Health in the European Union

Health is a state of complete physical, mental and social well-being and not merely an absence of disease or infirmity

(WHO 1948)

Non-curricolar, through experience, subconscious, parents,

peers, media, direct environment

Refers to the life long process whereby each individual acquires attitudes, values, skills and knowledge from the educational influences and resources, from daily experience and in any venue visited.

Voluntary, self-directed, self-motivation as driving force

Refers to any programme of personal and social education for young people, designed to improve a range of skills and competences outside the formal education curriculum

Among an estimated 507 million people in the EU-28:

• around 41 million were unemployed (half of which were long-term unemployed, year 2014)
• at least 74 million people had a low education level (ISCED 0, 1 or 2, year 2010)
• there were 34 million EU resident non-citizens (which includes neither illegal migrants nor migrants with EU citizenship already acquired, year 2013), and 6 million Roma (year 2012)

Among those defined as in poverty or at risk of poverty (124 M in 2014, mainly women, children, young people, people living in single-parent households, lower educated people and migrants), 43 million have been estimated to also be at risk of food poverty.

Food poverty, in affluent societies, has not been linked with dramatic energy deficiencies, but with some nutrient/micronutrient deficiencies and with energy-dense diets, overweight and obesity.

Sources:

• Eurostat
• ECHI data tool
• OECD

Educational level: the higher the level of education, the lower the prevalence of obesity; the obesity gradient is stronger in women than in men.

Ethnicity: there is a need to distinguish income, education and occupation differences from ethnic differences before assuming one or the other is solely responsible for the raised risk of obesity.

Sources:

• Obesity and inequality, WHO (2014)
• Marmot report, WHO (2014)

The role of WHO

in ensuring health and well-being

World Health Organization:

specialized agency, with the aim to direct and coordinate international health within the United Nations’ system.

Main areas of work:

• Health systems
• Promoting health through the life-course
• Noncommunicable diseases
• Communicable diseases
• Corporate services
• Preparedness, surveillance and response

Universal health coverage in the EU

EU ≠ European Region

Moving beyond the 3 Ps

of public health:

policy and advocacy

Bismark model

Beveridge model

"Although social health insurance is compulsory, only 86% of the population is actually covered", Romania HiT (2016)

WHO European Action Plan for Strengthening Public Health Services and Capacity

2012

WHO Europe

Advancing public health research

to inform policy and practice

Advocacy, communication and social mobilization

for health

Wikipedia: Advocacy is an activity by an individual or group which aims to influence decisions within political, economic, and social systems and institutions.

Policy:

the fourth P

The 3 Ps

of public health:

Promo- Protec- Preven- tion

Gamification

Major

and 2 municipal councilors (budget and social affairs)

Local Health Authority

WHO European Action Plan for Strengthening Public Health Services and Capacity

2012

WHO Europe

Financial

investors

Two Italian towns (10 k ppl)

Possibility to open a shopping mall

Preliminary agreements propose:

- 3 fast-food restaurants and 1 fast-food outlet

- 100 mt from school

Health promotion

(including action to address social determinants and health inequity)

Disease prevention

(including early detection of illness)

Health protection

(including environmental, occupational, food safety and others)

WHO NCDs Country Profiles

School representatives

Community: the safety net

Unemployed

residents

1995, Chicago

July, 12, for 5 days heat index reached 125F

Approx 750 deaths,

mainly in poor neighborhoods

• no AC
• no open doors for crime fear

Low # deaths in Latinos: SOCIAL COHESION

Impressive example on the role of the COMMUNITY

Creative solutions are needed!

Enablers: among others, advocacy

What is

public health?

Knowledge

Skills

Attitude

NFE in the EU

Public health refers to all organized measures (whether public or private) to prevent disease, promote health, and prolong life among the population as a whole (WHO)

Education

• Formal education
• Informal education
• Non formal education

Building up definitions

School

Subconscious

Peers

Books

Self-directed

Compulsory

Learning through experience

Job

Teacher

Direct environment

Curricula

Non-curricolar

Self-motivation

Certificate

Parents

Voluntary

Media

Formal learning

Non formal learning

School, certificate, job, compulsory, curricola, teacher, books

Refers to the structured education system that runs from primary school to university and includes specialized programmes for technical and professional training

Informal learning

Primary focus on populations

Emphasis on disease prevention

and health promotion for the whole community

Public health paradigm employs a spectrum of interventions aimed at the environment, human behavior and lifestyle, and medical care

http://www.efsa.europa.eu/interactive_pages/animaldiseases/AnimalDiseases#how-to-reduce-the-risk

Safe

RASFF – the Rapid Alert System for Food and Feed

Created in 1979, RASFF enables information to be shared between its members and ensures that urgent notifications are sent, received and responded to collectively and efficiently.

It's composed of EU-28 national food safety authorities, EC, EFSA, ESA, Norway, Liechtenstein, Iceland and Switzerland.

2015 alerts: 775

Other examples

of policies to ensure

access to nutritious food

Complexity: everything

is connected

Key competences

Communication in mother tongue

A framework

Monitoring

NOURISHING policy framework to promote healthy diets & reduce obesity

1.Communicating in a mother tongue

2. Communicating in a foreign language

3. Mathematical, scientific and technological competence

4. Digital competence

5. Learning to learn

6. Social and civic competences

7. Sense of initiative and entrepreneurship

8. Cultural awareness and expression

OKkio alla SALUTE è un sistema di sorveglianza sul sovrappeso e l’obesità nei bambini delle scuole primarie (6-10 anni) e i fattori di rischio correlati.

Recommendation 2006/962/EC on key competences for lifelong learning

OKkio alla SALUTE è collegato al programma europeo “Guadagnare salute” e ai Piani di Prevenzione nazionali e regionali e fa parte dell’iniziativa della Regione europea dell’OMS “Childhood Obesity Surveillance Initiative (COSI)”.

Health claims

Reformulation

"The aggressive marketing of the baby food industry misleads and confuses parents, undermines breastfeeding. For example, Nestlé is currently promoting to health professionals in Botswana a new acidified ‘growing-up milk’ Pelargon 3 with unsubstantiated claims that it: reduces the risk of infection from: Dirty water; Child Minding/Day care; Exposure when travelling and Exposure in warm, wet seasons."

• EU Framework for national salt reduction initiatives

• EU framework for national initiatives on selected nutrients (saturated fat, trans fat, energy, total fat content, added sugars, portion sizes and consumption frequency)

38th Codex Alimentarius Nutrition Committee

Global standard-setting committee puts child health before trade

Food system

"By eliminating tariffs

on unhealthy food,

drinks and meat, CETA

could contribute to

the epidemic of noncommunicable

diseases

and obesity in Europe."

Nutritious

Nutrition security

• WHO considers nutrition security a basic human right
• Nutrition security is rarely on the agenda of decision makers
• What is nutrition security?

The obese are living in a food-insecure environment

Food insecurity exists in developing countries,

where the population is simultaneously suffering from under-nutrition and dying of cardiovascular diseases

at the highest rate worldwide

Denmark:

a country experience

Europa o no

Source: DK country profile

Health in the European Union

"E' più ragionevole pensare che l'europeismo francesce nascesse innanzitutto dalla necessità di proteggere l'interesse nazionale minacciato dalla Germania".

POLICY PROGRAMMES aimed at decreasing use of TRANS FATS

REFORMULATION

Denmark was the first country in the world to introduce a policy on trans fats in 2003. The Danish legislation sets an upper limit of 2 g of industrially produced trans fats per 100 g of fat or oil.

The costs of, and sales losses caused by, product reformulation have not been studied in quantitative terms, but multiple reports have concluded that the economic impact of this trans-fat legislation on Danish industry has been limited. The Ministry of Food, Agriculture and Fisheries of Denmark has reported no complaints following its implementation.

"E' in questo contesto che nasce il primo Piano Monnet, un programma quinquennale di ricostruzione industriale che prevede di fare della Francia il principale produttore di acciaio in Europa.

Parte integrante di questo piano è il controllo economico francesce delle principali zone minerarie tedesche: ovvero la Saar e la Ruhr. A questo scopo, nel 1947 la Saar è trasformata in un protettorato francese e ritornerà sotto l'amministrazione tedesca nel 1957".

Key points:

• no programme for fats and sugars
• the Whole Grain Campaign - network with private stakeholders and NGOs
• salt reduction:
• salt content in food and salt intake are measured
• salt intake is measured through urinary sodium collection method – results: stagnation in reduction of salt!

FOOD TAXATION POLICIES

Promotion of healthier school environments

Key points:

• There were discussions on alcoholic beverages but it was not accepted.
• Denmark’s tax on saturated fat – implemented on 1 October 2011 was abolished on 1 January 2013.

In October 2011, Denmark became the first country in the world to introduce a “fat tax”. The tax received global attention when it was enacted, and generated controversy in some circles where it was claimed that the tax was inefficient, ineffective and would generate unintended negative consequences.

1. Healthy school meals policies:

• School meals (and its procurement)
• Vending machines and marketing to children
• School milk and school fruit

2. Nutrition in school curricula

• 2 hours/week; school decision on voluntary or mandatory

3. Physical activity in school curricula

Food and nutrition

What is a common market? Various perspectives...

Other policies

How

did we get here,

then?

• Brief advice in primary care: The Danish Health Authority published in autumn 2015 materials to hospitals and primary care supporting a focus on an initial assessment of the patient’s lifestyle (alcohol, tobacco, diet, physical activity and drugs), information of the patient in relation to the patient’s lifestyle and health, and if necessary and wanted by the patient referral to intervention in primary care e.g. brief advice.
• Breastfeeding
• Health at work

Researcher

Economist

Public

health

Activist

Government

Time to re-read the history?

Let's not forget that this is an aspect related to economic globalization, more than to the EU

"The EU aims to ensure the provision of safe, nutritious, sufficient and sustainable food"

Why a Common Agricultural Policy?

"The vision of a peaceful, united

and prosperous Europe"

Subsidies

What consequences?

Inequities, at global scale

The Common Agricultural Policy

Overproduction,

inside the EU

Isis: for ISIS read security

The public health

perspective

"We need to maintain and enhance our skills in health

protection, resilience, emergency planning and response and public preparedness."

"We also need new strategic alliances with international lawyers, political scientists, conflict

resolution specialists, anthropologists and social scientists."

Aims of the CAP (Treaty of Rome, 1957):

• ensure a fair standard of living for farmers
• stabilise markets
• ensure that supplies reach consumers at reasonable prices
• modernise farming infrastructure.

"In the era of crop failure and antimicrobial resistance we need to understand ‘biosecurity’ and ‘food security’."

Stabilise markets

Reasonable prices

Modernising infrastructure

Fair standard of living to farmers

The Economist, 2007:

• Cheap no more - Rising incomes in Asia and ethanol subsidies in America have put an end to a long era of falling food prices

Setting the stage

The Green

Revolution

• The end of cheap food - Rising food prices are a threat to many; they also present the world with an enormous opportunity

• Among an estimated 507 million people in the EU-28 in 2014, around 124 million people lived in poverty or at risk of poverty.

• Among those defined as in poverty or at risk of poverty (mainly women, children, young people, people living in single-parent households, lower educated people and migrants), 43 million have been estimated to also be at risk of food poverty.

Food poverty, in affluent societies, has not been linked with dramatic energy deficiencies, but with some nutrient/micronutrient deficiencies and with energy-dense diets, overweight and obesity.

Crop failure

Room for discussion:

• Consequences of high food prices?
• Who is mostly hit?
• What is the "enormous opportunity"?

• Declared objectives vs real consequences
• US vs EU (food security / independence)
• Worldwide: North vs South
• Europe: North vs South

Is "healthy" food more expensive than "unhealthy" food?

Food banks, SNAPs, etc

Did the EU get it all wrong?

http://www.theatlantic.com/past/docs/issues/95dec/chilearn/drucker.htm

Challenges in addressing the question:

• definition of "healthy" vs "unhealthy"
• price is not the only determinant:
• time
• distance from grocery shops
• cooking hardware
• personal preferences
• etc

"There is growing realisation that conflict in Syria had its roots in crop failure caused by climate change."

" We cannot have health without peace, justice and

fairness."

Not at all!!!

These goals have largely been achieved.

Moreover, consumers today enjoy security of supply and the prices of agricultural products are kept stable, protected from fluctuations on the world market.

The policy is financed by the European Agricultural Guarantee Fund (EAGF) and the European Agricultural Fund for Rural Development (EAFRD).

"We cannot have a healthier environment and a resilient and healthy food system without

addressing mass overconsumption, unequal distribution and addiction to sugar and highly processed

foods."

Among the best achievements in health policies:

Safety & quality of medicines

Precautionary principle

For ‘antimicrobial resistance’ read

‘a One-Health approach’

Universal health converage (UHC)

Cross-border healthcare (XBC)

"A continued rise in resistance by 2050 would lead to 10 million people dying every year and a reduction of 2% to 3.5% in Gross Domestic Product. It would cost the world up to 100 trillion USD."

Sufficient - f. security

Among

enablers: advocacy

"It requires those involved in animal health and human health to work together and it shows how there is only

‘One Health’."

Combacting risk factors for chronic diseases

Non formal learning & education

Complexity:

everything is connected

What is

public health?

The CAP today

Food and nutrition: set the stage

Is there a way

to structure

the discussion?

However, the CAP became a victim of its own success:

• production grew far faster than consumption, placing a heavy burden on the EU budget
• in order to resolve the problem, production has been curbed.

Major critiques to CAP

Gaps:

inequalities

in the EU

• Most of the EU budget goes to farmers!
• Because food and commodity prices are high, we can scrap our farm subsidies!
• The common agriculture policy creates food surpluses and hurts farmers in the world's poorest countries!

Commitment:

what does

it mean?

http://ec.europa.eu/budget/explained/myths/myths_en.cfm

The role

of the EU

Are we protecting the ones in need?

New roles of the farming community:

• ensure a certain amount of economic activity in every rural area and protect the diversity of Europe’s countryside
• negotiate within WTO to put more emphasis on food quality, the precautionary principle (‘better safe than sorry’) and animal welfare
• combat climate change.

The shrimp-turtle case (WTO)

In early 1997, India, Malaysia, Pakistan and Thailand brought a joint complaint against a ban imposed by the US on the importation of certain shrimp and shrimp products. The protection of sea turtles was at the heart of the ban.

Measures to protect sea turtles would be legitimate under GATT Article 20 (i.e. XX) which deals with various exceptions to the WTO’s trade rules, provided certain criteria such as non-discrimination were met.

The US lost the case, not because it sought to protect the environment but because it discriminated between WTO members. It provided countries (mainly in the Caribbean) technical and financial assistance and longer transition periods to start using turtle-excluder devices. It did not give the same advantages, however, to the four Asian countries that filed the complaint with the WTO.

https://www.wto.org/english/tratop_e/envir_e/edis08_e.htm

Definitions and key aspects of "sustainable diet"

Erasmus+ JM dev4h

Definitions

• “Diet composed of foods chosen for their contribution not only to health but also to the sustainability […] of the agricultural system” (Gussow & Clancy, 1986)
• “Those diets with low environmental impacts which contribute to food and nutrition security and to healthy life for present and future generations” (FAO & Biodiversity International, 2012)
• “Sustainability is not a static notion but a moving target which should be understood as a challenge to preserve the adaptability and resilience of the natural (biotic and abiotic) systems that form the basis of economic and social development” (Aiking 2014)
• “Diets high in vegetables, fruit and whole grains, with limited intake of saturated fat, trans fats, sugar and salt” (WHO 2014, Food and Nutrition action plan)

Source: EUPHA F&N section

Sustainable

Not all pyramids are the same!

Commitment:

what does it mean?

The EU

The European Union is more

than just a confederation of countries,

but it is not a federal state.

Health inequality and inequity

Conditions to enter the EU

Sustainability, GMO, and research question

???

[

• Use of chemicals
• Biodiversity
• Food safety
• Economic consequences
• Monopolies
• Etc

http://www.oecd.org/health/health-at-a-glance-europe-23056088.htm

Research

• Research cannot answer all questions
• Research can answer well-framed questions ("is fruit juice a healthy option?" is not a well-framed one)

Copenhagen Criteria:

• stable institutions guaranteeing democracy, the rule of law, human rights and respect for and protection of minorities
• a functioning market economy and the capacity to cope with competitive pressure and market forces within the Union
• the ability to take on the obligations of membership (e.g. public administration capable of applying and managing EU laws)

Research and sustainability into perspective

Sustainability

From MDGs to SDGs:

• Goal 2 "End hunger, achieve food security and improved nutrition and promote sustainable agriculture"
• Goal 3 "Ensure healthy lives and promote well-being for all at all ages"
• Goal 12 "Ensure sustainable consumption and production patterns"
• Goal 14 on conserving oceans, seas and marine resources

Source: Europe in 12 lessons

Definitions

Health inequalities between Countries

Health inequalities

Differences in health status or in the distribution of health determinants between different population groups:

• differences in mobility between elderly people and younger populations;
• differences in mortality rates between people from different social classes.

Are we protecting

the ones in need?

Some EU

crucial principles

Health inequalities within Countries

Health inequities

The uneven distribution may be unnecessary and avoidable as well as unjust and unfair, so that the resulting health inequalities also lead to inequity in health.

Within countries, vulnerable (and often socially excluded) population groups are characterized by one or more of the following conditions:

• low household income;
• low educational level;
• unemployment (especially long-term unemployment);
• low socio-economic status (SES, which often includes one or more of the already mentioned conditions);
• poverty (or at risk of poverty);
• migrant background;
• ethnic minority background.

Part 1

Part 2

Health tends to worsen as one moves from society's richest to poorest, often referred to as social gradient in health. Age and gender differences can worsen health inequalities.

• Precautionary principle – 2 formulations

where there are possibilities of large or irreversible serious effects, scientific uncertainty should not prevent preventative actions from being taken (Brutland) – permissive expression

action should be taken where there are possibilities of large or irreversible serious effects (=risk awareness) – mandatory expression

• Prevention principle – from control to prevention
• Polluter pays principle
• Safeguard clause – it allows Member States to take provisional measures to protect the environment in cases of urgency (restriction on dangerous products, restriction on biocidal products, restriction on products whose classification, packaging or labeling is no longer appropriate)

• Principle of attribution (or conferral) – defines the extent of the Union’s competence
• Principles of subsidiarity and proportionality – “in areas which do not fall within its exclusive competence, the Union shall act only if and in so far as the objectives of the proposed action cannot be sufficiently achieved by the Member States, either at central level or at regional and local level, but can rather, by reason of the scale or effects of the proposed action, be better achieved at Union level”
• High level of protection – “A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities” – Article 168 TFEU

Reducing health inequalities: absolute vs relative

• Absolute inequalities: differences in events between population groups (e.g. difference in mortality rates between lowest and highest SES)
• Relative inequalities: ratio of an event occurring in one group relative to another (e.g. ratio of mortality rates between lowest and highest SES)

Health inequalities between and within Countries

HiAP: health and health systems are most affected at EU level by policies born in other sectors, particularly those affecting:

• the determinants of health (such as environment policy, as well as social policy)
• the integration of the internal market (through issues such as cross-border health care or professional mobility)
• health regulation (as with regulations on labour and pharmaceuticals)

The only relevant area of shared competence between the EU and the Member States is “common safety concerns in public health matters”; for the wider objective of the “protection and improvement of human health”, the EU may only “support, coordinate or supplement” Member States’ action.

Index of: life expectancy, math and literacy, infant mortality, homicides, imprisonment, teenage births, trust, obesity, mental illness including drug & alcohol addiction, social mobility

Source: Wilkinson & Pickett, The Spirit Level (2009)

Shaping the EU role

Sustainable development

The European identity in a globalized world

The EU guarantees a "critical mass" in decision making.

Examples:

• International negotiations:
• World Trade Organisation (WTO)
• United Nations conferences on climate change
• Clear position on sensitive issues (environmental

protection, renewable energy resources,

‘precautionary principle’, etc)

• Global warming: leading effort

• Lisbon strategy: make Europe by 2010 “the most competitive and knowledge-based economy in the world capable of sustainable economic growth with more and better jobs and greater social cohesion”
• Europe 2020

Employment: 75% of the 20-64 year old to be employed

R&D/Innovation: 3% of the EU’s GDP (public and private combined to be invested in R&D/innovation – techno oriented approach)

Green house gas emission 20% ( or even 30% if a satisfactory international agreement can be achieved to follow Kyoto) lower than 1990;

20% of energy from renewable

20% increase in energy efficiency

Do we have a EU Constitution?

Source:

Ashford

2011

• A draft EU Constitution was signed in October 2004, to replace all the existing treaties
• The text was rejected by two national referendums in 2005
• The Constitution was replaced by the Treaty of Lisbon (signed in December 2007, into force on 1 December 2009)
• It amends but does not replace the previous treaties
• It introduces most of the changes featured in the Constitution (European Council Permanent President, High Representative of the Union)

Some cases to debate

Legislation

Contribution to NHS funds

Functioning

of the EU

Cost of food

It should be based not only on income, but also on the individual lifestyle risk factors (i.e. smokers pay more than non-smokers)

The Lisbon Treaty (2009):

TFEU (Treaty of Rome) + TEU (Treaty of Maastricht)

The Treaties (known as ‘primary’ legislation) are the basis for a large body of ‘secondary’ legislation which has a direct impact on the daily lives of EU citizens.

The secondary legislation consists mainly of regulations, directives and recommendations adopted by the EU institutions.

Consumers should pay the real price of food production (i.e. no subsidies or taxes should be applied on food)

Food marketing

to children

There should be little regulation and little govt interference, because it's an issue that is relevant to parenthood

Labeling

Health inequalities in the EU

Institutions

Health inequalities

There is no need of mandatory food labeling on environmental/ethical aspects: the initiative could be left to individual industry' preferences

These laws, along with EU policies in general, are the

result of decisions taken by:

• Council (representing national governments)
• European Parliament (representing the people)
• European Commission (a body independent of EU governments that upholds the collective European interest)

We should be more concerned about inequalities within countries than inequalities between countries

Disambiguation

International organisation focused on promoting human rights, democracy and the rule of law in Europe

Council of Europe

Council of the European Union (or Council)

European Council

Council of Ministers representing the Member States' governments

Third institution of the EU

Heads of state or government of the MS

Involved in setting the EU's political agenda

How to reach targets?

Intervention ladders

Different level = different level of intrusiveness.

Each individual rung does not include all lower levels.

To give an example, "enabling choice" does not mean that "monitoring" and "providing information" are included in the intervention action.

The example of environmental health

Traditional or direct or command & control approach

Economic incentives/disincentives (polluter pays)

Environmental quality standards – “prescribe the level of pollution, nuisance or environmental interference which are permitted and which must not be exceeded in a given environment or particular media”

Example: air quality standards

Product standards – “establish levels for pollutants or nuisance which must not be exceeded in the manufacture or emission of a product”

Example: construction of new oil tanks with double hulls

Emission standards – “set levels for pollutants or nuisance which are not to be exceeded in emissions from installations or activities”

Example: atmospheric emissions from automobiles

Process standards – “installation design standards, to determine the requirements in the design and construction of installations to protect the environment, and operating standards, to determine the requirements in the activities and the operation of installations”

Example: process for the treatment of municipal waste

Charge and taxes

Joint implementation & tradable permits

Example: IET in Kyoto protocol (1997) and tradeable permits (emission reduction units); EC: GHGs emission allowance trading within the EC

Deposit-refund system

Example: Danish Bottle case (containers for beer and soft drinks)

Investment incentives

Example: Joint Implementation & Clean Development Mechanism (Kyoto)

Environmental agreement

Example: agreement between association of European, Japanese and Korean car manufacturers in the reduction of CO2 emissions

Consumer information incentives – “to capitalize on the perception that many consumers take environmental considerations into account”

Example: Eco-labelling

Inequalities in behaviours (diet, PA)

2014-20

financial programme

Main EU agencies with relevance to health policy:

• European Centre for Disease Control and Prevention (ECDC)
• European Food Safety Authority (EFSA)
• European Medicines Agency (EMA)
• European Monitoring Centre for Drugs and Drug Addiction
• European Environment Agency
• European Agency for Safety and Health at Work

Eur 155 bn in 2016

How is it spent?

Main actors

Areas of EU activity

How is it collected?

The Parliament

The Commission

The Council

Policies

to tackle inequalities

1. Smart and Inclusive Growth [ab 50%]

• Competitiveness for growth and jobs
• Economic, social and territorial cohesion (incl. disadvantaged areas and cohesion fund)

2. Sustainable Growth / Natural Resources [ab 40%] (incl. CAP and rural development)

3. Security and citizenship (incl. justice, immigration, public health, consumer protection)

4. Global Europe (incl. foreign policy, excl. European Development Fund, EDF, 4 bn, funded from MS direct contributions)

5. Administration

6. Compensations

Special instruments

• Elected body (since 1979, universal suffrage, every 5 years)
• President: <<Schultz>>
• Plenary sessions: monthly, attended by (all) MEPs
• Main job: to pass EU laws (responsibility shared with the Council)
• Other duties: adoption of EU budget, approval or rejection of the European Council's nominee of the Commission President, and approval of the Commission after hearings, dismissal of the Commission, and questions to Council and Commission

• 28 members appointed by MS, every 5 years
• President: Junker
• Commissioners are assisted by civil servants working in Commission or Agency
• It alone has the right to draw up proposals for new EU legislation
• Main jobs: uphold the common interest (it must not take instructions from any national government), ensure that law is adopted and implemented (‘Guardian of the Treaties’), and implement policy decisions (EU executive arm)

• Ministers from national governments
• Council Presidency: MS in turns, for 6-month
• Council meeting: attended by one minister (depending on the topic)
• Main job: to pass EU laws (responsibility shared with the European Parliament)
• Other duties: adoption of EU budget, signature of international agreements negotiated by the Commission
• Decisions: simple majority vote, qualified majority vote or unanimously

< 1.5 bn (2014):

• Emergency Aid Reserve

e.g. Syria, Mali, Sahel

• European Globalisation Adjustment Fund

e.g. GM Antwerp shut-off

• European Union Solidarity Fund

e.g. Abruzzo Earthquake

• Flexibility instrument

e.g. 2009 energy plans

F&V consumption: low-income households have the lowest F&V consumption in the EU. Highly educated people tend to eat vegetables more often than their less educated counterparts. In children, low consumption is associated with parents' low education, low income and unemployment. Fruit consumption is more common in adolescents with higher parental occupational status.

Breastfeeding: mothers from lower SES are less likely to breastfeed than mothers from higher SES.

Breakfast & family dinner: children from high-affluence families are more likely to eat daily morning and evening meals than children from lower affluent households.

Soft-drinks consumption: adolescents with higher parental occupational status have lower consumption than their counterparts.

TV watching: children from low-affluence families are more likely to watch at least 2 hours of TV per day.

PA: in adults, reported level of PA increases with gross household income, and the percentage of adults doing sport increases with educational level. High-affluence children are also more likely to be active.

Direct financing

Indirect financing

EU legislation, although decided by the Council and parliament, can only begin with a Commission proposal, which gives the Commission enormous

influence in shaping what is ultimately decided.

The parliament works principally through standing committees for the different policy areas, with the committee responsible for the subject of a proposal taking the lead in the parliament’s consideration of it.

The lead committee for health issues is the Environment, Public Health and Food Safety Committee.

http://ec.europa.eu/budget/mff/index_en.cfm

Examples

Other main actors

Sources:

• HBSC, WHO (2016)
• Marmot report, WHO (2014)
• Innocenti report, UNICEF (2016)

Examples:

• Programs under ERDF
• Programs under ESF
• Cohesion fund
• CAP (pillar I)
• Rural dev. (p. II) / EAFRD
• CFP / EMFD

Examples (2014):

• Horizon2020 (9 bn)
• Erasmus+ (1.5 bn)
• Creative Europe
• COSME
• LIFE
• EaSI

European Council

Court of Justice

European Central Bank

Court of Auditors

Restrict or eliminate choice

European Economic and Social Committee

Decision-making

Process

Enable choice through changing the default

Committee of the Regions

• FEAD - http://europa.eu/!Yn68pP

European Investment Bank

Inequalities in

health conditions

• Restrict access to less healthy foods and sweets on school premises
• Encourage urban policy-makers to limit the density of fast food outlets and restaurants in disadvantaged areas and around schools

• Implement targeted measures to make participation in physical activity more attractive to girls in schools
• Foster promotion of urban food initiatives (e.g. community gardens and cooperatives)
• Restrict marketing of high-fat, -sugar and -salt foods and sugar-sweetened beverages to children
• Encourage food manufacturers to make healthier reformulated products without price increase

Guide choice through incentives/disincentives

http://ec.europa.eu/budget/mff/programmes/index_en.cfm

Civil society involvement and Lisbon Treaty

Regulation

Binding legislative act (Art 288 ex TFEU)

Population involvement has been encouraged:

there is a legal requirement of social dialogue, in order to increase a participatory democracy in the EU.

• Ensure welfare payments in vouchers include healthy food
• Consider granting free entry to local swimming pools and other sport facilities for residents in low-income suburbs

Infringement Procedure

For example, when the EU decided to take action to better protect human health and the environment against the risks associated with chemical substances, it adopted a regulation on this issue (REACH, Reg EC 1907/2006).

Another example is Regulation (EC) No 178/2002, laying down the general principles and requirements of food law, establishing the European Food Safety Authority and laying down procedures in matters of food safety.

Challenging questions:

• Are all Member States equally empowered, confident and skilled to take up a meaningful role in this dialogue?
• Is the political decision-making in health and social fields representative and a complete reflection of the European society?

Directive

Legislative act, sets out a goal for all EU MS

Provide information

Where it detects a failure to comply with Community law, the Commission may initiate the procedure for failure to fulfill an obligation provided for in Article 258 of the TFEU:

• the Commission sends the Member State a letter of formal notice (2 months to reply and comply)
• the Commission may issue a reasoned opinion (2 more months), which goes to press release
• the Commission can take the case to the Court of Justice, whose judgment is binding
• further letter of formal notice
• further reasoned opinion
• further referral to the Court of Justice, seeking the imposition of a penalty payment under Article 260 of the TFEU

It is up to the individual countries to devise their own laws on how to reach these goals.

The Drinking Water Directive (Council Directive 98/83/EC; consolidated as EU 2015/1787) concerns the quality of water intended for human consumption.

Other examples are the Air Quality Directive, and the Working Time Directive.

Others

• Consider that consumers with low numeracy or literacy skills may be more receptive to pictograms/pictures, rather than to detailed numerical nutritional information on food labels
• Employ peer mediators with diverse ethnic and socioeconomic backgrounds
• Deliver services (including dietary and physical activity counselling) in community settings (e.g. churches)

Decisions: binding on those to whom it is addressed (e.g. an EU country or an individual company) and directly applicable.

For example: authorisation / refusal of novel foods and novel food ingredients by Commission Decisions.

Recommendations: allows the institutions to make their views known and to suggest a line of action without imposing any legal obligation.

For example: country-specific recommendations (tailored policy guidance to MS), in the context of the European Semester.

Opinions: non binding-statement.

Reccomendations take place principally as Communications (from the Commission), Conclusions (from the Council) and Opinions (from the Parliament).

These are legal acts but without any legal mechanism of enforcement.

Nevertheless, the political weight of such a commitment is substantial, and they have proved effective in the health area on subjects such as cancer screening (Council Conclusion).

Example - Council conclusions on food product improvement, 2016

http://www.consilium.europa.eu/press-releases-pdf/2016/6/47244642807_en.pdf

There is a strong social gradient in obesity: lower SES have higher levels of obesity compared with the rest; this is particularly true for women and children.

In the European Region, about 20–25% of the risk of obesity among men and 40–50% among women can be attributed to differences in SES.

Sources:

• Marmot report, WHO (2014)
• OECD
• Eurostat