On Monday, 29th March, EuroHealthNet Director Caroline Costongs delivered the following remarks to a European Economic and Social Committee (EESC) public hearing on ‘building a European Health Union’.

EuroHealthNet brings together national public health institutes and regional health authorities, working on health promotion, disease prevention, and tackling health inequalities.

We welcome the Commission proposals on a European Health Union – they can lead to a strengthened health crisis management and preparedness. However, our overarching concern is that proposals are mainly developed from a biomedical perspective, and not sufficiently incorporating psycho-social measures.

The COVID-19 pandemic can be regarded as a syndemic. This means that the severity of COVID-19 is magnified by existing non-communicable diseases (diabetes, obesity etc) and by existing inequalities. Recent data from the Netherlands shows that 20% of the population at the lower end of the social gradient have 3 times higher risk of dying from COVID-19 than the 20% at the highest. This kind of data will be emerging in other Member States too. The European Health Union package should respond to this injustice.

The EESC opinion fortunately addresses some of these issues, referring to health inequalities.

However, some reinforcements can be made in several areas. I will mention three:

  • Mental health – Mental health services are part of health services, yet they are largely invisible in all the plans. Mental health problems were already one of the leading causes of suffering and disability in EU. They have exacerbated during COVID-19. There is an increase in loneliness, in anxiety and stress, in particular among younger people. Mental health services are under-resourced and struggling, there are long waiting lists, this should not be ignored. Investments in mental health systems and measures must be part of any crisis package.
  • Gender – women make up the majority of frontline workers. They face higher exposure to the virus. Women’s health and mental health is also more likely to be challenged by job insecurity, poverty, the increased burden of informal labour, domestic abuse, and decreased access to services. Gender is important to consider as a horizontal factor. Gender-based solutions are crucial for a better and fairer recovery.
  • Digital exclusion and digital health literacy – The pandemic has clearly accelerated the digital transformation. Many health services offer tele-health measures and online solutions. However, there is a clear risk that those solutions do not reach the people that need them most. Addressing digital exclusion and health literacy are therefore also vital to consider in building a European Health Union of the future.

The members of EuroHealthNet are National Public Health Institutes and regional health authorities. Many are involved in front-line measures. I would like to make two further points how the European Health Union can support their work:

  • Mis- and dis-information – A strong element of the work of our members is on communication with the public, understanding their needs and building trust. Some have set up units on behavioural insights, carried out surveys understanding the concerns of people, go in dialogue with people. In times of crisis, it is vital to give comprehensive and targeted information, dealing with the media etc. This whole area of communication requires resources and coordination, and should be reflected in the plans for a European Health Union, as Member States can learn a lot from each other.
  • The ECDC external evaluation highlighted that MS’ public health systems do not have the capacity to effectively contribute and benefit from the ECDC’s activities. This means that solutions for a strengthened ECDC and HERA need to go in parallel with measures to strengthen PH systems in MS. They need to help build the national and regional capacities for protection, disease prevention and promotion of health and health equity. This obviously needs to happen from local onwards and not top-down. Building on the existing expertise, consult and involve local authorities in planning, design.

In short, the EESC opinion could make stronger references to the fact that the European Health Union should put health inequalities at the core of the package, have a stronger focus on psych-social factors such as mental health, gender equality and digital health literacy.

It should also include ways to address mis- & dis-information and help build regional and national public health systems.

The full potential of the Recovery & Resilience Facility and in fact the entire European Semester process to contribute to this, could also come up stronger in the opinion.

The EuroHealthNet partnership is keen to further cooperate with EESC.