EuroHealthNet welcomes the launch of the Healthier Together – EU Non-Communicable Diseases (NCDs) Initiative, that signifies the European Commission (EC) commitment to support EU Member States in reducing the burden of NCDs. We applaud the ambitious budget linked with its implementation and are pleased with the comprehensive steering approach that addresses the currently untenable situation, where quality of life of Europeans is being impaired by rising levels of NCDs that are, in many cases, preventable. Treating these diseases consumes 80% of health budgets.
We praise the co-creative and country-owned process through which the EC developed the Initiative, and the substantial resources that are being committed at its outset. We commend that the Initiative does not just focus on actions that can be taken within the health sector, but also on ‘integrated approaches’ that require the health sector to engage across sectors policy areas, to address the underlying causes of NCDs and the associated health inequalities.
The guidance document that was published last week sets out ambitious actions, legal and financial tools that will be applied towards the implementation of the Initiative. It is a useful Toolkit to help EU Member States and other stakeholders move towards accelerated action on NCDs. What remains unclear however, is how relevant actors can employ these instruments in a strategic and coordinated way to progress towards EU and international goals relating to NCDs, by when and by whom.
We believe that to maximise the impact of these resources, they must be deployed in a more clearly defined, common strategic framework, complemented with necessary legislation if and where appropriate evidence calls for it. The impact of the proposed Joint Actions and the transfer and implementation of good practice will for example be limited, if they do not contribute to a more collectively orchestrated process of systemic change.
We therefore call on the EC to, as part of implementation, establish sustained structures and mechanisms that bring together key stakeholders to refine the Initiative, encourage member states to take on ambitious, well integrated actions, and to help coordinate the overall approach. A proposed new Joint Action may offer some of solutions to this avail, but more could be done. This especially includesdeveloping plans to strengthen the capacities of health professionals at all levels to engage across sectors, to work with non-state actors, to use the leverage of EU instruments and to ensure a much wider consideration across policy areas for health and health equity impacts.
“In absence of a dedicated EU-level coordination mechanism that helps EU health stakeholders define, govern and pursue common plans for change, we fear the focus will remain on easier – ‘downstream’ and lifestyle-oriented actions, with too little consideration for ‘upstream’ factors influencing these, such as socioeconomic and commercial determinants”,
said Caroline Costongs, Director of EuroHealthNet, the European partnership for Health, Equity and Wellbeing.
The development of a well-coordinated strategic approach to the implementation of the NCD Initiative also requires more insight into whether and how additional funds to support it will be deployed over its five-year lifespan. With this in mind, EuroHealthNet also calls for the EC to provide a transparent process of accountability and information into which stakeholders will be able to draw on the available resources, considering eligibility and co-funding criteria of EU member states’ joint actions.
EuroHealthNet stands ready to support its public health member agencies to take forward the ambitions of this initiative and to prioritise action within their own national settings. We will encourage our members across European states to take stock of the main opportunities they see to benefit from the Initiative, while seeking solutions to overcoming barriers that they face with its implementation on the ground.
We will also capture their ideas on how best to apply the existing tools launched in a strategic manner, to maximise impact on the reduction of NCDs across Europe and ensure meaningful cross-sector engagement in the process. We will feed these ideas to the EC and other stakeholders across the EU, Europe and globally. We will continue building capacities among our partnership, to support a whole-of-society approach and advocate transformative action on the prevention of NCDs in foreseen Joint Actions and EU4Health annual programmes, as part of the wider European public health community.
“The EuroHealthNet Partnership is determined to take the full advantage of this new EU NCDs Initiative, supporting both the EU institutions and member states in accelerated action to address deep structural and systemic determinants of the growing burden of NCDs. Our input toward the Initiative’s design highlighted some of solutions for how this could be done”, Ms Costongs concluded.
Member States will now embark on a priority-setting exercise to identify which promising actions and policies from the Healthier Together toolkit can be transferred into their national contexts, Considering our concerns as set out above, EuroHealthNet strongly advocates for:
- Identification and analysis of key barriers and opportunities for implementation
Investment in research capacities to identify: (1) how interventions can be adapted and upscaled to the national context and resource availability; (2) what the barriers to implementing recommended interventions are; and (3) their level of impact.
- Mapping of (sub-)national and international resources to support implementation of effective interventions
Resource mapping of funds at (sub)national and international level can indicate areas for better synergy and collaboration across Ministries to achieve a more integrated response to NCD prevention. This process should also be part of maximising the European Semester and the implementation of the national Recovery Plans (and others, eg. European Child Guarantee Action Plans) to holistically implement promising NCDs-related practices. It is also important that the provisions outlined in the WHO Implementation Roadmap 2023-2030 for the Global Action Plan for the Prevention and Control of Non-Communicable Diseases 2013-2030 are utilised to further spur implementation.
- Meaningful stakeholder engagement for whole-of-society health governance
While ownership at Member State level is an important component, “whole-of-society” governance for health is essential to engage multiple actors, including civil society, throughout the implementation phase of this Initiative. This can be further supported through the engagement of civil society in EU Member State platforms, such as the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases, and global platforms such as WHO’s global coordination mechanism on the prevention and control of NCDs.
- Defining accountabilities to support concerted efforts in tackling NCDs and their health determinants
As outlined in the WHO Implementation Roadmap for NCDs referenced above, country leaders should be responsible for providing strategic leadership through whole-of-government and health-in-all policies approaches and creating space for meaningful engagement with stakeholders. The role of public health authorities and Health Ministries should be defined synergistically with their social, educational, environmental, and financial counterparts, and in consultation with non-state actors through institutionalised processes.
Notably, the United Nations Interagency Task Force on the Prevention and Control of Non-Communicable Diseases (responsible for supporting countries and mobilising resources to deliver multisectoral action), the new United Nations Multi-Partner Trust Fund to Catalyze Country Action for Non-communicable Diseases and Mental Health and a proposed web-based simulation tool (to be developed this year, supporting the prioritisation and upscaling of NCD interventions per country by generating the health impacts of recommended interventions).