Check against delivery.
Ladies and Gentlemen,
First of all, let me thank each and every one of you for taking the time to come here today to attend this meeting. I also want to thank those of you who are following us online. I invite all of you to take part of the debate on twitter.
I am delighted to have this opportunity – to discuss with you on the questions related to chronic diseases.
I am particularly glad to see the present and future European Union Presidencies here - the Netherlands, the Slovak Republic and Malta. Your role is essential in steering our work, and in helping to coordinate cooperation. I hope that public health and risk factors management will stay on the Presidencies' agendas at least until the end of my mandate and hopefully way beyond.
I am also pleased to welcome representatives from key international organisations and from civil society, in particular patient representatives and health professionals.
We will discuss how we can best work together to deliver meaningful results; underpinning and enhancing Member States' efforts.
I would like to recall that all Member States are all bind by the Treaty where we enshrined the principle of guarantee of a high level of health protection for European citizens in all of the European Union policies and activities.
I keep on repeating that I am not the commissioner for Sickness, I am the commissioner for Health. But what is health? What is the definition of health?
I am asking this question at every dialogue with citizens in every Member State. The answers vary, depending on the public, on the country, but if I sum it up – in common understanding health is almost always treated as opposition of disease.
"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity."
'Health in all policy sectors' is therefore not just an empty wording. It must be integrated into all policies: educational, social, environmental, fiscal etc.
When we look at the set of instruments that can be used for the fight against risk factors we will see that a lot of them are in the hands of different political levels and sectors. This is why only coordination and cooperation can bring added value.
I often hear – 'health is in the hands of member states' or 'commissioner, please remember the subsidiarity principle'. But public health and non-communicable diseases are way broader issue.
Let me give you a few examples of rules at the European level that affect public health: tobacco directive, minimal excise duty, audio-visual directive as it involves tobacco advertisement…I am not even mentioning food related policies.
For me, public health is a European issue and the best results can only be achieved through cooperation.
Now how do we keep our citizens in good health?
I have been defending since the beginning of my mandate (and before) the thesis which consists of the following:
If we want to keep people healthy for as long as possible we need to focus on three Ps: Prevention, promotion and protection.
- Promoting good health – through healthy eating, exercise, healthy living and working conditions.
- Protecting citizens – by ensuring safety at work, on roads, or elsewhere.
- And of course - preventing disease - tackling all the risk factors.
I reiterate my views - which sometimes come across as harsh, when I speak to journalists or citizens in general – most of the healthcare costs are created by the industry that earn money from risk factors: in particular tobacco and alcohol, but also unhealthy food.
It is no secret that many chronic diseases are the result of this invisible hand that take away health and eventually lives of our family members, friends, neighbours or colleagues when they smoke, abuse of alcohol, eat unhealthy food, don’t exercise.
Most often these are the most vulnerable groups that are on the first line, those who suffer the most, not being able to afford recreational activities or healthier lunch option.
This is why the role of public health specialists is very important. If they have a good overview of where the issues arise and are able to work in coordinated manner with a number of sectors, using appropriate instruments and measures, they can create programmes that allow reducing risk factors that affect healthy people and hence reducing non-communicable diseases.
The instruments and measures are known and their efficiency has been proven, to help us address the risk factors. You can see them on this slide - taxation, marketing, others. Some of these do not cost anything and can deliver incredible results.
Allow me to highlight just a few pertinent examples and illustrate why both 'preventing' and 'addressing' some diseases are important:
In Europe half of all adults are overweight or obese and one third of all children are obese – and therefore at risk of developing type 2 diabetes or cardiovascular diseases.
The costs related to obesity are rising and – as the OECD points out – already account for 2 to 3 per cent of healthcare budget spending.
Earlier this month, the WHO released new figures showing that diabetes has quadrupled since nineteen eighty (1980) and now stands at four hundred twenty two (422) million worldwide and thirty two (32) million in Europe alone.
Obesity is one of the major factors for developing diabetes of type two which is mostly preventable. What are we doing on the EU level and where is our added-value?
- We work on food reformulation and this thanks to the Dutch Presidency
- I continue working on nutrient profiles which are currently under REFIT
- I am pushing for setting legal limit on trans-fatty acids from the products
- we have milk and fruit and vegetable schemes for Schools.
These are just a few examples.
Now another area which is an enormous risk factors for developing chronic diseases: tobacco.
Tobacco kills prematurely 700,000 Europeans every year. EU countries spend over 25 billion euros a year to treat their citizens for diseases caused by tobacco. And most smokers start early by age 17.
The case for acting on tobacco is clear. Just think of all the human suffering and economic costs we could avoid if people stopped smoking!
Here again, EU-wide action has added value. On the twentieth of May the EU Tobacco directive becomes law. It contains a set of measures that will help reduce smoking.
On the thirty first we will celebrate World no-tobacco day. I hope on you to spread the message about the dangers of tobacco on that and other days of course.
Ladies and gentlemen, colleagues, like-minded friends,
We all know that the impact of chronic diseases can be greatly reduced if diseases are diagnosed early and managed within an integrated approach. Indeed, we need to overcome the fragmentation and isolation of prevention, diagnosis, treatment and care.
For example, it makes little sense to discuss alcohol abuse or poor diets as separate issues independent from the diseases these determinants provoke.
This is why I am calling for evidence based prevention, and comprehensive and integrated treatment and care that make the best use of available funds.
I am a pragmatic person, a realist – I know that these are not in hands of the Health Commissioner, not the Health Ministers alone. To implement these instruments, we need co-ordinated engagement of many policy makers.
By the way, I therefore particularly welcome colleagues from other services within the Commission. I am hopeful that this shows that the momentum has come for understanding that fighting for good health and against chronic diseases is a multi-sectorial battle.
We have all committed ourselves to prolonging the expected healthy lives of our citizens by two years by 2020. We are obsessed with healthcare budgets and spending. Health is most often seen or presented as a cost factor – a negative element – in public budgets. Let me be clear – our job is to address the roots of the problem.
People will live longer, morbidity will rise, medicines will not always be available and affordable, and therefore there is no other way than the one which ensures good health for longer.
Good health opens doors to better productivity, less absenteeism, less pressure on health budgets, more prosperity and better quality of life.
If we can hammer home this message together, across the 28 member states, we have a chance of being heard.
Chronic diseases already account for up to 80% of European healthcare budgets so the prize, even of modest progress, would be nothing short of enormous.
If I may schematise – I see three main aspects on how to advance in preventing and addressing chronic diseases:
- first, acting on factors preventing healthy people to fall into the traps of illness by acting on risk factors. I already talked about it, this is the role of all policy makers and public health specialists.
- second, developing lifestyle medicines and adopting proper monitoring that help people with disorders or 'manageable' diseases to live better lives.
- and third, ensuring efficient and functional healthcare systems that provide treatment and care needed by those who suffer from chronic diseases with treatment and care.
The EU has many instruments in place to support these processes, such as the investment plan of President Juncker, or research and economic support programmes. I urge Member States to make full use of these opportunities.
In this perspective, we will discuss today several angles to streamline action in support of a more efficient response to chronic diseases and efforts towards reaching the voluntary WHO and UN targets.
This includes reinforced cooperation with the WHO on the development of a new Action Plan for Non-Communicable Diseases for Europe; as well as monitoring and evaluation of progress made.
Let me highlight three further areas where I believe we need to pursue efforts:
First we need to look into helping Member States to shape and implementing comprehensive national plans or strategies to prevent risk factors, keep people healthy and address chronic diseases.
Such plans should be based on concrete measures, adequate budgets and the means to monitor progress.
The work of DG SANTE on country specific analysis will help to design tailored policies with high EU added value. We are working on reports outlining 'State of Health' in the EU and Member States in close cooperation with OECD.
Second, we are reviewing the contribution that relevant groups and networks can deliver to this process.
In this regard, I am pleased to announce the launch, today, of the “Health Policy Platform”. This Platform will provide a forum to exchange information on key health issues such as risk factors, health determinants, chronic and also rare diseases.
Third, I intend to enhance closer cooperation of Member States through the Health Programme.
We need to look into the financing of pilot projects – bringing together all Member States or clusters of like-minded states facing the same problems – for example on alcohol, on tobacco control, on sugar reduction. My aim is to help deliver concrete results on the ground.
This year's work plan of the Health Programme dedicates no less than 7.5 million to support actions on chronic diseases.
The Programme has been co-financing action in this area for a while. For example, the project on “Economics of Chronic Diseases” developed a computer model to test the cost-effectiveness of prevention, screening and treatment on the cost of chronic diseases. It found that significant health and economic gains can be achieved with even small reductions in obesity.
And last but not least, I am pushing for more eHealth, mHealth and telemedicine. We are living in the twenty first century – these must be at the top of our lists of tools for health promotion and fight against chronic disease. Obviously these tools must be accessible to all citizens. Reducing inequalities is a necessary part of this process.
Ladies and Gentlemen,
I spoke of three Ps. There is the fourth one – Participation. I count on your contribution. I count on you to help me spread the message that we have to be stronger on prevention, on addressing risk factors, on keeping citizens healthy.
So let us mobilise Member States, Presidencies, patients groups, health professionals and all stakeholders to build a solid and committed alliance to better prevent and manage chronic diseases.