An Introduction to the European Union 17 January 2011 Anne Hoel European Policy Manager EPHA – European Public Health Alliance

EU ID 27 Member States – soon 28? 27 Member States – soon 28? 480 million citizens 480 million citizens World’s biggest economy: generate approx 21% of the global economy (GDP) in 2009 = 14.8 trillion US dollars World’s biggest economy: generate approx 21% of the global economy (GDP) in 2009 = 14.8 trillion US dollars 20% of global imports and exports 20% of global imports and exports But… 1 child /5 lives in poverty But… 1 child /5 lives in poverty million people at risk of poverty million people at risk of poverty

EU is an economic area EU = economic area first and foremost EU = economic area first and foremost = Single Market = Single Market = Free movement of people = Free movement of people = Free movement of workers = Free movement of workers = Free movement of goods = Free movement of goods = Free movement of capital = Free movement of capital = Right to establishment and right to provide services = Right to establishment and right to provide services Single Market as a tool and a goal in itself Single Market as a tool and a goal in itself Competence on health very limited Competence on health very limited European law takes precedence over national law and even national constitutional lax European law takes precedence over national law and even national constitutional lax

Areas of conflicts between social (health) and economic objectives regulation deregulation state subsidies free competition solidarity market efficiency territoriality principle non- discrimination price fixing prohibition of cartels

Areas of conflicts between social (health) and economic objectives compulsory membership free choice supply restrictions free movement monopoliesfreedom of establishment Selective contractingno abuse of dominant position Source: Rita Baeten (observatoire social Européen, 2007) Source: Rita Baeten (observatoire social Européen, 2007)

Making the case for health Why regulation in health (and social) sector?  Access is fundamental right  Information asymmetry  Third payer  Harmful commodities (taxation, provision, advertising) How to define the specificity of health and social services?  Values, objectives, instruments;  Solidarity, inclusion How to anchor a good balance between economic and social objectives?

And now? Opportunities to act 2009: New Treaty of Lisbon balancing better the objectives and articles : launch of a process to revise the Single Market June 2010: Monti report November 2010: publication of the Single Market Act Consultation until 28 Feb 2011 Single Market Forum

Who decides? European Commission (DGs) European Commission (DGs) European Council (Council of Ministers) European Council (Council of Ministers) European Parliament (MEPs) European Parliament (MEPs) Economic and Social Committee Economic and Social Committee Committee of the Regions Committee of the Regions European Court of Justice European Court of Justice Court of Auditors Court of Auditors EU Ombudsman EU Ombudsman !!! EU competence on health is very limited !!! !!! EU competence on health is very limited !!!

The role of civil society and advocacy 17 January 2011 Anne Hoel European Policy Manager EPHA – European Public Health Alliance

Who decides? European Commission (DGs) European Commission (DGs) European Council (Council of Ministers) European Council (Council of Ministers) European Parliament (MEPs) European Parliament (MEPs) Economic and Social Committee Economic and Social Committee Committee of the Regions Committee of the Regions European Court of Justice European Court of Justice Court of Auditors Court of Auditors EU Ombudsman EU Ombudsman !!! EU competence on health is very limited !!! !!! EU competence on health is very limited !!!

Lobby jungle Private sector – economic operators Private sector – economic operators Interest groups and trade associations Interest groups and trade associations Non-governmental organisations Non-governmental organisations Think Tanks Think Tanks Public affairs consultancies Public affairs consultancies Law firms Law firms Non-EU governments Non-EU governments Media Media Local and regional authorities Local and regional authorities Academics Academics Trade unions Trade unions

What role for health advocates? Achieving policy change: Nothing for us without us Upholding values – general interest Watchdog role – balancing big economic interests

What is EPHA? The European Public Health Alliance (EPHA) is a Brussels-based network representing the public health community throughout Europe. Mission: “To play a leading role by advocating for a healthier European society and greater participation of people in policy making at the European level.” Members: ranging from academics to diseases-related advocates, population’s groups, patients’ groups, health professionals… From the local to international level

What tools do we have to advocate for greater health outcomes? 1/2 European Commission:  before any proposal, need for input - Consultations (Green Paper)  Meet with desk officers, heads of Unit  Send them your positions and reports  Imapct Assessment  Commissions studies European Parliament:  Provide amendments for MEPs  MEPs can question the Commission (Oral and Written – available on the EP Website)  Written Declarations The Council of Ministers– work at national level

What tools do we have to advocate for greater health outcomes? 2/2 Our values Evidence-based positions, reports from projects, concrete examples Scientific and/or grassroot expertise Manifestos for the elections Campaigning and working together

Role Play The role of stakeholders in building health public policy 17 January 2011 Anne Hoel and Alison Abrahams EPHA – European Public Health Alliance

Hearing in the European Parliament on the Single Market Act Let’s imagine… The new Single Market Act is out THe European Parliament has to make an opinion They call on experts to present their views, with several cases One on alcohol One on health and social services

Hearing in the European Parliament on the Single Market Act 4 groups One NGO ‘PreventAlcohol’ One trade associations of Wine producers (Winers of Europe) One NGO providing social and health services (People First) One trade association of businesses (Health Services Centre) Three MEPs

Hearing in the European Parliament on the Single Market Act 30 minutes to prep 30 minutes to debate (5’ per group to speak) 20 minutes of debrief

Debrief Feedback? Questions? Discussions?

European Public Health Alliance Rue de Trèves 49 – 51 Boite 6 BE Brussels +32 (0)