potential healthy life worldwide due to premature deaths or disability. The average in the EU 
is 10% but between and within countries there are also differences of twice the levels of ill 
health,  mainly  due  to  socio-economic  inequities.  The  annual  burden  of  disease  is  4  times 
higher in the world's poorest billion (with almost half their potential healthy life lost due to 
poverty and perpetuating it) than in the richest billion which most EU citizens belong to.  

3.1.1.  Principle 2: Health Is Wealth 

There is growing evidence showing how health contributes to wealth and how investment in 
health contributes to long term growth and sustainability of economies. In 2005, the Healthy 
Life  Years  (HLY)  indicator  was  included  as  a  Lisbon  Agenda  Structural  Indicator, 
recognising that the population's life expectancy in good health was an important measure in 
understanding  and  supporting  economic  growth.  But  health  does  not  only  contribute  to 
economic growth, it also represents a major provider of employment in the EU and globally. 

3.1.2.  Principle 3: Health in All Policies (HIAP) 

HIAP is a concept that already underpins work on health at the European level. Under article 
168 of the Treaty, the EU is required to make sure that "a high level of health protection [is] 
ensured  in  the  definition  and  implementation  of  all  Policies  and  Activities  of  the  Union". 
HIAP  approaches  will  be  further  encouraged  and  promoted  at  all  levels,  including  through 
giving Member States' new opportunities to network, share experience and best practice, with 
the  aim  of  supporting  increased  inter-sectoral  cooperation  in  the  field  of  health.  The  use  of 
HIA (Health Impact assessment) and HSIA (Health Systems Impact Assessment), is already 
recognised  as  part  of  the  Commission's  Impact  Assessment  mechanism  also  in  reference  to 
encourage "health-in-all-policies" in third countries. 

3.1.3.  Principle 4: Strengthening the EU's Voice in Global Health 

The EU has a Treaty obligation in Article 168 to "foster cooperation with third countries and 
the  competent  international  organisations  in  the  sphere  of  public  health",  with  a  particular 
emphasis on the regional dimension and on candidate, potential candidate and the European 
Neighbourhood  Policy  countries.  The  EU  is  committed  to  create  better  outcomes  for  health 
through  "sustained  collective  leadership  in  global  health".  Coherence  between  internal  and 
external health policies, as well as the sharing of values, experience and expertise, is essential 
in attaining the EU's global health goals. 

9 

WHO Statistical information system : http://www.who.int/whosis/en/ 

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3.2. Three areas of EU added value in addressing global health challenges 

Objective 1: Fostering Good Health in a changing world 

The predicted trend towards demographic ageing, resulting from low birth rates, increasing 
longevity, and the ageing of the "baby boom" generation is now well established on political 
agendas worldwide. The demographic trend, together with the effects of lifestyle- risk factors, 
influences a changing epidemiology with growing effects of non-communicable and chronic 
diseases. It will pose major economic, budgetary and social challenges which are expected to 
have  a  significant  impact  on  growth  and  lead  to  significant  pressures  to  increase  public 
spending,  making  it  difficult  for  Member  States  to  maintain  sound  and  sustainable  public 
finances  in  the  long-term.  In  order  to  address  this  problem,  the  EU  needs  to  ensure  that  its 
population  ages  in  good  health  and  remains  active  and  that  healthy  life  expectancy  evolves 
broadly in line with change in age-specific life expectancy. Actions include the promotion of 
health  and  prevention  of  disease  throughout  the  lifespan,  including  the  tackling  of  health 
determinants  such  as  nutrition,  physical  activity,  alcohol,  drugs  and  tobacco  consumption, 
environment  and  socioeconomic  factors.  The  EU  can  contribute  with  third  countries  in 
exchanging experiences related to this challenge. 

3.2.1.  Objective 2: Protecting Citizens from Health Threats 

Protecting  citizens  from  health  threats  (such  as  communicable  and  non-communicable 
diseases,  and  special  health  issues  including  health  threats  from  deliberate  releases  of 
pathogens, chemicals, radiological, and nuclear substances, and the health effects of climate 
change) and enhancing global response capacity to tackle acute threats is of ever increasing 
importance in an interconnected and interdependent world. At international level the WHO's 
International  Health  Regulations  (2005)  have  been  implementing  global  rules  to  enhance 
national,  regional  and  global  public  health  security.  This  legally-binding  agreement 
significantly  contributes  to  global  public  health  security  by  providing  a  new  framework  for 
the coordination of the management of events that may constitute public health emergencies 
of  international  concern,  and  improves  the  capacity  of  all  WHO  countries  to  detect,  assess, 
notify  and  respond  to  public  health  threats.  As  the  protection  of  human  health  is  also  an 
obligation  under  Article  168  of  the  Treaty  an  EU  action  is  necessary  to  coordinate  health 
threats  of  cross-border  character  and  multi-sectoral  nature  in  order  to  provide  a  coherent 
approach in front of the WHO. This is crucial when cross-sectoral issues where IHR involve 
matters of the EU exclusive competence and shared competence between the EU and Member 
States (e.g. common safety concerns in public health matters). 

3.2.2.  Objective 3: Supporting Health Professionals, Dynamic Health Systems and 

new Technologies 

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In light of the fact that Member States are facing a number of common problems with their 
health  workforces,  there  is  much  to  be  gained  by  promoting  cooperation  and  common 
approaches between the Member States and at a later stage exchange best practices at a global 
level. This will inform the EU position towards the global voluntary code of recruitment of 
health  workers  and  contribute  to  the  sustainable  availability  of  adequate  national  health 
workforce in third countries. 

To support dynamic health systems, the EU needs to respond to the challenges of increasing 
mobility  of  patients  and  professionals,  migration  in  general,  citizens'  rising  expectations, 
population ageing, changing disease patterns, as well as innovation and development of new 
technologies. More investment will be needed in capacity building for health professionals 
and  workforce  planning;  quality  and  availability  of  education  and  training  for  health 
professionals needs to be improved; the potential for Regional Policy programmes and other 
tools such as the Lifelong Learning Programme needs to be recognised; and possibilities for 
networking need to be encouraged and the further development of eHealth solutions needs 
to be supported. eHealth is inextricably linked to all of these challenges and its development 
and  deployment  will  be  key  to  ensuring  the  future  sustainability  of  health  systems.    In  all 
these  areas,  the  use  of  information  and  communication  technologies  will  offer  major 
opportunities.  The  Commission  could  support  Member  States  and  Regions  in  identifying, 
assessing and providing guidance on innovation in healthcare, and share with third countries 
its experiences. 

4.  SEVEN PILLARS FOR ACTION 

In this approach to EU global health policy and strategy, EU overarching action is built upon 
seven pillars as essential and distinct action fields:  Development, Public Goods and Security, 
Research,  Internal  and  External  Cooperation  and  Coordination,  Foreign  Policy,  and 
Response to Globalisation (Market/Services).  

Goals,  priority  issues  and  approaches  are  divided  into  Action  Pillars,  many  of  which  are 
cross-sectional,  and  cooperation  and  coordination  between  action  fields  remains  of  crucial 
importance. 

The following sections give an outline of ongoing European Commission action in the field, 
with specific examples. 

The  Accra  Agenda  for  Action  (AAA)  reflects  the  international  commitment  to  support  the 
reforms needed to accelerate an effective use of development assistance and to help ensure the 
achievement of the MDGs by 2015. 

• 

• 

• 

    Work on a multisectoral health strategy, including education, gender, equality, non-
discrimination,  and  respect  for  fundamental  rights  with  particular  attention  to  children's 
rights, adequate nutrition, safe water and hygienic environments. 

    Work on sustained development and economic growth, in order to ensure long-term 
improved living conditions. 

    Address the global shortage of health workers and the crisis in human resources for 
health in developing countries as well as for same aspects in the EU, e.g. as a follow up to 

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the  2008  Commission  Green  Paper  on  the  European  Workforce  for  health10  and 
responding  to  the  WHO  code  of  practice  on  the  international  recruitment  of  health 
personnel11. Health workers' international migration has been increasing worldwide over 
the  past  decades,  especially  from  lower  income  countries  whose  health  systems  are 
already very fragile, in several cases leading to what is often referred to as "brain drain". 

• 

    Respond to food crisis, combat malnutrition, enhance food and feed safety. 

All  the  above  are  influenced  by  many  aspects  that  go  beyond  the  health  sector  (global 
economy,  incentives  for  migration,  global  negotiation  on  services  etc).  Therefore,  they  can 
only be modified through political action at the national, regional, and global level.  

Ongoing Commission action 

•  Commission  services  working  on  global  health  are  pursuing  a  coordinated  and  coherent 
approach in this area. Health is a strong component of programming  and assistance,  not 
just towards achievement of the Millennium Development Goals but also in responding to 
health threats in third countries and towards saving and preserving lives in emergency and 
immediate post-emergency situations.  

•  The Commission plays a key role in intergovernmental discussions to improve medicine 
access,  availability  and  affordability  of  human  resources  for  health  in  the  developing 
world,  including  through  constructive  input  to  the  WHO  debate  on  public  health, 
innovation and intellectual property (the (IGWG) process).  

•  The  Commission  works  for  strong  international  cooperation  to  tackle  antimicrobial 
resistance  in both  human and  veterinary medicines. It  notably participates in the  EU/US 
Transatlantic  Task  force  on  antimicrobial  resistance  focusing  on  appropriate  therapeutic 
use of antimicrobial drugs in the medical and veterinary communities, prevention of both 
healthcare-  and  community-associated  drug-resistant  infections,  and  strategies  for 
improving the pipeline of new antimicrobial drugs. 

•  The  Commission  also  works  for  strong  international  agreements  in  health  which  are  of 
greater  relevance  to  EU  citizens,  in  particular  by  supporting  full  implementation  of  the 
International  Health  Regulations  (IHR)  and  the  Framework  Convention  on  Tobacco 
Control (FCTC).   

4.1.  Development: the crucial role of ensuring that coherence for development 

addresses global health challenges 

Health is a central, cause and consequence of poverty reduction and sustainable development 
while,  ill  health  is  a  barrier  to  any  social  and  economic  progress.  However,  there  are  good 
examples  where  the  combination  of  stability,  democracy,  political  commitment,  adequate 

10 

11 

Commission Communication in 2004: Communication on patient mobility and healthcare developments 
in the EU (COM(2004) 301 of 20 April 200410 
http://ec.europa.eu/health/ph_systems/docs/workforce_gp_en.pdf 
Resolution WHA57.19 (http://www.who.int/hrh/en) 

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levels  of  domestic  public  funding  for  health,  complementary  aligned  and  predictable 
international  support  resulting  in  public  funding  above  a  minimum  threshold,  frank  and 
inclusive  policy  dialogue  leading  to  health  sector  reforms  aimed  at  greater  efficiency  and 
equity,  a  harmonized  progress  in  other  social  sectors,  mainly  education  and  social  cohesion 
with especial emphasis on gender equity and protection of children rights, and sustainable and 
wide based economic growth, have led to sustained progress in reducing child and maternal 
mortality. 

The  European  social  model  includes  common  features,  including  systems  of  guaranteed 
healthcare for all citizens across Europe. The EU has agreed to the value of solidarity towards 
equitable and universal coverage of quality care.  

The  Staff  Working  Paper  "Contributing  to  Universal  Coverage  of  Health  Services  through 
Development Policy" defines how the EU external action can more effectively contribute to 
the  reduction  of  health  inequities  worldwide  and  progress  towards  universal  coverage  of 
health  services.  Despite  a  decade  of  unprecedented  increase  in  health  development  aid,  the 
progress towards health MDGs is uneven and grossly off track in least developed countries. 
The  mentioned  Staff  Working  Document  identifies  actions  in  the  level  of  EU  health  aid,  a 
more  equitable  distribution  to  partner  countries,  increasing  the  compliance  with  aid 
effectiveness commitments in the health sector, strengthening the EC and EU capacities in the 
health  sector  dialogue,  ensuring  inclusive  processes  and  paying  special  attention  to  fair 
financing schemes towards equitable and universal coverage of health services. 

However, despite the best efforts of development policies, the net effect of EU policies in the 
health  sector  in  third  countries  may  be  negative  if  there  is  no  clear  attention  to  ensuring 
coherence between internal and external policies that affect global health. The five main areas 
are reflected in the priority issues under the EU policy on policy coherence for development: 

• 

 Financing  and  trade  policies  influence  the  overall  national  financing  capacities  and  the 
access  to  affordable  and  essential  medicines  and  health  commodities.  Fiscal  policies, 
which  increase  equitable  tax  revenues  and  prevent  tax  evasions,  are  critical  to  enable 
adequate  levels  of  public  financing  for  health.  In  parallel  to  this  communication,  the 
European  Commission  is  adopting  a  staff  working  document  on  fiscal  governance  and 
development. EU fiscal frameworks allow almost three times higher tax revenues on GDP 
than  those  in  developing  countries  and  are  linked  with  national  social  spending.  This 
experience can be a clear added value in the dialogue and cooperation with third countries. 
The EU has a major influence in the International Financing Institutions (IFIs) which in 
turn  enable  or  limit  the  national  capacities  to  finance  health  services  and  progress  to 
equitable access to health services. Fiscal and public spending policies influenced by IFIs 
serve the frameworks on which the EU channels an increased share of its ODA through 
budget  support.  The  Court  of  Auditors  report  on  EC  support  to  health  in  sub-Saharan 
Africa, calls for increased links between budget support and health policies, strategies and 

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outcomes. The EU dialogue on fiscal and macroeconomic frameworks and health policies 
is fundamental to ensure coherence towards  MDGs and improved health. Trade policies 
also influence the economies of the EU and third countries and have a direct effect in the 
access to medicines, subject to global markets and patent rights, which may hinder access 
to  affordable  medicines  in  poor  countries.  TRIPS  provisions  theoretically  enables 
exemptions to patent monopolies but these have not been used in an effective manner and 
have  been  further  challenged  by  the  enforcement  of  TRIPS  in  middle  income  countries 
(and  major  generic  producers  as  India)  and  will  be  further  tested  by  the  compliance  of 
least  developed  countries  in  2016.  In  addition,  EU  bilateral  trade  agreements  need  to 
ensure and facilitate the use of TRIPS provisions and assess the effects of liberalization of 
health services (GATTS), to ensure coherence towards the principle of solidarity towards 
equitable and universal access to health services. 

Migration policies have a major impact on global health. Health professionals tend to follow 
market forces towards better salaries and conditions, to the detriment of health resources in 
poorer countries. There is a difficult balance between the rights of free movement, quality of 
life  and  career  development  of  health  workers,  with  the  State's  responsibility  to  guarantee 
the  right  to  access  of  the  population  to  quality  health  care.  Further,  if  not  conceived 
carefully, public investments in training health workers may fuel brain drain to the private 
sector,  to  international  organizations  and  to  third  countries,  undermining  the  capacities  of 
national  public  health services  aimed  at equitable universal coverage of health services. A 
voluntary code for recruitment of health professionals will be discussed in the 2010 WHA 
where this Communication on global health  can better inform an EU vision and voice in a 
more  equitable  distribution  of  health  workers  in  the  EU  and  worldwide,  while  respecting 
their  individual  rights.  While  there  is  a  need  to  recruit  additional  health  workers,  some 
telemedicine services also have the potential to contribute to a more balanced global health 
approach.  

• 

 Migration  policies  also  affect  the  health  of  migrants,  which  is  often  undermined  by 
policies which restrict their access to basic social services including health promotion and 
care.  Besides  the  compliance  with  the  mentioned  EU  health  principles,  the  equitable 
access  to  health  services  by  migrant  communities  has  an  indirect  effect  in  the  overall 
health  of  their  host  community.  The  EU  has  the  challenge  to  promote  equitable  health 
services  for  migrant  communities  in  the  EU  and  promoting  the  same  principles  in  third 
countries. 

•  Security policies are an essential element of the EU external policies. Early integration of 
public health into peace building strategies and programmes is a priority for the safety of 
populations  and  an  important  element  towards  recovery  and  long-term  development. 
Additionally,  progressive  flows  of  goods  and  people  may  also  pose  increased  health 
threats. A recent European Commission's staff working document describes the concerns 
to health security in the EU. At the global level, the growth of trade and migration carries 
a  risk  of  pandemics  from  emergent,  re-emergent  and  resistant  pathogens;  as  well  as  on 
goods,  especially  food,  with  negative  effects  on  health.  The  International  Health 
Regulations  set  a  framework  for  detection  and  response  to  health  threats,  based  on 
national  and  a  global  coordinating  mechanism.  However,  the  national  capacities,  in 
correlation with comprehensive national health services, remain weak in most developing 
countries which may impact on health negatively. On the other hand, the access to global 
goods to respond to health threats remains also subject to the market and undermines the 

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equity  of  global  response.  The  recent  H1N1  pandemic,  although  of  lesser  global  impact 
than  foreseen,  is  a  clear  example  of  a  biased  availability  of  global  goods  (vaccines  and 
medicines)  against  poorer  economies,  often  subject  as  well  to  greater  risks.  There  is  a 
need to regulate the markets of global goods with major implications in global health and 
to  enable  developing  countries  to  increase  their  capacities  to  predict,  detect  and  react  to 
health emergencies. The EU plays a leading role in Humanitarian health aid, now under 
the same coordination of civil protection services for emergencies in the EU region; and 
can better link health relief to the development aid towards increased national capacities. 
The  EU  will  progressively  benefit  from  the ECDC,  which  can  also  play  a  major  role  in 
improving to the EU and global capacity to react to health threats.  

lack  access 

in  poorer  communities 

•  Food security is directly related to nutrition, possibly the most important attributable risk 
for ill health globally, and responsible for one third of under five mortality.  Over 1 billion 
persons 
to  adequate  calories,  proteins  and 
micronutrients. The number of hungry people in the world is increasing due to the effects 
of  the  financial  and  economic  crisis,  the  food  prices'  crisis  and  climate  change.  At  the 
same  time,  obesity  grows  even  faster  and  affects  not  only  the  EU  and  industrialized 
economies, but also middle income countries and middle and upper classes in developing 
countries. The EU is the main food importer globally and applies food safety regulations 
in  protection  of  EU  citizens.  On  the  other  side,  the  EU  Common  Agricultural  Policy 
protects  its  rural  and  agricultural  sectors  through  agricultural  subsidies  which  may 
condition  the  export  capacities  of  third  countries.  The  EU  can  share  its  experience  of 
public  health  interventions  aimed  at  reducing  obesity  and  sedentary  lifestyles  with 
countries  gradually  facing  the  same  health  challenges.  In  the  external  action,  the  EU 
prioritizes actions in promotion of rural development and food security and provides high 
levels of humanitarian food assistance.  A parallel communication will propose an update 
of  the  EU  policy  on  food  security  outlining  its  four  dimensions:  availability,  access, 
utilization and crisis management. These dimensions relate to the right to food and food 
governance, undermined by poverty, marginalization and lack of participation in decision 
making. The coherence of external action with internal policies, towards increased global 
food  security  should  also  include  global  health  challenges  to  ensure  that  it  effectively 
leads to adequate nutrition and improved health.   

•  Climate  change  is  potentially  the  most  serious  challenge  humanity  has  ever  faced  in 
history. Its consequences in health are multi-faceted. It is already and will progressively 
affect the access to safe and sufficient water and food, the main risk factors for ill health. 
It  will  also  gradually  affect  the  epidemiology  of  vector-borne  and  food-borne  diseases. 
Thermal excesses will affect health globally while the effects in low lands and economic 
disruption will affect the health of citizens in all regions in ways still difficult to forecast. 
The  EU  plays  also  a  leading  role  in  committing  to  reducing  CO2  emissions  in  the 
development  of  renewable  energies.  There  is a  large  potential  of  new  energy  sources  in 
developing countries which can benefit rural communities by reducing deforestation and 
in-door smoke, and improving the capacities of remote health services. The promotion of 
new  healthier  lifestyles  will  also  encourage  more  responsible  and  sustainable  use  of 
natural resources (reducing carbon footprint) such as active transport and healthier diets. 
The  climate  change  conventions  will  be  a  source  of  global  funding  mechanisms  which 
should  also  contribute  to  the  potential  mitigating  and  necessary  adaptation  measures  of 
health services worldwide. 

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4.2. Promotion of Fundamental Rights and Public Goods  

As  set  out  in  the  EU  Health  Strategy  2008-2013,  EU  action  in  global  public  health  should 
build on fundamental rights relating to health as a global public good. Health equity, social 
justice,  equal  access  to  good  quality  care,  elimination  of  all  forms  of  discrimination  on 
grounds  as  stipulated  in  Art.  21  of  the  Charter  of  Fundamental  Rights,  provision  of  highest 
attainable  standard  of  health  to  children  and  universality  stand  at  the  core  of  Commission's 
work.  

The central areas of work include the encouragement of universal access and the elimination 
of financial and other barriers to health access (which in turns allows us to move away from 
user  fees  and  generalising  of  prepayment  and  pooling  schemes),  as  well  as  health  system 
strengthening and health system financing. 

“Healthy lifestyles and good health for all” is a strategic theme of the 2008-2013 EU Health 
Strategy. It covers specific actions and areas of work and is particularly targeted to addressing 
the problem of population ageing in Europe. In order to address the latter, we need to have 
healthy life expectancy evolving broadly in line with change in age-specific life expectancy. 
The  Commission  is  committed  to  promoting  health  and  prevent  disease  throughout  the 
lifespan by tackling health determinants such as nutrition, physical activity, alcohol, drugs and 
tobacco consumption, environment and socioeconomic factors and by the encouragement of 
further development of ICT health solutions (eHealth). The development of Personal Health 
Systems (PHS), for example, can assist in the provision of continuous, quality controlled, and 
personalised  health  services  to  empowered  individuals  regardless  of  location  and  can  help 
prevent  complications  in  chronic  conditions.  When  faced  with  a  challenge,  there  should 
always  be  a  right  approach  to  addressing  it.  By  addressing  the  problem  locally  –  within 
Europe – the EU will be in a better position to assist in addressing the challenge globally as 
well. 

Global health cannot be improved without addressing the growing burden of health problems 
associated with non-communicable diseases. Chronic diseases such as heart disease, stroke, 
cancer, chronic respiratory diseases and diabetes, are by far the leading cause of mortality in 
the  world,  representing  60%  of  all  deaths,  with  80%  of  these  deaths  in  low-  and  middle-
income countries.  These deaths are preventable but require concerted action by all.12 People 
should be better informed about the effects of certain lifestyles on their health. At European 
level, there has been some progress but this is not enough. The exchange of knowledge and 
practices should be done at global level.  

Health  information  systems:  The  EU's  current  health  information  system  does  not  always 
provide  consistently  high-quality  and  fully  comparable 
information.  The  European 
Commission  is  actively  working  to  improve  the  mechanisms  for  health  reporting  including 
Electronic  Health  Records  and  interoperability  of  health  systems  and  has  therefore  outlined 

12 

Cf.  ECOSOC  Annual  Ministerial  Review:  Implementing  the  internationally  agreed  goals  and 
commitments in regard to global public health, Geneva, 30 June – 3 July 2009, Report of the Secretary-
General, p.8  

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recommendations  and  strategies  for  improving  quality,  widening  access  to  and  improving 
comparability of health information at EU level.13  

In addition to this the Commission has managed to upgrade and improve two very important 
alert  systems  for  food  and  feed  and  also  for  all  dangerous  (non  food)  consumer  products. 
Through these systems the Commission has managed to provide a high level of protection of 
health, on both the global and EU level. 

Rapid Alert System For Food and Feed (RASFF): this system was set up so as to provide 
the control authorities with an effective tool for exchange of information on measures taken to 
ensure food safety. In 2006, with the entry into force of the "Feed Hygiene" Regulation (EC) 
N°  183/2005,  animal  health  and  environmental  risks  were  added  to  the  scope  in  relation  to 
feed. RASFF was set up some 30 years ago and significant development has been made since 
as the system is moving into new regions and parts of the world. International co-operation is 
a  priority  area  for  action,  for  example  with  other  systems  such  as  the  International  Food 
Safety Authorities Network (INFOSAN) of the World Health Organization.  

This  international  aspect  is  crucial.  For  example,  although  Europe  was  only  marginally 
affected  by  the  recent  melamine  crisis,  products  containing  contaminated  milk  ingredients 
were  shipped  all  around  the  world.  Due  to  the  global  scope  of  the  problem,  the  EU  and 
RASFF  needed  to  collaborate  with  third  countries  as  well  as  with  regional  networks  and 
INFOSAN. This marked a new level of international cooperation in relation to a food safety 
crisis. 

RAPEX is the EU rapid alert system for all dangerous consumer products, with the exception 
of food, pharmaceutical and medical devices. It allows for the rapid exchange of information 
between Member States via central contact points and the Commission of measures taken to 
prevent  or  restrict  the  marketing  or  use  of  products  posing  a  serious  risk  to  the  health  and 
safety  of  consumers.  Both  measures  ordered  by  national  authorities  and  measures  taken 
voluntarily by producers and distributors are covered by RAPEX.  

4.3. Research/Knowledge Management 

The  third  Action  Pillar  is  that  of  Research  and  Knowledge  management,  an  area  of  work 
necessitating  its  own  and  distinct  delineation,  especially  in  the  sphere  of  global  health.  It  is 
now widely understood that the determinants of health extend far beyond the health sector and 
that “research for health” must encompass not only the immediate causative agents of diseases 
but  also  social,  political,  economic  and  environmental  factors  that  contribute  to  the  health 
status of individuals and populations. 

13 

internationally agreed set of international classifications, operational systems for collection of data on 
the state of health of populations, summary measures and population health indicators; current work on 
developing  a  European  system  of  health  indicators  needs  to  be  continued,  based  on  common 
mechanisms  for  collecting  comparable  health  data  (for  example,  the  European  Health  Survey  System 
including a European Health Examination Survey); improve the collection and compatibility of health 
data is a strategic objective of the Commission Staff working document accompanying the White Paper 

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Health research and scientific evidence are crucial to improve the health of all individuals, to 
harness  knowledge,  science  and  technology,  but  also  to  increase  credibility  and 
transparency  of  health  policy  at  a  global  scale.  Information  on  how  the  results  of  health-
related research are used as a basis for health policy thus also needs to be actively and widely 
disseminated.  Only  then  can  the  EU  gain  and  retain  a  strong  voice  in  global  health  and 
contribute to shaping the global health research agenda. Indeed, it one of the values stated 
in  the  Health  Programme  that  health  policy  must  be  "based  on  the  best  scientific  evidence 
derived from sound data and information, and relevant research."  

To  generate  valuable  knowledge,  the  Commission  also  ensures  coherence  with    health 
research  under  the  Seventh  Framework  Programme,  which  supports  public  health  research 
with a budget of 6 100 billion (2007-2013). 

Priority should be given to the following activities:  

•  Biomedical research:  

Ensuring  that  the  results  of  biomedical  research  will  ultimately  reach  the  citizens.  Special 
attention  will  be  given  to  communicating  research  outcomes  and  engaging  in  dialogue  with 
civil  society,  in  particular  with  patient  groups,  at  the  earliest  possible  stage,  of  new 
developments arising from biomedical and genetics research. 

•  Modern biotechnology 

The  Commission  has  30  years  of  sustained  and  increasing  involvement  in  biomedical  and 
health  research.    The  activity  "Biotechnology,  generic  tools  and  technologies  for  human 
health"  aims  to  expand  and  validate  the  necessary  tools  and  technologies  that  will  make 
possible the production of new knowledge and its transition into practical applications in the 
area of health and medicine.14 

•  Health Security Research 

In order to assure that Health Security issues are addressed in an evidence-based manner, the 
EU has been financing in the past research in the area of Health security. The outcomes are 
used for policy making in that crosscutting area. 

•  Health policy and system research 

treat 

illness.  These 

There  has  been  a  great  evolution  in  healthcare  systems  in  part  as  a  result  of  the  rapid 
development of new technologies which are revolutionising the way we promote health and 
predict,  prevent  and 
information  and  communication 
technologies  (ICT),  innovation  in  genomics,  biotechnology  and  nanotechnology.  Work 
under  FP7  and  CIP  ICT  Policy  Support    will  focus  on  policy  formulation,  relationship  of 
policy to evidence, and prioritisation; on health systems management, functions, efficiency, 
effectiveness,  system  factors  affecting  access,  scale-up,  monitoring  and  evaluation.  In 
particular  by  co-funding  deployment  across  national  borders  ICT  funding  is  also  enabling 
Member States to address in a coordinated manner the political and regulatory issues which 
are hindering such development. 

include 

•  Social sciences and behavioural research 

14 

ftp://ftp.cordis.europa.eu/pub/fp7/docs/health_factsheets_en.pdf 

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Social, political, economic, environmental determinants for health and their relation to equity, 
access, lifestyles and health seeking behaviours. 

•  Operational research 

Research  on  factors  affecting  the  functioning  of  programmes,  effectiveness  of  targeting, 
impact on behaviour, disease burdens and public health. 

•  Business Opportunities 

Increasing  and  strengthening  of  the  competitiveness  and  innovative  capacity  of  European 
health-related industries and businesses. 

•  Research and Development 

EU  should  support  the  development  of  knowledge  management  for  health  in  developing 
countries and assist them in developing information products and services to meet the needs 
they identify. 

•  Clinical Research 

Under FP7, clinical research will tackle a number of diseases such as cancer, cardiovascular, 
infectious, mental and neurological diseases, and in particular those linked with ageing, such 
as Alzheimer's and Parkinson's diseases. Through international multi-centre trials involving 
the required number of patients, new drugs and treatments would be developed in a shorter 
time  frame.  New  technologies  as  the  Virtual  Physiological  Human  (VPH)  will  enable 
academic,  industrial  and  clinical  researchers  to  improve  their  understanding  of  human 
physiology and pathology, to derive predictive hypotheses and simulations, develop and test 
new  therapies,  with  the  eventual  outcome  of  better  disease  diagnosis,  treatment  and 
prevention tools in healthcare. 

4.4. Cooperation, Coordination, Export of Knowledge and Experience 

Sharing  expertise,  experience  and  best  practice  in  global  health  is  essential  for  research, 
governance,  coordination  and  cooperation  within  and  outside  the  EU.  The  EU  works  on 
different  fronts  in  order  to  achieve  dissemination  of  knowledge,  the  promotion  of  EU 
values and principles and capacity building:  

Firstly,  platforms,  fora  and  events  as  mentioned  under  Action  Pillar  2,  are  crucial  for 
gathering  sustained  information  on  consumers  and  stakeholders.  They  also  serve  as  contact 
points  between  health  experts  for  information  sharing,  finding  partners  for  projects  and 
developing and testing new ideas. This is also enhanced across the EU and more broadly, for 
example by using web-based technology, the Health Portal of the EU15 and newsletters16. 

Secondly,  international  co-operation  with  third  countries  and  international  organisations, 
which  is  also  an  explicit  requirement  under  Article  168  of  the  Treaty  can  also  gather 
knowledge and encourage experience sharing. On a bilateral basis, the EU is strengthening its 
links with Switzerland, Canada, China, Russia and the USA in health questions. Health plays 

15 
16 

www.health.europa.eu 
Eg. published by DG SANCO: "Health and Consumer Voice Newsletter", "Newsletter of the European 
Commission Scientific Committees", "What’s Next?, DG Health and Consumers’ Futures’ Newsletter", 
"Health and Consumer e-News" 

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an  important  role  in  its  relations  with  the  ACP  countries  and  the  EU-Africa  strategy.  EU 
action  also  aims  at  strengthening  the  regional  dimension  of  cooperation  on  health  by  active 
involvement in the work of several regional networks (South East European Health Network 
and  the  Northern  Dimension  Partnership  in  Health  and  Social  well-being).  The  EU 
encourages  participation  of  third  countries,  particularly  candidate  countries,  potential 
candidate countries and European Neighbourhood countries in the Health Programme and in 
EU  Agencies  related  to  health.  Regional  health  networks  (South  East  European  Health 
Network  and  Northern  Dimension  Partnership)  are  also  an  important  multiplier  for  the  EU. 
The  EU  also  constantly  works  on  improving  its  relations  with  international  organisations  in 
health.  An  example  is  its  work  with  third  countries  and  the  World  Organisation  for  Animal 
Health (OIE) towards the eradication of animal diseases and pathogens as well as the supply 
of animal vaccines, leading also to the improvement of lot of farmers in developing countries. 

Ongoing Commission action 

•  Routinely  promotes  the  EU  health  acquis  in  its  bilateral  relations  with  third  countries  – 
particularly  candidate  countries,  potential  candidate  countries,  European  Neighbourhood 
countries and Switzerland. 

•  Encourages  where  appropriate  capacity  building  and  the  establishment  of  networks  for 
exchange  of  best  practices.  This  includes  areas  such  as  rare  disease  treatments, 
nanotechnology, neglected poverty diseases, but equally in the area of zoonoses and food 
safety related issues, where these can affect public health. 

•  Contributes to normative work at  global level for setting  high safety standards for  food, 

feed, animal and plant health as well as product safety. 

•  Promotes its Rapid Alert Systems and makes information available on the internet relating 

to food and feed safety, product safety, animal, plant and human health. 

•  Routinely inspects facilities in Member States and third countries and publishes the results 
of its inspections on the internet. As with the Rapid Alert systems, this can be considered 
as  a  global  public  good  in  that  it  raises  standards  and  informs  all  interested  parties  of 
problems with the food supply. 

•  Encourages training throughout the world to increase the capacities of third  countries in 
dealing  with  food  and  feed  law,  animal  health  and  welfare  and  plant  health  rules.  For 
example,  the  Commission  training  initiative  "Better  Training  for  Safer  Food"  trains 
Member  States'  and  candidate  countries'  national  authority  staff  involved  in  official 
controls  in  these  areas.  Training  is  also  organised  specifically  for  third,  particularly 
developing  country  participants,  so  as  to  familiarise  them  with  EU  approach  and 
requirements.  Other  programmes  under  the  various  external  assistance  instruments  help 
developing countries building their capacity in these fields. 

•  Contributes wherever possible in international meetings on global health. 

4.5. Foreign Policy, Governance 

The  interdependence  produced  by  globalisation  has  turned  health  into  an  increasingly 
important  challenge.  In  pursing  self-interest,  nations  might  undermine  the  solutions  that 
respond to the challenges of growing interdependence, and there is thus an urgent need to find 
shared  values  and  approaches  in  the  area  of  global  health,  that  would  be  embodied  in  the 

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relations between countries. The UNGA Resolution on Global Health and Foreign Policy17 of 
December  2009  drew  specific  attention  to  the  issues  of  emerging  infectious  diseases  and  of 
workforce but there are many other potential examples. 

The  objectives  at  EU  level  are  to  build  strategic  alliances  and  collaborate  effectively  with 
global health partners, to enhance EU visibility in global health and contribute to shaping the 
global health agenda.  

The EU is dedicated to strengthening its voice in global health  through sustained collective 
leadership.18 By sharing values, experience and expertise and by ensuring coherence between 
its  internal  and  external  health  policies,  the  EU  can  provide  significant  support  to  attaining 
global  health  goals  (e.g.  Millennium  Development  Goals,  European  Consensus  on 
Development Cooperation, the 2005 Paris Declaration and the Accra Agenda for Action). In 
addition,  this  will  ensure  that  the  EU  plays  a  crucial  role  in  the  response  to  global  health 
threats  (European  Centre  for  Disease  Control,  implementation  of  international  health 
agreements  such  as  Framework  Convention  for  Tobacco  Control  and  International  Health 
Regulations). 

But  the  relevance  of  foreign  policy  and  global  health  is  not  only  about  national  health 
security  and  development.  Health  and  foreign  policy  are  also  of  crucial  importance  for 
alliances, for reputation and for trade issues. In all of these areas, health and governance are 
mutually dependent on each other, in fact intrinsically entwined. Global health issues have an 
impact on EU health issues and governance and vice versa.  

Health  can  be  a  good  entry  point  to  initiate  dialogue  across  borders,  thus  contributing  to 
building  trust  between  parties  (e.g.  breakdown  of  health  services  in  armed  conflicts,  high 
casualties, damage to infrastructure, loss of health workers in natural disaster situation and re-
establishing  of  health  services  as  a  primary  focus  during  the  reconstruction  phase,  post-
conflict, and in the aftermath of a disaster). For example, in South-East Europe following the 
conflicts in the Balkans during the 1990's the establishment of the South-East Europe Health 
network  helped  to  build  bridges  across  hitherto  hostile  communities  which  then    faced 
common problems. 

Recognition of the need for policy coherence, strategic direction and a common value base in 
global health is beginning to emerge at the level of nation states.  A few European countries 
are  beginning  to  address  global  health  more  consistently  at  the  national  level  by  mapping 
many activities in global health across all government sectors, establishing new mechanisms 
of  coordination  within  government  and  developing  a  "national  global  health  strategy", 
frequently  at  the  initiative  of  the  international  departments  in  the  ministries  of  health.  The 
realisation of a financial crisis has also pushed foreign security policy makers to set up a clear 
agenda for bringing at least global health security higher in the foreign policy agenda. 

In  Europe,  the  most  recent  –  and  possibly  the  first  –  such  national  global  health  policy 
document  has  been  developed  in  Switzerland,  where  a  joint  strategic  approach  to  global 
health  was  developed  by  the  Departments  of  the  Interior  (represented  by  the  Swiss  Federal 
Office of Public Health) and the Department of Foreign Affairs. The document is unique in 
documenting  the  interface  between  the  protection  of  the  health  interests  of  the  Swiss 

17 
18 

UN General Assembly A/64/L.16 of 4 December 2009 Global health and foreign policy 
This  follows  from  TFEU  Article  168  calling  for  cooperation  with  third  countries  and  international 
organisations  in  public  health  and  from  the  Commission's  strategic  objective  of  Europe  as  a  World 
Partner (Annual Policy Strategy for 2008 – COM(2007) 65) 

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population  and  the  improvement  of  the  global  health  situation.  It  forms  the  basis  for  a  new 
type of policy coherence between national interests and global responsibilities. 

The UK Government has also launched a national global health strategy, in September 2008, 
which aims at greater coherence between government departments in matters of global health. 
A  number  of  other  European  countries  are  also  working  on  similar  agreements  between 
sectors in order to advance global health. 

Ongoing Commission action 

•  Brings  together  stakeholders  from  all  Member  States  and  from  the  private  and  public 

sector monthly in the Global Health policy forum. 

•  Builds  upon  existing  EU/WHO  cooperation  in  areas  such  as  tobacco  control,  obesity, 
mental health, humanitarian aid and health research. In 2008-2009 it seconded an official 
to WHO in Geneva. 

•  Consistently  calls  upon  partner  countries  to  give  priority  to  the  implementation  of 

international health agreements to which they are parties. 

•  Encourages  participation  of  third  countries,  particularly  candidate  countries,  potential 
candidate  countries  and  European  Neighbourhood  countries  in  the  2008-2013  Health 
Programme and in EU Agencies related to health.  

•  Encourages enhanced cooperation and dialogue on health with European Neighbourhood 
policy  partners  including  through  the  implementation  of  the  European  Neighbourhood 
Policy Action Plans. 

• 

• 

 Is negotiating a Health Agreement with Switzerland on health and has signed agreements 
with Canada, China and Russia on how to improve health cooperation. It is ready to open 
discussion with the new US Administration on how to expand existing cooperation. 

Is expanding the ongoing collaboration with Africa in the area of health as emphasised in 
the  Joint  Declaration  between  the  African  Union  Commission  and  the  European 
Commission in their meeting in October 2008. 

•  Works  with  third  countries  and  the  OIE  towards  the  eradication  of  animal  diseases  and 
pathogens,  supply  of  animal  vaccines  and  generally  improving  the  quality  and 
productivity of the global herd – thus improving indirectly the economic status of farmers 
in developing countries and working towards the eradication of malnutrition there. 

•  The  EU's  integrated  approach  to  food  safety  is  also  reflected  in  the  Commission's 

involvement in the work of the OIE and Codex Alimentarius. 

4.6. Security 

Protecting  citizens  against  health  threats,  such  as  communicable  and  non-communicable 
diseases,  including  health  threats  from  deliberate  releases  of  pathogens,  chemicals, 
radiological,  and  nuclear  substances,  and  the  health  effects  of  climate  change,  as  well  as 
enhancing global capacity to respond to acute threats is of ever increasing importance in an 
interconnected and interdependent world. 

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The Commission has a key role in coordinating the efforts of  Member States on addressing 
health  security  threats  effectively  and  in  a  coherent  way  as  it  provides  clear  added  value  as 
many of these trans-border issues cannot be tackled effectively by individual Member States. 
The  protection  of  human  health  has  been  specifically  set  out  in  the  Treaty19.  Commission 
work in this area includes consumer protection, combating cross border health threats such as 
infectious diseases and food contaminants, improving preparedness and response to epidemics 
or bioterrorism, and supporting Member States in addressing communicable disease threats. 

Consumer protection: The EU integrated approach to food production aims to assure a high 
level  of  food  safety,  animal  welfare  and  plant  health  within  the  European  Union  through 
coherent  farm-to-table  measures  and  adequate  monitoring,  while  ensuring  the  effective 
functioning  of  the  internal  market.  Coordination  must  be  ensured  on  issues  such  as  animal 
diseases which can be transferred to humans, and on ensuring food safety.  

Combat cross border health threats: The need for communicable diseases to be addressed 
effectively  and  in  a  coordinated  way  internationally  has  been  demonstrated  over  the  last 
decade, especially with the outbreak of SARS, Avian Influenza A (H5N1) and most recently 
the  influenza  A  (H1N1).  The  Commission  is  committed  to  improving  preparedness  and 
response  to  this  kind  of  epidemic  or  deliberate  acts  such  as  bioterrorism,  as  well  as  to 
supporting Member States in addressing communicable disease threats such as HIV/AIDS and 
tuberculosis/MDR-TB. In order to respond rapidly to health threats globally and enhance the 
EU’s and third countries’ capacity to do so, the  Commission put in place a set of mechanisms 
to coordinate measures at the EU level and globally20 .  

•  Actively  participates  in  the  G7+  Global  Health  Security  Initiative  and  hosted  the 
Ministerial  Meeting  of  G7+  Health  Ministers  in  December  2008  and  the  extraordinary 
ministerial meeting on pandemic H1N1 (2009) in September 2009.  

•  Works  with  the  WHO  and  others  to  reinforce  global  responsiveness  and  to  provide 

funding through the pledging process for avian influenza response. 

•  Works  very  closely  with  the  European  Centre  for  Disease  Control  (ECDC)  to  monitor, 

assess and respond to communicable disease health threats. 

•  Encourages  European  Neighbourhood  countries  to  participate  increasingly  in  EU 

Communicable diseases networks. 

•  Promotes bio security measures as a crucial component of its Animal Health Strategy for 

2007-13. 

•  Promotes evidence-based and high levels of food safety, animal and plant health as well as 
product  safety  at  the  multilateral  level,  with  a  view  to  facilitating  trade  under  safe 
conditions  and  improving  the  contribution  of  these  policy  areas  to  overall  health 
protection. 

19 

20 

Article  168:  "A  high  level  of  human  health  protection  shall  be  ensured  in  the  definition  and 
implementation of all Community policies and activities" 
Council Conclusions, 30 April 2009 

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4.7. Response to Globalisation (Markets/Services) 

With globalisation and the opening up of international trade and business opportunities, health 
has  become  an  important  part  of  export  and  trade  profit  in  the  EU  (export  of  health 
solutions,  policies,  products,  services,  knowledge).  But  health  has  also  become  increasingly 
dependent on global market dynamics. Health systems and health policies are becoming more 
interconnected  than  ever  in  the  past,  human  resources  and  access  to  essential  medicines 
depends  on  market  dynamics,  and  so  does  also  international  safety  of  medicines,  of  food, 
feed and other products. 

This is due to many factors, including the movement of patients and professionals (facilitated 
by rulings of the European Court of Justice); the common public expectations across Europe; 
the  dissemination  of  new  medical  technologies;  and  techniques  through  information 
technology. .A coherent strategy on health in relation to trade within the EU and with other 
countries is thus needed.  

Patient  mobility:  Until  recently,  the  circumstances  under  which  cross-border  healthcare 
could  be  provided  and  reimbursed  were  still  unclear.  On  2  July  2008,  the  Commission 
adopted  a  proposal  for  a  Directive  on  the  application  of  patients'  rights  in  cross-border 
healthcare, which, once adopted by the European Parliament and the Council, will provide a 
Community  framework  for  safe,  high  quality  and  efficient  cross-border  healthcare,  by 
reinforcing cooperation between Member States and providing legal certainty over the rights 
of patients to seek healthcare in another Member State.21 

Trade  agreements  (TRIPS  flexibilities  etc):  Trade  policy  measures  can  have,  indirectly, 
both  negative  and  positive  effects  on  the  health  of  a  country’s  population.  This  potential 
conflict of interest is taken into account in one of the major exceptions to the WTO’s basic 
principle  of  unrestricted  market  access  whereby    measures  essential  to  protecting  health  are 
permitted  in  principle,  provided  they  are  not  discriminatory  or  used  as  a  covert  means  of 
restricting international trade. 

Another  example  is  the  agreement  on  TRIPS  flexibilities,  which  ensures  both  adequate 
protections of intellectual property as well as access to essential drugs for the world's poorest 
countries.  The  EU  has  consistently  led  efforts  to  widen  access  to  vital  medicines  in 
developing countries and to strike the right balance between the intellectual property rights of 
pharmaceutical  companies  and  the  need  to  ensure  that  medicines  are  available  for  poor 
countries facing public health crises.  

In 2003, the EU adopted new rules on tiered pricing that prevented the re-export to the EU of 
drugs  sold  by  European  pharmaceutical  companies  to  developing  countries  at  heavily 
discounted prices, thus enabling the European pharmaceutical companies to sell their goods to 
developing countries at prices cheaper than they charge in Europe. 

21 

EU  citizens  facing  a  health  problem  while  travelling  in  another  Member  State  can  already  obtain 
healthcare  and  be  reimbursed  thanks  to  the  coordination  of  EU  social  security  systems.  Those  who 
cannot get the healthcare they need in their own country within a reasonable time can also rely on this 
system.  But  citizens  may  have  other  reasons  for  travelling  abroad  to  receive  treatment.  For  example, 
they may live in a border region where the closest health facilities are across the border. These people 
will  in  future  find  it  easier  and  safer  to  be  treated  in  other  Member  States  thanks  to  the  Commission 
initiative.  

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Moreover, the EU has now integrated an amendment to the TRIPS Agreement which extends 
the  concept  of  compulsory  licensing22  to  other  countries  into  its  own  law  so  that  EU 
pharmaceutical companies can apply for a licence to manufacture, without the authorisation of 
the  patent  holder,  pharmaceutical  products  for  export  to  countries  in  need  of  medicines  and 
facing public health problems. 

International safety standards: Finally, the European Commission also works to agree and 
ensure international safety standards for food, feed and products regardless of origin. As the 
world's biggest importer and exporter of foodstuffs, the European Union works closely with 
international  organisations  and  offers  advice  as  well  as  assistance  to  third  country  trading 
partners. Indeed, the high standards of food, feed and product safety expected by EU citizens 
imposes a requirement on the Community to have the high EU standards accepted at global 
level so that we can stay compliant with WTO rules. 

5.  BENEFITS OF COOPERATION FOR GLOBAL HEALTH  AT EU AND GLOBAL LEVEL 

It  is  not  an  easy  task  to  establish  policy  coherence  across  such  a  wide  variety  of  sectors, 
services and Member States involved in global health issues. However, if the sectors involved 
in  each  action  field  manage  to  collaborate  effectively,  if  concerted  policy  approaches  are 
taken both within and between Action Pillars, and if policy coherence can be ensured across 
Member States, then it will be possible to reach increased visibility, competence, credibility 
and effectiveness of the EU.  

The  legal  basis  for  this  is  to  be  found  in  various  Treaty  articles,  such  as  on  the  Internal 
Market, Environment, Consumer Protection, Fundamental rights, Social Affairs including the 
Safety and Health of Workers, Development Policy, and Research, amongst many others. The 
important role of the EU in health policy has also been reaffirmed in the Lisbon Treaty.  

With  greater  visibility,  competence,  credibility  and  effectiveness,  the  EU  will  be  able  to 
appear on the global scene as a leader with a strategic framework. It will gain greater political 
and economic weight in international health; its role will be shifted from donor to convening 
EU  collective  voice  and  action;  in  short,  it  will  become  a  more  trusted,  more  efficient  and 
more powerful global player in the field of health. In fact, considering its remarkable system 
of  shared  sovereignty  between  its  27  Member  States  and  the  Union,  the  EU  will  be 
particularly suited to serving as a model on the global scene. 

The  main  actors  involved  in  the  global  health  field      (the  EU,  International  Organisations, 
countries,  NGOs,  Foundations,  Think  Tanks,  Academia  etc)  need  to  come  together  and 
establish  partnerships  and  processes  to  define  a  global  health  agenda.  There  is  a  need  to 
engage systematically with policy makers and stakeholders at all levels, including the private 
sector, industry and civil society; a need to promote new ways of working within a range of 

22 

The principle of compulsory licensing allows a developing country facing a public health crisis, after 
consultation with the patent-holder, to grant a license to a domestic company without the approval of 
the  patent-holder  to  produce  a  generic  medicine  patented  by  a  foreign  pharmaceutical  company.  This 
medicine is for the use of the domestic market and may not be exported. 

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traditional and non-traditional stakeholders, and to find ways of bringing in new partners and 
building synergies. 

6.  OUTCOMES FOR GLOBAL HEALTH 

Collective  and  coordinated  power  and  a  strong  political  will  to  improve  the  health  of  all 
citizens  could  thus  lead  to  sustained,  imaginative  and  democratically  accountable  political 
leadership  and  a  successful  global  health  agenda.  Prosperity,  security  and  stability  could  be 
improved in the field of health as such, but also in all related spheres. Economic prosperity is 
heavily  reliant  on  the  sound  health  of  the  population23.  Working  towards  a  sustained  and 
concerted  global  health  agenda  by  agreeing  on  adequate  global  health  objectives  and 
mechanisms will be essential to reaching the ultimate and ideal state of global health. 

23 

As also specifically recognised under the Lisbon Agenda. 

EN 

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   EN