EU Health Policy – The political approach of the EU with respect to cancer

Health Promotion Around the World: EU Health Policy –

The political approach of the EU with respect to cancer

Written by Martin Zabrodsky, Master Degree in International Health Care Management 

Introduction

For only the second time in its history after HIV/AIDS, the United Nations held a high level summit on a health issue addressing the rising burden of noncommunicable diseases (NCDs) (comprising cardiovascular diseases, cancer, diabetes type I and II diabetes, etc.) in September 2011. Recognizing the threat of NCDs, representatives of the European Union (EU) voted unanimously in favor of adopting the final resolution promising to reinforce and implement action with respect to NCDs. Although the European population only accounts for an eighth of the world’s population, 25% of all global cancer cases occur in Europe. This makes cancer the single highest cause of death in Europe (1). Despite the accession of Romania and Bulgaria in 2007, a slight increase in prevalence and mortality rates for cancer in the EU was observed illustrating the urgency of action to combat the disease (2). In light of the fiscal crisis and its repercussions for health systems globally, the World Economic Forum calls NCDs a threat for development and economical growth caused by both high direct and indirect costs (3).

Cancer policy in the European Union

The EU lifted cancer on its health agenda over 20 years ago by creating the “Europe against Cancer” program. The program is composed of ten points addressing primary and secondary prevention which served as a basis for future cancer policy. However, due to the subsidiarity principle in terms of health issues, the EU has no direct possibilities to take legal action to address public health issues. Nevertheless, according to the Lisbon Treaty, the EU is obligated to ensure health is not put at risk through EU-legislation (4). Thus, with respect to the free movement of goods within the European Union, the EU is capable of taking measures addressing the three major primary risk factors for cancer: tobacco, alcohol, and unhealthy food (5).

In order to get legal drafts approved by the bodies of the EU representing the interests of the Union, which includes both the states and the population, the EU requires solid evidence to gain government support. In contrast to public health issues, the EU possesses competences to take legal action concerning internal market affairs and work places and thus tries to inform and protect people from health threats such as indoor smoking which is perceived as a competitive detriment (6). This is one of the main reasons why the EU instead focuses on enforcing plain packaging for cigarettes: a total ban of smoking in public places across the EU is rather unlikely to happen, as this would be perceived as a public health measure and thus out of the area of competences from the EU.

Implications

The EU is using its unique opportunity of gathering experts and scientists (e.g. the European Partnership Action Against Cancer (EPAAC) platform) to create and draft legislation targeting primary and secondary risk factors for cancer (7). Currently, the

EU counts 27 Member States in which health systems, cultures, attitudes towards healthy lifestyles, etc. vary severely. This makes it difficult to draft one legal proposal addressing risk factors to obtain the required approval from federal ministers which must justify the decision considering the possible anger of voters for future elections.

However, despite the decreasing number of smokers in the EU, the number of adolescents who are smoking and drinking a harmful amount of alcohol should raise concerns across the Member States. Further, the steadily increasing number of obese children and adolescents (see table to the right) will lead to unprecedented challenges for the health sector on all levels and for countries in all different kind of fields. These unhealthy lifestyle habits will have an unpredictable impact on their future health and leads us to a threat for the individual and the society as a whole. With reference to health strategy papers, the EU has explicitly declared the importance to protect children and adolescents, as unhealthy lifestyle habits have a huge impact on their development and future life. In particular, the direct communication of health threats seems crucial: only 11% of the population reacts to mass media campaigns, but roughly 75% would change their lifestyle if they realized their habits would have a negative impact on personal health (8). Moreover, the issue of not only proposing but telling individuals how to live a life is a huge challenge for politicians and thus an issue no one seems to want to engage with. This leads to the question around whether the current public health policy needs to be revised, as we cannot assume that people will make rational decisions in terms of lifestyle products (9).

Summary and Conclusion

With respect to the current developments in terms of cancer, the encouragement of the incorporation of the social determinates of health (= Health in All Policy approach) is an inevitable step for political action. Addressing risk factors by taking a variety of actions comprising agricultural, traffic, and warning signals on food beverages or even financial measures (e.g. taxes) as proposed by the United Nations (10) and implemented by some Member States (e.g. Denmark) (11). Moreover, existing health inequalities, for example unequal access to services, need to be eradicated in order to address the issue properly. Further, the EU calls for more research and a standardized data acquisition system to make results available and applicable for all. It has been estimated that the implementation of a proper information system would cost less than one percent of one percent of current health expenditures and would be of huge benefit for all (12).

Addressing the cancer burden will be one of the major challenges of the 21st century and will require increased efforts from all stakeholders involved.

If you are interested in contacting Martin, you can reach him by email:  martin.zabrodsky@gmx.at.


References

Bray; F. The Burden of Cancer in Europe. In: Coleman, M., et.al (2008). Responding to the challenge of cancer in Europe. 7-41.Institute of Public Health of the Republic of Slovenia, Ljubljana, Slovenia

IARC (2012). Globocan 2008. (18 February 2012)

Bloom, D.E., Cafiero, E.T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl,A.B., Gaziano, T., Mowafi, M., Pandya, A., Prettner, K., Rosenberg, L., Seligman, B., Stein, A., & Weinstein, C. (2011). The Global Economic Burden of Non-communicable Diseases. Geneva: World Economic Forum.

Official Journal of the European Union (2010). Consolidated Version of the Treaty on the Functioning of the European Union. C 83. Brussels, Belgium

WHO (2011a). Cancer. Fact sheet N°297. URL: http://www.who.int/mediacentre /factsheets/fs297 /en/index.html (12 October 2011)

European Parliament (2001). Directive 2001/37/EC of the European Parliament and of the European Council 5 June 2001 on the approximation of the laws, regulations and administrative provisions of the Member States concerning the manufacture, presentation and sale of tobacco products. Luxembourg, Luxembourg.

Micheli; A., Baili; P. Information on Cancer. In: Coleman, M., et.al (2008). Responding to the challenge of cancer in Europe. Institute of Public Health of the Republic of Slovenia, Ljubljana, Slovenia.

OECD (2010), Health at a Glance: Europe 2010, OECD Publishing. URL http://dx.doi.org/10.1787/health_glance-2010-enw (22 October 2011)

Personal interview with a former civil servant from the EU Health Commission Department

De Schutter; Olivier (2011). United Nations General Assembly. Report submitted by the Special Rapporteur on the right to food, Olivier De Schutter. 19th session Human Rights Council.

European Public Health Alliance (2012), Food taxation in Europe: Evolution of the legislation (31 March 2012)

Personal interview with a former civil servant from the EU Health Commission Department

Published: October 2012, Health Promotion Connection

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