March 25, 2017, marks the 60th anniversary of the signing of the Treaties of Rome—two treaties that gave birth to the European Economic Community (EEC) and to the European Atomic Energy Community (EURATOM). The treaty establishing the EEC affirmed in its preamble that signatory states were “determined to lay the foundations of an ever closer union among the peoples of Europe”. Security, solidarity, and freedom are protected in the Charter of Fundamental Rights of the European Union (EU). The 1992 Maastricht Treaty placed the health mandate of the EU centre stage and although delivery of health care remains a national competence, EU law governs many areas, such as medicines regulation. Yet with the UK Brexit vote last year, and rising support for extremist anti-EU parties across Europe, closer union and solidarity in the 28 EU member states appears to be at risk. The global refugee crises, with European countries absorbing more than 2 million asylum applications since January, 2015, shows no sign of abating. With important elections in France and Germany imminent, now is the time to ask: what has Europe ever done for health?
The 2013 Lancet series on Europe, led by Martin McKee of the London School of Hygiene & Tropical Medicine, UK, reported that most European countries have made impressive (although uneven) progress in population health in the past two decades, showing how Europe offers a natural learning community enabling each country to benchmark itself against others.The EU has been especially effective in certain areas. In tobacco control, it resisted powerful industry lobbying by mandating changes to the packaging of tobacco products, including graphic photographs that must cover 65% of the front and back covers of packs. In the development of European guidelines, professional bodies with EU support have promoted evidence-based management of a wide range of conditions. The newly established European Reference Networks connecting 900 medical teams across Europe tackle complex or rare diseases and conditions that require highly specialised treatment knowledge and resources.
EU institutions have concentrated expertise and ensured harmonised decision making. The European Medicines Agency (EMA), established in London, UK, provides a single pathway for new drug approval. The European Commission's Directorate General for Health and Food Safety Consumer Protection (DG SANTE), with its mission to protect and promote the wellbeing of its citizens through public health, food safety, and consumer protection, continues to provide leadership to implement the Health in All Policies initiative towards greater recognition of how health contributes to economic growth and social cohesion. The European Centre for Disease Prevention and Control, in Stockholm, Sweden, provides invaluable infectious disease surveillance and, among other tasks, was mandated by DG SANTE to produce scientific advice on the main health needs of migrant populations. The European Food Safety Agency, in Parma, Italy, contributes to evidence-based standards by providing rapid responses to threats to food safety from chemical or infectious agents, such as melamine or Escherichia coli. Finally, the European Court of Justice has consistently upheld public health principles, such as rejecting challenges to tobacco legislation.
Despite these successes, there is still much to do. Engagement with younger generations, intersectoral collaboration, and investment in primary health care are key to addressing the double challenge of epidemiological and demographic transitions and the multimorbidity of chronic mental and physical ill-health. DG SANTE has done little about the Sustainable Development Goals, while the EMA has not progressed on drug pricing, arguably because cooperation with industry influences the health research and policy agenda. Yet Jan De Maeseneer, Chair of the independent EC Expert Panel on Effective Ways of Investing in Health, says, “This is an opportunity to build a social Europe—politicians need a viable social cohesion project using health systems as the direct interface to improving quality of life and sustainable development.” McKee, also a panel member, agrees, but warns that recent comments by the European Commission President, Jean-Claude Juncker, suggest that he fails to recognise the great contribution that the EU has made to health, with the risk that health's role could be weakened in a streamlined future EU.
The dawn of the next 60 years in Europe heralds an opportunity to tackle all these challenges. EU collaboration and investment in health can build a visibly cohesive European community based on founding values of solidarity, freedom, sustainability, and wellbeing—which remain even more relevant today than 60 years ago.
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