40 The EU and global health
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8281/10
+ ADDs 1-3
COM(10) 128
| Commission Communication: The EU Role in Global Health
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| Legal base | —
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| Document originated | 31 March 2010
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| Deposited in Parliament | 25 May 2010
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| Department | International Development
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| Basis of consideration | EM of 23 June 2010
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| Previous Committee Report | None
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| To be discussed in Council | 10 May 2010 Foreign Affairs Council
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| Committee's assessment | Politically important
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| Committee's decision | Cleared, but relevant to the debate on Communication 8910/10
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Background
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]
Conclusion
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 http://www.theglobalfund.org/en/ for full information. Back
165
The Global Alliance for Vaccines and Immunisation; see http://www.gavialliance.org/about/index.php
for full information. Back
166
http://register.consilium.europa.eu/pdf/en/08/st11/st11096.en08.pdf. Back
167
The full conclusions are available at http://www.consilium.europa.eu/uedocs/cms_Data/docs/pressdata/EN/foraff/114352.pdf
. Back
168
(31519) 8910/10; see chapter 2 of this Report. Back
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