EU Structures and Public Health
The EU
The
European Union (EU) was established by the Treaty
on European Union (TEU) agreed in Maastricht.
The EU incorporates and continues the previous European Community (EC). The EC is described in a second treaty - The Treaty establishing the European Community (TEC)
Policy areas from each treaty are dealt with differently by the European Institutions. A key difference is that those areas which are solely specified by the Treaty on European Union are outside the jurisdiction of the EU Court .
Few things can happen within the EU context without reference back to these 2 treaties. The legal basis has increased in complexity with periodic treaty amendments and revisions - an important reason for replacing them with the European Constitution.
Competence for Health of the EU
Health is dealt with exclusively under the European Community (EC) Treaty. This establishes the following: (brackets refer to the article number of the treaty):
- that a task of the community is the raising of the standard of living and quality of life (2)
- that protection of health is a must in all EU policies and activities (3,152)
- EU legislation is possible on health grounds in certain circumstances in relation to goods, services, agriculture, establishing businesses and movement of people, health and safety of workers (30,39,40,46,95,152) legislation is also permitted in relation to blood, blood products, organs and substances of human origin (152)
- that action to improve public health is a legitimate activity at EU level (152)
- the EU should promote cooperation between member states in areas of health but that EU legislation is prohibited except in the areas specified elsewhere in the treaty.(152)
- that the EU can provide incentive measures ( funding) in the field of public health (152)
- that member states are responsible for organising and running health services (152)
- that EU environment policy should protect human health (174)
Competence for health is thus shared between the EU level and member states.
Member States are completely responsible for:
Financing, organising, managing and running health services
National health policies
The EU is responsible for
- ensuring that all EU policies and actions provide a high level of health protection
- assisting member states to coordinate their action and collaborate on health
- joint action with member states on 'threats to health' particularly where there is a cross border dimension.
- Standard setting and regulation in specific areas such as pharmaceuticals, medical devices, blood products, organs for transplantation.
Outputs from EU policymaking can include:
- Legislation,- e.g. tobacco advertising Directive,
- Funded programmes - e.g. The EU Public Health Programme (Euros 350m), the research programme.
- Public Health infrastructure - e.g. the new European Centre for Disease Prevention and Control
- Coordinated action e.g. -national action plans for social inclusion
- This page has more information on current EU health policy
EU institutions and Health
The Commission - the EU civil service
The
25 European Commissioners take collective responsibility. Androulla Vassiliou is the lead commissioner for public
health. The 25,000 civil servants who work for the Commission are organised into 30 Directorates General (DGs). Robert
Madelin is the Director General for Health and Consumers (DG
SANCO) which covers public health, food safety and consumer affairs.
Andrzej Rys is the the Director for Public Health within DG SANCO which has units based in Luxembourg and Brussels.
Public Health legislation, projects, position papers and meeting documents are readily available on the Europa web site.
Click here for brief overview on the Faculty site of European Health Policies
Other parts of the Commission also relate to health, for example:
Health care and care of the elderly
Employment and health and safety
Free movement of people and recognition of professional qualifications
EU Specialised agencies provide a range of supporting functions.
European Centre for Disease Prevention and Control
European Medicines Evaluation Agency
European Agency for Health and Safety at Work
European Foundation for the Improvement of Living and Working Conditions
European Monitoring Centre for Drugs and Drug Addiction.
The Council of the European Union: National Governments deciding together
The
Council of the European Union, often abbreviated to the Council of Ministers
or just the Council, is the main decision making body of the EU and consists
of the relevant ministers for each policy area from each member state.
The Employment,
Social Policy, Health and Consumer Affairs Council (EPSCO) covers heath.
It meets four times a year. Its functions are to:
- debate health issues
- exchange information and support collaboration between member states on health issues
- scrutinise and agree legislation in conjunction with the European parliament
The chair of the health council is taken by a minister from the member state holding the presidency of the council of ministers which rotates every 6 months.
The UK Permanent Representation to the European Union Coordinates the UK's input into the Council.
The European Council brings together the heads of state and or heads of government of the member states in gatherings referred to as European Summits. It sets the overall strategy of the EU. Strictly speaking it is not part of the EU institutional apparatus defined in the treaties. When the heads of government wish to take EU decisions directly then they sit themselves as a configuration of the Council of the European Union.
The European Parliament: Directly elected local representation
The European Parliament legislates jointly with the Council and can also exert influence through questions to the Commission, budget approval and other ways. Health topics are debated within the parliamentary committee on Environment, Public Health and Food Safety (ENVI).
Economic and Social Committee: a view from workplaces
The European Economic and Social Committee is a statutory EU body which considers and gives an opinion on a wide range of proposed EU legislation including most things relating to health. It contains people nominated by central government who represent employers, employees and professions. Work is carried out in 6 sections. The Section for Employment, Social Affairs and Citizenship (SOC) considers health issues..
Committee of the Regions: local government opinions
The
317 members of the Committee of the Regions are elected members or key
players in local or regional authorities nominated by their national government.
The Committee is consulted and provides opinions on proposed EU legislation.
Work is carried out in subcommittees known as commissions. The
Committee of the Regions (COR) Commission for Economic and Social Policy
(ECOS) covers health.
Other Actors: can say, will say.
The
EU member states are of prime importance in all the processes of the EU
but a huge range of other organisations and individuals communicate directly
or indirectly with the Commission and other European institutions. These
include local and regional governments, professional lobbyists, voluntary organisations, governmental
and non governmental organisations, professional groups, and other interest
groups.
Some of these bodies have the influencing of EU policy as their main function, whilst for others it is an occasional activity. Methods include:
- representations to members of EU institutions which have a formal input into EU policy making - the council, the parliament, committee of regions, social committee - see above.
- direct communication with commission officials
- holding meetings, conferences
- publishing reports, websites,
- stunts, protests and publicity generating activities of one sort and another
- work with the mass media
Organisations with a European public health interest include:
European Public Health Alliance
The European Public Health Association
International Union for Health Promotion and Education
EU policy processes
In
brief:
The European Commission, proposes policy.
The Council of Ministers, together with the European Parliament, consider, legislate and allocate budgets.
The Committee of the Regions and the Economic and Social committee provide formal consultation
The European Court of Justice interprets EU law and adjudicates.
Other bodies may influence either through one of the above EU institutions or via a range of formal and informal consultation mechanisms.
Policy Influences
While the right to propose policy is reserved for the Commission it is influenced by the contributions and interactions with the various EU institutions and with external bodies. These include:
- the priorities of the Council presidency
- conclusions and recommendations of Council discussions - published in press releases
- opinions of the european parliamentary committees - generally drafted by a rapporteur ( an MEP appointed by the committee for each topic)
- discussions with stakeholder groups such as the EU Health Forum and similar bodies established by the Commission for consultative purposes.
Collaborative mechanisms
The EU has a range of collaborative mechanisms in addition to the main policy processes. The Open Method of Coordination (OMC) is one these which is being applied to health. Under OMC member states agree to exchange information and coordinate policy with the Commission providing support. Following initiatives on health and long term care of the elderly and on patient mobility the Open Method of Coordination on health is currently being further developed.
The EU Health Forum was established by the Commission to help the EU's health strategy to be open and responsive to public concerns. It provides an information and consultation mechanism with representative of patients, health professionals and other stakeholders, such as health service providers. The Forum has three components: An Open Forum for a discussion with a wide range of organisations and individuals, a Health Policy Forum with a defined membership and provides opportunities for wider interaction in a Virtual Forum.
For more detail see for example the BMA guide to European and international medical organizations.
For General information on EU structure and function see 'The European Union at a Glance'
