1. EU Policy on Health Promotion and Chronic Disease Vilnius, 24 November 2015 Michael Hübel, Head of Unit Programme Management and Diseases DG Health and Food safety

2. 30 years of EU action against cancer 1985 - European Council in Milan, the Heads of State decide to launch the first "Europe Against Cancer" programme The first 'European Action Plan Against Cancer' adopted for 1987-1989 and the Second for 1990-1994

3. Major chronic diseases Musculo-skeletal diseases Cardiovascular diseases Diabetes Lack of physical activity Neuro- degenerative diseases Cancer Genetic Background Environment Health systems Communicable diseases Social factors Tobacco Alcohol Mental diseases Respiratory diseases ObesityOver nutrition

4. Healthy life years are not increasing

5. Economic impact

6. Chronic diseases and the economy - changing the paradigm 70% to 80% of all healthcare costs, €700 billion, spent on chronic diseases in the EU Yearly cost of disease related absenteeism estimated at 2.5% of GDP Early retirement: Chronic diseases (Musculo- skeletal, mental disorders,…) Labour market reintegration – 'survivorship'

7. International goals, targets UN General Assembly High Level Meeting on Non-communicable diseases Integrated approach across diseases Behavioral risk factors Environmental factors Health systems response, primary care Overall socio-economic development 7

8. Global NCD Action Plan, targets by 2015 25% relative reduction in risk of premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases. At least 10% relative reduction in the harmful use of alcohol, as appropriate, within the national context. 10% relative reduction in prevalence of insufficient physical activity. 30% relative reduction in mean population intake of salt/sodium. 30% relative reduction in prevalence of current tobacco use in persons aged 15+ years. 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure, according to national circumstances. Halt the rise in diabetes and obesity. At least 50% of eligible people receive drug therapy and counselling (including glycaemic control) to prevent heart attacks and strokes. An 80% availability of the affordable basic technologies and essential medicines, including generics, required to treat major non-communicable diseases in both public and private facilities.

9. Article 168 of the EU Treaty A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities. Union action, which shall complement national policies, shall be directed towards improving public health, preventing physical and mental illness and diseases, and obviating sources of danger to physical and mental health. Such action shall cover the fight against the major health scourges, by promoting research into their causes, their transmission and their prevention, as well as health information and education, and monitoring, early warning of and combating serious cross-border threats to health. The Union shall complement the Member States' action in reducing drugs- related health damage, including information and prevention.

10. EU action on health determinants - Tobacco - Nutrition and physical activity - Alcohol and drugs - Mental health - Environment and health - Social determinants and health inequalities

11. Disease Group Specific Actions Cancer: Guidelines on screening, European Partnership for Action Against Cancer CVD: support to European Heart Health Charter Mental health: Actions on depression and suicide European initiative on Alzheimer’s disease and other dementias 11

12. ( -Not a funding instrument but a stakeholder-led, cross sectorial, collaboration instrument for research, innovation & intervention. -Launched 2012 as part of Europe 2020 Strategy. -Reach a critical mass for action by pooling EU resources/ expertise & recognising innovation/ excellence. Reference Sites Action Groups TWO STREAMS FOR ACTION Sustainable & efficient care systems growth & expansion of EU industry health & quality of life of European citizens The EIP on Active and Healthy Ageing approach +2 Healthy Life Years by 2020 Triple win for Europe SIX AREAS OF INTERVENTION A1. Adherence to treatment A2. Preventing falls A3. Frailty & cognitive decline B3. Integrated care C2. Independent Living D4. Age-friendly environments SIX AREAS OF INTERVENTION A1. Adherence to treatment A2. Preventing falls A3. Frailty & cognitive decline B3. Integrated care C2. Independent Living D4. Age-friendly environments

13. Improving health system performance Towards effective, accessible and resilient health systems (Commission communication 2014) Health system performance assessment Quality of care, patient safety Integration of care Health workforce Cost effective use of medicines Implementation of cross border Directive Health Technology Asesssment Health information e-health

14. EU ACTION ON CHRONIC DISEASES Health systems cooperation Disease specific actions Risk factors and health deteminants "(…)Union action, which shall complement national policies, shall be directed towards improving public health, preventing physical and mental illness and diseases, and obviating sources of danger to physical and mental health.(…)" (Art. 168, TFEU) PROMOTE PREVENTPROTECT Legislation EU programmes ESIF Exchange of good practices

15. The Cancer Example: an integrated approach from health promotion to control

16. EU added value in the field of cancer Support to Member States Prevention of Cancer - Primary Prevention (including work on health determinants) Secondary Prevention/Screening (Guidelines, European Initiative on Breast Cancer) Cancer Data and InformationResearch

17. Aim: Integrated cancer plans in all Member States to contribute to reducing the cancer burden in the EU – Target: 15% incidence reduction by 2020. 25 of the 28 Member States had a plan or strategy by 2014. EPAAC Cancer joint action (2010-2013) Health Promotion and cancer prevention, including screening, Identification of best practice in cancer-related healthcare, The collection and analysis of comparable data and information, A coordinated approach to cancer research. European Partnership for Action Against Cancer

18. CanCon Joint Action - Workpackages 1.Coordination 2.Dissemination 3.Evaluation 4.Guide 5.MS Platform 6.Integrated Cancer Control 7.Community level cancer care 8.Survivorship 9.Screening

19. www.cancercode.eu

20. The health promotion challenge Redefining the boundaries: promotion/prevention, primary/secondary, screening/early diagnosis Chronicity/Multimorbidity Rehabiltation/treatment/survivorship Target vulnerability

21. The EU contribution Help Member States develop strategic approaches Review our instruments, using them to address chronic diseases Pilot and scale up good practice Create transparency: improve monitoring and evaluation Implementing WHO goals, objectives and targets

22. Collection, validation and dissemination of good practises to address chronic conditions  EIP-AHA  networking, chronic disease community Health promotion and prevention focus on behavioural risk factors, social determinants and inequalities in health  streamlining Diabetes: a case study on barriers to prevention, screening and treatment of diabetes and improvement of cooperation among Member States to act on diabetes  Country analysis, policyadvice Work on multi-morbidity with focus on multi-disciplinary & integrated care, patient safety and professional training Development of common guidance and methodologies for care pathways for multi -morbid patients  Health outcomes, quality of care How does CHRODIS contribute to reduce the burden of chronic diseases in Europe?

23. Thank you!