Is the European Union Going to Abandon Health Entirely?

Desperate to re-invent itself as it approaches its 60th birthday this year, the European Union is contemplating a range of scenarios aimed at regaining public credibility and political momentum – and one of the options it is examining is abandoning entirely any policy in the field of public health.
 
The surprising suggestion comes in a strategic policy document (http://europa.eu/rapid/attachment/IP-17-385/en/White%20Paper%20on%20the%20future%20of%20Europe.pdf) that the European Commission has prepared for its summit in Rome at the end of March, which will mark the anniversary of the signing of its founding document, the Rome treaty. The document offers a range of possible scenarios – including focusing attention and resources on a reduced number of areas, and ceasing to act in "domains where it is perceived as having more limited added value, or as being unable to deliver on promises" – including, explicitly, public health.
 
The rationale is that such an approach would allow the EU to act more quickly and decisively in its chosen priority areas. The added efficiency would "help to close the gap between promise and delivery, even if expectations remain unmet in certain domains."
 
And the consequence would be that "citizens’ rights derived from EU law are strengthened in areas where we choose to do more, and reduced elsewhere."
 
It forms part of one of five options the Commission has advanced, ranging from carrying on at present, to doing more everywhere, or less in many areas.
 
The EU has been forced into profound existential reflection by the predicament it finds itself in as it moves into its seventh decade. It has manifestly lost the trust of many of its citizens – to such an extent that, in the UK, a majority of voters have set in train the process of complete withdrawal from the EU. And that is only part of the challenges facing the EU.
 
As the Commission acknowledges in its discussion paper, "many Europeans consider the Union as either too distant or too interfering in their day-to-day lives. Others question its added-value and ask how Europe improves their standard of living. And for too many, the EU fell short of their expectations as it struggled with its worst financial, economic and social crisis in post-war history."
 
At the same time, Europe’s place in the world is shrinking, as other parts of the world grow. In 1900, Europe accounted for around 25% of global population. By 2060, it will account for less than 5%. No single EU member state will have more than 1% of the world population by then. And Europe’s relative economic power is also forecast to wane, accounting for much less than 20% of the world’s GDP in 2030, down from around 22% today.
 
Meanwhile, tensions mount in the geopolitical world, migration on an unprecedented scale in half a century is exerting new pressures on the EU, and security is challenged by terrorism. In these circumstances, the EU has to look forward at how it will carve a vision for its own future, as a union of only 27 member states once Brexit removes the UK. That is why the Commission has contributed this reflection on the main challenges and opportunities for Europe in the coming decade, and why it presents its scenarios for how the Union could evolve by 2025.
 
The discussion document "marks the beginning of a process for the EU27 to decide on the future of their Union," it says. First conclusions could be drawn at the December 2017 EU summit. This will help to decide on a course of action to be rolled out in time for the European Parliament elections in June 2019 – and for the post-Brexit world the EU expects to be living in then.
 
"Many of the profound transformations Europe is currently undergoing are inevitable and irreversible. Others are harder to predict and will come unexpectedly. Europe can either be carried by those events or it can seek to shape them. We must now decide," says the Commission document. It says it wants to initiate "an honest and wide-ranging debate with citizens on how Europe should evolve in the years to come. Every voice should be heard."
 
So anyone with a view is not just entitled, but invited, to make it known. What will the health community say?

Peter O’Donnell is a freelance journalist who specializes in European health affairs and is based in Brussels, Belgium.