European Scrutiny Committee Contents

40 The EU and global health



+ ADDs 1-3

COM(10) 128

Commission Communication: The EU Role in Global Health

Legal base
Document originated31 March 2010
Deposited in Parliament25 May 2010
DepartmentInternational Development
Basis of considerationEM of 23 June 2010
Previous Committee ReportNone
To be discussed in Council10 May 2010 Foreign Affairs Council
Committee's assessmentPolitically important
Committee's decisionCleared, but relevant to the debate on Communication 8910/10


40.1 The Commission's starting point is that "Global health is a term for which no single definition exists." For the Commission, however, it "is about worldwide improvement of health, reduction of disparities, and protection against global health threats." Addressing global health, thus defined, "requires coherence of all internal and external policies and actions based on agreed principles."

40.2 As health is increasingly influenced by globalisation, "the EU's social model, its strong safety norms, and its global trade and development aid position allow it to play a major role in improving global health." The World Health Assembly has the authority to adopt resolutions and binding international regulations: but "most resolutions are not binding and compliance depends on national capacities and political will." Progress towards the health Millennium Development Goals (MDGs) is uneven and largely off track in most developing countries. The EU is already exercising its treaty-based powers via the EU Health Strategy, its Research Framework Programmes and the European Consensus on Development. All in all, "the EU's leading role in international trade, global environmental governance and in development aid, as well as its values and experience of universal and equitable quality healthcare give it strong legitimacy to act on global health."

The Commission Communication

40.3 Against this background, the Commission says that this Communication "proposes an EU vision on global health, defines the guiding principles that should apply to all relevant policy sectors and presents a number of areas where the EU could more effectively act." It is accompanied by three Commission Staff Working Documents with more detailed information regarding "Contributing to Universal Coverage of Health Services through Development Policy", "Global health: responding to the challenges of globalization" and "European Research and Knowledge for global health".

40.4 The Commission calls for "A Stronger EU Vision, Voice and Action". With "a plethora of actors and initiatives engaged in global health and a continuing need to mobilize resources", there is a need for "a clearer and more efficient global leadership." With the entry into force of the Lisbon Treaty, "the role of the EU in WHO would need to be included in wider reflections concerning its role in the United Nations". At global level, "the EU should defend a single position within the EU agencies [and] … support stronger leadership by the WHO in its normative and guidance functions".

40.5 "An Enhanced EU Response" should:

—  increase the alignment and predictability of EU support, prioritising fragile states, AIDS orphans and off-track health MDGs;

—  improve its capacity for analysis and dialogue on global health challenges at national, regional and international levels;

—  assume research capacities to making the biggest impact on public health;

—  ensure that the EU's internal or external policies and actions coherently promote equitable and universal coverage of health services, particularly in its five main Policy Coherence for Development areas, viz., trade and financing, migration, security, food security and climate change;

—  work towards reducing fragmentation of funding and shifting WHO funding to its general budget;

—  promote the strengthening of health systems that deliver health care for all through EU participation in global financing initiatives, such as the GFATM[164] and the GAVI,[165] and by "its participation in the governance of" the International Financial Institutions (IFIs);

—  support the implementation of national health strategies by country systems, offering predictable EU aid of at least three years duration and channelling two thirds of health Official Development Assistance (ODA) through partner-countries'-owned development programmes and 80% using partner countries' procurement and public financing management systems;

—  help partner countries to strengthen the participation of all stakeholders in national health policies, and to formulate policies that raise domestic revenue for the health sector so user fees can be replaced with fair financing;

—  tackle maternal and child malnutrition by supporting government nutrition policies through interlinked health and food security interventions in the worst-affected countries; and

—  "ensure that all relevant internal or external policies contribute to promoting equitable and universal coverage of quality health services", with the impact assessment of the relevant policy areas to include analysis of the effects of policy options on global health.

40.6 The Commission concludes with a number of concrete proposals, such as Member States ensuring that their migration policies do not undermine the availability of health professionals in third countries, and designating a coordinator on global health, to work with Member State counterparts and the Commission in a platform to exchange information and meet regularly to agree on common positions and opportunities for joint action.

The Government's view

40.7 In his Explanatory Memorandum of 21 June 2010, the Parliamentary Under-Secretary at the Department for International Development (Mr Stephen O'Brien) says that the decision to produce a Communication on the EU role in Global Health "was inspired by the UK's Department of Health-led inter-departmental strategy Health is Global", and that, with the primary goal for this Communication being to promote a more effective strategic approach to Global Health, his Department represented the UK Government on the Expert Group that "fed into this Communication as the main focus of the paper relates to international development and the achievement of the Health Millennium Development Goals (MDGs)."

40.8 The Minister then explains that this document "supports many UK priorities in the health sector", including:

  • "increased coherence and harmonisation of EU and Member State actions towards key MDGs"
  • "strong support to national health strategies and systems"
  • "a commitment to increased resources being made available to reach the health MDGs"; and
  • "endorsing the International Health Partnership (IHP), which seeks to apply the good-aid Principles of the Paris Declaration on development assistance to the health sector, and the associated Joint Assessment of National Strategies (JANS) process, which serves to help strengthen and assess the robustness of the national health strategy."

40.9 Within the Communication, the Minister notes "support for designing a financial system that will remove financial barriers to accessing health services, which is considered a key step in making progress against the maternal and child mortality MDGs."

40.10 He describes family planning and reproductive health as "central to the achievement of the MDGs, and particularly MDG 5 on improving maternal health". He continues thus:

"The UK is committed to supporting reproductive health, and universal access to family planning and reproductive health services, supplies and information, as set out in the ICPD and Beijing Declarations and Programmes of Action. This issue often proves controversial for some EU Member States, and is lacking in the Communication. The emphasis on reproductive health in the Council Conclusions is therefore welcome."

40.11 The Minister then:

"accepts that the Communication does not contain detailed reference to achieving outcomes in specific health areas, as this was meant to be a high-level strategic guidance document. From the outset, the European Commission aimed to produce a brief strategic guide to how itself and EU Member States should engage with global health issues — instead of listing detailed priority health issues, it would promote strong health systems as the best way to achieve the health MDGs, with external assistance aligned behind robust national health plans focussed on achieving the health MDGs."

40.12 The Minister also says that he "would have wished to see more on increased donor commitments, along the lines of the 2008 EC Agenda for Action on MDGs[166]", but that "this met with considerable resistance and was not ultimately included."

40.13 Turning to the role of the EU and Member States in WHO and other international institutions with a Global Health mandate, the Minister notes that the Communication makes specific reference in places to these matters

"For example, it states that "With the entry into force of the Lisbon Treaty, the role of the EU in WHO would need to be included in wider reflections concerning its role in the United Nations". It also suggests that 'the EU should endeavour to defend a single position within the UN agencies'".

40.14 Against that background, the Minister then says:

"The Government will wish to ensure that further work on the matters outlined in the Communication fully respects the division of competences between the EU and the Member States. Work is still on-going in Brussels on the question of EU representation and participation in international bodies and organisations such as the WHO following the entry into force of the Lisbon Treaty. The Government's position is that the Lisbon Treaty does not change the balance of competencies between the Member States and the EU. Therefore, any proposal for enhanced EU engagement in international bodies such as the WHO should be approached on a case by case basis and will require a detailed analysis of the costs and benefits relating thereto."

40.15 The Minister concludes by noting that Council Conclusions on "The EU Role in Global Health" were adopted at the Foreign Affairs Council on the 10th of May 2010.

40.16 In welcoming the Communication, the Council says that these conclusions are "part of the overall process of establishing the EU position for the MDG High Level Plenary Meeting to be held in New York, which will further define the EU response to the most off-track situations", noting that "Progress towards achieving the health-related MDGs has been uneven and insufficient, particularly for MDGs 4 and 5 and especially in Sub-Saharan Africa." The Council affirms that the "EU has a central role to play in accelerating progress on global health challenges, including the health MDGs and non-communicable diseases, through its commitment to protect and promote the right of everyone to enjoy the highest attainable standard of physical and mental health."

40.17 The conclusions also call on the EU and its Member States "to act together in all relevant internal and external policies and actions by prioritizing their support on strengthening comprehensive health systems in partner countries … strengthening their capacities to develop, regulate, implement and monitor effective national health policies and strategies [and ensuring] full participation of the representatives of civil society and other relevant stakeholders, including the private sector."

40.18 On the question of the WHO and the respective roles of the EU and Member States, the Conclusions say:

"The Council calls on EU Member States and the Commission to support an increased leadership of the WHO at global, regional and country level, in its normative and guidance functions addressing global health challenges as well as in technical support to health systems governance and health policy, given its global mandate. Accordingly, the Council requests Member States to gradually move away from earmarked WHO funding towards funding its general budget. Without prejudice to respective competencies, the EU and its Member States will endeavour to speak with a stronger and coherent voice at the global level and in dialogue with third countries and global health initiatives." [167]


40.19 Given the inter-relationship between the subject matter of this Communication and the related Communication 8910/10, "A twelve-point EU action plan in support of the Millennium Development Goals", we consider it relevant to the debate in European Committee B that we have recommended on the latter in chapter XX of this Report.[168]

40.20 As well as discussing the way forward on the Millennium Development Goals, the debate will also provide an opportunity to examine further the Minister's position on the question of EU representation and participation in international bodies and organisations such as the WHO following the entry into force of the Lisbon Treaty. Given his view that the Treaty does not extend the EU's legislative powers in the field of human health, which Article 6 TFEU confines to actions to support, coordinate or supplement the actions of Member States, we find it odd that he seems to see any proposal for enhanced EU engagement in international bodies as dependent not on legal principles but rather upon "a detailed analysis of the costs and benefits relating thereto."

40.21 We now clear the document.

164   The Global Fund against Aids, Tuberculosis and Malaria; see for full information. Back

165   The Global Alliance for Vaccines and Immunisation; see for full information. Back

166 Back

167   The full conclusions are available at . Back

168   (31519) 8910/10; see chapter 2 of this Report. Back

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