Health and food safety standards in Europe have improved dramatically since World War II. What are some highlights that come to mind?
On the health side, I can flag a file which has been very high on my agenda since the beginning of my mandate: vaccination, which not only protects individuals, but society as a whole. It is undoubtedly one of the most powerful and cost-effective public health measures developed in the 20th century. The figures speak for themselves: every year, immunisation programmes prevent 2.7 million people worldwide from getting measles, and around 2 million people from getting seasonal flu in Europe alone. As a doctor, I can testify that before vaccines existed, many children would die or become crippled for life. Thanks to vaccination, smallpox has been eradicated, and countless deaths from diseases such as measles, diphtheria and meningitis are now a thing of the past. Nevertheless, the current misconceptions about vaccination are a leading factor in falling vaccination coverage rates. People are no longer sufficiently aware of the vital role that vaccination has in saving lives, and their focus is turning increasingly to a fear of possible side effects. This is a worrying trend and I am doing my utmost to stress vaccine safety, and the benefits to society of herd immunity.
On the food front, we must never forget that the EU was dependent on the outside world in the 1960s – when the CAP was launched – whereas it is now a powerhouse on the agriculture trade front, offering its citizens a wide variety of goods. I view the EU’s food legislation itself as its major achievement. This legislation is probably the most comprehensive in the world, covering the scientific assessment of products before they reach the markets to surveillance and reactivity in case food alerts are triggered. It aims to provide safe, nutritious, high-quality and affordable food to the consumer and is based on an integrated and comprehensive approach that covers all steps of the food and feed chain. Another important aspect in my view is animal health. Thanks to common approach and financial support, the Union has also achieved success in terms of reduction of the number of outbreaks of animal diseases and zoonoses, which pose a risk to human and animal health, as well as of prevention of the occurrence of such outbreaks. On the global stage, the EU also benefits from well-recognised, high standards – in food safety, animal welfare, environmental protection, as well as traceability of the products on its markets.
What are some of the biggest challenges remaining when referring to health equity, both across Europe and within different European countries?
The health status of Europeans has improved over the past decades. We live longer and in better health than ever before. Life expectancy across Member States has increased by more than six years since 1990, and currently stands at 81 years on average across the EU. Still, this is just one side of the coin. Large differences in health still exist between and within all countries in the EU, and some of these inequalities are widening.
The Health at a Glance: Europe 2018 report that we published in November of last year reveals that universal health coverage does not always mean that all citizens enjoy a right to healthcare or enjoy it equally. While most EU countries have achieved universal coverage for a core set of services, Cyprus, Bulgaria and Romania still have at least 10% of their population not covered for health services. In Bulgaria, the ones left behind are those who have lost their coverage because they fail to pay their contribution. In Romania, they are mainly people working in agriculture, the self-employed or unemployed who are not registered for social security benefits, and Roma without identity cards.
Costs borne by patients directly can be an important driver of health inequity. Across the EU, around 20% of all health spending is borne directly by households. When this spending becomes large in relation to capacity to pay for healthcare, this produces financial hardship. The incidence of such out-of-pocket payments varies across Europe; ranging from fewer than 2% of households in France, Ireland, Slovenia and Sweden, to over 8% of households in Greece, Hungary, Latvia, Lithuania, Poland and Portugal.
Despite the progress in average life expectancy in the EU, health inequalities still persist because of differences in socioeconomic status or education. Obesity levels clearly illustrate this point: 12% of people with higher education levels are obese, compared to 20% of those with lower education. Health inequalities are largely due to differences in exposure to health risk factors such as tobacco, alcohol and unhealthy diet, but also disparities in access to high quality care. For instance, tobacco consumption is the largest avoidable health risk and most significant cause of premature death in the EU.
These behaviours are preventable, which is why we need a new way of thinking about prevention as a key strategy for good health. We need to prioritize prevention, thus reducing the prevalence and postponing the onset of chronic diseases, diminishing health inequalities, and improving timely access to good quality care, particularly for disadvantaged groups. By prevention I do not mean simply awareness raising campaigns. We know that those are not particularly effective alone, for example in the cases of tobacco, alcohol harm and obesity. For instance, even though the risks of smoking are well publicised nowadays and widely known, nearly one third of young people still smoke today.
The most effective strategy is in fact reducing or eliminating marketing for unhealthy products and reducing accessibility. This is mostly in the hands of national governments.
It is clear that gaps in access to healthcare require a closer look and policies can bridge them only if their distribution across Europe and within countries is well identified and understood. The Expert Panel opinion on benchmarking access to healthcare that we published last year provides a self-assessment tool that can be used by Member States to get a more complete picture of challenges in access to healthcare.
What policies are you advancing most fervently during your term as Commissioner for Health and Food Safety?
As Commissioner for Health and Food Safety, I firmly believe that the health of all Europeans is the responsibility of every one of us. This is why I have always advocated that health must be integrated into policies in all sectors, in a “health in all policies” approach. Health determinants are cross-cutting issues, so it is only by adopting a holistic approach that we can successfully improve population health and health equity. For example, as the Health at a Glance: Europe 2018 report shows, life expectancy for people with lower education levels is 6 years less than those with higher levels. And chronic non-communicable diseases, which are generally caused by preventable lifestyle risk factors, tend to affect the most disadvantaged groups of society the most. I am convinced that a paradigm shift towards prevention of disease rather than treatment is necessary to reduce health inequalities, improve efficiency of healthcare systems and create a healthier society as a whole.
Antimicrobial resistance (AMR) is another area where I have focussed strongly during my time as Commissioner. If AMR is left unchecked, the effects will be catastrophic. Currently, 33 000 people die every year from infections due to antibiotic-resistant bacteria, showing the huge scope of this problem. This is why we adopted the One Health Action Plan, which recognises the intrinsic link between public health, animal health and the environment when it comes to AMR. The Veterinary Medicines Package, which regulates the use of antimicrobials in agriculture, is an integral component. The fight against AMR also highlights the need to include health in all sectors.
Throughout my term, I have also made fighting food waste one of my top priorities. We have done much in this regard, with the creation of the EU Food Waste Platform, revised waste legislation including specific measures on preventing food waste, new guidelines on food donation, and looking at ways to improve date marking, to name just a few. In order to reach the Sustainable Development Goal of halving food waste by 2030, we need to continue to amplify these efforts at every level of the food production and consumption chain.
Of course, this is only a tiny flavour of the many priorities I have advanced fervently during my term. Overall, I do believe the most important role of the European Commission is to strengthen collaboration and pool our expertise in the aim of improving the health of all of our citizens. For example, the European Reference Networks (ERNs) do just this, by linking specialists around the EU and giving people with rare diseases the diagnosis and treatment they might not otherwise have access to.
How do these tie into the broader UN Sustainable Development Goals for Europe and more globally?
The Sustainable Development Goals (SDGs) were adopted by the UN in 2015, with the aim of giving us tangible aims towards achieving a more sustainable future. Health is clearly an integral part of sustainability and is enshrined in SDG3: “ensure healthy lives and promote well-being for all at all ages”. The European Commission is fully committed to delivering on the SDGs, as shown by the recent Sustainable Development in the EU 2018 report, which I am proud to say shows that we have in fact made the most significant progress in SDG3.
In terms of food waste, the aim is to “halve food waste at the retail and consumer levels and reduce food losses along production and supply chains”. The revised waste legislation adopted in May 2018 marked an important milestone, because it laid out new rules on food waste prevention programmes, as well as monitoring and reporting of food waste. Monitoring and measuring waste is indeed a vital step, as it allows us to accurately see how much progress we will make with these steps in place.
The shift towards a focus on disease prevention over treatment is also key if we want to achieve the goal of reducing the number of deaths from non-communicable diseases. Not only do prevention strategies prolong lives, they are also cost-effective and make healthcare systems more sustainable by reducing unnecessary costs. A focus on tobacco, alcohol consumption and obesity, the three main preventable risk factors that cause chronic diseases, is especially important. And of course, because children are our future, if we want to make lasting progress in the SDGs, we must focus on them in all our strategies.
The most important thing to remember is that diseases do not respect borders. This is particularly true for antimicrobial resistance (AMR), with new resistance mechanisms emerging and spreading around the world at an incredible pace. Around 10 million deaths are projected worldwide between 2015 and 2050, if the current trends continue. The One Health Action Plan casts a wide net to tackle AMR, bringing in animal health, the environment, as well as human health. It also aims to actively promote global action and give the EU a leading role in the worldwide fight against AMR. To this end, for example, the Commission has started hosting regional workshops on AMR around the world, to strengthen global cooperation on this issue, and make tangible effects around the world.