Intended for healthcare professionals


The implications for health of European Union enlargement

BMJ 2004; 328 doi: (Published 29 April 2004) Cite this as: BMJ 2004;328:1025
  1. Martin McKee, professor of European public health (,
  2. Ellen Nolte, lecturer in public health
  1. European Observatory on Health Care Systems, London School of Hygiene and Tropical Medicine, London WC1E 7HT

    Challenges and opportunities lie ahead

    The European Union has come a long way from its beginnings in 1957 when six countries signed the Treaty of Rome, committing themselves “to lay the foundations of an ever closer union among the peoples of Europe.”1 This aspiration has become reality. The original grouping has widened progressively, to include most of western Europe. It has also deepened, extending beyond coal and steel production to an entity with its own flag, foreign policy, currency, and laws that impinge on almost all areas of daily life. On 1 May 2004 the European Union will undergo the latest stage in its evolution over the years as 10 new countries join it. What impact will this enlargement have on health and health policy?

    Although this is only the latest of a series of enlargements, this one is very different from those that have gone before. The most obvious difference is its scale. Earlier enlargements added between one and three countries; this one brings 10, increasing the European Union's surface area by 34% and its population by 28%. A second difference is the …

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