Intended for healthcare professionals


A new European health strategy

BMJ 2000; 321 doi: (Published 01 July 2000) Cite this as: BMJ 2000;321:6

Offers many opportunities, but can it be implemented?

  1. Elias Mossialos, director,
  2. Martin McKee, professor of European public health
  1. LSE Health, London School of Economics and Political Science, London WC2A 2AE
  2. London School of Hygiene and tropical Medicine, London WC1E 7HT

    The relation between the United Kingdom and the European Union continues to divide both of Britain's main political parties. The major controversy is whether or not Britain should join the single European currency, but the economic debate hides a deeper concern about national sovereignty and, in particular, the extent to which “Europe” can decide policy that is binding in the United Kingdom. A lack of understanding of the nature and scope of European law has provided a fertile ground for fantastic speculation about what the European Commission would or would not like to do.1 Health policy has been especially vulnerable to misinterpretation, in part because the decision making process is especially complicated.

    Firstly, although Romano Prodi, the president of the commission, has created a directorate for health and consumer protection, with primary responsibility for health matters, many public health responsibilities continue to be scattered among other directorates. Secondly, although the union has had the power to act in the field of health since at least the Maastricht Treaty, many directives with implications for health arise from developments related to the single market. A notable example is the ban on tobacco advertising, which the European Court seems likely to rule as unlawful precisely because it was enacted on grounds of internal market harmonisation rather than public health.2

    A major problem has been the union's restricted definition of public health, which is limited to specified areas such as “prevention,” “major health scourges,” and “drug dependence.”3 Thus, union programmes have adopted a medicalised model, focusing on specific diseases such as cancer, AIDS, and Alzheimer's disease. This is politically attractive but not especially effective in its execution.4 In particular, previous European health policies have been criticised for their failure to address broader determinants of health and to adopt an intersectoral approach to tackling them. A second criticism has been the absence of any serious consideration of the contribution to health of health services

    Against this background the new European health strategy5 should be welcomed. If adopted by the European Parliament and the Council of Ministers it will go some way to meeting the earlier criticisms.

    The proposed strategy has three main strands: improving information and knowledge; responding rapidly to health threats; and addressing health determinants. These will have implications for those responsible for health at a population level. A high priority will be enhancing data collection and health reporting across Europe, and the strategy envisages improvements in arrangements for managing cross border outbreaks of infectious disease.

    The strategy will, however, also have consequences for those delivering clinical care. Here, a key element will be the creation of a series of networks that will build on best practice to review and disseminate information on the effectiveness of health technologies, cost effectiveness of pharmaceuticals, clinical guidelines, and quality of care. These networks will create opportunities, as these activities have so far developed unevenly across Europe. They will also bring challenges, especially for countries with functioning systems. How, for example, would a network deal with a situation in which two network members, such as the National Institute for Clinical Excellence in Britain and its equivalent in another country, made different recommendations on, for example, the effectiveness of interferon beta?

    The communication also foresees a change in the decision making process, which has previously been both complex and opaque. For the first time, it identifies the need to involve a wide range of interests in developing European policy, encompassing representatives of patients and health professionals.

    The commission has embarked on an ambitious and challenging programme which, if supported by the parliament and member states, will significantly enhance the involvement of Europe in delivering health services. It will make it much easier for health professionals to learn from best practice and avoid institutional duplication. It will also provide many opportunities for the United Kingdom, with its pioneering initiatives such as NICE and the Commission for Health Improvement, to influence the European agenda. The one major concern is how the commission, with very few public health professionals, will be able to implement such an important programme.


    Both authors have received funding from European Union research projects.


    1. 1.
    2. 2.
    3. 3.
    4. 4.
    5. 5.
    View Abstract