Public health

T H E E U R O P E A N
U N I O N
E X P L A I N E D
The EU wor ks t o pr ot ect
and i mpr ove t he heal t h
of al l Eur opeans t hr oughout
t hei r l i ves
Improving
health for all
EU citizens
CONTENTS
Why we need
a public health policy . . . . . . . . . . . . . 3
How the EU goes about it. . . . . . . . . . 5
What the EU does . . . . . . . . . . . . . . . . 6
Outlook . . . . . . . . . . . . . . . . . . . . . . . . 15
Find out more. . . . . . . . . . . . . . . . . . . 16
The EU explained: Public health
European Commission
Directorate-General for Communication
Publications
1049 Brussels
BELGIUM
Manuscript completed in February 2014
Cover and page 2 picture: BananaStock/Jupiterimages
16 pp. 21 29.7 cm
ISBN 978-92-79-35689-6
doi:10.2775/15123
Luxembourg: Publications Office of the European Union,
2014
European Union, 2014
Reproduction is authorised. For any use or reproduction
of individual photos, permission must be sought directly
from the copyright holders.
This publication is a part of a series that explains
what the EU does in dierent policy areas,
why the EU is involved and what the results are.
You can see online which ones are available
and download them at:
http://europa.eu/pol/index_en.htm
THE EUROPEAN UNION
EXPLAINED
How the EU works
Europe 2020: Europes growth strategy
The founding fathers of the EU
Agriculture
Borders and security
Budget
Climate action
Competition
Consumers
Culture and audiovisual
Customs
Development and cooperation
Digital agenda
Economic and monetary union and the euro
Education, training, youth and sport
Employment and social aairs
Energy
Enlargement
Enterprise
Environment
Fight against fraud
Fisheries and maritime aairs
Food safety
Foreign aairs and security policy
Humanitarian aid and civil protection
Internal market
Justice, citizenship, fundamental rights
Migration and asylum
Public health
Regional policy
Research and innovation
Taxation
Trade
Transport
3
P U B L I C H E A L T H
Citizens health is a core EU priority. EU health policy
complements national policies to ensure that everyone
living in the EU has access to quality healthcare.
The main objectives of EU health policy are to:
prevent disease,
promote healthier lifestyles,
promote well-being,
protect people from serious cross-border threats to
health,
improve access to healthcare,
promote health information and education,
improve patient safety,
support dynamic health systems and new
technologies,
set high quality and safety standards for organs and
other substances of human origin,
ensure high quality, safety and efficacy for medicinal
products and devices for medical use.
While the organisation and delivery of healthcare is the
responsibility of individual countries, the EU brings
added value in helping countries achieve common
objectives. EU health policy generates economies of
scale by pooling resources, and helps countries to tackle
the common challenges, including health threats such
as pandemics, the risk factors associated with chronic
diseases or the impact of increased life expectancy on
healthcare systems.
Key challenges
To achieve a high level of human health and quality of
healthcare across the EU, a significant number of
challenges must be overcome, including those listed
below.
Sustainability: Healthcare systems must adapt to
demographic changes and a growing demand for
care, and make the best use of innovative health
technologies. Health system reforms must guarantee
universal access to high-quality care and improve the
efficiency and financial sustainability of the health
systems.
An ageing population: EU citizens are living longer
often well beyond the retirement age but the
average age to which they enjoy good health remains
the same. This places pressure on society and the
economy, as well as healthcare systems. The
incidence of certain diseases, for example Alzheimers
and dementia, is also increasing as the population
gets older. The EU seeks to increase the number of
healthy life years by two by 2020 to help Europeans
remain active and productive for as long as possible.
Reducing the incidence of preventable diseases:
Cancer, heart disease, diabetes, respiratory, mental
and other chronic diseases represent great suffering
to citizens and come at a huge cost to society and the
economy. It is estimated that they will cost the global
economy around 22.5 trillion between 2012 and
2030. In the EU, the cost of diseases linked to
smoking alone totals over 100 billion. Chronic
diseases are responsible for 87 % of all deaths in the
EU. Many cases of chronic diseases are preventable
and linked to four common risk factors tobacco,
harmful use of alcohol, nutrition and lack of physical
activity.
Why we need a public health policy

S
h
u
t
t
e
r
s
t
o
c
k
,

I
n
c
.
/
A
l
e
x
a
n
d
e
r

R
a
t
h
s
The EU seeks to improve the quality of healthcare for
all its citizens.
T H E E U R O P E A N U N I O N E X P L A I N E D
4
Health inequalities: Huge differences in health and
healthcare exist between and within EU countries and
regions. The level of disease and the age at which
people die are strongly influenced by factors such as
employment, income, education and ethnicity, as well
as access to healthcare. For example, life expectancy
at birth varies by 10 years between EU countries.
New and emerging health problems: New diseases,
or strains of diseases, are being identified all the
time. AIDS, for example, was first clinically observed
in 1981, the corresponding virus, HIV, was identified
in 1983; in 2009, a new type of pandemic influenza
H1N1 was identified. Some bacteria have
become resistant to the drugs used to treat them.
This has made it harder to treat specific infections
with certain antibiotics. Mental health problems are
another disease group where the number of
diagnoses has increased significantly.
Health security: serious cross-border health threats
including biological agents and infectious disease,
chemical agents and environmental hazards pose
a great threat to health and international travel and
trade. The 2011 E. coli outbreak and the 2009 global
H1N1 flu pandemic are recent examples that
demonstrate the importance of being able to tackle
health threats at a multinational level.
EU health trends
Good news
Increased life expectancy: on average, life
expectancy in the EU increased from 65 years
in the 1950s, to 80 years by 2010.
Drop in infant mortality: there was a
cumulative reduction in infant mortality of over
80 % between 1975 and 2010.
Better treatment of life-threatening
conditions such as heart attacks, strokes and
cancer: mortality rates following hospital
admission for a heart attack fell by 50 %
between 2000 and 2009.
Increase in the survival rates for different
types of cancer, including colorectal and
breast, thanks to earlier detection and better
treatment.
Increase in the number of doctors per capita:
from 2.9 per 1 000 population in 2000 to 3.4 in
2010.
Bad news:
Inequality: life expectancy still varies by around
9 years between EU countries.
Increase in cancer deaths: since 1985, EU
cancer deaths have increased by 12 % for men
and by 9 % for women.
Increase in diabetes: according to the
International Diabetes Federation, 35 million
adults were living with diabetes (both type 1
and type 2) in Europe in 2011. This is expected
to increase by 23 %, to 43 million, in 2030.
Increase in Alzheimers cases: the likelihood of
developing dementia in people aged 65+
roughly doubles every 5 years in Europe.
The EUs healthcare bill for chronic disease:
700 billion, or 7080 % of healthcare costs.
Sources: Eurostat and Organisation for Economic Cooperation
and Development.
5
P U B L I C H E A L T H
The scope for EU action in health policy is set in Article
168 of the Treaty on the Functioning of the European
Union. The overriding principle is that human health is
well protected and accounted for in the development of
all EU policies and activities.
The Treaty also makes clear that the EU shall fully
respect the responsibility of individual Member States
to define their health policies and organise and deliver
their health services and medical care, including any
resources assigned to them.
The EU mostly complements and supports the work that
goes on in individual EU countries on issues where
coordination, cooperation and exchange of information,
knowledge and best practice is the best way forward. It
also uses legislative instruments to regulate certain
areas.
In 2007, the EU adopted its Health strategy.
It is based on four key principles:
Europeans have shared health values;
health is the greatest wealth;
considerations about health must be included in all
policies;
the EUs voice must be heard on all issues affecting
global health;
It identified three key objectives:
fostering good health in an ageing Europe;
protecting citizens from health threats;
supporting dynamic health systems and new
technologies.
These principles and objectives support the goals of the
Europe 2020 strategy for smart and sustainable
growth: targeted investment in health boosts
productivity and innovation, creates new skills, helps
reduce inequalities and contributes to more sustainable
health systems.
In February 2013, the European Commission adopted a
package entitled Social investments for growth and
cohesion. One part of this package is dedicated to
investments in health. The main message is that health
is a value in itself, and also a key to economic
prosperity. The document emphasises that smart
investments for sustainable health systems, investing in
peoples health as human capital, and investing in
reducing inequalities in health can contribute to
economic growth. The EU will support reforms through
the European semester process and through its funding
instruments, i.e. Structural Funds and health
programme.
EU financial support
The EUs current health programme runs from 2008 to
2013 (a third multiannual EU health programme will
begin in 2014 and run to 2020). Its objectives are: to
improve citizens health security, to promote health and
to generate and disseminate health information and
knowledge. All 28 EU countries plus Iceland,
Liechtenstein and Norway participate in the programme.
The total budget of the 200813 programme is 321.5
million, which so far has been used to fund more than
120 different actions.
Since 2003, the EU health programme has provided
funding for a total of 673 individual projects and
operating grants, supporting a range of initiatives.
Other sources of EU financial support, e.g. Structural
Funds and the research framework programmes, also
contribute to health priorities.
How the EU goes about it
T H E E U R O P E A N U N I O N E X P L A I N E D
6
Access to healthcare in all EU countries
If you fall ill unexpectedly during a trip to another EU
country and need to visit a doctor, theres no need to
cut short your visit to return home for treatment. Take
your European Health Insurance Card with you to a local
doctor.
The European Health Insurance Card makes it easier
for you to claim this right to healthcare in other EU
countries and Iceland, Liechtenstein, Norway and
Switzerland. It is issued free of charge by your national
health insurance provider and gives you access to
unplanned medically necessary, state-provided
healthcare during a temporary stay in any of the
partner countries. The card can either feature on the
reverse of a national health card or be entirely
separate.
Separate legislation on cross-border healthcare gives
you:
access to information on your right to receive
healthcare anywhere in the EU, and on the quality
and safety of the care you will receive;
the right to be reimbursed some or all costs for any
treatment you receive in another EU country to which
you would have been entitled at home;
the possibility to process your prescriptions abroad so
that you can obtain abroad the medication you need.
Did you know?
20 million Europeans received medical treatment in
another EU country in 2010.

Fighting serious cross-border threats to
health
As the world becomes increasingly interconnected,
biological, chemical or environmental health threats
pose a greater risk than ever to health and international
travel and trade. Various cross-border health
emergencies, including the 2009 H1N1 pandemic, the
volcanic ash cloud in 2010 and the E. coli outbreak in
2011, have highlighted the importance of a coordinated
EU response.
EU action is largely linked to improving cooperation and
coordination between national governments. This is
achieved through:
EU alert systems: If an EU country detects a threat
to citizens health and safety, it notifies the European
Commission through one of the EUs rapid alert
systems. These ensure that information is transmitted
EU-wide, quickly and that there is a rapid response.
The Early Warning and Response System (EWRS) and
the Rapid Alert System for Food and Feed (RASFF), for
example, were triggered in 2011 in response to the
E. coli outbreak in Germany and the Fukushima
nuclear disaster in Japan.
EU Health Security Committee (HSC): This
committee coordinates health security measures,
preparation and planning and the response to an
emergency. It is made up of representatives from all
EU countries.
European Centre for Disease Prevention and
Control (ECDC): The centre aims to strengthen the
EUs defences against infectious diseases such as
influenza, tuberculosis and HIV/AIDS. It works with
national health authorities across the EU to identify,
assess and communicate current and emerging
health threats.
The European Health Insurance Card gives you access to
medical treatment and care across Europe.
What the EU does

D
i
e
g
o

G

m
e
z
/
e
p
a
/
C
o
r
b
i
s
7
P U B L I C H E A L T H
EU-wide research networks: Specific projects linked
to serious cross-border threats to health have also
been awarded EU funding. These include an Alerting
System for Chemical Health Threats (ASHT II) which

The European Commission held daily meetings with

national public health and food safety authorities to
monitor the outbreak and coordinate responses, and
posted daily updates on its website to keep citizens
informed.

Having identified the source of the outbreak

fenugreek seeds used for sprouting imported
from Egypt the EU ordered the destruction of all
fenugreek seeds imported from one exporter and a
temporary ban on imports of other risky products.

The EU started work with national authorities, the

European Food Safety Authority (EFSA) and the
European Centre for Disease Prevention and Control
(ECDC) to identify areas for further cooperation,
improvement and preventative action.


What happens in an EU health crisis?
The case of E. coli
Between May and July 2011, an outbreak of illness
caused by a harmful strain of E. coli a common
and normally non-harmful bacterium found in the
digestive systems of humans and animals
left 55 people dead, 850 seriously ill and a further
3 000 unwell in the EU. This is how the EU
responded.

German authorities notified the European

Commission of the outbreak.

EU-wide alert systems and response networks were

activated.

Scientists quickly identified the strain of E. coli

responsible for the outbreak.
The E. coli bacterium: an
outbreak in 2011 triggered
the EUs Rapid Alert System
which helped authorities in
other EU countries to combat
the risk efficiently.

S
h
u
t
t
e
r
s
t
o
c
k
,

I
n
c
.
/
T
o
m
a
s
z

N
i
e
w
e
g
l
o
w
s
k
i
has brought together poison centres in different EU
countries to improve the response to potential
cross-border chemical threats to health.
T H E E U R O P E A N U N I O N E X P L A I N E D
8
Protecting you from resistant bacteria
Antimicrobial agents such as antibiotics are
substances that kill or reduce the growth of micro-
organisms including bacteria, fungi and parasites. They
are an essential tool in modern medicine and have
dramatically reduced the number of deaths from
infectious diseases since they were introduced 70 years
ago. These drugs have been used so widely and
inappropriately, however, that some of the organisms
they target have become resistant to them. It is
estimated that this resistance results in 25 000 deaths
per year and 1.5 billion in additional healthcare costs
and productivity loss.
Since this problem was first recognised in the 1990s,
the EUs health programme has supported various
projects and research into antimicrobial resistance
(AMR). For example, a study launched in 2009 focused
on antimicrobial resistance and the prescription of
antibiotics in children. The EU also monitors AMR on an
ongoing basis with the support of the ECDC and EFSA.
In 2011, the European Commission launched an action
plan to help tackle the rising threats from antimicrobial
resistance. It identifies seven areas for future action:
the appropriate use of antimicrobials in humans and
animals;
prevention of microbial infections and their spread;
development of new, effective antimicrobials or
alternatives for treatment;
international cooperation to contain the risks of
resistance;
better monitoring and surveillance of antimicrobial
use;
research and innovation;
better communication, education and training.
Did you know?
Around 40 % of Europeans used antibiotics in
2009.
One in two patients wrongly believes that
antibiotics are effective against viruses.
Every year, about 4.1 million people in the EU
acquire an infection whilst receiving healthcare,
often caused by resistant bacteria.

Strengthening the quality, safety and
efficacy of medicines
The EU has clear rules in place for the authorisation and
distribution of medicinal products. Before medicines can
be sold, they must either be authorised by the individual
EU Member State or be available for sale throughout
the EU. The latter is ensured by the European Medicines
Agency, based in London, and the European
Commission. This ensures patients are treated with
medicines that are in compliance with strict standards
on quality, safety and efficacy. These rules contributed
to ensuring a high level of patient safety while giving
them access to medicines of their choice, including
innovative medicinal products, and products for rare
conditions (orphan medicinal products) and for
paediatric use.
EU rules ensure that patients are treated with medicines that
comply with strict standards on quality, safety and efficacy.

S
h
u
t
t
e
r
s
t
o
c
k
,

I
n
c
.
/
p
h
l
o
x
i
i
9
P U B L I C H E A L T H
Once a medicinal product has been authorised in the
Union and placed on the market, its safety is monitored
during its entire lifespan to ensure that in case of
adverse reactions the appropriate action is taken
swiftly, including additional warnings, restrictions of use
or even withdrawal of the product. In order to further
improve this control, the EU introduced a new symbol in
the form of a black inverted triangle to identify
medicines for which additional monitoring is considered
necessary. As of September 2013, the new symbol will
be printed on the package leaflet and the summary of
product characteristics of the medicines concerned,
along with information on how to report suspected side
effects. This is particularly important as patients now
have the right to report suspected side effects directly
to their national authorities.
A cornerstone of the legislation is the supervision of all
steps in the medicines distribution system, from
manufacturing to distribution including specific rules for
the sale of medicines over the Internet.
To protect patients from the risks associated with
unauthorised fake or falsified medicines, the EU has
introduced strict rules which became applicable at the
beginning of 2013. These include:
rules for imports of active substances from third
countries, controls and inspections;
rules for record-keeping by wholesale distributors;
rules on inspections; and
the obligation for manufacturers and distributors to
report any suspicion of falsified medicines.
The sale of falsified medicines over the Internet is also
addressed. By the end of 2013 the EU plans to define a
common logo that will help to identify legally operating
online pharmacies/retailers of medicines. This logo will
become obligatory by the end of 2014.
Ensuring the safety and quality of
donated blood, tissue, cells and organs
Donated blood, tissues, cells and organs are essential in
the treatment of a number of serious and life-
threatening medical conditions including cancer and
heart problems. In 2011 alone, there were 30 000
organ transplants in the EU, many of them carried out
in a different EU country to the organs origin.
To guarantee quality and patient safety, the EU has
developed common rules and procedures that apply
across the EU to ensure that all donated human
material is of high quality and carefully screened to
prevent the transmission of disease, for example HIV or
hepatitis. This ensures that patients in all EU countries
have the same high level of protection and guarantees
cooperation between countries in case of shortages.
There are also strict EU rules regarding the donation,
procurement and traceability procedures of donated
human substances. Donation must be voluntary and
unpaid and donated organs must be traceable. EU rules
also require national authorities to exchange and store
information on cross-border organ exchanges and to
provide a 24/7 service in case of serious or adverse
reactions or events.
As more people turn to the Internet to buy medicine, the EU is
helping to identify online pharmacies operating within the law.

S
h
u
t
t
e
r
s
t
o
c
k
,

I
n
c
.
/
K
i
n
e
t
i
c

I
m
a
g
e
r
y
T H E E U R O P E A N U N I O N E X P L A I N E D
10
As demand for these treatments increases, the EU is
taking steps to encourage voluntary organ donation.
Around half of the EU Member States report regular
shortages and there are currently around 50 000
patients in the EU on an organ transplant waiting list,
12 of whom will die, each day, while waiting for an
organ. An important element of the EUs action plan on
organ donation and transplantation is the appointment
of hospital transplant donor coordinators to develop
proactive donor detection programmes. Studies have
shown this is one effective way of facilitating the organ
donation process.
The EU also funds projects linked to blood, cell, tissue
and organ donation. Recent examples include the
setting-up of Efretos, a new pan-European registry of
the evaluation of organ transplants.
Did you know?
37 % of the Europeans participating in a
Eurobarometer survey of 2010 had given blood at
least once in their life.

Tackling rare diseases
Rare diseases are life-threatening or chronically
debilitating diseases which affect fewer than 1 in
2 000 people. While the number of people suffering
from an individual disease may be small, overall,
between 27 million and 36 million Europeans suffer
from a rare disease. The impact of such diseases on
sufferers, their families and carers is substantial and
patients often go undiagnosed due to a lack of scientific
and medical knowledge or to difficult access to medical
expertise.
The EU supports research into rare diseases to help
improve rates of diagnosis. It also offers a number of
incentives to pharmaceutical companies (10-year
market exclusivity, for example) to encourage research,
development and marketing of new orphan drugs
which could be used to diagnose, prevent or treat rare
diseases. Without such incentives, the costs of
developing these drugs would not be covered by sales.
The EU also supports the distribution of information on
rare diseases, including through Orphanet a database
of rare diseases and the alliance of patients
organisations, Eurordis, (European Organisation for Rare
Diseases) which brings together over 350 rare disease
organisations from across the EU.
Did you know?
The Orphanet database defines 5 958 rare
diseases;
Between 6 and 8 % (2736 million citizens) of
the (EU-27) population in all the EU countries
are, or will be, affected by a rare disease during
their lifetime.

Tackling the risk factors of chronic
disease
The onset and development of many chronic diseases
are influenced by common risk factors such as smoking,
harmful alcohol consumption, an unhealthy diet and a
lack of exercise. They can often be prevented by making
certain lifestyle changes. The EU is tackling this problem
from multiple angles, for example via public information
campaigns, encouraging action by relevant industries
and NGOs, supporting individual country initiatives and
through specific, targeted support, for example to help
people give up smoking.
Helping to reduce tobacco smoking
Smoking is the single largest cause of avoidable death
in the EU and accounts for around 700 000 deaths each
year. Despite this, one third of EU citizens smoke
regularly.
Over the years, the EU has adopted various rules to
help reduce the number of smokers in the EU and the
costs associated with smoking. They include compulsory
warning labels on all tobacco products about what
tobacco smoking does to peoples health: for example
Smoking kills, Smoking causes fatal lung cancer,
Smoking causes heart attacks and strokes and
Smoking when pregnant harms your baby.
Towards a smoke-free life.
11
P U B L I C H E A L T H
The EU also promotes the use of graphic images and
photographs on cigarette packages to reinforce the
message that smoking can seriously damage your
health.
In addition, EU law prohibits tobacco advertising in all
print media, radio and Internet in the EU. Tobacco
sponsorship at international events and sports activities
is also banned.
In 2005, the EU launched HELP for a life without
tobacco, a multimedia campaign targeted at 15- to
25-year-olds to raise awareness about the risks
associated with smoking. The campaign was screened
on almost 100 TV channels.
In 2011, the EUs Ex-smokers are unstoppable
campaign was launched to promote the benefits of
giving up smoking. FC Barcelona and the European
Commission designed a free quit smoking programme
that guides smokers step-by-step towards a
smoke-free life.
At the centre of the campaign is iCoach, an innovative
digital health platform. iCoach supports and motivates
users to quit smoking and charts their progress through
a personalised programme. Users have access to an
extensive support network via social media sites such
as Facebook and Twitter.
By the end of 2012, almost 300 000 EU citizens had
signed up to iCoach. The campaign also received the
EURO EFFIE awards in 2012 for excellence in marketing
communication.
Fighting obesity
It is estimated that over 200 million adults are
overweight or obese in the EU over half the adult
population. One in four children are also overweight or
obese. Obesity leads to serious physical and mental
health problems including heart disease, diabetes,
cancer and psychological disorders. It accounts for up to
8 % of the EUs healthcare costs. Since obesity is a
complex problem, it is vital to pool a wide range of
expertise at local, national and international level.
Coordination at EU level is essential.
The EU Platform for Action on Diet, Physical Activity
and Health, set up in 2005, brings together a wide
range of European organisations committed to tackling
poor nutrition and physical inactivity. To date, it has
triggered 300 actions by key EU actors in industry and
civil society, including a voluntary restriction of the
marketing of soft drinks to children under 12 years old,
better nutritional information in restaurants, the
redesign of recipes to lower salt, sugar and fat levels,
and the promotion of sport in schools.
In 2007, the EU established a High-Level Group on
Nutrition and Physical Activity, which has brought
together government representatives from all EU
countries, Norway and Switzerland to work towards
solutions for obesity-related health issues.
Other efforts include the introduction of EU-wide rules
for food labelling. These mean that consumers in all
EU countries can rely on food labels to give them
accurate information on health and nutritional values.
For example, if a food claims to be good for your heart,
this must have been scientifically proven. Nutrition
labels must also include clear details on the level of
energy, fat, saturates, carbohydrates, salt and sugar.
Finally, a number of projects are supported by the EUs
health programme and the research framework
programme to reduce and prevent obesity. Between
2007 and 2011, the EU helped to fund 27 projects
related to diabetes and obesity at a total cost of 123
million.
The EU is working with organisations across Europe to tackle
the problems associated with poor diet and obesity.

S
h
u
t
t
e
r
s
t
o
c
k
,

I
n
c
.
/
G
a
n
g

L
i
u
T H E E U R O P E A N U N I O N E X P L A I N E D
12
Reducing the harm caused by alcohol
Harmful alcohol consumption is the third main cause of
early death and illness in the EU, after tobacco and high
blood pressure. It is responsible for an estimated
195 000 deaths each year in the EU.
The EU works with national authorities (which are
primarily responsible for national policies on alcohol),
industry and other relevant parties to address harmful
drinking and irresponsible marketing of alcoholic drinks.
Since 2006, the EU has promoted responsible drinking
through the European strategy to reduce alcohol-
related harm. The strategy has five priorities:
protecting young people and children,
preventing drink-driving,
reducing alcohol-related harm amongst adults,
raising awareness of the impact of harmful and
hazardous alcohol consumption on health,
collecting reliable data on alcohol consumption and
the impact of policy measures.
It also encourages cooperation and coordination
between EU countries to promote education and
consumer information. The strategy includes actions
across EU policies. For example, the EUs action
plan on road safety supports initiatives to tackle
drink-driving.
In 2007, the EU set up an Alcohol and Health Forum,
which aims to mobilise actors across society to commit
to take action in support of the EU strategy. It includes
key stakeholders such as alcohol producers, advertisers
and retailers, as well as health professionals, youth
representatives and health NGOs. To date, the forum
has generated 246 commitments by these members. In
parallel, there is a Committee on National Alcohol Policy
and Action, which enables EU countries to share
information and promote best practice.
Tackling cancer
Cancer is a key health concern and puts a major burden
on society. Around 2.5 million people are diagnosed with
cancer in the EU each year. By working together with
national authorities, the EU is able to share knowledge,
capacity and expertise and tackle cancer in Europe more
effectively.
The EUs policies include:
Helping to prevent cancer by addressing its risk
factors, in particular tobacco smoking.
Partnership: The European Partnership for Action
Against Cancer (EPAAC) was launched in 2009 and
brings together key players from across Europe. It has
received over 3 million of EU funding and has a wide
range of goals including health promotion, screening
and early diagnosis, identification of best practice in
cancer-related healthcare, and collection and analysis
of cancer data. Its aim is to reduce the incidence of
cancer by 15 % by 2020.
Screening: EU health ministers agreed on the
principles of best practice for cancer screening and
early cancer detection in 2003. Since then, the EU has
also published guidelines on breast, cervical and
colorectal cancer screening.
Regular screening for cancer
is just one of the ways in
which this disease can be
tackled more effectively.

S
h
u
t
t
e
r
s
t
o
c
k
,

I
n
c
.
/
M
o
n
k
e
y

B
u
s
i
n
e
s
s

I
m
a
g
e
s
13
P U B L I C H E A L T H
Research: EU funding for cancer research since 2003
amounts to over 1.1 billion, contributing to 183
projects.
The European Code Against Cancer: This is a list of
recommendations, based on scientific evidence, which
advises citizens on how to prevent cancer. It was first
produced in 1987 and is currently being updated: a
new version will be available at the end 2014.
Preventing AIDS and supporting those
living with it
Over 50 000 people in the EU and its neighbouring
countries are diagnosed with HIV/AIDS each year. While
current treatments can slow down the development of
AIDS and allow sufferers to live long and fulfilling lives,
there is still no cure or vaccine.
The EUs policy, as set out in its 2009 communication
Combating HIV/AIDS in the EU and neighbouring
countries, focuses on disease prevention and support
for people living with HIV by improving access to
prevention, treatment, care and social services.
Particular efforts are aimed at high-risk groups and
migrants from countries with a high prevalence of HIV.
In order to understand, improve and share data and
evidence on HIV/AIDS, the EU works closely with the
ECDC.
The EU has also funded projects on HIV/AIDS through
the health programme and the research framework
programme. The EU funded 900 000, for example,
towards the Correlation II project. This project provides
help and information to sex workers, people who use
drugs and migrants without papers who need access to
health services that offer treatment for blood infections,
particularly hepatitis C and HIV.
Promoting healthy and active ageing
Europeans are living longer, but the number of years
they live in good health remains unchanged. On
average, EU citizens spend 20 % of their lives in poor
health which affects their quality of life and places
significant pressures on national healthcare systems.
In 2011, the EU launched the European Innovation
Partnership on Active and Healthy Ageing. It brings
together researchers, health authorities, health
professionals, businesses, regulators and patient
organisations to examine new ways of reducing the
pressure on healthcare and contributing to sustainable
growth. The overall goal of the partnership is to
increase healthy life by 2 years by 2020, enabling more
people to enjoy life for longer.
Other EU initiatives include:
The European initiative on Alzheimers disease and
other dementias (2009), which provides EU support
for national efforts in four key areas: prevention of
dementia, early diagnosis, better coordination of
research efforts across Europe, and ethical questions
linked to the rights, autonomy and dignity of people
with dementia.
This initiative was implemented through the Alcove
joint action, which brought together 19 EU countries
to exchange good practices and formulate policy
recommendations; and through the joint programme
Neurodegenerative disorders, the largest global
research initiative aimed at tackling the challenge of
such diseases.

S
h
u
t
t
e
r
s
t
o
c
k
,

I
n
c
.
/
N
i
x
x

P
h
o
t
o
g
r
a
p
h
y
The EU is working to prevent
HIV/AIDS and improve
treatment for sufferers.
T H E E U R O P E A N U N I O N E X P L A I N E D
14
Increasing access to health information
Increasing access to information is a vital part of the
EUs efforts to promote good health and tackle health
inequalities.
The Public health website of the European Commission
highlights the work of the European Commission in the
area of public health. On this website you can find press
material, legal documents, videos, information on
events, statistics and news on health in Europe.
The EU also holds an annual EU Health Prize for
Journalists, to reward high-quality journalism on issues
linked to healthcare and patients rights. (See the Find
out more section on page 16 for links to the above
mentioned websites.)
Research and health expertise
The EU coordinates and supports European research in
a number of areas. Health is one of them. Since 2007,
the EU has spent 6 billion on health research, with an
emphasis on:
translating basic discoveries into clinical applications;
developing and validating new therapies;
health promotion and prevention strategies;
better diagnostic tools and medical technologies;
sustainable and efficient healthcare systems.
European reference networks have also been introduced
for a wide range of health issues from air pollution to
maternal health. They help national authorities and
health professionals to exchange best practice and
expertise. EU funding for recent projects linked to this
has included initiatives to support electronic health
records and a European health and life expectancy
information system.
The European Pact for Mental Health and Well-
Being (2008). Mental disorders have become one of
the most prevalent disease groups in the EU. Mental
disorders are a leading cause of work absence,
disability and early retirement and are often
associated with stigmatisation and social exclusion.
The pact provides an EU-wide framework for EU
countries, non-governmental organisations and
stakeholders to exchange information on the
challenges linked to mental health. Best practices are
collected in the online database European compass
for action on mental health and well-being.
Assessing scientific risks
The European Commissions scientific committees
provide high-quality, independent scientific advice on
consumer safety, health and environmental risks and
emerging and newly identified health risks. In 2012, the
scientific committees assessed 45 health issues
including silicone breast implants, security scanners for
passenger screening, cadmium in fertilisers and
cosmetic ingredients such as hair dye chemicals.
The work of the EFSA and the WHO also feeds into the
EUs scientific risk assessment.

S
h
u
t
t
e
r
s
t
o
c
k
,

I
n
c
.
/
A
l
e
x
a
n
d
e
r

R
a
t
h
s
As Europeans live longer, the problems associated with
dementia are increasing.
15
P U B L I C H E A L T H
Securing health for future generations
The EUs efforts will consolidate existing activities in the
field of health and healthcare with a particular focus on
improving the sustainability of healthcare systems.
Multiannual programme of action for
health 201420
At the end of 2011, the European Commission proposed
a public health programme for 201420. It emphasises
the role of good health in promoting productivity at
work, economic competitiveness and living a better
quality of life for longer. The EUs work will complement
and support national efforts in four key areas:
health promotion and disease prevention;
protecting citizens from cross-border health threats;
innovative and sustainable health systems;
better and safer healthcare for citizens.
The budget proposed by the European Commission is
446 million. It is expected to enter into force on
1 January 2014.
Increasing the use of e-health and
telemedicine
E-health using digital technology to improve access
to care, quality of care and make the healthcare sector
more efficient will become an increasingly essential
element of EU health policy in the future. Examples of
EU efforts in this area include the establishment of a
voluntary e-health network in 2011 to promote the use
of electronic health systems and new, innovative
solutions for healthcare.
E-health allows:
the possibility to be treated and monitored remotely;
doctors and patients to access electronic medical
records;
data, e.g. test results or prescriptions, to be delivered
rapidly;
better coordination of cross-border treatment;
better collaboration between health service providers;
patients to take more control of their own care.
Future objectives for e-health include the creation of a
comprehensive and standardised electronic health
records system, and new health information networks
to link points of care. Another aim is to coordinate
reactions to health threats, and the further
development of teleconsultation, e-prescribing,
e-referral and e-reimbursement capabilities.
Tighter rules for medical devices
There are around 500 000 different medical devices
on the EU market ranging from a simple, everyday
plaster, to replacement joints and kidney dialysis
machines. They include any instrument, apparatus,
implant or similar device used in the diagnosis,
treatment, cure or prevention of disease or other
conditions. In vitro medical devices include diagnostic
tests, such as home pregnancy tests or blood tests for
cholesterol and HIV.
In September 2012, the EU proposed new rules to
boost safety, efficiency and innovation in the medical
device sector. They are designed to improve traceability
and coordination between national surveillance
authorities, give clear rights and responsibilities to
manufacturers, importers and distributors, set stricter
requirements for clinical evidence and support a
comprehensive, public database on medical devices
available on the EU market. The new requirements are
expected to come into force in 2015.
Strengthening health security
In recent years, the EU has been challenged by a
number of pan-European health threats including the
flu pandemic in 2009, the volcanic ash cloud in 2010
and the outbreak of E. coli in 2011. It has learned
important lessons from these events which are
reflected in its proposals for new rules to protect EU
citizens from a wide range of serious cross-border
health threats, e.g. flu, food and waterborne diseases
such as salmonellosis, chemical incidents or the result
of extreme weather conditions.
Outlook
T H E E U R O P E A N U N I O N E X P L A I N E D
16

N
A
-
0
2
-
1
4
-
1
2
5
-
E
N
-
C
Find out more
ISBN 978-92-79-35689-6
doi:10.2775/15123
X Public health: http://ec.europa.eu/health/index_en.htm
X The European Commissions Directorate-General for Health and Consumers:
http://ec.europa.eu/dgs/health_consumer/index_en.htm
X Ex-smokers are Unstoppable: celebrating the achievements of ex-smokers across Europe:
http://www.exsmokers.eu
X Questions about the European Union? Europe Direct can help: 00 800 6 7 8 9 10 11
http://europedirect.europa.eu
The new rules are designed to fight or minimise the
effect of these threats on the health of citizens by:
extending the existing EU coordination mechanism for
communicable diseases to include all health threats
caused by biological, chemical or environmental
factors;
strengthening the existing rules on preparing for and
managing health emergencies;
reinforcing the mandate of the EUs Health Security
Committee (composed of national representatives) to
react in a crisis situation;
providing the means to recognise a European health
emergency situation;
allowing EU Member States to purchase vaccines and
medical countermeasures jointly during a pandemic
or during an emergency situation.
The new rules are due to be adopted in 2013.
Revision of the tobacco products
directive
The European Commission proposed new rules for
tobacco products in December 2012 following a public
consultation which generated an unprecedented 85 000
responses from all levels of society.
The proposals which aim to bring tobacco legislation
up to date and make smoking less attractive to younger
people target manufacture, presentation and trade in
tobacco products.
Key elements include:
a prohibition of tobacco products with strong
flavourings, e.g. vanilla or chocolate, that mask the
taste of tobacco;
mandatory, pictorial health warnings covering at least
75 % of the front and back of cigarette packages and
roll-your-own tobacco, with further health warnings
on the side;
a continued ban on the oral tobacco snus
outside of Sweden;
authorisation under pharmaceutical legislation of
products containing nicotine, e.g. e-cigarettes, above a
certain limit of nicotine;
regulation for cross-border distance sales of tobacco
products;
a new EU-wide tracing and tracking system to protect
against illegal trade in tobacco products.
The proposed measures are expected to help reduce
smoking by 2 % in 5 years and respond to international
developments such as the WHOs Framework Convention
on Tobacco Control, which entered into force in 2005.
The proposals are now under discussion in the European
Parliament and Council. It is hoped they will come into
force in 201516.