HEALTH AND CONSUMER PROTECTION STRATEGY
Letter from Rt Hon Rosie Winterton MP,
Minister of State for Health Services, Department of Health to
Thank you for your letter of 6 July 2006,
further to my Explanatory Memorandum (EM) of 21 June. I am writing
in response to the points raised in your letter and to update
you on progress in negotiations on this dossier.
The Finnish Presidency have held several discussions
in the Council's Public Health Working Group over the summer.
During the course of these, UK officials have agreed amendments:
emphasising the importance of measuring
the impact of work undertaken in relation to the programme
objectives and the need for effective monitoring at project level
(we do recognise, however, that some public health projects are
difficult to evaluate in the short to medium term);
highlighting the need for data on
socio-economic factors and the health impact of other policies,
within national constraints around availability; and
clarifying that any further proposals
for action arising from projects funded should respect the Council
Conclusions of June 2006, which emphasise that while EU health
systems share common values and principles, how these are implemented
in practice is for Member States to decide.
In terms of timing, the Finnish Presidency are
now keen to achieve political agreement on this dossier at the
Health Council on 30 November. To this end they have held several
trialogue discussions with the Commission and the European Parliament.
The Parliament have indicated that they are broadly content with
the revised proposal but would like:
a further programme objective on
major diseases. In practice they are likely to accept a compromise
stating that other objectives (eg on promoting health) should
contribute to the reduction of major disease. The Government is
content with this; and
a (very small) funding increase of
around 3 million per year. The Government's position will
depend on the source of additional funds. Although we have no
problem in principle with a small increase, funds must not be
taken from other, already agreed, programmes or lead to an increase
in overall EU budget ceilings agreed earlier this year.
I also enclose a copy of our Initial Regulatory
Impact Assessment, which reflects consultation with stakeholders.
I hope that this update is helpful, and gives
you the information you need to clear this proposal from Scrutiny.
17 October 2006
Amended proposal for a decision of the European
Parliament and of the Council establishing a second Programme
of Community action in the field of Health and consumer protection
(2007-13); Adaptation following the agreement of 17 May 2006 on
the Financial Framework 2007-13.
Council Document: 9905/06.
1. The Commission has set out three core
objectives for this programme:
Improve citizen's health security
including actions to:
protect citizens against health threats;
improve citizen's safety.
Promote health for prosperity and
solidarity including actions to:
foster healthy, active ageing and
help bridge health inequalities; and
promote healthier ways of life by
tackling health determinants.
Generate and disseminate health knowledge
including actions to:
exchange knowledge and best practice;
collect, analyse and disseminate
2. The Commission has published its amended
proposal for a Programme of Community Action in the field of Health
and consumer protection (2007-13), following agreement of the
overall EU budget for 2007-13 and amendments voted by the European
Parliament in March.
3. The Commission's original proposal combined
public health and consumer protection. However, following objections
from the European Parliament, the proposal has been split off
into two separate programmes (on public health and consumer policy).
4. The budget for the public health programme
is set at 365.6 million (compared to 1,203 million
originally proposed by the Commission for the joint programme).
Amounts available on an annual basis for operational expenditure
on the programme are slightly below the current public health
programme (approximately 47 million per year compared to
51 million in 2006).
5. The current health programme results
from Decision no 1786/2002/EC of the European Parliament and the
Council of 23 September 2002 adopting a programme of Community
action in the area of public health, and covers the period 2003-08.
6. The objectives of the current programme
provide health information;
respond to health threats; and
promote health by addressing health
Rationale for intervention
7. Article 152 of the Treaty states that
in order to promote the interests of the public and to ensure
a high level of human health protection, the Community will take
action to complement national policies towards improving public
health, preventing human illness and diseases, and obviating sources
of danger to human health. The Community shall encourage cooperation
between Member States (and where necessary lend support to Member
8. In its impact assessment, the Commission
lists key areas of need where the EU can add value by complementing
national action, facilitating exchange of expertise and best practice
and co-ordinating action where appropriate (for example on health
threats). These include:
health inequalities within and between
common challenges faced by Member
States, such as how to promote policies that will tackle the growing
burden of avoidable diseases;
the need to tackle global health
threats (such as SARS and avian influenza); and
the potential for helpful collaboration
between Member States on improving the quality and efficiency
of health services.
9. Evidence from the UK and the EU that
relates to the areas of need set out by the Commission is below:
In all EU countries with available data, rates
of premature mortality are higher among those with lower levels
of education, occupational class of income. These inequalities
in mortality lead to substantial inequalities in life expectancy
at birth (4-6 years among men, 2-4 years among women). In 2001,
the inequality in life expectancy at birth by occupation class
in England and Wales was 8.4 years among men and 4.5 years among
Exchange of best practice at EU level in this area and action
to reduce health inequalities is a key priority for the UK government.
Common challenges/avoidable diseases
1 in 5 children in EU Member States are overweight
with 400,000 children becoming overweight every year. Obesity
is directly linked to diseases including Diabetes. The EU wide
average prevalence of Diabetes if 7.5% and this figure is set
to increase to 8.9% by 2025.
Lifestyle related ill health also has a negative
effect on the economies of EU counties. In England, alcohol related
conditions cause a productivity loss of £6.4 billion/year.
National authorities in the EU-15 spend 135 billion every
year on cardiovascular diseases.
Member States can learn from each other in developing
actions to combat these common challenges. For example, the North
Karelia Project in eastern Finland was instrumental in reducing
the amount of deaths by CHD amongst middle aged men by 83% through
Global health threats
Clearly, infectious diseases do not respect
borders. Modelling work indicates that having built up over 2-4
weeks in a country of origin in Asia, it could taken as little
as 2-4 weeks for pandemic influenza to spread to the UK. On the
other hand effective surveillance (eg of which age groups are
most effected) and sharing of information in the early stages
of a pandemic could help countries respond more effectively once
a pandemic has spread to their borders. Enhancing the capacity
for collaboration across the EU, and with other international
partners, is therefore key.
Collaboration between Member States health services
EU Member States face common challenges in the
provision of health services. These include: demographic change
and ageing populations; avoidable diseases (see above); rising
costs and the need to ensure financial sustainability. In England,
the number of people over 65 years living with long-term condictions
is expected to double each decade. This poses a significant challenge
for the NHS.
Learning from other Member States can add real
value to national policies. For example, the Our health, our
care, our say White Paper which set out the government's strategy
to help people live more independently in their own homes, including
through having more local specialist care and developing community
health facilities, was informed by the best practice of other
European countries. (France carries out most follow-up outpatient
appointments in community settings and Germany has developed polyclinics
that provide specialist services locally).
The UK's position has been agreed with relevant
Government departments, and with the Devolved Administrations.
The Commission's impact assessment sets out
that the proposed programme is based on the results of a consultation
held by the Commission in July 2004, entitled "Enabling good
health for all, a reflection process for a new EU health strategy",
with contributions from national authorities (including the UK),
NGOs, universities, citizens and companies. It also used a range
of other forums to consult Member States and other stakeholders.
The Department of Helath also held a three month
public consultation on the original proposal and on possible revisions,
with responses from professional bodies/Royal Colleges as well
as other stakeholders including Local Government.
Overall, respondees were supportive of the public
health objectives of the programme. There was a range of opinions
on the right approach to prioritisation within a revised programme
with a reduced budget, from the view that all of the proposed
objectives in the original programme should be retained to the
view that work on health promotion, disease prevention and tackling
determinants is the key priority.
Respondees were supportive of collaboration
between health systems, while recognising that these differ significantly
between Member States. Other general points included the need
for effective targeting of health promotion/prevention activities
and to ensure that such activities were taken forward at the appropriate
level (eg nationally, regionally, locally). [The revised proposal
no longer contains a reference to EU wide awareness campaigns.]
Options for the revised programme are:
Do Nothingdo not negotiate,
the most likely outcome is that the actions are accepted without
Support all the actions in the revised
Support some of the actions/negotiate
for a revised package; or
Oppose all the proposed actions.
As outlined in our Explanatory Memorandum, the
Government supported the objectives and actions in the original
proposal, and particularly welcomed many of the Commission's revisions,
such as the increased focus on health inequalities. The Government
is therefore supporting all the actions in the revised proposal.
Actions under the Public Health programme
Proposed actions under each heading of the revised
proposal are summarised below.
Protect citizens' health security
This includes work around monitoring and response
to communicable and non-communicable health threats, including
avian and pandemic influenza, through support for effective planning,
surveillance, risk management and prevention as well as developing
the capacity for Member States to collaborate effectively in a
health emergency. It also includes some wider work on safety (including
Promote health to improve prosperity and solidarity
This includes action on health inequalities,
as well as to promote healthy ageing in the context of Europe's
demographic changes. The Commission is also keen to explore the
impact of health on the broader issues of productivity and labour
market participation under this heading. The work on tackling
the determinants of health and on disease prevention is included
here (including nutrition, physical activity and combating tobacco,
alcohol and drugs).
Generate and disseminate health knowledge
This includes exchange of best practice between
health systems and on other key issues, such as mental health.
It also includes work to build on EU health data and information
and to improve dissemination of information to/consultation with
EU citizens stakeholders and policy makers.
The actions proposed under this objective will
involve costs for the European commission, but will not impose
direct costs on business, the voluntary sector or consumers. Clearly,
some projects funded will seek to influence consumption patterns
(for example of tobacco, alcohol, junk food etc) for health reasons
which may in turn indirectly impact related businesses. However,
this is in line with our national policies as set out in the Choosing
Health White Paper.
UK based organisations are likely to benefit
from funding to lead work under the programme's objectives (the
current public health programme has resulted in funding for the
Health Protection Agency, University of Edinburgh and London School
of Economics among others). Many more UK based organisations will
benefit as partners collaborating in projects funded, gaining
the opportunity to build knowledge and share best practice with
others across the UE.
The Commission's impact assessment notes wider
potential benefits of these actions including:
The economic impact of improving
population health (according to a recent study, health improvement
represented 11% of the causes of growth over a 25 year period
in the EU 15)
National authorities better supported
to effectively monitor and respond to health threats, and to co-operate
across the EU in the event of a health emergency (such as an influenza
National health systems supported
to combat major diseases and to provide cost-efficient and effective
healthcare, through mutual collaboration and learning across countries;
A stronger voice base on the rationale
for public health interventions.
Reducing health inequalities is a key element
of the proposed programme.
Not applicable to this proposal.
Not applicable to this proposal.
The actions proposed by the Commission will
not have enforcement and sanctions effects. The revised proposal
sets out arrangements for monitoring, which have been strengthened
following input from the European Parliament. These include provision
for an external and independent evaluation mid-way through the
programme and following its completion.
Letter from the Chairman to Rt Hon Rosie
Thank you for your letter of 17 October and
the attached Initial Regulatory Impact Assessment. These were
considered by the Sub-Committee on 23 November.
We note that the changes made to the previous
version of the proposal, which were agreed in a Council Working
Group over the summer, are satisfactory to the UK and that the
revised proposals have general support from UK stakeholders.
We are therefore content to clear this document
23 November 2006
136 Correspondence with Ministers, 40th Report of Session
2006-07, HL Paper 187, pp 512-513. Back
Health Inequalities: Europe in profile, Prof Dr Johan P Mackenbach,
2006 (commissioned by the UK Presidency of the EU). Back
Diabetes-the Policy Puzzle: Towards Benchmarking in the EU 25,
Federation of European Nurse in Diabetes & International Diabetes
Federation European Region. Back
Internal Analytical report, The Cabinet Office, Prime Minister's
Strategy Unit, 2003. Back
Eurohealth volume 9, Spring 2003. Back
Successful prevention of non-communicable disease: 25 years experiences
with North Karelia Project in Finland, World Health Organisation,
Health's contribution to economic growth in an environment of
partially endogenous technical progress, Disease control priorities
project, Jamison, Lau and Wang, February 2004. Back