Correspondence with Ministers October 2006 to April 2007 - European Union Committee Contents


Letter from Rt Hon Rosie Winterton MP, Minister of State for Health Services, Department of Health to the Chairman

  Thank you for your letter of 6 July 2006,[136] further to my Explanatory Memorandum (EM) of 21 June. I am writing in response to the points raised in your letter and to update you on progress in negotiations on this dossier.

  The Finnish Presidency have held several discussions in the Council's Public Health Working Group over the summer. During the course of these, UK officials have agreed amendments:

    —  emphasising the importance of measuring the impact of work undertaken in relation to the programme objectives and the need for effective monitoring at project level (we do recognise, however, that some public health projects are difficult to evaluate in the short to medium term);

    —  highlighting the need for data on socio-economic factors and the health impact of other policies, within national constraints around availability; and

    —  clarifying that any further proposals for action arising from projects funded should respect the Council Conclusions of June 2006, which emphasise that while EU health systems share common values and principles, how these are implemented in practice is for Member States to decide.

  In terms of timing, the Finnish Presidency are now keen to achieve political agreement on this dossier at the Health Council on 30 November. To this end they have held several trialogue discussions with the Commission and the European Parliament. The Parliament have indicated that they are broadly content with the revised proposal but would like:

    —  a further programme objective on major diseases. In practice they are likely to accept a compromise stating that other objectives (eg on promoting health) should contribute to the reduction of major disease. The Government is content with this; and

    —  a (very small) funding increase of around €3 million per year. The Government's position will depend on the source of additional funds. Although we have no problem in principle with a small increase, funds must not be taken from other, already agreed, programmes or lead to an increase in overall EU budget ceilings agreed earlier this year.

  I also enclose a copy of our Initial Regulatory Impact Assessment, which reflects consultation with stakeholders.

  I hope that this update is helpful, and gives you the information you need to clear this proposal from Scrutiny.

17 October 2006

Annex A



  Amended proposal for a decision of the European Parliament and of the Council establishing a second Programme of Community action in the field of Health and consumer protection (2007-13); Adaptation following the agreement of 17 May 2006 on the Financial Framework 2007-13.

  Council Document: 9905/06.



  1.  The Commission has set out three core objectives for this programme:

    —  Improve citizen's health security including actions to:

    —  protect citizens against health threats; and

    —  improve citizen's safety.

    —  Promote health for prosperity and solidarity including actions to:

    —  foster healthy, active ageing and help bridge health inequalities; and

    —  promote healthier ways of life by tackling health determinants.

    —  Generate and disseminate health knowledge including actions to:

    —  exchange knowledge and best practice; and

    —  collect, analyse and disseminate health information.


  2.  The Commission has published its amended proposal for a Programme of Community Action in the field of Health and consumer protection (2007-13), following agreement of the overall EU budget for 2007-13 and amendments voted by the European Parliament in March.

  3.  The Commission's original proposal combined public health and consumer protection. However, following objections from the European Parliament, the proposal has been split off into two separate programmes (on public health and consumer policy).

  4.  The budget for the public health programme is set at €365.6 million (compared to €1,203 million originally proposed by the Commission for the joint programme). Amounts available on an annual basis for operational expenditure on the programme are slightly below the current public health programme (approximately €47 million per year compared to €51 million in 2006).

  5.  The current health programme results from Decision no 1786/2002/EC of the European Parliament and the Council of 23 September 2002 adopting a programme of Community action in the area of public health, and covers the period 2003-08.

  6.  The objectives of the current programme are to:

    —  provide health information;

    —  respond to health threats; and

    —  promote health by addressing health determinants.

Rationale for intervention

  7.  Article 152 of the Treaty states that in order to promote the interests of the public and to ensure a high level of human health protection, the Community will take action to complement national policies towards improving public health, preventing human illness and diseases, and obviating sources of danger to human health. The Community shall encourage cooperation between Member States (and where necessary lend support to Member States' action).

  8.  In its impact assessment, the Commission lists key areas of need where the EU can add value by complementing national action, facilitating exchange of expertise and best practice and co-ordinating action where appropriate (for example on health threats). These include:

    —  health inequalities within and between Member States;

    —  common challenges faced by Member States, such as how to promote policies that will tackle the growing burden of avoidable diseases;

    —  the need to tackle global health threats (such as SARS and avian influenza); and

    —  the potential for helpful collaboration between Member States on improving the quality and efficiency of health services.

  9.  Evidence from the UK and the EU that relates to the areas of need set out by the Commission is below:


  In all EU countries with available data, rates of premature mortality are higher among those with lower levels of education, occupational class of income. These inequalities in mortality lead to substantial inequalities in life expectancy at birth (4-6 years among men, 2-4 years among women). In 2001, the inequality in life expectancy at birth by occupation class in England and Wales was 8.4 years among men and 4.5 years among women.[137] Exchange of best practice at EU level in this area and action to reduce health inequalities is a key priority for the UK government.

Common challenges/avoidable diseases

  1 in 5 children in EU Member States are overweight with 400,000 children becoming overweight every year. Obesity is directly linked to diseases including Diabetes. The EU wide average prevalence of Diabetes if 7.5% and this figure is set to increase to 8.9% by 2025.[138]

  Lifestyle related ill health also has a negative effect on the economies of EU counties. In England, alcohol related conditions cause a productivity loss of £6.4 billion/year.[139] National authorities in the EU-15 spend €135 billion every year on cardiovascular diseases.[140]

  Member States can learn from each other in developing actions to combat these common challenges. For example, the North Karelia Project in eastern Finland was instrumental in reducing the amount of deaths by CHD amongst middle aged men by 83% through diet alterations.[141]

Global health threats

  Clearly, infectious diseases do not respect borders. Modelling work indicates that having built up over 2-4 weeks in a country of origin in Asia, it could taken as little as 2-4 weeks for pandemic influenza to spread to the UK. On the other hand effective surveillance (eg of which age groups are most effected) and sharing of information in the early stages of a pandemic could help countries respond more effectively once a pandemic has spread to their borders. Enhancing the capacity for collaboration across the EU, and with other international partners, is therefore key.

Collaboration between Member States health services

  EU Member States face common challenges in the provision of health services. These include: demographic change and ageing populations; avoidable diseases (see above); rising costs and the need to ensure financial sustainability. In England, the number of people over 65 years living with long-term condictions is expected to double each decade. This poses a significant challenge for the NHS.

  Learning from other Member States can add real value to national policies. For example, the Our health, our care, our say White Paper which set out the government's strategy to help people live more independently in their own homes, including through having more local specialist care and developing community health facilities, was informed by the best practice of other European countries. (France carries out most follow-up outpatient appointments in community settings and Germany has developed polyclinics that provide specialist services locally).


Within government

  The UK's position has been agreed with relevant Government departments, and with the Devolved Administrations.

Public consultation

  The Commission's impact assessment sets out that the proposed programme is based on the results of a consultation held by the Commission in July 2004, entitled "Enabling good health for all, a reflection process for a new EU health strategy", with contributions from national authorities (including the UK), NGOs, universities, citizens and companies. It also used a range of other forums to consult Member States and other stakeholders.

  The Department of Helath also held a three month public consultation on the original proposal and on possible revisions, with responses from professional bodies/Royal Colleges as well as other stakeholders including Local Government.

  Overall, respondees were supportive of the public health objectives of the programme. There was a range of opinions on the right approach to prioritisation within a revised programme with a reduced budget, from the view that all of the proposed objectives in the original programme should be retained to the view that work on health promotion, disease prevention and tackling determinants is the key priority.

  Respondees were supportive of collaboration between health systems, while recognising that these differ significantly between Member States. Other general points included the need for effective targeting of health promotion/prevention activities and to ensure that such activities were taken forward at the appropriate level (eg nationally, regionally, locally). [The revised proposal no longer contains a reference to EU wide awareness campaigns.]


  Options for the revised programme are:

    —  Do Nothing—do not negotiate, the most likely outcome is that the actions are accepted without UK influence;

    —  Support all the actions in the revised proposal;

    —  Support some of the actions/negotiate for a revised package; or

    —  Oppose all the proposed actions.

  As outlined in our Explanatory Memorandum, the Government supported the objectives and actions in the original proposal, and particularly welcomed many of the Commission's revisions, such as the increased focus on health inequalities. The Government is therefore supporting all the actions in the revised proposal.

Actions under the Public Health programme

  Proposed actions under each heading of the revised proposal are summarised below.

Protect citizens' health security

  This includes work around monitoring and response to communicable and non-communicable health threats, including avian and pandemic influenza, through support for effective planning, surveillance, risk management and prevention as well as developing the capacity for Member States to collaborate effectively in a health emergency. It also includes some wider work on safety (including patient safety).

Promote health to improve prosperity and solidarity

  This includes action on health inequalities, as well as to promote healthy ageing in the context of Europe's demographic changes. The Commission is also keen to explore the impact of health on the broader issues of productivity and labour market participation under this heading. The work on tackling the determinants of health and on disease prevention is included here (including nutrition, physical activity and combating tobacco, alcohol and drugs).

Generate and disseminate health knowledge

  This includes exchange of best practice between health systems and on other key issues, such as mental health. It also includes work to build on EU health data and information and to improve dissemination of information to/consultation with EU citizens stakeholders and policy makers.


  The actions proposed under this objective will involve costs for the European commission, but will not impose direct costs on business, the voluntary sector or consumers. Clearly, some projects funded will seek to influence consumption patterns (for example of tobacco, alcohol, junk food etc) for health reasons which may in turn indirectly impact related businesses. However, this is in line with our national policies as set out in the Choosing Health White Paper.

  UK based organisations are likely to benefit from funding to lead work under the programme's objectives (the current public health programme has resulted in funding for the Health Protection Agency, University of Edinburgh and London School of Economics among others). Many more UK based organisations will benefit as partners collaborating in projects funded, gaining the opportunity to build knowledge and share best practice with others across the UE.

  The Commission's impact assessment notes wider potential benefits of these actions including:

    —  The economic impact of improving population health (according to a recent study, health improvement represented 11% of the causes of growth over a 25 year period in the EU 15[142]) and productivity;

    —  National authorities better supported to effectively monitor and respond to health threats, and to co-operate across the EU in the event of a health emergency (such as an influenza pandemic);

    —  National health systems supported to combat major diseases and to provide cost-efficient and effective healthcare, through mutual collaboration and learning across countries; and

    —  A stronger voice base on the rationale for public health interventions.


  Reducing health inequalities is a key element of the proposed programme.


  Not applicable to this proposal.


  Not applicable to this proposal.


  The actions proposed by the Commission will not have enforcement and sanctions effects. The revised proposal sets out arrangements for monitoring, which have been strengthened following input from the European Parliament. These include provision for an external and independent evaluation mid-way through the programme and following its completion.

Letter from the Chairman to Rt Hon Rosie Winterton MP

  Thank you for your letter of 17 October and the attached Initial Regulatory Impact Assessment. These were considered by the Sub-Committee on 23 November.

  We note that the changes made to the previous version of the proposal, which were agreed in a Council Working Group over the summer, are satisfactory to the UK and that the revised proposals have general support from UK stakeholders.

  We are therefore content to clear this document from scrutiny.

23 November 2006

136   Correspondence with Ministers, 40th Report of Session 2006-07, HL Paper 187, pp 512-513. Back

137   Health Inequalities: Europe in profile, Prof Dr Johan P Mackenbach, 2006 (commissioned by the UK Presidency of the EU). Back

138   Diabetes-the Policy Puzzle: Towards Benchmarking in the EU 25, Federation of European Nurse in Diabetes & International Diabetes Federation European Region. Back

139   Internal Analytical report, The Cabinet Office, Prime Minister's Strategy Unit, 2003. Back

140   Eurohealth volume 9, Spring 2003. Back

141   Successful prevention of non-communicable disease: 25 years experiences with North Karelia Project in Finland, World Health Organisation, 2002. Back

142   Health's contribution to economic growth in an environment of partially endogenous technical progress, Disease control priorities project, Jamison, Lau and Wang, February 2004. Back

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