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Vytenis Andriukaitis, EU Commissioner for Health and Food Safety, speaking in Dublin

Putting up an EU front against premature deaths

‘If we do nothing now, we will be too weak to reduce premature deaths’

EU Health Commissioner Vytenis Andriukaitis is passionate about his brief, particularly about tackling the scourge of premature deaths, whose impact on member states’ economies terrifies him. Lloyd Mudiwa reports

Born in a tough Siberian Gulag and later a former dissident, one could be forgiven for presuming nothing scares former medical doctor and heart surgeon (1975-93), Lithuanian Minister for Health (2012-14) and now EU Commissioner for Health and Food Safety (2014-19) Vytenis Andriukaitis.

The Commissioner, however, expressed his surprise in an exclusive interview with Irish Medical Times during a recent visit to Dublin, why no one else seemed to be “scared” by one of the biggest public health threats currently facing Ireland and the EU — premature death.

On the biggest public health threats across Europe, he commented: “For me it’s very painful to see every year a high number of premature deaths.

Every year, we estimate there are about 1.5 million deaths that are avoidable. Can you imagine how painful it is to see that because of a lack of preventative public health instruments on the ground and political will to address main risk factors?

“If people die because they smoke or because they were drunk-driving and got into an accident, can you imagine how damaging it is?”

The EU was already encumbered by other challenges such as an ageing population combined with a demographic decline, Commissioner Andriukaitis noted.

Pledges to achieve the goal of healthy ageing without implementing public health instruments were unrealistic, he said, exclaiming: “Don’t lie to me!

“If you are not ready to introduce evidence-based public health instruments and effectively maintain them long-term, you will never achieve healthy ageing,” he pointed out.

Health was not only about treatment, however, but also about creating possibilities to strengthen Europe’s health resources targeted at parts of society that while relatively healthy now faced heavy pressure from chronic multi-morbidity from risk factors such as lack of physical activity or unhealthy nutrition. There was the challenge of reducing the consumption of sugar and salt in foodstuffs along with the use of tobacco and alcohol products, particularly among children, by campaigning against marketing etc., deliberately targeting kids, he added.

“In 15 years’ time, today’s children will be candidates for stroke, cancer, heart diseases and premature deaths,” the Commissioner worryingly contemplated. “That is the main challenge in the EU today. To understand that if we do nothing now, it means that in future we will be too weak to reduce the number of premature deaths in the EU every year. But the EU is the biggest user of alcohol, tobacco and sugar all around the globe.

“Despite this picture, nobody seems to care. How are we to achieve healthy ageing?”

Economic cost
Commissioner Andriukaitis said last year Europe lost about 9,000 economically productive people to deaths on the roads alone. “It’s much more than the number of deaths incurred in the military conflict between Russia and the Ukraine and nobody is scared?” he pondered.

“It’s as if it’s up to those who died. No headlines, no discussions, nothing. And if you get stuck into the discussion immediately different lobby groups will point to the number of jobs and contribution to the economy alcohol is making. But how much damage to the economy is it making with the deaths of people between the ages of 18 years and 60 years? That is the message not to healthcare ministers, but to parliaments, governments and society, so that they understand this.”

The EU, Andriukaitis said, currently represented 5 per cent of the world’s total population, but this proportion would reduce significantly to 1 per cent by 2030. There was need for EU countries to have a demographic policy, sound reproductive health policy, and measures for the prevention of premature deaths, and to prolong the healthy years and healthy ageing. This also meant creating opportunities for people to stay longer in the labour force.

Some member states were extending the age of retirement at a time when they were prolonging the age of pensioners, but they also had a lot of people who suffered from multi-morbidities. “We must speak about the economy of the health.”

The implementation of a public health strategy was not about the cost, the EU Health Commissioner allayed. “It is crystal clear that not having the ability to have a comprehensive plan in all states, in the first instance, in the areas of primary care, prevention and lifestyle, and long-term care can be detrimental. You must understand that it is a chain. Now you cannot view them separately or in silos.”

For instance, he said long-term care was not solely in the remit of the health budget, but also fell under the social and welfare, infrastructure, and transport budgets. “You can imagine how difficult it must be to organise long-term care, knowing that it falls under several sectors,” he observed.

Silver economy
It also meant understanding that health was a large sector of the economy, according to Andriukaitis. “It is very important to understand that it is not about just spending, it is about the possibilities to create new jobs, and about the secondary economy and the possibilities to encourage the younger generation to understand that there are a lot of opportunities to get new jobs in the area of long-term care.”

It was hard to understand how people often considered health solely as an expense, he said, arguing that health was a big factor in the development of a country and helped to boost an economic recovery via investments in healthcare.

Pharmaceutical firms, medical device companies and hospitals created a lot of opportunities to provide jobs, with new technologies also triggering start-ups, and there was a need to encourage EU governments to understand this and come up with investment strategies, Andriukaitis told IMT.

He said investing in long-term care meant countries had a good opportunity to develop segments of the silver economy — the part of the economy that concerns Europe’s older citizens and that is closely linked to current trends in Europe’s demographics, and the effects on older adults’ quality of life and on the wider region’s economy. It includes all the economic activities relevant to the needs of older adults, and impacts on many sectors, for example, health and nutrition, leisure and wellbeing, finance and transport, housing, and education and employment.

Health funding
On how the Health Commission could help fund Ireland’s health service reforms, Commissioner Andriukaitis, who took the opportunity during his visit to Ireland to discuss public health issues with the Joint Oireachtas Committee on Health and the Minister of Health Simon Harris, said that “healthcare is a subsidiarity issue”.

Another Oireachtas Committee on the Future of Healthcare has just published its 10-year health strategy for Ireland, which would require extensive funding. By stating that healthcare is a “subsidiarity issue” he meant that the Treaties, or the legal basis for EU action, did not give strong powers in the area of Health, as this was deemed to be a member state affair.

The EU could support, encourage and cajole but ultimately much of the room to act legally lay at national level, which was what the member states had chosen to do, he said.

“From the EU-side, as you know we have very complex measures and mechanisms in relation to countries accessing funding for their health services. As you know, healthcare systems are in the hands of the individual member states.

“It is absolutely under the remit of governments, local communities and local parliaments, and the EC, endorsed by the Council, presents country-specific recommendations (CSRs).”

National Reform Programmes were also a specific document which each country must update and submit to the Commission every year. It should reflect the recommendations of the CSRs and other economic advice as well as the budget rules.

He explained that the CSR instruments (issued just last month for 2017), which were part of the annual economic governance under post-crash rules (known as the European Semester), allowed the EU Health Commission to consult, assist, provide information, improve healthcare system performance assessment instruments and also to draw attention to weaknesses and problems in every member country.

He elaborated that the distribution of structural funds was down to the competence of national authorities: it was not the competence of the EU. “We are providing money, yes, but how to distribute that money is up to individual governments, parliaments. While we ask them to present national reform programmes to us, to see if they are coherent to different instruments and coordinate, supplement, advise.

“Of course, it’s a good idea to see how much structural funds you can invest into your healthcare institutions, but we also have today European Reference Networks.”

He said these structures, which would form part of a chain of 313 hospitals in the EU joining 24 thematic networks in platforms using e-health instruments and building up e-health infrastructure, would facilitate online consultations, diagnostic assistance and treatment and other virtual possibilities.

Public health
Commissioner Andriukaitis told the Joint Oireachtas Committee on Health that he was very happy that the Irish Government had presented such a very comprehensive bill regulating alcohol, as well as its adopted position to fight against obesity, particularly childhood obesity, which he described as a very worrying area of public health in Ireland.

In addition to alcohol and tobacco, other main risk factors were sugar, salt and trans fats, he said, while also drawing attention to physical inactivity in children and adults.

The Commissioner, who also explored the potential and possibilities of regulating for those issues and providing for more public health instruments in different political policy areas, told IMT: “It means that this is not only the responsibility of the Minister of Health. It is the responsibility of all Ministers. It means health and all political sectors.”

He said there was a need for responsibility for health in every sector — agriculture, transport, and education as well as in fiscal and taxation policy, keeping an eye on the possibility to introduce scientific-based instruments in real-life to avert a public health crisis in 10-15 years’ time.

“Then a high incidence of chronic disease will press healthcare system and service providers both in primary care and secondary care sectors,” Andriukaitis predicted.

This would, however, require utilising a lot of public money for treatment. The Commissioner advised: “To change this narrative we need to have more investment in preventative measures, keeping in mind that the benefits of doing so will only become apparent in 10-15 years’ time, to reduce the cost and number of people succumbing to chronic conditions and diseases, as well as pubic spending in treatment.”

He also raised the possibility of once again encouraging coordination between the veterinary, medical and environmental sectors on the monitoring of the challenging threat of antimicrobial resistance, and promoting the use of Health Technology Assessments and their possibility to help provide new methodologies, which could help countries to better regulate their assessment of devices, new technologies, and medicines.

Ministerial meeting
During his visit, the Commissioner also held a bilateral meeting with the Minister for Health Simon Harris. “We have a lot of concrete discussions about European Reference Networks, healthcare workforce issues and measures to strengthen our common activities against the main risk factors and possibilities to use EC financial instruments and investment instruments strengthening primary healthcare construction.”

They were to also discuss the potential to promote and encourage cooperation between countries, covering the pricing of medicines and possibilities to guarantee access to new treatments.

“Of course without cooperation it will be difficult to access drugs for some member states,” he accepted.

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