Opinion: Time for EU to put a pan-European focus on health

Professor Angela Brand (pictured below), founding director and full professor of the Institute for Public Health Genomics at Maastricht University

When it comes to the health arena, Europe is seriously fragmented: its 28 member states having varying standards, different levels of access and cost systems that don’t relate to one other.

This causes myriad problems, especially for the patient, and affects, for example, the ability to gather and share data efficiently and effectively, as well as causing problems with targeted clinical trials, cross-border health care and much more.

Despite not having a concrete mandate that covers health, the EU has had a policy for two decades and it needs to step this up and do so now. With 500 million citizens and an aging population, Europe is facing a serious issue with regards to present and future patients. It is clearly time for action.

However, where will this action come from? If the powers-that-be in Europe are to improve coordination not only between member states but also between the countries’ own regions in some cases, then the EU needs to broaden its shoulders and take on the burden of a much stronger role in healthcare.

All politics may well be local, as Tipp O' Neill said, but there’s a job to be done in order for this to happen in health care. The ‘locals’, in other words the citizens and specifically the patients of today and tomorrow, need to see effective policies that can be applied at local level.

Admittedly, this is difficult because of the way the EU is structured. The Union is often blamed for a lack of patient access to the best treatments and medicines available as well as a lack of investment in research. Some of this criticism is justified but the main issue here is that the EU needs to be supported so as to facilitate the natural synergies and coordination that should be occurring between member states and regions but that patently is not occurring.

Some citizens feel that the EU is a distant body and is disconnected from them and their daily lives. We’ve heard much about the ‘democratic deficit’ but a lot of that sentiment comes from the EU’s complexity and the man in the street’s perception of it. ‘Local level’ politics do not reality apply at EU level as there is a huge difference between electing a local representative who then heads off to the council or the national parliament and, hopefully does the voters’ bidding, and an MEP who cannot create the law but only amend it, hundreds, if not thousands, of miles away from his or her constituency.

Meanwhile, policy is being decided by the European Council (made up of heads of state and government) alongside the European Commission, with the latter not being directly elected (although the individual commissioners are put forward by the Member States’ government of the day). The problem with this is clear – citizens haven’t a clue who actually represents them. And yet the EU has legal competence in many areas for the well-being of these citizens.

From the patient perspective, pretty much every stakeholder in healthcare claims to represent them and this poses a dilemma for policymakers, lawmakers and decisionmakers in the sense that they are bombarded by varying viewpoints and, in many cases, cannot see the wood for the trees. If every interested party is shouting ‘I’m Spartacus!’ or ‘I represent the patient’s views and needs’, then this leads to confusion and, in certain cases, a lack of action that is often blamed on the EU. It’s an easy target in this respect.

An idea of the kind of quagmire that the EU wades into can be given by the fact that the Clinical Trials Directive took a decade to revise and the Data Protection regulatory measure led to more than 4,000 amendments. Yes, you read that correctly – 4,000!

It’s fair to say that often the representation, wishes and needs put in front of the EU before and during the setting out of legislation is often confusing and, in some cases, downright contradictory. So perhaps we should not be too quick to point the finger at an institution that has taken just 60 years to get to where it is now and shout ‘J’accuse…!’ from the top of the Berlaymont.

Yes, the EU needs to do more to look after its millions of citizens by creating an environment in which member states and all stakeholders can cooperate to produce better healthcare across the bloc. Yes, it needs to fund and encourage research and development while giving better incentives to industry. And, yes, it definitely needs to understand who, exactly, is representing the patient.

Frankly, the only way that the Commission and MEPs can actually understand all the issues is by listening closely to a multi-stakeholder group in any particular arena rather than answering dozens of ‘knocks on the door’ from dozens of, often conflicting, parties.

At least this is happening in the rapidly developing area of personalised medicine. The European Alliance for Personalised Medicine (EAPM) will hold its annual conference on 9-10 September in Brussels and bring together all stakeholders - patients, clinicians, researchers, academics, industry partners, member state affiliates, policymakers plus new MEPs - and is timed to precede the five-year term of the incoming European Commission.

With its ongoing STEPs campaign (Specialised Treatment for Europe’s Patients), and the setting up of an MEPs’ STEPs Interest Group, EAPM has created a regular forum in which all stakeholders can hear what the patients want and need, and the policymakers can then hear one voice instead of a babble of many. This is the only way to give out a single, very clear message.

Without question this is what is required to equip politicians and the Commission with the right tools to undertake the huge task of building a healthier, and thus wealthier, Europe for this generation and those that will follow.

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