Stepping up healthcare

An overview on health and consumer protection in Europe: John Dalli, Maltese, married, two children, elected national minister numerous times, in these capacities he took on Malta’s Finance, Economy, and Social Policy portfolios. He currently serves as EU Commissioner for Health and Consumer Policy. He knows his mind, despite the complexities of his mandate. He acknowledges countless hanging questions along with the problem of financial resources that need to be invested in this field at national level. “Further resources need to be allocated for prevention and health – he said – so as to reduce the risk of diseases whilst ensuring financial sustainability, considering that in Europe only 3% of national health budgets is targeted to this end. It’s not enough!” Dalli highlights another point: “It’s necessary to reduce hospitalization, obviously whenever possible. Prevention and family care benefit the sick person”. Gianni Borsa interviewed him for SIR Europe.Commissioner, among the EU’s responsibilities figure measures aimed at improving public health services, preventing the spread of diseases and infections, and eliminating dangers to human health. In concrete terms, do community institutions possess the power and tools to protect their citizens?“Member States are primarily in charge of adopting health policies and of the organization and supply of health services for their citizens. However, there are areas where Member States cannot deliver efficient results alone and thus cooperation at Community level is crucial. This includes addressing health dangers, notably pandemics and bioterrorism, at cross-border level. Another example are the European regulations on transmissible diseases, blood, tissue, cells and organs, pharmaceutical vigilance, false medicines and the right to receive cross-border health treatments. Furthermore, EU health protection measures represent an added value to national provisions, notably in the area of disease prevention, including food safety and nutrition, pharmaceutical safety and combating nicotinism”.As known, healthcare encompasses numerous sectors: countering cardiovascular or infective diseases, combating AIDS, promoting research on cancer… But the EU includes 27 Countries with different health and social systems. What do you think of national public healthcare measures?“European health systems are subjected to increasing pressure in order to respond to the challenges of population ageing, to citizens’ expectations, migration flows, as well as to patients’ and medical staff mobility. This all takes place at a time of public health expense austerity. In December 2010, the European Commission and the Economic political committee issued a joint report on health systems aimed at providing a better understanding of public health expenditure across Member States. The report shows that the Commission and EU Member States ought to step up cooperation in order to promote best practices aimed at efficient health systems. It is not my role to express my appreciation of national health systems, however the Commission can assist EU States by bringing together health and financial stakeholders, identifying the best solutions to common challenges”.Europeans’ mean life span, as said, is increasing. There are more old people, and also for this, health systems are called to address new challenges, including financial sustainability. In your opinion are there feasible solutions?“Indeed, as a result of population ageing, the picture of diseases at European level is rapidly changing, resulting in a source of pressure on the sustainability of European health systems. Innovative solutions are certainly required. This is the purpose of the European Association for Active and Healthy Ageing, launched in 2010 within the framework of the flagship initiative ‘Innovative Union” that falls within the Europe 2020 Strategy for intelligent, sustainable, and inclusive growth. The purpose of the Association for Active and Healthy ageing is to help European citizens to live on average at least two years more and in good health. Continuing to focus on health promotion and chronic disease prevention is equally crucial to decrease the burden of national health systems”.In order to combat diseases, including the most common and the rare diseases alike, it is necessary to increase investment and cooperation in Europe. Are steps being made in this direction?“Cooperation in the area of public health will increase as a result of the recently adopted directive on cross-border healthcare. Cooperation on rare diseases is a good example of existing cooperation, whereby the added value of EU cooperation is undeniable. A Committee of European experts in this field was set up in November 2009. The Committee cooperates with the Commission to monitor, evaluate and disseminate information on the outcomes of measures in the field of rare diseases. Ongoing investments in health measures and research are carried out through financial mechanisms, namely the public health program, providing for up to 321 million euro subsidies in the period 2008-2013, the Seventh Framework Program for research, with a 2011 budget of 658 million euro for health research, structural Funds, along with investments through social and economic cohesion policies”.Research brings new challenges in medical health, namely, questions regarding the realm of “bioethics”. Are there domains for debate and discernment at European level regarding the protection of life in all its stages, the treatment of terminal patients, and that address the furthermost areas of medical research?“The Commission disposes of manifold opportunities along with discussion forums at different levels: at citizens’ level, among experts, up to ministerial level, according to the nature of the topic addressed. An example pertaining to my sector is the European Health Policy Forum, that brings together various associations – 52 at present – along with stakeholders of the health sector, whose purpose is to ensure that the European health strategy is clearly acknowledged and that it responds to public concerns”.The EU has just adopted a “cross-border healthcare” directive, that you previously mentioned. What are the primary objectives of this directive?“I am very glad that the Council has adopted this Directive. It will certainly help patients seek safe and quality healthcare in another EU Member Country and be reimbursed, in particular, patients in need of specific treatments, as in the case of rare diseases. It will also help reduce health inequalities, making healthcare more accessible in Europe. Moreover, the directive will step up cooperation of national health authorities with other EU Member Countries in order to promote the exchange of information on healthcare standards. However, in order to promote the sharing of know-how through these networks and beyond, it is necessary to progress in the area of electronic health records. In fact, the Commission is planning to set up a network to promote cooperation in this field”.More often than not, European public opinion is alarmed by news on all sorts of epidemics -albeit the information is not always reliable -. Such is the case of the “mad cow disease”, “avian flu”, “Swine flu” (H1N1)… To what extent does the media exert its influence?“The H1N1 pandemics of 2009 highlighted the potential of a pandemics of influenza that could rapidly spread causing high death tolls and societal disruptions. It was also the occasion to identify the most appropriate communication system aimed at informing citizens on developments without causing serious alarm. Communication is of major importance during a sanitary crisis. For this, it’s vital to avoid transmitting catastrophist, unclear or contradictory messages. In 2001 the Commission created the Health Safety Committee, to ensure that homogeneous public health measures are adopted by the various health authorities, by the Commission, and by the competent Agencies. The Committee is tasked with providing citizens with efficient, accurate and coherent information and counsel”.Health protection is linked to consumer protection. Health risks can derive from food, fabric, wrong treatment and medication… What are the EU’s tools in this field?“A primary resource is the EU Pharmacovigilance system, that is called to provide useful information on pharmaceutical safety, thus promoting the adoption of opportune measures, whilst ensuring a positive risk-benefit ratio. Another tool is Rapex, another EU rapid alert system for all dangerous consumer products, except for drugs and food products, while Traces database tracks the movement of animals and certain types of products both within the EU and from outside the EU. Finally Rasff, Rapid Alert System for Food and Feed, that has been active for over 30 years”.