Twenty years ago EU health was born. Or rather the European Community, as it was then, took on a role or legal ‘’competence’’ in public health by the inclusion of an article in the inter-governmental Treaty just signed at the Maastricht summit of its heads of state. The European Union itself formally came into being on 1 November 1993. It is one measure of how its overall role has grown in those two decades that the new treaty article was first numbered 120, then 132, and is now 168. You will have your own view of whether that is a good thing or not, but the founding pioneers of EuroHealthNet thought at the time they ought to take it seriously and do something about it. I think they were far sighted to have that vision, and we still have work to do to realise it.
By Clive Needle
Lots of discussion had already gone on between people in European governments, the Commission and Parliament about what that first role might include. They consulted experts who had been behind some early programmes to look at cancers and other medical research, or environmental policies. Happily they also listened to those behind the WHO treaties, such as the Ottawa Charter setting out the basis for health for all and health promotion approaches. So through the 1990s a number of modest initial programmes were developed including health promotion, and that resulted in the birth of the European Network of Health Promotion Agencies (ENHPA).
That network, with EC support, first explored how states and experts, many of them already linked globally through the International Union for Health Promotion and Education (IUHPE), could develop some common tools like a glossary, and start to work on the core mission of improving health and tackling inequalities.
In November this year, a major European Public Health Conference will be held in Brussels to critically consider, celebrate or commemorate that first twenty years of the role taken by the European Union. EuroHealthNet, as the successor membership body to ENHPA, is a leading partner in the conference organising committee; the network and many of its members will actively participate in sessions.
As for health promotion, how has it fared?
On one measure, there is no longer a specific EU programme so there must be some concerns about how the cause and its professional iterations are valued within and beyond health systems. Still the proportion of specific expenditure remains woeful, inequalities persist or worsen. But taken as a whole, there are many exciting developments across the continent, where new approaches for improving health are lengthening lives and increasing quality, for which resources may be included in other budgets such as transport, environment or housing, for example. Many EU programmes, not only the integrated Health Action programme which now includes health and care service elements, include health improvement measures. The EU now has a major economic role in how many states set budgets for their care systems. New evidence on cost effectiveness of promotion and prevention measures is anticipated from WHO Europe, OECD and others soon which needs to be brought to bear in those decisions.
EuroHealthNet and IUHPE members have played a full part in the inevitable ebbs and flows of such gradual and at times frustrating progress. Now the time is right, in the wake of the worst global financial crisis since the EU began, to take health promotion forward another step. EuroHealthNet members have launched their development plan 2014 – 2020. This will include the establishment of Health Promotion Europe as a focal point for capacity building and ideas across the continent, bringing the best of traditional values and knowledge together with techniques for the modern era. We welcome new members who have a responsibility in this broad field, from local authorities to expert institutes to regional and state bodies and governing departments. If there is now no specific programme, we need to play a leadership role to support and implement what works.
That developmental network will be backed by a new research centre (CIRI) to help translate growing evidence of innovation and cost effectiveness in wellbeing into practice. That will be appropriately launched at the Brussels conference, with its public health research and study emphasis. Also showcased there will be our third pillar, a new Platform for Health and Social Equity (PHASE), bringing together all who advocate, influence and work for health in all EU policies in a way not yet achieved by the EU mechanisms – we need to show more clearly what works.
The need for such initiatives has not diminished after twenty years of hard work in Brussels and around the continent. In fact, as the numbers of young people out of work or training has soared, distinguished experts anticipate that crisis causing ‘’a public health emergency’’ based on hard evidence of health determinants. Much of the work of health promoting practitioners is done quietly behind the scenes, in systems, communities, settings, institutions, processes, often in adversity with too few resources. The aim of working with the EU remains to use the levers of real power and resources across all its policies and instruments for the good of all, whether it is described as health, wellbeing, inclusion, cohesion, environment, education, whatever.
Another important anniversary falls in 2013.
The world has just commemorated the 50th anniversary of the famous Washington speech by Martin Luther King in which his refrain ‘’I have a dream’’ rang round the world and hugely influenced change. It is not impertinent but essential to have a renewed vision that in a further twenty years the aims of the founders of EuroHealthNet, encouraged by the architects of the EU health role, will be realised that all European citizens and their children should have fair health outcomes as defined by the WHO Charter as ‘’not merely the absence of disease but a complete state of mental, physical and social wellbeing.’’ That really is something worth working for together, and that is what the renewed EuroHealthNet will do.
Clive Needle
Clive advises the EuroHealthNet Executive Board and managing director on policies relating to health for all EU activities and actions on social, economic and environmental determinants of equity and wellbeing. He was formerly overall EuroHealthNet director for thirteen years and continues to work in support of WHO and other international organisations and projects in Europe.