Does Europe matter - non-government point of view

Derek Rutherford Eurocare

Asking the question ‘Does Europe matter?’ will elicit differing responses, for the EU means different things to different people. Those, like myself, whose childhood and youth were fashioned and influenced by the immediate post war period of the mid forties and fifties, could clearly appreciate and accept the vision of the founding fathers “to keep the peace of Europe”.

Over the past 50 years we have moved on. We have a different generation of Europeans whose life experience are different from those of the founding fathers. Ask “Why Europe?” in the new Member States, generations brought up in a totally different political environment, often respond, “to maintain our security and protection”.

The economic success of European membership is often the common answer among people from member states that have experienced growth in their GDP’s and standard of living. However, in older member states, opinions reflected in referenda or public opinion polls reveal that the average person in the street is disconnected with Europe, viewing it as irrelevant or meddlesome.

For many, Europe has become the playing field of political and commercial elites.

How then do we get our fellow citizens “to embrace” Europe, to give to them a sense of ownership or partnership? For a new generation we need to challenge them with the global world - its social and political realities. A world where, the largest economies in the future, are forecast to be China, India and, of course, the United States. To meet such a challenge we need a healthy Europe and a healthy workforce.

In remarks to a Nuffield Trust and EPC meeting last year, Robert Madelin felt that “the overriding priority for the Commission had to be to put the individual back in touch with Europe” and went on to say “a field that affected all, such as health policy, might just be the way to achieve such a connection”.

When posing such a view, I wonder if the Director General had in mind Benjamin Disraeli’s observation: (one of the eminent British Prime Ministers of the 19th century). “The first consideration of a Minister should be the health of the people”.

He strongly objected to those who felt improvements in the social and work conditions of the people would undermine economic prosperity. Disraeli would have applauded Madelin’s view: “Health has to be seen as an economic factor in the Union: healthy life years are a factor in competitiveness”.

From its outset, fifteen years ago, Eurocare’s Charter emphasised that: “the EU can no longer remain solely an economic union, it must become a social community where the collective health interest takes precedence over individual economic interests.”

A major challenge for the public health community will be to succeed in ensuring that the drive towards less regulation, reducing red tape for business and competitiveness does not come at the expense of public health concerns.

The factor that changed the attitude of the British Trade Union Movement from being anti to pro EC was the European Social Model. A Model, which they felt was losing ground with the then economic decisions of the United Kingdom Government.

Public trust in NGO’s is far, far higher than that in politicians and commercial concerns. This factor makes us well placed to persuade public opinion to the relevance of Europe. Provided (and there is an important caveat) that European institutions ensure a level playing field for our voice in the shaping of policy. The example set by DG SANCO is good, but it would be helpful if other Commission Directorates followed suit.

The European Alcohol Policy Network developed by EUROCARE is a good example of the importance of the EU in social and health policy. All member states, candidate and associate countries are represented, covering NGO’s, Public Health Authorities and academia. It would do well for EU institutions to comply with Treaty obligations. The treaties maintain that the Union should:

“Contribute to the attainment of a high level of health protection” and that “Health protection requirements shall form a constituent part of the Community’s other policies”

Thus the Treaty recognises the impact that EU Council andCommission policies can have on health. But how far is the principle executed? Have sufficient resources been allocated in order to assess such decisions and their health implications?

It is worth noting that in the debate on excise duty in the nineties, the European Commission accepted the principle that taxes on alcohol had a public health dimension.

In the 1993 White Paper on ‘Growth, Competitiveness and Employment’ it stated: “An increase of excise duty on tobacco and alcohol provides a source of additional budget revenue and a means of preventing widespread social problems, and can help social security budgets to make savings by reducing the need to treat cancer and alcoholism”.

Having been asked to select one area in health that the EU should prioritise, it would have to be one of the five key health issues that the DG considers needs tackling. It would be a lifestyle related social and health problem that also impacts on health inequalities.

The one I have selected causes in the EU:

• 4 out of every 10 homicides - 2,000 per year

• Over 1 in 6 suicides - 10,000 per year

• 1 in 3 road traffic deaths 17,000 per year 10,000 of which are estimated to happen to ‘innocent’ victims

• 200,000 Unprotected sex incidents among 15/16 year olds

• 1 in 7 Child abuse/neglect cases

• After tobacco and high blood pressure it is the third highest risk factoring mortality and morbidity

Alcohol costs an estimated 125 billion Euros annually, almost half due to lost productivity. It contributes to health inequalities both between and within countries.

Alcohol plays a considerable role in the lowered life expectancy in the EU 10 compared with the EU15.

If it were any other substance, other than alcohol, there would certainly be demands for governmental action. However, with alcohol we are dealing with not just an irresistible pleasure but massive vested interest.

In 1979 a British Government Minister speaking to the AGM of the National Council on Alcoholism (of which at that time I was the Director) said that alcohol was a lifestyle problem and that dealing with lifestyle problems demanded ‘not incision at the surgeon’s table but decision at the cabinet table.’

The drinks industry responded very quickly to this perceived threat. Critical of what they considered to be the late and inadequate response of the tobacco industry to similar threats, they were determined to set the research agenda. The voice of the public health lobby had to be countered, but, if possible, also wooed.

There is no escaping the fact that there is a conflict of interest between the industry and public health.

It should come as no surprise that we face an alcohol epidemic throughout Europe. An epidemic to which public health authorities have been alerted through the WHO European Alcohol Action Plan; Two WHO Ministerial Health Conferences – the last one advising that “Public Health Policies concerning alcohol need to be formulated by Public Health Interests, without interference from Commercial Interests”. Why does the industry have such a hold on governments when polls of civil society give them such a poor rating? Why do we have inaction on policy relating to advertising when, where polling has been carried out, the public want positive action to curtail volume and content.

At least the European Parliament saw the need for action over alcopops.

The Council of Ministers has issued recommendations on alcohol consumption by young people and called for an EU strategy. It is in the process of being formulated by DG Sanco.

Why address children and young people? Because it is the children who pay the price of the last round! Much is said about passive smoking, little recognition is given to the third party victims of alcohol. Up to nine million children of the EU will return from school today to a home with a parental drinking problem. 29% of young males between the ages of 18 to 29 will die from an alcohol related cause – the major cause of death for young people in the EU.

The EU is concerned about human rights. The rights of the child should have high importance. One of the five ethical principles of the WHO in relation to alcohol is:

• All children and adolescents have the right to grow up in an environment protected from the negative consequences of alcohol consumption and, to the extent possible, from the promotion of alcoholic beverages.

While awaiting the DG SANCO alcohol strategy, we can embrace and publicise the newly adopted WHO Alcohol Policy Framework.

But above all else let us remember:
If we take care of the children of Europe, Europe will take care of itself.