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Table 4 Summary of public health relevant EU-level actions and their perception as achievement, failure or missed opportunity

From: Twentieth anniversary of the European Union health mandate: taking stock of perceived achievements, failures and missed opportunities – a qualitative study

Topics Achievement Missed opportunity Failure
Treaty Inclusion of the health mandate as enshrined in Article 129 of the Treaty of the European Union. Missing implementation of a connection/share of power between economic and social EU policy.  
Directorate general for health and consumers (DG SANCO) Existence and persistence of DG SANCO. DG SANCO is not strong enough to push health in other DGs. DG SANCO set-up: Missing link to social policy.
Public health programme. Public health did not become a key aspect of EU policy.
Sustainability development strategy: DG SANCO is not playing an active role in the marketing of the strategy.
Cooperation Cooperation between EU, WHO and OECD. Missing connection and joint forces between EC and WHO.  
EC agencies Development of agencies: ECDC, EFSA, EMA, EMCDDA.   
ECDC Legislation on infectious disease control. ECDC mandate should include responsibilities in risk management of infectious diseases.  
European Programme for Intervention Epidemiology Training (EPIET). ECDC profile should cover also non-communicable diseases and SDoH.
EMA Coordination of the approval of efficacy, safety and quality of drugs. Cost-effectiveness of pharmaceuticals is not taken into account. Problem of not being able to tackle pharmaceutical pricing.
Reversal of the approval of already approved drugs not handled on EU-level.
EFSA Control of health claims of food products. EFSA mandate should include/be stronger on health promotion aspects of nutrition (e.g. regulation of advertisement of unhealthy food products).  
Food safety Directive.  
Health in All Policies (HiAP) approach Health mandate assures that health protection should be guaranteed in all EU policies. HiAP and Health Impact Assessment have never been implemented fully (tick box exercise).  
Leads to the discussion of health in other sectors.  
Lifestyle factors Common tobacco legislations in Europe (WHO Framework Convention of Tobacco Control; tobacco product-; tobacco advertising Directive). The tobacco regulations could have been designed stronger (e.g. more harmonized realisation of smoking prohibition on public places). Tobacco regulation has some aspects of failure since a strict, general ban is not reached.
Food safety measures and regulations on health claims. Missing political will to tackle obesity and related life style factors like unhealthy food products.  
Health Research Programme EU health research budget and outcomes of the programme.   Missing integration of the research programme and EU health research outcomes in public health.
EU budget Largest budget proportion shifted in the Multiannual Financial Framework 2007–2013 from agriculture financing to the funding of cohesion and sustainable growth policies.   
Health research budget.
The use of Structural Funds for investments in health (2007–2013).
Internal market provisions   Internal market rules as source for legislation should be more attentive to health concerns. Internal market provisions cause problems if member state regulation is more protective regarding health threats than EU regulation.
Patients’ rights directive The patients’ rights Directive in general. Negotiations on patients’ rights Directive failed to include a strong emphasis on the development of common standards.  
Effect on cross-border cooperation.
Gives legal certainty to policy makers.
Common Agriculture Policy Policy field which starts to recognize health, e.g. in its white paper on the CAP after 2013 (2009/2236(INI)). Unrecognized potential for health of the CAP by public health sector.  
Health information Health life years as indicator in the Lisbon strategy.   Missing health information system.
Lack of morbidity data.
Different public health topics    
health inequalities EC communication: solidarity in health: reducing health inequalities in the EU.   
HTA Strengthening of the HTA approach in the EU. Coordinating cross-country level health technology assessments.  
Rare diseases Coordinated management of rare diseases.   
Tuberculosis    Existing drug resistance of tuberculosis as indicator for lacking disease management.
Health of minorities Health of minorities (e.g. Roma) as part of the European agenda.   
Social care   Social care is hardly seen as EU competence.  
Environment (and health) Environmental standards set by the EU. Missing follow-up process on the Environment and Health Action Plan (2004–2010).  
Information to patients Blocking of direct to consumer advertising of prescription-only pharmaceuticals.   
Governmental issues White paper on governance (2001) increased transparency.   
More standardisation of methods (evaluation of indicators, outcomes, policies) and common language.
Increased understanding of the public health community about the impact of EU policies on public health.
Industry involvement    Cooperation with industry influences the health research agenda and policy-making.
Evidence-based policy-making: the interest of the industry is against public health.
  1. ECDC: European Centre for Disease Prevention and Control.
  2. EFSA: European Food Safety Authority.
  3. EMA: European Medicines Agency.
  4. EMCDDA: European Monitoring Centre for Drugs and Drug Addiction.
  5. HTA: Health Technology Assessment.
  6. DG: Directorate General.
  7. SDoH: Social Determinants of Health.
  8. EC: European Commission.
  9. OECD: Organization for Economic Cooperation and Development.
  10. WHO: World Health Organization.