1. EU AND HEALTH A MEMBER STATE’S VIEW Councellor Arto Koho Permanent representation of Finland to the EU

2. Health? Public health –systematic population level approaches to protect, maintain and promote health and prevent diseases –health monitoring Health services and medical care –Counselling (individual approaches to promotion and prevention) –immunisation, screenings –early detection and prompt treatment of diseases, rehabilitation, long-term care

3. Public health ”A contribution to the attainment of a high level of health protection” Article 3.1. (p) ****Sisämarkkinaprovisio***** ”High level of health protection shall be ensured in the definition and implementation of all Community policies and activities” ”Community level action … shall complement the national policies…” Article 152.1

4. Health is potential and capital – not absence of disease Investment in health is profitable Policy and social strategies are increasingly emphasised Determinants of health are mainly located in other sectors than health It essential that health is taken into account in all relevant decision making Health impact should be systematically assessed Health services play a role, but their main task is the treatment of disease Modern view on health promotion

5. No health ministry of any Member State has a similar broad mandate than the EU Keeping health on the other sectors’ agenda is hard work at national level Though: health impact assessment is, for example, done increasingly –screening, assessment, follow-up Talking about mandate…

6. But what about measures? ”improving public health, preventing human illness and disease” ”obviating sources of danger to human health” ”fight against major health scourges, research into their causes, their transmission and their prevention, as well as information and education” ”reducing drugs-related health damage” ”recommendations” Article 152

7. Health services ”The community action in the field of public health shall fully respect the responsibilities of Member States for the organisation and delivery of health services and care” Article 152.5.

8. However, After the adoption of the public health programme decision, health services increasingly on the agenda European Court of Justice jurisprudence

9. Meanwhile, There is nothing in the Treaty on health services, which – thus – remain in the mandate of Member States Secondary legislation on the mobility of patients is being discussed

10. Perhaps an imbalance? The Treaty gives a high public health objectives but does not give appropriate measures In retorics a fifth freedom has been introduced: free mobility of patients

11. Way forward? Added value is available in public health Increased Union mandate in health threats and communicable diseases? Public health legal base for tobacco and alcohol? In health services, Need to clarify the Member State mandate? Need to clarify the framework of patient mobility