The EU must finish what it started for the benefit of smaller states’ health

By European Alliance for Personalised Medicine (EAPM) Executive Director Denis Horgan

In 2015, the European Union will have as its rotating presidencies two of the smaller member states: Latvia, with a population of around two million (president from 1 January), and Luxembourg, with a population of just over half-a-million (president from 1 July).

Compared to, for example, Germany with its 80-plus million citizens, France (around 66 million), and the UK (almost 65 million) these countries are tiny. Yet, since the ‘big bang’ enlargement of 2004, when ten new countries joined the Union, smaller states have had more and more influence, especially in EU health matters.

As far back as 1992, the Maastricht Treaty gave the EU a legal public health mandate, which was updated in the Amsterdam Treaty in 1997. Article 35 of the EU Charter of Fundamental Rights – which entered into force with the signing of the Treaty of Lisbon almost five years ago - states: "A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities."

Now, theoretically, everyone has the right of access to preventive health care and the right to benefit from medical treatment under the conditions established by national laws and practices.  That phrase “national laws and practices” acknowledges that, to this day, health and healthcare systems remain a member state competence, although the EU does have a complementary and supporting role by shaping the conditions for, among other things, health workforce mobility, the purchase of goods and supplies, the financing of health systems and the delivery of services.

But, when it comes to health policies, has the EU properly recognised the vulnerabilities of smaller member states who, because of their need for collaboration, tend to have a more positive approach to networks, exchange of best practices and EU processes? 

Well, the European Commission has positions that appear to be marginally closer to those of these countries and is viewed as their natural ally. Going back to the pre-2004 accessions negotiations, smaller member states were even given a special mention in the famous ‘Cyprus clause’ (Article 126a), which gave these countries, for example, an abridged form of registration for medicines.

That was a good start. However, in order to achieve a high-level of health across the EU, the European Alliance for Personalised Medicine (EAPM) believes that health policies need to recognize and tackle the inherent health system vulnerabilities faced, specifically, by these smaller countries and in the regions of the larger ones.

This will include, but is not exclusive to, the development of a new socio-economic paradigm, or model, that: acknowledges the growing rift between expectations and realities; finds an equilibrium between raising citizens’ expectations and current crisis/supply constraint scenarios; ensures that there is no further exacerbation of already growing inequalities; reduces administrative burdens; avoids new bureaucracies and authorities, and; minimizes and simplifies reporting obligations in line with the EU’s better regulation agenda.

EAPM also strongly believes that future EU health policy needs to stimulate engagement with all stakeholders; work towards achieving more policy coherence and inter-sectoral alignment of health policy; be part of a health policy- friendly European semester process; ensure access to medicines at affordable prices; establish better capacity-building programmes among public health leaders and practitioners, and; encourage the pooling of resources and expertise across all member states for quality standards oversight.

These are not small ‘asks’ but they need to be addressed if Europe is to celebrate ‘unity in diversity’ by working to reduce the current clear disparities while, at the same time, respecting that precious diversity. For its part, EAPM will be working closely with both presidencies in 2015 to help push the agenda.

There is no doubt that to bring about a brave, new, healthier Europe the EU and its stakeholders must recognize that we are more likely to be successful via the pooling of expertise and resources and the will to develop fresh perspectives on health policy.

This will result in an EU-level health perspective that is mindful of the needs and aspirations of all of Europe’s 500 million citizens across all 28 Member States – whether those states be big or small.

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