The Future of health care in Europe University College London 16 May 2011

1. The Future of health care in EuropeUniversity College London 16 May 2011 Michael Hübel European Commission DG Health and Consumers

2. Challenges Economic situation growing health gaps Citizens’ expectations Internationalisation of health care delivery

3. “Die Medizin ist eine soziale Wissenschaft, und die Politik ist nichts weiter als Medizin im Großen.“ Rudolf Virchow (1848) Health and social policy…

4. Defense 17th cent. on Consumer protection (Professional regulation ) 19th cent. Social Protection - 20th cent. Economic – 21st Cent Health care sector Labour force participation …and other policies T. Hobbes “The social contract” 1652

5. This role of the health care sector could become more important as life expectancy increases Oldest age at which at least 50 percent of a birth cohort projected to be still alive Source: Vaupel J et al – see also Christensen K, Doblhammer G, Rau R, Vaupel JW. Lancet. 2009 Oct 3;374(9696):1196-208.

6. Currently healthy life years are not increasing in line with life expectancy EU Healthy life years at birth, males - Eurostat

7. longstanding illness is a major issue for the working age population Prevalence of longstanding illness or disability EU 2008 Source EU SILC 2008

8. health problems are associated with early retirement and inactivity Source EU SILC 2008 Prevalence of longstanding illness EU 2008

9. Main causes of illness and disability * Disease burden in the WHO-EURO Region, Projections for 2015. DALYs: Standard DALYs (3% discounting, age weights) - Baseline scenario. Source: WHO http://www.who.int/healthinfo/global_burden_disease/projections/en/index.html

10. Much is preventable… % of deaths caused by key risk factors Source: Global health risks: mortality and disease attributable to selected health risks. WHO 2009, table 1 – high income countries

11. EU role? - General Principles for EU action on health • EU Treaty • public health (168) • other policies in health– eg internal market, health and safety at work • EU Health Strategy 2008-2013 • Common values in health systems

12. A high level of human health protection shall be ensured in all policies Union action shall complement national policies be directed towards improving public health respect responsibilities of MS for the definition of their health policy and for the organisation and delivery of health services Encourage complementarily of health services in cross-border areas Commission to promote MS cooperation, guidelines, indicators, exchanging best practice EU Treaty – Article 168

13. EU Health Strategy – Shared values • Universality, access to good quality care, equity, solidarity • Health is the greatest wealth • Health in all policies • Global health Together for Health: A strategic Approach for the EU 2008-2013 COM (2007)630

14. Universality - no-one is barred access to health care; Solidarity – finance and management of health services ensures accessibility to all Equity - equal access according to need, regardless of ethnicity, gender, age, social status or ability to pay Council Conclusions - 2006 Common Values in Health Systems EPSCO Council 2 June 2006

15. Health largely determined by factors outside of health care services Need for action by a range of sectors across society Health in all policies approach

16. Free movement: travel and work within EU Professional qualifications Pharmaceuticals, medical devices Health and safety at work – working time Cross border health care Patient Safety EU Action on health care

17. Determinants approach Social and economic situation Environmental quality

18. EU Action on Health Determinants • Tobacco • Nutrition and physical activity • Alcohol and drugs • Mental health • Environment and health • Social determinants and health inequalities

19. Cancer Mental disorders, Alzheimers Cardiovascular disease Rare diseases … EU Disease Prevention

20. Communicable disease control Pandemic influenza Deliberate release Health threats

21. Health in the future: Europe 2020 • A smart, sustainable and inclusiveeconomy • 75% of the 20-64 year-olds to be employed • at least 20 million fewer people in or at risk of poverty and social exclusion • 3% of the EU's GDP (public and private combined) to be invested in R&D/innovation • greenhouse gas emissions 20% lower than 1990 • 20% of energy from renewables • 20% increase in energy efficiency • Reducing school drop-out rates below 10% • at least 40% of 30-34–year-olds completing third level education

22. 7 Flagship initiatives • Innovation Union - (including healthy and active ageing) • European platform against poverty and social exclusion (including health inequalities, and mental health) • Youth on the move • Resource-efficient Europe • An industrial policy for the globalisation era • An agenda for new skills and jobs • Digital Agenda for Europe

23. Health in Europe 2020: Innovation platform for healthy and active ageing • increase healthy life years by 2 years by 2020 • Innovation in health technology and health systems

24. “poor people should not have to suffer poor health” Health in Europe 2020: European platform against poverty and social exclusion John Dalli – Commissioner for Health and Consumer Policy

25. Challenges to health care sector • Health promotion and prevention • Strengthen cooperation with other sectors – social care, employment, education • Fair cost containment.

26. Preventable chronic diseases No diseases Risk factors Genetic predisposition Diseases Primary Prevention: Population Tertiary Prevention: Patients Nutrition Secondary Prevention: Risk groups Alcohol Drugs Cancer screening CVD …

27. Promotion/prevention/treatment Citizen/patient/professional Individual/societal Research/Innovation EU/national/local Public policy/stakeholders UN Summit September 2011 A reflection process on chronic diseases

28. Final reflections Breaking down barriers • a need for integration – society/sectors • New alliances • Empowerment – inequalities • EU role: support the process

29. Thank you!