European Public Health Forum

Introduction

On 16 May 2000, the European Commission adopted a Communication on "the health strategy for the European Union" and a proposal for an EU action program in the field of public health1.

The new health strategy, and the public health action programme as its core instrument, will bring about a substantial reform of European health policy. Not only does the action programme provide for a more horizontal approach to improving the health of EU citizens, but it also, for the first time, explicitly commits to consultation with a wide range of stakeholders in the health community.

This paper is a response to the request by the Commission for submission of views on the Public Forum aspect of the wider programme.

Part 1

Strengthening NGO's

As a patient group, an NGO and a not-for-profit organisation, ECPP welcomes the clear commitment in the strategy communication to consult stakeholders in the health community. Patient groups and NGO’s have a very important contribution to make in EU policymaking and programmes. Patient groups, Community Based Organisations and NGOs are often under-resourced. They are often effective, “value for money” organisations with considerable “considerable added value2”.

In order to support the involvement of citizens and their representative organisations in the formulation, implementation and evaluation of public health actions, the Commission should further consider the need for core funding of patient groups and NGOs. Core funding of representative NGOs is already a well-established funding mechanism in other key programme areas including social policy, development, and environment and consumer policy.

Part 2

The European Health Forum

Developing the citizens' dimension of EU health policy implies involving civil society in the policy planning process. Dialogue with NGOs in the health field is still fairly under-developed, this is in contrast with other sectors such as consumer or environment policy where NGOs receive 100% funding, and provide valuable expertise to the policy development process. Within health policy, an institutionalised forum for exchange does not exist, despite recent policy statements from the Commission about the significance of NGOs3.

The ECPP welcomes the Commission's intention expressed in its communication to establish a structure for consultation with stakeholders.

Supporting the weaker parts of civil society

While some stakeholders - in particular those representing commercial or other profit-oriented interests, have access to considerable resources, others - in particular NGOs - face severe financial restrictions when it comes to participating in consultation processes in Brussels and elsewhere. In terms of organisational capacity, NGOs advocating the public interest in health are clearly and often the weakest partner in the EU public health arena. Therefore, core-funding for EU offices of health NGO’s representing a wide spectrum of interests, and payment of travel expenses, (which are crucial to participation) would be useful to building a balanced dialogue between the Commission and civil society.

Structure

The three tiered approaches, of a Forum (with invited members), a yearly open health forum and the virtual forum, can be successful – with the following provisos.

Membership

The consultation should aim to include the broadest possible range of relevant stakeholders in EU health policy within the patient’s organisation, not-for-profit and non-governmental sector. Public health advice to the Commission should be based not only on objective and scientific assessments of health needs, but should also take into account the “softer” intelligence of patient groups. It is these groups who are likely to be aware of the impact of change on individuals and communities before those changes can be clearly and scientifically demonstrated. This can provide the Forum with valuable lead-time on any potential new public health threats.

With regard to Medical professionals, we would recommend the inclusion of such groups as Nurses, and Pharmacists.

Working Groups

There should be working groups to allow participants in the consultation process to focus on topics they are concerned with most, and where they have proven expertise/and or potentially valuable community links. There could be both permanent and ad hoc working groups, depending on the needs defined in the course of the consultation process.

Comprehensive

There should be a commitment by the Commission to consult on all health-relevant issues arising at the EU level, including issues not under the "lead responsibility" of DG Sanco.

There should be clearly defined ways for stakeholders to bring up issues, which are not yet on the Commission's agenda, as well as identifying those existing issues, which require higher priority.

Accountable

The Commission should take opinions expressed in the consultation process into account and systematically inform participants whether and why it has or has not supported these opinions.

Based on realistic expectations

One should be aware of the diversity of interests within the public health arena. Thus, reaching consensus amongst the participants of a consultation will not always be possible. The consultation should therefore primarily aim to be a forum to voice different positions, and provide opportunities for different interest groups to identify and agree common objectives and desired outcomes, while not always agreeing on the process of achieving these. Given the contradictory interests and attitudes present in an all-inclusive consultation process, a corporatist definition of aims where stakeholders are expected to elaborate common positions would not be realistic. However, sub-groups of stakeholders should of course be free to co-ordinate their action or to elaborate minority positions.

Transparency

The consultation process should be as transparent as possible. Information on which consultations are currently underway or upcoming/proposed, with whom, at which date/location, etc. should be publicly available through the Internet. Positions and working papers should also be published on the Internet. Where Internet access is not available and/or not reliable, sustainable alternatives must be put in place.

Linked to the institutional process

The consultation process should be designed in a way that it is compatible with the decision-making procedure in the EU institutions. In particular, meeting dates (and places where appropriate) should be chosen in such a way that co-ordination with the relevant committee in the Commission and Parliament is facilitated and time maximised.

Directly managed by the Commission

The task of organising the consultation process should lie with the Commission.

Part 3

Recommendations of priority issues

Bearing in mind subsidiarity, the Forum’s priorities should initially focus on those issues, which are not controllable by Member States. In this instance, the first priority are communicable diseases that are rising and posing a threat to the health and social cohesion of the Union – HIV, Hepatitis and Tuberculosis (particularly Multiple Drug Resistant TB).

The second priority which also impacts on the long-term health of all citizens, is the threat presented by the uncontrolled use of antibiotics, with strains of Tuberculosis being resistance up to 11 of the 12 available treatment antibiotics. This can only be tackled on a pan-European level, but impinges on Members States policy (e.g. over the counter purchase in Spain), and into the veterinary field.

1 Commission paper (COM 2000/285)
2 The Economic Equation of Volunteering, Centre for Research in Social Policy, 1996, Loughborough University
3 Prodi and Kinnock paper

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The Patient can be as knowledgeable as the expert, but is uniquely placed to have a holistic view of their condition

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