The Public Health Programme

Article 152 of the Treaty establishing the European Community states that a high level of human health protection shall be ensured in the definition and implementation of all Community policies and activities. The Community is required to play an active role by complementing national policies to improve public health, prevent human illness and diseases, and obviate sources of danger to human health.

The Public Health Programme (PHP) 2003-2008 aimed to address concerns about health risks and provide coherent and coordinated assistance to the Member States for a high level of health protection throughout the EU. Health related activities in the EU must have a high level of visibility and transparency and allow all stakeholders to be consulted and participate in oreder to promote better knowledge and communication flows. This enables greater involvement of individuals in decisions that concern their health by providing them with simple, clear and scientifically sound information about measures to protect health and prevent diseases in order to improve the quality of life.

The PHP integrated the previous eight separate health actions on different public health topics3 into a coherent framework.

1.1.1. General objectives

The three main objectives, as set out in the legal basis of the PHP, Decision N° 1786/2002/EC of the European Parliament and of the Council of 23 September 2002 (Official Journal L

271/1 of 9.10.2002.p. 1) are as follows:

• Improve information and knowledge for the development of public health,

• Enhance the capability of responding rapidly and in a coordinated fashion to threats to health,

• Promote health and prevent disease through addressing health determinants across all policies and activities

The Programme strived to improve public health and make it more efficient across the EU, by ensuring a high level of human health protection in the definition and implementation of all Community policies and activities and tackling inequalities in health. It seek to set up a high level of sustained cooperation and coordination between and with Member States' health

1.1.2. From general to specific objectives

The three main objectives of the PHP translate into three strands of activity:

Health information: To improve information and knowledge for the development of

public health;

Health Threats: To enhance the capability of responding rapidly and in a

coordinated fashion to health threats;

Health Determinants: To promote health and prevent disease through addressing

health determinants across all policies and activities.

These strands seek to create sustainable mechanisms to enable the Member States to coordinate their health-related activities and to tackle inequalities in health. They strive to improve public health by preventing human diseases and disorders, and to obviate sources of danger to health. This is done through preventive measures, education and information, health promotion and health systems.

More specifically:

- The objective of the health information strand is to establish a sustainable EU-wide system for comparable data and information on health and health-related behaviour as well as on diseases and health systems to support health policy development and implementation. This should be based on commonly agreed European-wide indicators. The system is being developed on the basis of previous work in former Community health programmes. It should complement the activities of the Community Statistical Programme and work underway in Community agencies and international organisations such as the WHO and the OECD. It provides regular reporting on health in general and generates a flow of information, analysis and exchange of best practice in the public health field at European level. (Article 3,

paragraph 2, points (d) and (e) of the Programme Decision)

- The strand for health threats addresses infectious diseases that threaten the health of EU citizens. It seeks to prevent the transmission of emerging pathogens and the resurgence of others, as well as enhancing a rapid and coordinated response to these threats. Epidemiological surveillance of communicable diseases seeks to bring about interventions that contribute to the reduction of morbidity and/or mortality. Strict quality and safety criteria for handling blood and substances of human origin constitute an important measure. Health threats from chemical, biological and radio-nuclear sources, including terrorist acts and environmental agents can be countered by early warning and rapid response systems, and by vaccination and immunisation strategies. (Article 3, paragraph 2, point (a) of the Programme Decision)

- Tackling major health determinants is crucial to reducing the burden of disease and promoting public health. Actions and networks for gathering, providing and exchanging information in order to assess and develop policies, strategies and measures, with the purpose of establishing effective interventions tackling the determinants of health, are encouraged and supported. Member States' efforts in this field are promoted, e.g. by way of innovative projects which provide examples of effective practice. Socio-economic factors and life cycle approaches are considered in all actions aimed at tackling lifestyle-related health determinants. (Article 3, paragraph 2 point (b) of the Programme Decision)

(Article 3 paragraph 2, point (c) of the Programme Decision).

The programme participates in joint strategies and actions with other relevant EU programmes and actions to incorporate health aspects and ensure that it is underpinned by policy (Article 4 of the Programme Decision).

The operational objectives of the Programme are formulated as actions and support measures described in the Annex of Decision N° 1786/2002/EC.

1.1.3. Implementation of the Programme

The Programme was allocated a budget of 284 M€. The Programme has been implemented through an operational budget of 260 M€, by call for proposals (90% of the operational budget), call for tenders for service contracts and direct grant agreements (10% of the operational budget). Administrative support measures and design of EU Community legislative instruments for health were financed by the Programme's Administrative budget of 24 M€ by means of technical assistance service contracts, reimbursement of experts for their participation in meetings and conferences etc. Detailed information is available in the Annual Activity reports for the implementation of the Programme for years 2003-2004, 2005, 2006 and 2007.

The calls for proposals were based on the priority areas described in the annual work plans for the Public health programme. Following a call for proposals, grant agreements were signed with successful candidates representing groups of partners from the Member States for projects with a life-span of two-three years. This instrument has the advantage of encouraging and supporting Members States' activities with the widest possible EU coverage in specific health areas. The widest possible cooperation was clearly underlined in the Programme decision on actions requiring implementation through local and regional authorities and non- governmental organisations.

Calls for tenders were used to address specific needs more effectively and to concentrate work on specific problems and methods with shorter timetables (1 year mostly) and where the results should be the property of the Commission.

The Programme was intended to support structures and projects which enhanced the capabilities of individuals, institutions, associations, organisations and bodies in the health sector. It aimed to facilitate the exchange of experience and best practice and provided a basis for a common analysis of the factors affecting public health. Expertise and experience in effective methods were expected to be gathered as a pre-requisite for implementing measures and quality criteria for promoting health with the aim to be incorporated in a transparent EU knowledge base.

The Programme set out to increase cooperation with international bodies such as the WHO, the World Bank, the OECD, the Council of Europe and the European Observatory on Health Systems and Policies. Direct grant agreements were negotiated for the first time in 2005 with the WHO and the OECD, and the experience was renewed in 2006 and 2007, on specific health issues on which the signing parties had jointly agreed to investigate and make progress. The Programme also set out to contribute to legislative activities through preparatory work either via the abovementioned calls for proposals and for tenders or via coordination of the