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Ladies and gentlemen, good morning,
It is a pleasure to see so many of you here in my beloved Vilnius. You might not know, but the geographical centre of Europe is just a few kilometres away from here. I would say, therefore, that there is no better place that Vilnius to unite East and West, and not only in health.
I know that people here in Lithuania and also in some other ‘Eastern’ Europe countries feel the divide between east and west very profoundly, not only in health promotion but also when it comes to quality of goods or access to medicines. It has been 14 years since these countries joined the EU, but many in the Western parts still refer to them as ‘new member states’, helping to sustain that feeling of divide. Over the past four years this Commission has worked hard to make every citizen, no matter where they live, feel worthy and equal. In dual food quality for example, my colleague Vera Jourova and myself have invested a lot of effort to fight against double standards.
Now, health inequalities across Europe is a subject that I feel strongly about and I welcome any attempt to shine a light on this problem. Over my mandate I have invested a considerable amount of effort to this issue and I will tell more about them, but first, I want to start with the World Health Organisation's definition of health.
Health is "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity".
This is a definition that we should use as our baseline at all times.
For instance, this event is called ‘EU’s role in promoting health of Europeans beyond East & West’, but yesterday while reading my papers for today while travelling from Brussels to Vilnius, I witnessed, once again, a confusion that continues to persist around what ‘health promotion’ is. It is not about healthcare and access to medicine, it comes before that!
Let me illustrate:
Let’s look at life expectancy.
The good news is that on average, we live longer and in better health than ever before. However, huge gaps remain between genders, regions, education levels and so on.
For example, life expectancy in Lithuania, Latvia and Bulgaria stands at about 75 years.
This is explained by different levels of exposure to social inequalities and to health risks such as tobacco, alcohol and unhealthy diets. These gaps will remain or even widen if we maintain the same slow pace of investment in social and human capital, housing, education and health.
Therefore, my friends, health promotion and disease prevention is something other than healthcare.
Let’s not fool ourselves: there is no way we are going to compensate in healthcare with ageing population and rising multi-morbidity if we don’t make this paradigm shift and put health promotion and disease prevention in policies across all sectors.
Our State of Health cycle provides us with enough evidence to know exactly what we need to do. This initiative provides policy makers, interest groups and health practitioners with factual data and insights into health and health systems across Europe.
Member States can compare their situation with others and draw conclusions about what to improve and how.
For example, where in Europe are gains in life expectancy slowing down and why?
Or, how is mortality due to air pollution and extreme weather conditions changing across Europe?
There is a wealth of expertise and knowledge across Europe -- and we need to share this experience and learn from it in a way that benefits European citizens.
Ladies and gentlemen,
Everything that we have learned to date emphasises that health determinants are cross-cutting issues. Health is clearly not the sole responsibility of the healthcare and cure sector.
With this in mind, we urgently need to promote an integrated, “Health in All Policies” approach.
This means developing public policies across sectors and with various communities that consider the implications of all decisions on population health.
One real example is the 2017 Tartu Call for a Healthy Lifestyle - it aims to strengthen coordination across different policy areas – including health, sport and education. The EU roadmap addresses physical inactivity, a sedentary lifestyle and an unhealthy diet in young Europeans.
I am also proud to announce that our Pilot Project on Health Equity, which focused on health inequalities related to alcohol consumption, nutrition and physical activity in the EU, has been just finalised.
The project has produced a useful set of tools to support Member States and stakeholders in addressing inequalities.
There is also a new EU-financed initiative on health inequalities that started last June. This will help the 25 participating Member States address social determinants, facilitate information sharing and strengthen capacity to act for greater equity in health.
I want to stress that Member States do not need to tackle health determinants alone. Instead, this is very much a collaborative effort and I am determined that we support countries as much as possible.
For example, the Commission's 'Best Practice Portal' will identify the most effective interventions, which can be transferred between Member States or scaled-up.
So far, best practices on nutrition, physical activity and health inequalities are available. And I know the portal also lists an important Lithuanian intervention aiming to reduce the use and abuse of alcohol, tobacco and illicit drugs among young teenagers.
I am using the Health Programme to help Member States pilot good practices developed in other countries.
Let me inform you that my services are finalising the staff working document related to nutrient profiles and health claims. I know that this issue has been particularly dear to you Monique. I regret I never got to try that delicious cake.
In a similar vein, the new Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases also seeks to maximise joint efforts with Member States.
Ladies and gentlemen,
I would like to turn to topics you are going to discuss today: limited spending in health, lack of access to newer, expensive medicines and treatments and distrust in generics. Indeed, I agree with most of the issues that are raised in the joint document.
It is no breaking news: it is primarily the role of Member States to manage and ensure sustainability and accessibility, due to the link to core national competences, such as the organisation of health services.
But, despite that, the Commission, and in particular, DG SANTE has directly or indirectly contributed to the goal of reconciling continuous innovation and competitiveness of the sector with patient access and health system sustainability by carrying out a number of activities. Let me mention if just a few:
- Optimisation of implementation of legislation (e.g. ATMPs, paediatrics, obligations to mitigate risks of shortages), including the Safe and Timely Access to Medicines for Patients expert group (STAMP) as the "go-to" forum for stakeholder exchange,
- Facilitation of the implementation of the clinical trials Regulation by 2020,
- Evaluation of pharmaceutical legislation with a focus on simplification, innovation and access (e.g. orphan, paediatrics, pharmaceutical incentives),
- Cooperation with the EMA on matters related to early/continued access to authorised medicines,
- Supporting cooperation on reference pricing methods and the set-up by the Member States of guidelines to mitigate unintended negative effects of international price benchmarking rules on access to care (grant to Euripid),
- Contributing to the European Semester process, which assesses the performance of the health systems and the cost-effectiveness of pharmaceutical expenditure,
- Supporting Member States for fostering accessible and sustainable medicinal care through a grant to the OECD to conduct capacity building (negotiating power, managed entry agreement design, etc),
Let me also say a word on the Commission's Communication on the Digital Transformation of Health and Care, which is an important step that seeks to maximise the potential of digital innovations in healthcare.
For example, it aims to ensure patients' access to their data and foster person-centred care.
It considers actions in support of mobile health and telehealth that would also empower citizens to assume a more active role in their own healthcare and cure. This would increase accessibility, which is important if we want to reduce inequalities.
The Communication also wants to connect vast amounts of health data to advance research, prevention and personalised health and care.
Remember, it's not enough to create innovative technologies, products and solutions. In order to reduce inequalities, we have to ensure that these innovations are implemented, accessible and affordable to all citizens.
In this context, it is worth referencing the Commission’s legislative proposal to strengthen EU cooperation on Health Technology Assessment, which is currently discussed in both the Council and Parliament.
HTA provides decision-makers with solid, scientific assessments and helps Member States to identify high-quality medicines with real benefits for patients.
And it can be especially beneficial for lower income Member States where the health budget is often restricted and where innovative medicines often reach patients with a long delay compared to other EU countries. We expect that EU cooperation on HTA will help to accelerate the access to these medicines across the EU.
Ladies and gentlemen,
You play an important part in that movement and I look forward to a productive and forward-looking discussion.
Lastly, let me add once again that Lithuania is an excellent choice of location for this discussion. One hundred kilometres from here lies the University of Kaunas, which in 2016 launched the first Masters in lifestyle medicine in the European Union. A few years ago, here in Vilnius, I gave start to the European Reference Networks for rare diseases,yet another example of what we did to provide better access to therapies. The ERNs already have helped a number of people and I am looking forward to them developing into a bigger ecosystem.
To conclude, inequality is a a serious issue. I know that people feel and love it deeply. I believe that the Commission, myself and my services, do not differentiate between east west, south or north: we are doing what is in our power to offer people the same access. Ultimately, I must say, as a convinced European, we would gain more if we cooperate more, also in health, and this year will be very important for those who want more European cooperation: the votes we will sow in May will become fruits we will be picking up for the next 5 years.
Please vote and let’s do all we can to get ahead of disease and keep all European citizens as healthy as possible for as long as possible.