Interview with Vytenis Andriukaitis: Health in all policies will address inequality and contribute to smart, sustainable growth

3rd June 2015

As he looks forward to the Riga Health Conference, Vytenis Andriukaitis, European Commissioner for Health and Food Safety, outlines in this interview how the European Commission will support member states in their efforts to ensure universal access to healthcare

Question: The Vilnius Declaration of December 2013 is an important legacy of the Lithuanian Presidency of the EU. As your country’s Health Minister then, and now as EU Health Commissioner, you have made clear your commitment to respond to the call for action in the Vilnius Declaration.

First, the big picture: how will the philosophy and approach of the Juncker Commission help to drive forward measures to bridge inequalities in healthcare, outcomes and life expectancy that exist within and between member states and bring the Vilnius Declaration to life?

Answer: The Juncker Commission has committed itself to be “bigger on big things and smaller on small things”. Under the new approach, one of my key tasks is to ensure that the Commission’s activities contribute to improving the health of our citizens. As health is cross-cutting by nature and contributes to smart, sustainable and inclusive growth and reducing poverty – I must see to it that health is considered in all policies.

When it comes to health inequalities, a “health in all policies” approach is especially important. Housing, education and employment policies, together with universal access to high quality healthcare, all need to be addressed.

It is unacceptable that in some Member States a 30-year old man with a low level of education has a life expectancy up to 17 years lower than a person with a university education. Here, the Commission can help by co-funding projects and programmes in the Member States, through the European Structural and Investment Funds, for example.

Another dimension to consider is that chronic diseases account for 4/5ths of human suffering and health costs in our societies. And most of these are lifestyle-related and preventable. In other words: our attention does not always seem to be focused on the big things. The fact that prevention accounts for less than three percent of health spending illustrates this. If we focus on prevention by addressing risk factors like nutrition and physical activity, alcohol and tobacco, we can go a long way towards reducing chronic diseases. That said, early detection and management of diseases we cannot prevent is also extremely important.

Question: What progress do you think has been made in the three key areas for action in the Vilnius Declaration to date, and what new initiatives would you like to see in each area?

1. Investing in cost-effective health promotion and disease prevention?

Answer: In health promotion – one of my key priorities – the revised Tobacco Products Directive adopted last year is a major success. After all, smoking is the biggest avoidable cause of death in Europe, responsible for around 700,000 deaths per year. We are now working with Member States to ensure effective and timely implementation of this Directive.

I am also pleased that European Action plans to reduce childhood obesity as well as youth and binge drinking have been endorsed by the Member States since the Vilnius Declaration. I am further encouraged that at the recent informal meeting of Health Ministers in Riga Member States strongly supported European action to reduce alcohol-related harm.

In terms of concrete improvements to prevent chronic diseases, my intention is to put forward a framework of action to address all the risk factors of chronic diseases, encompassing alcohol, tobacco, nutrition and physical activity. It is important that all stakeholders including policy makers, experts, NGOs, parliaments, participate in such a framework.

2. Ensuring universal access to high quality health services?

As recommended in the Vilnius declaration, a partnership approach to ensure universal access to high quality people-centred health services has been promoted. A stakeholder partnership has been fostered by patients’ associations and has been working to find solutions to improve equity in access to healthcare. A MEP interest group on access to healthcare has been created in the European Parliament to help ensure issues relating to access to healthcare will feature high on the EU agenda.

These are encouraging signs and the Commission has been working actively within these initiatives to improve access to healthcare across the EU. We however still need to reflect on ways to cooperate together to increase patient’s access to innovative medicines as well as foster the discussion on increasing pricing transparency.

3. Ensuring health system reforms are evidence-based and focussed on cost effectiveness?

Health system reforms are primarily tasks for Member States. However, the Commission is increasingly providing support and coordination, while always recognising Member States’ competence in the field.

To ensure that health system reforms are evidence-based and focused on cost effectiveness, the Commission may, in close contact with the Member States, establish indicators, organise the exchange of best practice, and prepare the necessary elements for periodic monitoring and evaluation.

In this regard, the Commission has been promoting Health System Performance Assessment and has recently set up an Expert Group on Health System Performance Assessment. This work is complemented by studies and research co-financed by the Health Programme and the Expert panel that provides advice inter alia on effective ways of investing in health. I would also attach great importance to increasing cooperation on Health Technology Assessment. This would ensure the development of the best possible innovation in a cost effective way.

Question: What do you see as the key measures that can be taken at an EU level to give citizens a meaningful role in promoting efficiency and sustainability and ensuring equitable access to healthcare?

Answer: EU citizens need clear information on access to healthcare, the performance of the healthcare system, and on their rights and entitlements. A citizen without clear, relevant and reliable information cannot have a meaningful role in promoting efficiency and sustainability and ensuring equitable access to healthcare. Making the right information available to citizens and to policy makers is a task in which all stakeholders must focus in the coming years.

Question: How can the objectives set by the Vilnius Declaration contribute to the important mission of translating national and EU investment in medical research into innovations that both boost the economy and deliver improvements in healthcare?

Answer: The Vilnius Declaration encouraged a partnership approach between all stakeholders in the health sector at national and European levels to deliver improvements in health care. A key example of how this is being achieved at European level is through the Health Technology Assessment (HTA) Network, a voluntary network which gathers all Member States, Norway and Iceland, and aims to support cooperation between national authorities or bodies responsible for HTA. European cooperation on HTA will promote innovation and accelerate the availability and take up of new and cost-effective solutions.

Question: What role do you see for digital technologies in delivering on the Vilnius Declaration? What part can the Digital Single Market play here?

Answer: Digital technologies such as eHealth and mHealth can contribute to health promotion, universal access to health services, patient empowerment and the sustainability of health systems.

Under the Cross-border healthcare Directive, the Commission established the eHealth Network. Through this initiative, the Commission and national authorities responsible for eHealth in EU countries are working together to harness the sustainable economic and social benefits of eHealth systems and services, and ensure their interoperability.

The Digital Single Market will ensure sectorial interoperability and standards in areas including telemedicine and mHealth which will enable the provision of high quality, reliable eHealth services. Another benefit of the Digital Single Market is its capacity to provide sufficient infrastructure to allow digital technologies to be used widely across the EU without difficulty.

Question: What can be done at an EU level to give member states the tools to assess the relative performance and drive up the quality of their healthcare systems, to ensure good quality healthcare for all citizens now and in the future?

Answer: The Commission helps Member States to assess the performance of their health systems in two ways: 1) by supporting the development of an EU health information system, with comparable and reliable indicators, and 2) by facilitating the exchange of best practice and identifying tools and methodologies for health systems performance assessment to support policy makers. The Commission is working with Member States to identify ways to assess quality of healthcare, and to help policy makers identify effective actions to improve the quality of care for patients. I expect some interesting findings identified by the Expert Group on Health System Performance Assessment already by the end of this year.

Question: You have previously expressed your commitment to health in all policies. How do you see this promoting the objectives of the Vilnius Declaration and what actions are you taking to enshrine health in initiatives across the Commission?

Answer: The objectives of the Vilnius Declaration – investment in health promotion and prevention, universal access to people-centred health services, health systems reforms focusing on cost-effectiveness, sustainability and good governance – cannot be achieved without a clear commitment and contribution from various players in a wide range of policy areas.

Health is cross-cutting by nature and contributes to smart, sustainable and inclusive growth – and therefore I am working closely with my fellow Commissioners to enshrine health concerns in all policies. The examples are many, in environment for example, on exposure to environmental risk factors including air and water pollution, noise, electro-magnetic fields, extreme weather conditions, carcinogens, emerging diseases and climate change. All these have an impact on human health.

In education, improving health literacy and the ability for example to choose healthy diet and follow a healthy lifestyle, have huge health benefits. You can find other examples in research, transport and many other areas. Health concerns us all and it is my job to make sure that everyone is concerned by it.

Question: The Riga Conference on Universal Health will mark the end of the Latvian Presidency of the EU, the first of ten Presidencies you will be involved in during your tenure as Commissioner. What outcomes would you like to see handed over to the Luxembourg Presidency to maintain the momentum of the Vilnius Declaration and what is your vision vis-à-vis the Declaration for the next four and a half years?

Answer: The Vilnius Declaration already reflects many of the priorities for my term, and I expect it will remain one of the main reference points when we discuss the future of our health systems.

I expect the Riga event to take the Vilnius Declaration a step further and contribute to the paradigm shift we need in health policy and in the way we finance, organise and operate our health systems – with a very strong focus on disease prevention, health promotion, efficiency, accessibility and patient-centeredness. This conference can also set the tone for discussions in Brussels and in the Member States on how best to ensure the access to innovative medicines and treatments for all patients.

Finally, I hope the Riga event will inspire the participation of stakeholders in the years to come. Health is a matter of universal concern. Everyone needs to be involved and be engaged – from the largest institutions right down to each of us as individuals.