The Battle Against Tobacco,

Cancer and Heart Disease

The adoption of the Tobacco Products Directive

19th

Summary of the meeting

Mr Busoi MEP (Chair of the MEP

opened the meeting. Mr Busoi stressed that in the European Union, cancer and cardiovascular

diseases (CVD) account for 65% of mortality.

major risk factor for these diseases; it is in fact the most important modifiable risk factor. 16% of

deaths from CVD in men and 5% of deaths in women, in the European Union, are due to smoking. A

higher proportion of premature deaths from CVD are due to smoking: in the age group 35

smoking causes 28% of CVD deaths in men and 13% in women.

Mr Peterle stressed the importance of prevention, especially in view of the shocking figures about

girls smoking, and the rise this gives in lu

across eight European and Scandinavian countries, 270,000 people are diagnosed every year with

cancers caused by smoking. Smoking is known to be a major contributor to a variet

including lung, colon and bladder cancers. In addition, current smokers are 2.6 times as likely as

never smokers to develop a tobacco

Tobacco use is the most important risk factor for c

71% of global lung cancer deaths. Deaths from cancer worldwide are projected to continue rising,

with an estimated 13.1 million deaths in 2030.

Florence Berteletti Kemp, Director of the

Commission’s proposal. She highlighted that the main

standardised packaging and pictorial warnings

showed a video demonstrating t

importance of not allowing the package to be a marketing tool that makes cigarette attractive for

children and young people but rather to present stark information about the c

1 Impact of Cigarette Smoking on Cancer Risk in the European Prospective Investigation into Cancer and

Nutrition Study, 2012 2 International Agency for Research on Cancer, 2012

The Battle Against Tobacco,

er and Heart Disease

The adoption of the Tobacco Products Directive

th February 12:30h to 14:15h

Mr Busoi MEP (Chair of the MEP Heart Group, ALDE, Rom) and Mr Peterle (Chair of MAC

Mr Busoi stressed that in the European Union, cancer and cardiovascular

diseases (CVD) account for 65% of mortality. CVD accounts for 40% and cancer for 26%. Tobacco is a

major risk factor for these diseases; it is in fact the most important modifiable risk factor. 16% of

deaths from CVD in men and 5% of deaths in women, in the European Union, are due to smoking. A

on of premature deaths from CVD are due to smoking: in the age group 35

smoking causes 28% of CVD deaths in men and 13% in women.

stressed the importance of prevention, especially in view of the shocking figures about

and the rise this gives in lung cancer among women. A recent study showed that

across eight European and Scandinavian countries, 270,000 people are diagnosed every year with

cancers caused by smoking. Smoking is known to be a major contributor to a variet

including lung, colon and bladder cancers. In addition, current smokers are 2.6 times as likely as

never smokers to develop a tobacco-related cancer and ex-smokers have 1.5 times the risk.

Tobacco use is the most important risk factor for cancer causing 22% of global cancer deaths and

71% of global lung cancer deaths. Deaths from cancer worldwide are projected to continue rising,

with an estimated 13.1 million deaths in 2030.2

Kemp, Director of the Smoke Free Partnership presented the challenges of the

She highlighted that the main priority for the public health community is

pictorial warnings covering 80% of the front and back of

demonstrating that children find cigarette packs attractive and underlining the

importance of not allowing the package to be a marketing tool that makes cigarette attractive for

children and young people but rather to present stark information about the consequences of

Impact of Cigarette Smoking on Cancer Risk in the European Prospective Investigation into Cancer and

International Agency for Research on Cancer, 2012

The Battle Against Tobacco,

er and Heart Disease

The adoption of the Tobacco Products Directive

(Chair of MAC, EPP, Sl)

Mr Busoi stressed that in the European Union, cancer and cardiovascular

for 40% and cancer for 26%. Tobacco is a

major risk factor for these diseases; it is in fact the most important modifiable risk factor. 16% of

deaths from CVD in men and 5% of deaths in women, in the European Union, are due to smoking. A

on of premature deaths from CVD are due to smoking: in the age group 35-69 years,

stressed the importance of prevention, especially in view of the shocking figures about

A recent study showed that

across eight European and Scandinavian countries, 270,000 people are diagnosed every year with

cancers caused by smoking. Smoking is known to be a major contributor to a variety of cancers,

including lung, colon and bladder cancers. In addition, current smokers are 2.6 times as likely as

smokers have 1.5 times the risk.1

ancer causing 22% of global cancer deaths and

71% of global lung cancer deaths. Deaths from cancer worldwide are projected to continue rising,

the challenges of the

y for the public health community is

front and back of pack. She

underlining the

importance of not allowing the package to be a marketing tool that makes cigarette attractive for

onsequences of

Impact of Cigarette Smoking on Cancer Risk in the European Prospective Investigation into Cancer and

smoking that will deter uptake of smoking.

http://www.youtube.com/watch?v=c_z

Other challenges with regard to

• Ingredients, flavourings and additives. Prohibition of certain flavourings and additives is

mentioned in the proposal, but it does not go

• Not including a ban on display of cigarette packs

Mr Tonio Borg, EU Commissioner fo

the main aim of the proposal is to prevent youngsters from picking up the habit of smoking.

The overall objective is to reduce the number

smoking”, the Commissioner said,

must look like tobacco and must taste like tobacco.”

health is a strong value in itself and i

unlikely to have net negative econ

tobacco would be spent in other sectors

The Commissioner emphasised that pictor

making it clear that using this product will damage their health.

As to Snus and smokeless tobacco, Commissioner Borg mentioned that people believe that when

there is no smoke, there is no harm.

harmful. The ban on Snus will remain

Snus but in exchange must comply with its obligation

European countries.

Some additives will be allowed, but not if they fall into the category of

Rapporteur Linda McAvan (MEP, S&D, UK)

prevent young people from starting smoking

people are going up now and take adequate measures to help

agreeing with Commissioners Borg that tobacco should look and taste like tobacco, not something

you want to be seen with.

Eugene Lennon, Health Permanent

2013 until 30 June 2013) mentioned that for Ireland, the focus would be on standardised packaging,

tobacco as a public health issue, the prohibi

informal Health Council in March 2013, Ireland will put the issue of smoke

agenda. Ireland was pleased to see the Commission adopted the proposal at the end of 2012 (as

promised) and intends to move this dossier forward quickly.

During the Question and answer session

will; Snus and other ingredients, e

that free will is not an issue: the new proposal does not prohibit

attractive for young people to start. He also said that

smoking-related diseases: the revenue of tobacco is less than the bill the state

care of people suffering from tobacco related

smoking that will deter uptake of smoking. The video can be downloaded here:

http://www.youtube.com/watch?v=c_z-4S8iicc

the proposal are:

ngredients, flavourings and additives. Prohibition of certain flavourings and additives is

mentioned in the proposal, but it does not go far enough.

an on display of cigarette packs at points of sale.

Commissioner for Health and Consumer Protection, informed the audience that

to prevent youngsters from picking up the habit of smoking.

The overall objective is to reduce the number of smokers by 2% over 5 years. “We don’t prohibit

said, “we make it less attractive to the young. That is why tobacco

must look like tobacco and must taste like tobacco.” The Commissioner also stressed the fact that

and it also has an economic value. He stressed that

economic consequences not least because money not spend on

in other sectors.

that pictorial warnings will help people take informed decisions by

that using this product will damage their health.

and smokeless tobacco, Commissioner Borg mentioned that people believe that when

there is no smoke, there is no harm. But, the Commissioner pointed out smokeless tobacco is also

will remain in place: Sweden will be allowed to keep it is concession to sell

must comply with its obligation not to bring Snus on the market in other

additives will be allowed, but not if they fall into the category of characterising flavours

Rapporteur Linda McAvan (MEP, S&D, UK) spoke out in support of the proposal, because it will help

from starting smoking. “We have to look at why the smoking trends in young

people are going up now and take adequate measures to help them not take up the

with Commissioners Borg that tobacco should look and taste like tobacco, not something

ermanent Representative for Ireland (Council Presidency from 1 Janu

il 30 June 2013) mentioned that for Ireland, the focus would be on standardised packaging,

tobacco as a public health issue, the prohibition of slim cigarettes. He also mentioned that at the

informal Health Council in March 2013, Ireland will put the issue of smoke free environments on the

agenda. Ireland was pleased to see the Commission adopted the proposal at the end of 2012 (as

ed) and intends to move this dossier forward quickly.

Question and answer session, the Commissioner answered questions on smoker’s free

and other ingredients, e-cigarettes and marketing of tobacco. Commissioner Borg stated

that free will is not an issue: the new proposal does not prohibit smoking; it just makes it less

attractive for young people to start. He also said that it is important to consider who pays the bill for

he revenue of tobacco is less than the bill the state has to pay for taking

obacco related diseases. He also indicated that Snus

ngredients, flavourings and additives. Prohibition of certain flavourings and additives is

informed the audience that

to prevent youngsters from picking up the habit of smoking.

“We don’t prohibit

we make it less attractive to the young. That is why tobacco

The Commissioner also stressed the fact that

also has an economic value. He stressed that the Directive is

not spend on

people take informed decisions by

and smokeless tobacco, Commissioner Borg mentioned that people believe that when

mokeless tobacco is also

Sweden will be allowed to keep it is concession to sell

on the market in other

characterising flavours.

, because it will help

We have to look at why the smoking trends in young

them not take up the habit.” She said

with Commissioners Borg that tobacco should look and taste like tobacco, not something

(Council Presidency from 1 January

il 30 June 2013) mentioned that for Ireland, the focus would be on standardised packaging,

tion of slim cigarettes. He also mentioned that at the

free environments on the

agenda. Ireland was pleased to see the Commission adopted the proposal at the end of 2012 (as

the Commissioner answered questions on smoker’s free

Commissioner Borg stated

it just makes it less

who pays the bill for

has to pay for taking

Snus is but a small

part of the Directive. Member States had forbidden

Commission sticks to status quo in the current proposal.

Commission has tried to make tobacco look and taste like tobacco, in an attempt to present it

(market it) in a way which does not make it more attr

In her concluding remarks, Nessa Childers MEP

stressed the importance of policy makers in the EP to work together with the rapporteur to protect

EU citizen’s health from tobacco

Tobacco Cessation organised by the MAC group in the European Parliament.

part of the Directive. Member States had forbidden Snus when Sweden entered the

Commission sticks to status quo in the current proposal. He further stressed the fact that the

Commission has tried to make tobacco look and taste like tobacco, in an attempt to present it

(market it) in a way which does not make it more attractive to young people.

Nessa Childers MEP, Vice President of the MAC group

stressed the importance of policy makers in the EP to work together with the rapporteur to protect

EU citizen’s health from tobacco use. She invited all participants to come to the Exhibition on

Tobacco Cessation organised by the MAC group in the European Parliament.

when Sweden entered the EU, and the

stressed the fact that the

Commission has tried to make tobacco look and taste like tobacco, in an attempt to present it

, Vice President of the MAC group (S&D, Ireland)

stressed the importance of policy makers in the EP to work together with the rapporteur to protect

She invited all participants to come to the Exhibition on

REPORT

Calling Time on Europe's Alcohol Problem

Using pricing policies to protect public health in Europe

-

A challenge for democracy

Co-hosted by Rebecca Taylor MEP (UK, ALDE)

Alyn Smith MEP (UK, Greens/EFA), Antonyia Parvanova MEP (Bulgaria, ALDE) and Catherine

Stihler MEP (UK, S&D)

European Parliament (Brussels)

24 April 2013, 16.45 – 20.00

Background information

The current EU framework in the area of alcohol - the EU Strategy to support Member States in

reducing alcohol related harm - came to an end in 2012 but Europe still remains the world heaviest

drinker. Over recent months, EU countries have been witnessing an increasing trend in applying

pricing measures to unhealthy products in order to discourage their consumption, in particular by at-

risk groups, most notably the proposal to introduce Minimum Unit Pricing (MUP) in Scotland.

The public health evidence as well as the social and health gains of raising alcohol price and thus

availability are unequivocal and indisputable, although they differ depending on the measure used.

The power of democratically elected governments to introduce such measures is however

threatened by the tactics of the alcohol industry. Lobbying and legal challenges are threatening to

slow down or derail electoral promises and economic and social gains in reducing alcohol harm.

Concerned by such an influence and the pressing need to protect Europe’s population from alcohol

abuse, the European Public Health Alliance (EPHA) and the Royal College of Physicians (RCP London),

supported by Eurocare gathered the public health community, Members of the European Parliament

and representatives from Member States to exchange on the way forward. In the current economic

climate more than ever, it is crucial that governments demonstrate their commitment to policy

making that supports a healthy and productive population, challenge the groundless arguments used

by economic operators, take action against preventable health threats and their associated costs and

do not hinder policy efforts to prioritise public health over economic interests.

Welcome and opening remarks

Rebecca Taylor, Member of the European Parliament

Rebecca Taylor MEP (ALDE, UK) welcomed participants to the seminar emphasising the timeliness of

the discussions as the Scottish Parliament passed the Minimum Pricing of Alcohol Bill a year ago

almost day by day, a scheme that should have come to force this month. At the time of the seminar,

the United Kingdom was also considering MUP although no proposals had yet been made. Given that

the European Union's Alcohol Strategy was due to be evaluated during 2013. Ms Taylor MEP shared

with the audience a question she had tabled with Ms Parvanova MEP asking the Commission

whether the Strategy would be reviewed.

Before introducing all speakers, Ms Taylor MEP pointed out the importance of having a Commission

representative attending the seminar that did not only focus on alcohol pricing policies, but did go

broader, tackling alcohol misuse and public health, including the influence of economic operators on

alcohol policy and the decision-making process.

Antonyia Parvanova, Member of the European Parliament

Ms Antonyia Parvanova MEP (ALDE, BU) followed on from her collegue Ms Taylor MEP. She stressed

the influence of economic operators on policies and in particular the production and use of

independent versus industry funded research to justify policies. While reminding participants about

the harmful use of alcohol and its social and health consequences, she emphasised the need to

protect young people in particular.

“Is the drinks industry damaging democracy as well as health?”

Nick Sheron, Royal College of Physicians Representative to the EU Alcohol and Health Forum

As a professional hepatologist, Nick Sheron began his presentation by sharing some of his

observations: liver deaths increased steadily over the past years, the majority of which being alcohol

related. Liver diseases have not only changed in terms of frequency, their nature has also changed.

While it used to be a disease of the rich, it increasingly has become a disease of deprivation. Dr

Sheron emphasised the relation between alcoholic beverages’ prices and consumption, comparing

the effects of taxation and minimum unit pricing. When mentioning the Scottish MUP scheme he

explained that the measure was part of the Scottish Nationalist Party Manifesto and that, as a rule, it

was forbidden to oppose the Manifesto once voted on. Thus, he highlighted that the current debates

were actually profoundly anti-democratic.

Responding to the alcohol industry data according to which MUP only affected poor people, Dr

Sheron demonstrated visually his data according to which the scheme had the most impact on

hazardous and even more on harmful and/or dependant drinkers. Nick Sheron concluded his

intervention by reiterating that MUP as a measure that would exquisitely target heavy consumers

and that alcohol industry main concern was to lose their profitability.

“Minimum alcohol price policies in action: the Canadian experience”

Tim Stockwell, Centre for Addictions Research of British Columbia, University of Victoria

Dr Tim Stockwell began his presentation by introducing and thanking his research team with whom

he produced the data he was about to present. Sharing the Canadian experience of minimum alcohol

price policies, Dr Stockwell informed participants that the measure was implemented in 8 regions of

Canada and in some of them for more than 40 years. This made Canada one of the 6 countries

worldwide where minimum unit pricing is being implemented (others were Russia, Ukraine, the

United States (5 States), Moldova and Uzbekistan). Dr Stockwell presented, according to their

effectiveness, different pricing measures that could be implemented to alcoholic beverages: ban on

below-cost alcohol being the least effective, minimum profit margin, minimum retail price per litre of

beverage, minimum price per unit of alcohol being the most effective measure. He then shared the

scientific evidence behind alcohol price and tax strategies, i.e a 10% price increase led to an average

5% reduced consumption, together with reduced hazardous drinking levels and reduced alcohol-

related injuries and illnesses.

To the question “Do increases in the minimum alcohol prices lead to reduced consumption?” Dr

Stockwell responded through two illustrative case studies: British Columbia and Saskatchewan. To

the question linking alcohol MUP and reduced related harm, he responded that a 10% increase in

minimum prices was associated with a 32% decrease in wholly alcohol caused deaths. Tim Stockwell

concluded his intervention by deconstructing, one by one, each of the alcohol industry criticisms he

was confronted to and by emphasizing that alcohol MUP was the most effective way to go.

“Ministerial perspective”

Alex Neil, Scottish Cabinet Secretary for Health and Wellbeing

The Scottish Cabinet Secretary for Health and Wellbeing Alex Neil thanked the previous speakers and

declared that in light of this evidence, it is profoundly clear the Scottish minimum unit pricing

measure is the right thing to do. Illustrating the alcohol-related situation in Scotland over recent

years, with an average 11 liters of pure alcohol consumed per adult every year and the associated

health consequences, Mr. Neil insisted that the scale of the problem required a meaningful and

effective government response. Changing Scotland’s relationship with alcohol has to be a priority.

Responding to some critics of the scheme, Mr Neil explained that alcoholic beverages’ affordability

increased considerably (by 45%) over recent years, especially in supermarkets.

Mr Neil presented the Scottish Court case, explaining that MUP would not be implemented before a

final Court decision is taken. He also explained the evidence behind the 50p proposal and briefly

responded to the Commission opinion, which demonstrated a preference for taxation, explaining

that taxation alone would not achieve what MUP could achieve.

The newly released London School of Hygiene & Tropical Medicine study was mentioned during the

discussions for the evidence it brought on the misleading arguments and information manipulation

deliberately used by the Scottish industry in the context of the consultation ran in 2008. The Scottish

Cabinet Secretary concluded his intervention by reminding the room that, with a built-in sunset

clause, if in 5 years time, the implementation of the scheme does not reach the expected outcomes,

the measure would be removed.

Roundtable discussions

Monika Kosińska, EPHA’s Secretary General chaired the roundtable discussions. She announced that

a slight change would occur in the agenda as a representative from the European Commission was

able to join the debate. She opened the discussion to the floor.

Peter Rice, Chair of the Scottish Health Action on Alcohol Problems (SHAAP) emphasised in his

intervention how untrue the arguments used by economic operators were and echoed some of the

facts and figures mentioned by Alex Neil illustrating the landscape in which alcohol policies have to

be considered (bigger bottles, increased deaths, etc.) in Scotland.

Tiziana Codenotti, Chair of the European Alcohol Policy Alliance (Eurocare) asked Mr Neil whether

MUP would apply differently on imported drinks, to which he responded that the measure would

apply to all alcoholic beverages sold in Scotland, regardless of origin and that current assessments

indicate that the majority of drinks affected originate in fact in Scotland.

Rebecca Taylor MEP (UK, ALDE) asked whether the measure would have an impact on the cross-

border sales between Scotland and the United Kingdom.

Monika Kosinska (EPHA) welcomed then the participation of Despina Spanou, European Commission

Director for Consumer Policy who began her intervention by reminding the audience the scope of the

day discussions: as far as the EU treaties are concerned, the internal market rules were stronger than

the public health ones. Ms Spanou briefly mentioned some of the results of the evaluation of the

current EU framework in the area of alcohol policy, i.e the European strategy to reduce alcohol-

related harm, reassuring the added value of EU action even though in her experience with the

Alcohol Strategy, five years were not enough.

Before passing the floor to Franco Sassi, Monika Kosinska re-emphasised the dichotomy between the

single market in the interests of economic operators versus in the public health interest.

“Response in light of a forthcoming OECD report on alcohol consumption”

Dr Franco Sassi, Organisation for Economic Co-operation and Development (OECD)

Franco Sassi shared some of the pressure felt by his organisation whilst conducting alcohol research,

pressure from both the industry and the non-governmental organisations. While both stakeholders

would prefer the OECD to focus its work on their specific areas of concerns, Dr Sassi highlighted that

multiple interventions in a broad range of domains was preferable according the evidence available.

He also pointed out that targeted actions were key, especially to target the most vulnerable groups,

which goes at odds to population approach.

“Response from the perspective of a medical practitioner working with the homeless community”

Henrik Thiesen, European Federation of National Organisations Working with the Homeless

(FEANTSA)

Henrik Thiesen shared his experience as a medical doctor working with homeless people in Denmark,

a majority of which were migrants from Central and Eastern Europe. Dr Thiesen pointed out that,

beyond the wide spread of cirrhosis, homeless people using alcoholic beverages experienced

increased levels of mortality. Dr Thiesen also emphasised how access to housing and healthcare

services was important as part of harm reduction approaches.

A number of Member States representatives were present in the room and were offered with the

opportunity to intervene and share their national experience and/or perspective on the issue.

Ariane Amberg representing the Permanent Representation of Switzerland to the European Union

informed participants that in March 2013, the lower chamber of the Swiss Parliament voted in favour

of alcohol MUP as part of a broader alcohol policy and that the second chamber opinion was

expected in the coming months. She also mentioned that the bilateral trade agreement Switzerland

had with the EU has been raised in some quarters as a potential obstacle to the adoption of alcohol

MUP.

Mathieu Capouet, representing the Belgium Ministry for Health mentioned that Belgium was in the

process of drafting a new alcohol plan therefore thanked the organisers and stressed he was

carefully listened to the discussions, which were very useful. He explained that Belgium hope to have

the new plan by the end of 2013.

Peter Hartog, representing the Dutch Ministry for Health said that he was very interested in the

discussions related to minimum unit pricing. He emphasised the misinformation that was

surrounding the issue and echoed the discussions related to the balance between economic/financial

interests and public health interests.

“Response in relation to alcohol lobbying and transparency”

Olivier Hoedeman, Corporate Europe Observatory

Oliver Hoedeman brought a new topic into to the debate: the issue of lobbying and transparency in

the area of alcohol policy. While the European Transparency Register was presented as a good tool

to reduce the influence of specific interests on policies, Mr Hoedeman explained that place was left

for improvement notably due to the fact that it remained voluntary. A review of the Register was

expected for June which presents an opportunity to improve the tool. Through his intervention, Mr

Hoedeman insisted on the importance of holding policy makers accountable for their actions and

thus requested more transparency from the European Commission as well as the European

Parliament when meeting with industry lobbyists. According to him, while the 2011 European

Parliament Code of Conduct was a first step in the right direction the text was poorly enforced which

threatened its efficiency.

“Response in relation to the public debate in Scotland”

Evelyn Gillan, Alcohol Focus Scotland

Evelyn Gillan concluded the round of interventions by sharing her experience as a leader of an

organisation directly involved in the Scottish Court case. In order to illustrate the massive powerful

vested interests operating in Scotland, she told participants that following on from the first

discussions on MUP and lack of Parliamentary adoption, the alcohol industry sent each member of

the Scottish Parliament a crate of beer. She concluded her intervention by reminding the room how

crucial coalitions were as well as good quality data and that public health interests should be put

ahead of industry interests.

“Concluding remarks”

Catherine Stihler MEP (UK, S&D) concluded the seminar discussions by pointing out that the evidence

on minimum unit pricing was overwhelming, that it was crucial to continue sharing best practices and

available evidence and that in order to advance alcohol policies a real political leadership was

needed.

Alyn Smith MEP (UK, Greens/EFA) expressed that support from different political groups was needed

in order to go ahead with such policies. More generally he welcomed meetings like this as it offered

opportunities to exchange best practices.

[Seminar report] Can EU Citizens Afford TheirMedicines?

A event on the Economic Crisis & Access to Medicines In Europe -16 May, 9:00–18.00 European Parliament (Brussels) Room Jan4Q2

This high level meeting revolved around various politicalprocesses linked to the economic crisis. Some of the topics discussed include implementation ofthe Europe 2020 strategy, as well as pharmaceutical legislation for ensuring that people living inEurope have access to a wide range of quality and affordable medicines.

The meeting hosted by Mr Alejandro Cercas, MEP (Spain,S&D) and by the Socialists and Democrats in theEuropean Parliament (S&D Group) served to assess the impact of cost-containment policies put in placein some EU member states. Participants debated which role new innovation models and instruments couldplay in ensuring the affordability of medicines.

The seminar brought together actors and institutions that do not traditionally meet or exchangeideas. The event put forward a set of recommendations on how multilateral institutions, ministries of finance,research and health can join forces to prevent that the current crisis on access to medicaments spirals out ofcontrol.

There are many ways in which you can learn about the main issues discussed in this seminar:

Watch the seminar recorded

Retreieve the Tweeter conversation at the conferece’s Twitter hashtag #access2medicinesEU

Read the conference’s press statement - Access to medicines in Europe: The EU cannot save banks whilesacrificing people’s health

Download the SPEAKERS’ PRESENTATIONS (pdf files):

David Hammerstein (Trans-Atlantic Consumer Dialogue -TACD)- The 10 key words on access to medicine inthe EU.Aida Batista (European Association of Hospital Pharmacists) - On the frontline of access to medicines inEurope.John Chave (Secretary General of the Pharmaceutical Group of the EU) - Medicine Shortages.Jose Manuel Silva (President of the Portuguese Medical Association) - Economic Crisis: Access to Medicinesin EuropeNicky Voudouri (Medical Coordinator, PRAKSIS) - Access to Health the Greek situation.Christine Leopold (Austrian Health Institute - WHO Collaborating Centre for Pharmaceutical Pricing andReimbursement Information) - Pharmaceutical policy measures implemented in response to the recession inEurope (2012-2013)Els Torreele (Director, Access to Essential Medicines Initiative Open Society Foundations) - Public interestdriven drug development is possible cost effective and leads to affordable medicines.Hugo Hurts (Director Department of Pharmaceutical Affairs and Medical Technology, Ministry of Health,Welfare and Sport - The Netherlands) - Cost Containment. Measures in the NetherlandsJames Love (Knowledge Ecology International) - Delinkage.The Economic Crisis and Access to Medicines inEurope.Joan Rovira (Department of Economic Theory, University of Barcelona) - Can EU citizens afford theirmedicines?.Lieven Annemans (Department of Health Economics at Ghent University and Brussels University) - What canbe done to increase equity in access to valuable medicines.Michel Goldman (Executive Director from the Innovative Medicines Initiative) - The Innovative MedicinesInitiative.Teresa Alves (La Revue Prescrire) - Innovation: a reality check.

To know more about the topic of access to medicines in the context of the economic crisis, read EPHAbriefing on access to medicines in Times of Austerity

Related documents

[Joint Press Statement]Access to medicines inEurope: The EU cannotsave banks whilesacrificing people’shealth

Revised EPHA positionon clinical trials

*Updated* EPHAbriefing on AntimicrobialResistance

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2/7/2014 IP Policy Committee blog » Blog Archive » Event summary: Greek Society demands fair access to medicine solutions

http://tacd-ip.org/archives/1127#! 1/11

Access to medicines crisis in Greece: Society demands fair solutions

European Parliament office in Athens, 13 December 2013

Event summary report

Conference Overview

130 people showed for the event from all sectors (news agencies, medical associations, doctors’

associations, patients’ associations, pharmacists and numerous representatives of the

pharmaceutical industry). The conference was attended by the parliamentary representative of the

leading opposition party SYRIZA Mr. Panayiotis Kouroumplis. European Commission’s Task Force for

Greece (TFGR) was represented by Ms Giulia Del Brenna who flew from Brussels. Moreover,

presentations were given by the author of the latest law on medicines in Greece Mr. Maniadakis and

from Mr. Charalambos Karathanos, pharmacist and close advisor to the Minister of Health Mr. Adonis

Georgiadis.

Médecins Sans Frontières (MSF), Médecins du Monde (MdM Greece), PRAKSIS NGO, Greece’s

leading consumer association and TACD member EKPIZO, the Greek cancer patients’ association

DEDIDIKA, MEP Nikos Chrysogelos (Greens/EFA, EL) and the European Public Health Alliance (EPHA)

all actively supported and promoted the event.

About 50 patients’ representatives coming from all over Greece attended the conference and

participated in the afternoon workshop.

2/7/2014 IP Policy Committee blog » Blog Archive » Event summary: Greek Society demands fair access to medicine solutions

http://tacd-ip.org/archives/1127#! 2/11

The conference’s webpage had 6.000 visits (10/11-30/12/2013) while 115 people registered in

advance.

There were articles in the press leading up to the conference as well as a detailed report of the

work of the conference on the same day published by one of Greece’s largest news portals

( www.news247 .gr ). An article also appeared in one of the country’s largest dailies “Efimerida ton

syntakton” on Monday 16 December 2013 (47.000 followers on FB). Overall, the event received

considerable publicity despite the fact that on the same day, there was a major high-level

conference organized in Athens by the Greek Ministry of Health in cooperation with the WHO and

the European Commission’s Task Force (TFGR) on the heath reforms in Greece.

The event was webstreamed live. Intensive live tweeting took place the days before and on the

day of the conference (twitter analy tics ).

Our save the date/invitation was widely circulated by the office of MEP Nikos Chrysogelos

(Greens/EFA, EL), Médecins Sans Frontières (MSF), Médecins du Monde (MdM Greece), PRAKSIS

NGO, Greece’s leading consumer association and TACD member EKPIZO (it was sent to its 23.000

members across the country) as well as by the Greek cancer patients’ association DEDIDIKA. In

addition to the above, it was published in numerous news & medical websites (see indicative list

below).

Health Daily (the country’s largest daily health newsletter reaching 7.000 professionals – the

invitation & press releases were published 3 times leading up to the conference)

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http://health.in.gr/news/various/article/?aid=1231279732

http://www.ygeia360.gr/el/news/item/8050-synedrio-gia-thn-prosbash-twn-ellhnwn-

asthenwn-sto-farmako

http://health.in.gr/news/various/article/?aid=1231279732

http://www.infospoudes.gr/index.php?

option=com_content&view=article&id=16816&catid=25028&Itemid=1209

http://www.almazois .gr/gr/index.php?option=ozo_content&perform=view&id=505

http://www.almazoispatras.gr/2%CE%BF-

%CE%B4%CE%B9%CE%B5%CE%B8%CE%BD%CE%AD%CF%82-

%CF%83%CF%85%CE%BD%CE%AD%CE%B4%CF%81%CE%B9%CE%BF-%CE%BF%CE%B9-

%CF%83%CF%85%CE%BD%CE%AD%CF%80%CE%B5%CE%B9%CE%B5%CF%82-

%CF%84%CE%B7%CF%82-%CE%BA/

http://www.mednet.gr/app/index.php/thenews/view/48

http://www.newmoney.gr/article/32350/synedrio-gia-tis-synepeies-tis-krisis-stin-prosvasi-

sta-farmaka

http://www.blog.gr/articles/168584/Diethnes-sunedrio-kai-seminario-me-ton-titlo-Oi-

sunepeies-tis-krisis-stin-prosbasi-sta-farmaka-H-koinonia-apaitei-dikaies-luseis.html

http://pharmateam.blogspot.gr/2013/12/blog-post_9125.html#axzz2oIT0z87c

http://www.life2day.gr/2013/12/sinedrioi-sinepies-tis-krisis-stin-prosvasi-sta-farmaka-h-

kinonia-apeti-dikees-lisis/

http://pefni.wordpress.com/2013/12/04/%CE%BF%CE%B9-

%CF%83%CF%85%CE%BD%CE%AD%CF%80%CE%B5%CE%B9%CE%B5%CF%82-

%CF%84%CE%B7%CF%82-%CE%BA%CF%81%CE%AF%CF%83%CE%B7%CF%82-

%CF%83%CF%84%CE%B7-

%CF%80%CF%81%CF%8C%CF%83%CE%B2%CE%B1%CF%83%CE%B7-%CF%83/

Synopsis of presentations’ main points

Welcome remarks

In his opening remarks, MEP Nikos Chrysogelos (Greens/EFA, EL) spoke of the need to have a

universal health coverage system in place. He emphasized the role of prevention as it reduces the

future cost of treatment. He underlined the fact that there are many cases reported in Greece of

people whose health has deteriorated considerably due to the fact that they either a) cannot afford

to take their treatments properly or b) they do not have access to primary health care.

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David Hammerstein, Senior advocate, TransAtlantic Consumer Dialogue, Brussels He

highlighted the importance of the Greek Presidency of the Council of the European Union (first half of

2014). He referred to the budget reduction measures put forth by the European Commission for which

there are no evaluation-impact studies. He described fight against corruption and transparency as

key elements in dealing with medicines in Greece. Last but not least, he underlined the lack of

concrete data regarding various dimensions of the health crisis in the country.

Eleni Alevritou, President of EKPIZO stressed the importance of collective action in times of crisis.

She described the Greek civil society movement as a weak and disorganized one which nevertheless

needs to better organize itself in order to become more efficient.

Policy-making session I: The situation on the ground in Greece concerning access to life-saving

medicines moderated by David Hammerstein, Senior advocate, TransAtlantic Consumer Dialogue,

Brussels

Dr. Kostas Athanassakis, Research Fellow, National School of Public Health (ESDY) gave an

overview of the agreements between the Greek government and the Troika over the past years. He

started by saying that public pharmaceutical spending will be reduced to 2bn euro in 2014 i.e. a 60%

reduction in comparison to the 5bn euro spent in 2009. He then presented the basic reforms

concerning medicines in Greece namely the active ingredient-based prescription and the prices of

reference for the national insurance organization EOPYY. He explained that if the 2bn euro threshold

is not respected, the agreements foresee additional measures such as increasing co-payment

percentages as well as moving more medicines to the “negative list” i.e. list of medicines which are

not reimbursed. According to the latest agreements between the Troika and Greece, generics will

need to cover 60% in pharmacies’ sales and 50% of the use in hospitals. Moreover, he referred to all

of the mistakes made in the operation of EOPYY which have resulted among others in many people

losing their social coverage over the past three years. According to Dr. Athanassakis hospitals have

become the primary focus of the reforms along with the future role of EOPYY. Since the start of the

agreements, cutting pharmaceutical spending has been the top priority. This was to be achieved by

a) slashing the prices of medicines, thus reducing the profits for suppliers and b) cost-sharing thus

making things worse for patients. He commented that the cost-sharing tool is very common, can be

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efficient in reducing pharmaceutical spending (average co-payment in Greece before 2009 = 9%,

today around 23%) but can also be extremely dangerous for health, as patients decide to forego

certain types of medicines which leads to immediate worsening of their health status. Furthermore,

deteriorating health conditions increase the cost of future treatment while chronic diseases become

lethal as regimens are not taken properly. He concluded by saying that reforms introduced so far

serve almost exclusively the goal of saving money today which will end up costing more tomorrow.

Prof. Christos Lionis, Director, Clinical Social and Family Medicine, faculty of Medicine & the

University Hospital of Heraklion (Crete) spoke of primary health care in Greece, a highly

controversial issue in the country since the government is in the process of introducing reforms in

this field too. He presented the data collected at the first primary care unit in the city of Heraklion

run by the University. This unit has been providing healthcare services to people with no insurance,

low income as well as migrants. He analyzed the profiles of patients visiting the unit concluding that

most of them are uninsured for over two years, they do not take their medicines as they are

supposed to either because their medicines are not available or they cannot afford them. He

emphasized that medical schools curricula need to change, become socially accountable and to

engage patients and other stakeholders.

Giorgos Zarkotos, President, Greek Association of Drugs and Substitutes Userscommented that

the crisis has deteriorated the problems that many marginalized social groups are faced with such as

prostitutes, substitute uses, prisoners, roma people, homeless, immigrants. He stated that most of

them apart from the social stigma have no access to health services. Moreover, state funding into

harm reduction programmes has been dramatically reduced. This has resulted in deteriorating health

situations such as a considerable increase in HIV cases in the country among drug users. Syringes

distribution has fallen to almost zero levels leading to this increase in HIV and Hepatitis C cases. He

emphasized that most Hepatitis C patients belonging to these social groups receive no treatment. He

called upon the Greek government to: a) support more needle and syringes programmes, b)

strengthen HIV testing and counseling, c) provide comprehensive and sustainable ART treatment, d)

focus on vaccination, diagnosis and treatment of viral hepatitis and e) reinforce prevention, diagnosis

and treatment of tuberculosis.

Liana Mailli, President, Médecins du Monde Greece presented valuable data from the MdM’s

activities on the ground. She said that more and more people visit the clinics & medical centres run

by MdM Greece in order to receive not only health services but also food and clothing. During the

first nine months of 2013, more than 13.000 people have used the mobile medical units of MdM

Greece. She emphasized that there is a 20% annual increase in the number of people using the

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various services of MdM Greece. Vaccines constitute the number one type of medicine that people

who turn to MdM Greece ask for which demonstrates that children are also very much affected by

the austerity crisis. In the first nine months of 2013, around 7.000 children were vaccinated. She

added that more than 2.500 people visit the main MdM clinic in Athens on a monthly basis. Most

people using MdM services are Greeks who have fallen off the social safety net. This means that

these people and their families do not have access to any health services anymore.

Policy-making session II: Benchmarks ahead moderated by Tassos Telloglou, Reporter,

Kathimerini newspaper & Star Channel

Rohit Malpani, Director, Policy and advocacy, Doctors Without Borders’ Access

Campaign explained that patent monopolies lead to extreme prices for life-saving treatments. He

gave the example of the recently approved Hepatitis Cdrug which will be sold at 60.000 euro for a

12-week course even though the cost of manufacturing it ranges between 50-100 euro. He criticized

the view that tiered-pricing is the way forward stating that price reductions are not always

sufficient, it is usually implemented in an arbitrary manner and all of the above; usually unfold in

complete lack of transparency. In relation to the issue of patents, he stated that these should only

be granted for true innovations and ever-greening should be avoided. In this respect, he mentioned

that a generic equivalent of the famous cancer drug Herceptin was recently approved in India. He

stressed that most innovation stems from publicly-funded research which should not be given as a

present to pharmaceutical industries. In addition to the above, he criticized the European Commission

for exercising pressure on developing countries that employ compulsory licensing and other

safeguards to ensure affordable treatment. In his view, the European Commission should refrain from

supporting tiered pricing as the solution to access. Moreover, he expressed the view that free trade

agreements should not limit the ability of EU Member States to use public health safeguards. Last but

not least, he reminded everyone that anti-competitive intellectual property strategies cost EU

consumers 2 billion Euros between 2000 and 2007.

Dr. Christos Ntellos, Director, Cardiac surgical dept. Tzanio public hospital (Pireaus) stated

that doctors overprescribe medicines in Greece. He stressed that innovative medicines which are

highly promoted by the pharmaceutical industry are not truly innovative while they cost a fortune for

the national health budget. He criticized the role of doctors in joining those glorifying innovative

medicines even though they know very well that there is no substantial difference. To this end, he

gave the example of medicines against cholesterol which are profusely prescribed even though it is

clear that exercise is much more effective in the fight against cholesterol. This is why; there is still a

lot of space for corruption. He called on doctors to stop playing with patients’ sense of agony and

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hope when it comes to generics and new innovative medicines. In his view, reliable generics are the

way forward. He commented that people need to realize that expensive medicines do not necessarily

equal better treatments. He concluded by pointing out the following: a) patients’ real needs in

medicines are much smaller than the medicines prescribed and consumed today, b) there need to be

strict therapeutic protocols in place, c) priority should be given to the use of generics and d) older

and cheaper medicines should not be sidelined.

Prof. Nikos Maniadakis, Associate Dean, National School of Public Health (ESDY) author the

latest pricing law on medicines gave an in-depth presentation of the piece of legislation. He analyzed

the spectrum of measures implemented by the Greek government in relation to medicines in Greece

(new lists of medicines, strict budget thresholds, new pricing scheme, e-prescription, generics,

guidelines and therapeutic protocols). In terms of patent medicines, their price will be defined

according to the three lowest prices in EU member states. As regards, off patent medicines, their

price will be halved following the expiry of the patent. As for generics, their price will be further

reduced and will be determined at 65% of the off patent medicine with a similar active ingredient. He

added that the law anticipates the possibility for some dynamic pricing i.e. the higher the sales of a

generic medicine are, the cheaper they can get. Editor’s note: This is considered by Greek pharma as

the most threatening provision. In their view, dynamic pricing is the Ministry’s present to foreign

pharma as it will enable the latter to lower their generics’ prices tremendously and consequently wipe

Greek companies off the map.

Giulia Del Brenna, Adviser, Task Force for Greece, European Commissionthanked the NGO

community for providing data on the real situation in Greece while she criticized the Greek

Government for not giving any reliable data on health coverage and access to medicines.

Sheexplained that the work of the Task Force is to ensure universal health coverage through a social

safety net with the use of clinical guidelines and protocols. She stressed that what is needed in

Greece is transparency. She highlighted the importance of primary health care reform. She reiterated

that it is up to the Greek government to decide which measures to implement in putting the reforms

in place. She acknowledged that “in an ideal world” there should have been impact assessment

studies of the reforms put forth. E-Health constitutes one of the main focal points of the technical

assistance when it comes to hospital management.

Charalambos Karathanos, Pharmacist, Advisor to the Minister of Health on medicines

issues clearly stated that the 2bn euro target for 2014 is neither feasible nor realistic. He repeated

the government’s position that 2.5 bn euro will be needed for 2014 and reiterated that the final figure

is still under negotiation with the Troika. He reaffirmed the government’s determination to encourage

the use of generics in the Greek NHS and criticized those who question the safety and quality of

generics. He reminded everyone that most generics used in Greece come from Greek pharmaceuticals

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that produce excellent quality products. On the issue of the uninsured people living in Greece, he

stated that the government is seeking to find solutions. Last but not least, he referred to the

presentation of Oliver Moldenhauer (TACD event in Athens, 31 May 2013) regarding the prospect of

using WTO provisions and flexibilities in order to allow for cheaper medicines to enter the Greek

market.

The Q&A session that followed was dominated by questions addressed to the TFGR representative

and the Minister’s advisor. Discussion was very much heated between the Minister’s advisor and

patients’ representatives.

Civil society empowerment workshop/advocacy capacity-building

(about 40 patient representatives coming from all over Greece)

Session 1: Towards an effective patients’ movement in Greece

Alex Wyke, Patient View, founder and Managing Director explained the reasons why policy-

makers need to listen to patient groups: a) Health costs are governed by the demands that patients

place on the national healthcare system, b) Such systems need to spend wisely—but also to

understand patients (and thereby not waste resources on unnecessary services) and c) Patient

groups understand patients. They can support patient empowerment, and help make the best use of

resources outside healthcare systems. She added that patients can play a crucial role in the

following areas: a) influencing the doctors’ environment, b) lobbying for budget, c) helping to set

prescribing guidelines, d) shaping government priorities and e) defining professional accountability.

There are numerous sources of information for patients; all they have to do is know where to look. In

addressing the Greek patients associations, she emphasized that fragmentation is their biggest

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challenge and enemy. Policymakers have little time, and do not want to speak to hundreds of patient

groups. They also believe that disease-oriented patient groups have vested interests, and are

prejudiced. Last but not least, fragmented patient groups are not as effective as networked patient

groups that present a unified image. She gave the example of cancer patients where PatientView has

identified 50 different types of patient groups which tend to act independently of one another.

Nevertheless, she commented that an ever-closer integration process is unravelling while cross-stake

holder coalitions are now increasingly happening.

Kathi Apostolidis, President, DE.DI.DI.KA. & Vice-president, European Cancer Patients

Coalition (ECPC) guided the audience through the social media world and its use today. In her view,

patient groups need to take advantage of the potential that social media has to offer. She stressed

that efficient social media use requires commitment, time and money as it usually takes a staff

member working exclusively on setting up and most importantly, sustaining in the long term an

organization’s social media platforms. These means can be used among others to raise public

awareness, attract attention and publicity, raise funds and recruit new members. For example, social

media platforms could be employed to recruit some additional volunteers in light of an event that the

organization is planning to host or to build new relationships with influential figures who can act as

multipliers for the organisation’s messages. She mentioned the following rules regarding the use of

social media: 1) Listen. Social Media is not about you. It is about people’s relationships with you.

Listen before you speak. 2) Get involved. Social Media is about conversations and building

relationships. It takes effort. 3) Don’t just talk about yourself. Ask questions, engage people and link.

Most of all be inspiring. 4) Give up control. You cannot control the conversation. If you want people

to spread your message, you have to trust them. 5) Be honest. You can’t spin the truth with Social

Media. Be open, honest and authentic in everything you say and do.

Following the two presentations, patient representatives were split into two working groups of about

15 people and were called upon to brainstorm on one question each. Working Group A was instructed

by Alex Wyke to present the main priorities of the patients’ movement in Greece while Kathi

Apostolidis instructed Working Group B to work on a social media strategy for their respective

organisations.

Debate in Working Group A was rather heated as participants found it difficult a) to comprehend

what was asked of them, b) to think beyond the narrow limits of their own organization and c) agree

on common priorities of mutual concern and interest. Nevertheless, they listed the following as

overarching priorities for all patients in Greece:

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1 . Universal public health coverage in Greece with special attention to chronic diseases

2. Access to health services irrespective of one’s employment status for everyone living in the country

3. Patient empowerment

4. Training of patients so as to be able to better participate and engage

5. Raising public awareness – prevention – diagnostics

6. Transparency at all levels when it comes to medicines a) safety & quality (cost-benefit analysis &

efficacy) and b) affordability (both for the patient as well as the state budget)

7 . Affordable medicines & treatments

8. Right to work for handicapped people & people with chronic diseases

Session 2: “Weapons” of the patients’ movement in times of crisis

Gaelle Krikorian, Adviser on Intellectual Property & Access to Knowledge-Greens/EFA,

European Parliament spoke about the special features of the following semester for Greece having

the EU presidency in combination with the European elections in May. She expressed the view that

people have a say in EU affairs through parliamentary questions, questions addressed to the

European Commission, the citizens’ initiative as well as the Troika enquiry. Therefore, she called on

participants to elect good parliamentarians next May. She then commented that expensive medicines

can be dealt with through good quality generics which nevertheless, do not solve the issue of patent

monopolies and outrageous medicines’ prices. She explained that it is a very sensitive subject which

when implemented causes a series of retaliations from both governments and the pharmaceutical

industry. She nonetheless explained that it is a goal worth pursuing as Thailand did. Thailand took

the political decision to issue a compulsory-license on heart, HIV and cancer medicines. Strong social

mobilization on behalf of patient groups, NGOs working on public health, academics and other civil

society stakeholders rallied behind the Thai government’s decision. Workshop participants were

encouraged to examine compulsory-licensing in the case of Greece.

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Maria Moudatsou, Forensic Psychologist, Director of Institutional & Vertical Fundraising, NGO

PRAKSIS guided patient groups through the process of fundraising. She explained everything ranging

from where to look for grants and funding opportunities, how to approach sponsoring entities such as

foundations, organizations and others, how to present an organization, how to apply for a grant etc.

She emphasized the need for synergies and forging alliances with other stakeholders. Strategic

planning & management constitute another pillar for the organization of a patient group.

Dimitris Kremalis, Partner, Kremalis Law Firm & President, Greek Health Law

Association provided a brief overview of the legal framework for patients in times of crisis

[Seminar report] Tackling Health Inequalities throughInvesting in Housing

Conference on 22 January in the European Parliament (Brx) organised by EPHA &CECODHAS Housing Europe, and hosted by the EP Urban Intergroup

The event ’Tackling Health Inequalit ies through Investing in Housing’ focused on theconnection between health inequalit ies and affordable housing. It emphasised thatinvestment in good quality housing can bring returns in health and environmentaloutcomes.

Evidence shows that decent housing is an important social and environmental determinantof health [1] These determinants lie outside of the health sector [2]. Nevertheless, neitherhealth professionals nor health policymakers are able to tackle health inequalit ies in the housingsector without the support and cooperation of their colleagues in the fields of housing. This madethe case for a joint seminar between the European Public Health Alliance, the Federationof public, cooperative and social housing and the European Parliament Urban Intergroup.

The Agenda of the event is available here.

MEP Karima Delli, vice-president of the EP Urban intergroup who hosted the event,deplored the fact that the link between housing and health is all too often overlooked at aEuropean level. She highlighted that EU member states are seeking to reform their welfare statesunder serious budget constraints, acknowledging that a more nuanced awareness of theintricacies between health and housing is necessary to promote more efficient spending in

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social and care services.

Karima Delli is the rapporteur of the EP own init iat ive report on Social housing in the EuropeanUnion

CECODHAS Vice-President Özgür Öner stated that “investment in social infrastructurestoday will relieve public budgets for health and social assistance in the longer run”.

EPHA Secretary General Monika Kosińska said that “improving housing for workers wasone of public health’s first areas at its birth. We need to rethink these synergies to ensure thatwe enjoy good quality public housing to reduce the impact of poverty and build healthypopulations and communities.“

Measuring the housing component of health inequalit ies in Europe Matthias Braubach, TechnicalOfficer of WHO Europe Environment and Health, coordinator of the WHO report onenvironmental health inequalities in Europe detailed the many housing-related environmentaldisadvantages that impact on people’s health: lack of flush toilets, shower or bath, dampdwellings, excessive exposure to noise, difficulty in accessing recreational or greenareas and thermal discomfort. [3]

Furthermore, high housing costs have indirect negative health outcomes as itdangerously limits families spending for other basic needs. According to a 2011 report [4],inadequate housing accounts for around 100 000 deaths per year in the WHO European region.

In all cases, poor households are more exposed to these disadvantages but dependingon the issue and the countries, it can be a more widespread problem (notably in new memberstates). Also worth underlining is the fact that housing-related inequalit ies areaccumulative and clustered. This means that populat ion groups that combine socio-economiccharacterist ics such as being low income, single parent families and/or large families haveincreased the chances to be exposed to housing-related environmental disadvantages and thatthey are often affected by several types of inequalit ies at the same t ime. the presentation of Matthias Braubach: Environmental Health Inequalit ies in Europe – Health and

Housing implications.

Carlotta Balestra, policy analyst in the Directorate of Statistics of the OECD , introduced theresults of an analysis by the OECD exploring the determinants of housing and neighbourhoodsatisfact ion among a series of micro-data?. She noted that people who assess their healthstatus as good, are much more likely to assess their housing situation assatisfactory.

There are great discrepancies across EU countries as regards child-injury risks,pointed out Morag MacKay from Childsafety Europe, who highlighted shortages in preventionpolicies concerning home safety of children. the presentation of Morag MacKay: Analysis of national policies to address injuries in the built

environment of the home

Investing in human capital: housing is more than just a roof!

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With the presentation of the OECD Better Life Init iat ive, Carlotta Balestra stressed theimportance of thebeyond-GDP approach and she proposed to shift from “treasuring what youmeasure - the GDP - to measuring what you treasure”. The index compiles eleven indicators ofhuman well-being including housing and health and safety. Ms Balestra insisted that housing is notonly about sheltering from bad weather: quality housing increases people’s self-esteemand social capital. Having access to decent housing is at the basis of human dignity. She finallyunderlined that well-being is sustainable over t ime because it builds up human, natural,economic and social capital that feeds into tomorrow’s well-being. the presentation of Carlotta Balestra: OECD findings on health inequalit ies and housing

Efficient spending: invest in social infrastructure today to save money tomorrow

This vision is likely to be endorsed by the up-coming Social Investment Package of the EuropeanCommission, suggested Fritz von Nordheim, from DG Employment and Social Affairs . Europeneeds to put an end to the destruction of human capital triggered by today’s soaringunemployment levels. More emphasis should be put on social investment because thequality of our labour force depends on the support we provide to people throughout their life. M.von Nordheim also recalled that the earlier you invest in somebody’s life, the higher the returns interms of reduction of inequalit ies and increases in their capacit ies.

Drawing from the example of social housing in Northern Ireland, Joe Frey, Head of Research at theNorthern Ireland Housing Executive, explained that if investment in energy efficiency of buildingshad failed to take place in the past years, fuel poverty would have gone up by 50%. He alsopresented the results of a study undertaken by the Building Research Establishment: investmentsof nearly € 600 million to reduce category 1 hazards in the housing stock in the UK would cutdown health expenditure by € 40 million per annum and thus have a payback period of 13 years. the presentation of Joe Frey: Health benefits of investing in housing and impact on health

expenditure/ Fuel poverty and health impacts

Capitalizing on synergies to improve service coverage and social integration

Dr Chris Handy, CEO of the Accord Group , advocated for a renewed partnership betweensocial housing providers and healthcare services. The Accord Housing Group endeavoursto open up new horizons with init iat ives such as Direct Health, where Accord Group acquired anindependent healthcare company in order to increase home care and residential support providedto tenants. the presentation of Dr Chris Handy: Cooperation between social housing organisations and

health services providers

Undertaking combined health-housing action proves very efficient when it comesto targeting marginalised communities. Deyan Kolev, from the NGO Amalipe pointed tosome de-segregating projects for the Roma in Bulgaria that involved integrated approaches -notably with housing and health dimensions - with support from EU funds. According to Kolev,these are pilot models that should be implemented on a national basis. the presentation of Deyan Kolev: Social housing sector inclusive towards marginalized

communit ies

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Natalia Rogaczewska from the BL housing associat ion explained how a Danish non-profithousing organization trains voluntary tenants to become Health Ambassadors and run seminarsamong tenants to promote healthy eating regimes and lifestyle. the presentation of Natalia Rogaczewska: Educating tenants for a healthy lifestyle

Finally, Dr Pascale Estecahandy, National Technical Coordinator of the "Un chez soi d’abord"programme, submitted encouraging results from a French experimental programme forreintegration of homeless people based on the “housing first” model. the presentation of Dr Pascale Estecahandy: Social housing sector, homeless population and

health outcomes

Recommendations for further action:

Rethink the relationship between end users and service providers According to Claire Roumetchanges come from the ground. The policies that work are the ones that take people and makethem act. Therefore public services should not be a place where people go but public servicesshould connect with each other and reach out to the people.Reconsider social spending as an investment for future human capital. The crisis is too oftenused as a false excuse to mit igate what can be done in part icular for marginalised groups likeRoma people, in the opinion of Michel Verschraegen from DG Justice. Member states needto continue to spend on social issues and budgetary adjustments should be implemented afterconsult ing with relevant stakeholders so as not to put social services in jeopardy.Combine general and targeted action to improve living conditions for all. More efforts can bemade to ensure affordable and quality housing for all as well as to reduce fuel poverty. Measuresto increase energy efficiency of buildings will be vital in the context of rising energy prices anddecreasing disposable income. Although this has been identified as a fundamental investmenteffort, inadequate ventilat ion has important negative health outcomes and should not bedisregarded.Continue research and collect more data in order to better identify the most vulnerablegroups.Both WHO and OECD plan to collect and harmonize more data about housing condit ionsand affordability. In the field of fuel poverty, trying to define vulnerable energy consumers needsto go further than the income element, contended Kyriakos Gialoglou, from DG Health andConsumers. Vulnerability has to do with situations that potentially concern everybody. A reportfrom the Vulnerable Consumers Working Group is expected by the end of 2013. the presentation of Kyriakos Gialoglou: Actions against energy vulnerability & towards delivering

warmer & healthier homes for European consumersIntegrating approaches and better coordination of initiatives were two points that wererepeatedly called for by speakers, notably when it comes to init iat ives funded by the EU. AndorUrmos from DG Regional and Urban Policy warned that for the next period 2014-2020, the EC willbe expecting more consistency between national policies and the operational programmes. the presentation of Wladyslaw Piskorz (presented by Andor Urmos): Inclusive Growth, Urban and

Territorial, DevelopmentAddressing homelessness by making accessible advice centres, as well as counselling andrehabilitation programmes Homelesses is the extreme form of deprivation of housing. Bypresenting the different element of the Social Investment Package, Fritz von Nordheim from

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DG EMPL highlighted the importance of investing in social infrastructure, as well.

Open discussion with the participations of MEPs.

At the end of the event, a roundtable discussion was held by the active part icipation of severalMEPs (Alejandro Cercas (Spain, S&D) MEP and shadow rapporteur of the EP report on socialhousing, Jean Lambert MEP (UK, Greens/EFA), Françoise Castex MEP (France, S&D) during whichpart icipants discussed the following issues:

Could and should the EU do more for a quality housing sector supporting health equity? Whatcould be done, when, by whom and to what end?

What do we need to make it happen? Research, funds, collaboration, political will, socialmovement, leadership?

How can the European elections 2014 help change the paradigm of social investment?

The main messages of MEPs are quoted in the EPHA-CECODHAS Housing Europe Jointpress statement "Fighting an uneven battle - without tackling poor housing, the race againstsocial exclusion risks stumbling", which is available on request.

on EPHA website on CECODHAS Housing Europe website

Related EPHA articles

[Seminar] Tackling Health Inequalit ies through Investing in Housing Energy and Health: How are these Policies Connected? Why should we Tackle Energy Poverty? European Urban Health Conference - Amsterdam, September 12th-14th 2012 The Impact of the Economic Downturn and Policy Changes on Health Inequalit ies - the example

of London Poverty is Not a Crime! - European campaign against the criminalisat ion of homelessness and

poverty kicks off in Brussels Most EU Member States Fail to Ensure the Right to Housing - FEANTSA Press Release

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Other articles you might find interestingabout environment

Footnotes

[1] Social and environmental determinants of health are the condit ions in which people are born,grow up in, live, work and age. They have impacts on the opportunit ies people have to havehealthy lives; affect the chances of developing illness and suffering injury; and also impact onpeople’s life expectancy.

[2] WHO Commission on Social Determinants of Health (2008) Closing the gap in a generation:Health equity through an action on the social determinants of health. Final Report. Geneva: WorldHealth Organisation

[3] Findings from the WHO report Environmental Health Inequalit ies in Europe, 2012.

[4] WHO report Environmental burden of disease associated with inadequate housing. Methodsfor quantifying health impacts of selected housing risks in the WHO European Region, 2011.

Last modified on February 5 2013.

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