Future of public health policy

PURPOSE: to present a possible plan for the development of public health policy in the European Community. CONTENT: This communication first considers a number of developments in health status and health systems in the Community, as well as principles and pre-requisites of public health action at Community level. These considerations lead to the conclusion that, although the principles and underlying philosophy of the 1993 communication on the framework for action in the field of public health remain valid, priorities, structures and methods are all in need of fundamental review and reformulation. The communication outlines a possible new Community public health policy, based upon three strands of action: 1) improving information for the development of public health: building on the current programme on health monitoring, the Commission proposes the development of a structured and comprehensive Community system for collecting, analysing and disseminating information on health status (trends and patterns of demography, morbidity and mortality, and of major health determinants, inequalities in health, socio-economic factors) and health systems (the impact of trends in health status on health systems, developments in health systems and their costs and financing, the role of the health sector as a productive factor in society and priorities in health). The aim of this system would be to promote and bring together activities in the Member States in these fields and pool expertise via appropriate networks. The outputs of the system would be linked to the development and implementation of Member States' policy; 2) reacting rapidly to threats to health: this involves the creation of coordination mechanisms at Community level for the surveillance, early warning of and rapid reaction to outbreaks of certain diseases. These mechanisms could help Member States to control outbreaks and deal appropriately with sanitary health hazards. Actions to be undertaken would include surveillance, swift analysis and investigation of specific problems or issues, including site visits, if appropriate. The subject matter of this strand of action could be extended beyond communicable and rare diseases to cover health requirements on food safety issues, phytosanitary and veterinary matters, zoonoses, blood and organ safety, environmental hazards, risks to health from chemical substances and poisoning and adverse effects of medicinal products and devices; 3) tackling health determinants through health promotion and disease prevention: this will give consideration to the following: covering conditions which are increasingly affecting the ageing population, notably Alzheimer's and other mental disorders, increasing work on nutrition and obesity and cardiovascular diseases, reducing drugs-related health damage, focussing more on the health of specific population groups, assuring access to health information and health advice for Community citizens moving to other Member States and adapting to the specific problems of accession countries. The Commission intends to come forward with concrete proposals on the new policy once the Treaty of Amsterdam has been ratified. There are two possible ways to formalise the newpolicy: - either to adopt a single "framework instrument" providing for the subsequent adoption of separate ones for each strand. This would involve the creation of a single financial envelope and two layers of decision-making and administrative structures; - or to adopt a separate legal instrument for each strand with no overall instrument which would need an implicit consensus on the funds to be allocated to each. The Commission considers that there should be scope for the introduction of binding provisions governing, for example, the collection of data, once the networks and other structures envisaged are fully in place. Under the new Article 152 of the Amsterdam Treaty, the Community could also adopt binding instruments on harmonisation. In the meantime, the Commission hopes that the ideas presented in this Communication will stimulate a broad debate.�