Get Active
Authors: Mark Thursz
Journal: Journal of Hepatology (2011)

January is traditionally a time for making (and breaking) New Year's resolutions. If your resolution is anything like mine it could probably be summed up as eating less and exercising more than the patients in my NAFLD clinic. Perhaps I could help you to find a more original resolution for 2012 – Get Active. No, I don't mean get physically active, I mean get politically active. The Hepatology community is very effective when it comes to clinical care and research excellence but I do not feel that we match up to other specialties when it comes to lobbying, advocacy, and influencing the political agenda in the health field. Is the political agenda really part of our remit? This is an entirely legitimate and yet somewhat naive question. At the current time, liver disease is now the fifth most common cause of mortality and in many European countries it differs from the top four causes of mortality because it is the only one with a rising mortality rate. Despite this, Hepatology remains a relatively small specialty with limited resources and very little support from public health authorities or research funding agencies. If we want to change this situation for the benefit of our patients then we need to get politically active. It is difficult to understand who sets the health agenda in political circles. Globally the UN and its various institutions appear to play an important role. The Millennium Development Goals set HIV, TB, and malaria at the top of the health agenda over a decade ago and this has been perpetuated by the Gates Foundation and WHO. However, this prioritisation has had a negative impact on other health issues. For example, it is now accepted that there are a group of 'neglected' infectious diseases but chronic viral hepatitis infection, affecting over half a billion people worldwide, does not even make it into this second political class of diseases. In 2010, EASL was delighted to see the adoption of World Health Assembly resolution number 63.18 calling for action on the prevention and treatment of viral hepatitis in response to lobbying activities from numerous groups including ourselves. However, 18 months later it is disappointing to see that the Hepatitis section of WHO consists of only 2 individuals compared to the thousands allocated to work on HIV, TB, cancer, etc. Over the last 12–18 months EASL has been working with other professional and patient groups as part of the European Chronic Disease Alliance (ECDA). The common denominators which link these groups are the major determinants of chronic disease in Europe: alcohol, tobacco, poor diet, and lack of physical activity. ECDA is lobbying for the implementation of evidenced based public health policies to tackle these issues. Potentially the most important event on the global public health calendar for 2011 should have been the UN High Level Meeting (HLM) on chronic diseases in New York. Even though I am writing this editorial in early September I can confidently predict that the outcome of the HLM will have been a disappointment. In my opinion, it is unlikely that any of the carefully worded goals written into the draft Political Declaration which commit governments to action will have been adopted. If by the time this editorial appears I prove to be wrong then I will be content in my embarrassment. The main obstruction to adoption of specific goals in the document is lobbying activity by companies with strong commercial interests. This is not, of course, a new situation. We have met similar opposition in the European Alcohol and Health Forum where professional groups such as EASL are only given the same level of influence as the alcohol industry. The usual argument is that legislation which effectively reduces the consumption of alcohol would threaten the economic prosperity of the European community. It is hard to see why this argument holds sway when the European Commission's own figures suggest that the economic contribution of the alcohol industry is €45 million per year whereas alcohol misuse costs the community €450 million per year. In 2011 a sustained advocacy campaign by the United European Gastroenterology Federation (UEGF) succeeded in generating a European Council Resolution on bowel cancer screening. Although Council Resolutions are considered 'soft law' in Brussels the reality is that policies advocated in these pieces of legislation are invariably implemented at a member state level. UEGF should certainly be applauded for this achievement. EASL, together with the European Liver Patients Association (ELPA) are currently lobbying for similar legislation on screening for viral hepatitis. This is clearly an uphill struggle, in part due to the unjustified stigmatisation of viral hepatitis but also due to the low volume of research on viral hepatitis screening policies and cost-effectiveness. At a European level the research agenda is embedded in the themes of Framework Programme 7 (FP7) where a casual glance will confirm that liver disease is not a priority. EASL has lobbied hard at the European Commission directorate for Research and Innovation (DG Research) for the past four years. This lobbying activity is followed up with financial support for consortia applying for FP7 grant funding and we are proud of the successes that the Hepatology community has achieved in the last three years. Nevertheless, it is frustrating to see hypothecated funding for diabetes, HIV, malaria, and TB and neurological diseases with liver disease occasionally mentioned as an appendage to other topics. Hypothecated funding for HIV research and clinical care has reduced the mortality from AIDs in Europe so that it is no longer considered a major public health threat. It is therefore all the more exasperating that the politicians and public health authorities are apparently unwilling to invest in liver disease to the same extent. How should we address these inequities? One way is for EASL to take the lead in setting and driving the political health agenda. In this we will work with ELPA and, where expedient, with our pharmaceutical company partners. This year EASL has appointed Margaret Walker as Director of EU Public Affairs. Please join me in welcoming her to the EASL team. Margaret will work with Dominique Valla, our EU Policy Councillor, and Markus Peck-Radosavljevic, EASL Vice-Secretary, on our EU agenda. However, EASL cannot achieve the necessary seismic shifts in political attitude on its own. Lobbying in Brussels needs to be supported and amplified by lobbying activity targeted at member state governments, at regional and at local politicians and public health organisations. EASL cannot reach these people but you can. So instead of contemplating whether your New Year's resolution should be focussed on the excess kilos accumulated over the festive period, I would implore you to Get Politically Active. To the EASL members and readers of the Journal of Hepatology I wish you all a happy and productive 2012.