While in Brussels for the European Health Journalist Award ceremony, MOIRA MIZZI finds time to catch up with the European Commissioner for Health and Consumer Policy, John Dalli to get to know more about what he has achieved during the first 10 months in office and about his plans and challenges for the coming years.
When Winston Churchill shared his dream of a “kind of United States of Europe” during a speech in 1946, when Europe was still grappling with the ravages of World War II, his focus was on common trade policies for coal, steel and agriculture. He certainly had no idea that he had given birth to an organisation that half a century later would span 27 countries and a myriad of institutions and entities which even a hybrid of Leonardo da Vinci, Albert Einstein and the Dalai Lama would find difficulty making heads or tails of.
In a nutshell, the organisational structure of the European Union comprises the European Commission, the European Parliament, the Council of Ministers and the European Court of Justice. The Commission is the administrative and executive body of the Union, being in charge of drafting initial proposals for legislation and policy for consideration by the Council of Ministers and the Parliament. Currently there are 27 Commissioners, one for each member state; each commissioner serves for five years and is nominated by national governments. Locally, John Dalli was chosen for this position, he is now the Commissioner for Health and Consumer Policy.
Tackling health issues spanning 27 countries and in some cases the whole world in the first decade of the 21st century is no ride in a sunny park for a variety of reasons. Health in 2010 has gone beyond being disease-free; in fact the World Health Organisation defines it as “a state of complete physical, mental and social well being and not merely the absence of disease or infirmity”. This has stretched the portfolio of health to include other issues such as the environment, health at the workplace, mental well-being, prevention of disease and consumer rights.
In fact, in his first speech as a commissioner, Mr Dalli not only disclosed the many areas of focus in his portfolio but also his vision when he said: “My vision is that of European citizens living a longer, healthier life because they live a healthy lifestyle, enjoy safe, nutritious and high-quality food and have access to high quality medical advice and care. My vision is a well-informed consumer who can take educated decisions on the goods and services they consume; a consumer that would not only be in the driving seat of his own lifestyle, but who would also be able to influence policy through the consolidation of the micro decisions that are taken in the market. Consumers can move policies on climate change, animal welfare, action on health determinants, to mention just a few”. Summing this up, his vision is not just having each and every consumer in the European Union being ensured the best of health in all aspects but also being empowered not only to take decisions about his own lifestyle but actually determining decisions and policies on a scale outside the perimeter of his nose.
Looking back at what was achieved during the first 10 months in office one cannot say he has not tried his best.
“The main focus for me is prevention of disease rather than cure,” he stresses as he lounges back in a comfortable armchair in his brightly lit meeting room, “cure is necessary only when things go wrong and people get sick but our aim is to prevent that from happening not only by ensuring that every citizen has access to the best standards of health care and safe food and environment but also in teaching the consumer how to make the best choices in keeping himself healthy even at an older age,” he says.
In fact during the first months in office a lot of attention was given to food safety especially where plant health, animal disease, the use of pesticides and genetically modified food are concerned.
“We are now making sure that food is safe from its inception to its consumption, literally speaking from farm to fork,” he explains enthusiastically, “in fact more budget is being dedicated to plant health and veterinary services inspecting and controlling animal diseases and more stringent border controls to ensure that even food coming from outside the EU is up to standard,” he continues.
Prevention of tobacco smoking and healthy eating were also one of the highest issues in the Health Commissioner’s priority list this year. In fact in his speech on World No Tobacco Day soon after his appointment, he was very clear in his intentions “to do everything in my power to reduce tobacco consumption”. True to his words a few months later the HELP campaign launched new anti-smoking messages targeting youngsters and the Tobacco Products Directive is currently being revised.
Mr Dalli admits that the thing that hit him the hardest was visiting certain parts of Europe and realising that a good number of European citizens still did not have access to any form of health care.
He refers to his speech during his Commission hearing where he made it very clear that his vision was “the access of all European citizens, irrespective of nationality and socioeconomic status to good and timely treatment and to affordable medicines; our objective will be to close the gap in health inequality that we are currently experiencing in Europe”.
This cross-border health-care reform is another highlight in the Mr Dalli’s priority list. The Europe 2020 which is the current strategy towards laying the foundation for Europe’s long term growth, has, as its main focus, collective actions and stronger collaboration between EU structures and member states “With this initiative I would like to set up a mechanism whereby any consumer can search for and get any cure when he needs it even if this is not available in his own country,” he explains “Obviously it is not my intention to make nomads out of European patients especially at such a vulnerable time in their lives; all that I am aiming for is to make it easier for people to get cures in other European countries,” he says.
In fact, Mr Dalli is pushing to put forward the “e-health strategy” where diagnosis and cure for most diseases can be given with the specialist being in one country and the patient in another.
“The patient will not have to travel unless he has to and even then we make sure that he is fully reimbursed,” explains Mr Dalli.
This strategy, which is being discussed at the European Parliament after having been blocked at the Council of Ministers last December is the first step towards providing all patients with basic information throughout the member states so that it is readily available to the health-care professional in the case of an emergency or if the patient seeks professional help in another member state.
The directive on organ donation and transplantation adopted earlier this year is an example of what the EU can do to improve health care for its citizens. The directive aims at promoting higher safety and quality of the organs used for transplantation, providing the legal set up to facilitate the infrastructure to facilitate organ donation in each member state and also promotes the “sharing” of organs between the different European countries. This would not only help the 50,000 patients in the EU waiting for a donor organ but would also drastically reduce the literal waste of organs that are not used due to failure to find a matching recipient in that particular member state.
The directive, however, does not deal with ethical aspects, the consent to the organ donation, allocation of the organs and the certification of death issues. “I believe that the competence of the member state should be respected” is Mr Dalli’s explanation to this. “Subsidiarity is an EU value, we believe in empowerment of the consumer not the ‘father-figure’ type of protection”. Information to patients, in fact, is another issue currently at the forefront of his portfolio, this being the basis of empowerment of the individual in the European Union. “We believe that patients should have access to information on prescription drugs that are on the market… we must continue to empower the consumer by backing him with clear, scientifically based information” he had stressed during his hearing speech.
Food labelling is another area where much interest has been focused. “We are aiming at changing processes not the ingredients and we are zeroing in at how this information should be stated on each label, whether by portion size or whether per 100g to enable the consumer to take wise, informed decisions on the choice of healthy food,” he explains.
Being in charge of pushing for health policies in all of the European Union did not blur his vision of his country of origin. “We have quite a big opportunity to be the ‘capital of the Mediterranean’ if we use the resources given judiciously,” he says and a wave of nostalgia fleets over his face as he explains, “we have advanced a great deal as a result of the many adjustments we had to do prior to our accession; by removing subsidies and privatisation we have managed to build an economic base enabling us to compete with the best. Thus, Malta can be a very good template for all these processes currently underway as part of Europe 2020, such as e-health and the European Innovation Partnership (EIP) on active and healthy aging considering we have a good cohort of an aging population,” he concludes with satisfaction.
Up to now I had always wondered how an accountant with no medical background whatsoever could run a health system especially at such a high level as the Commission for Health and Consumer Policy. Mr Dalli had the answer to this too. In the conclusion to his hearing speech last February he highlighted how “shrinking national budgets coupled with increased demands by citizens for better services brings to the fore the issue of sustainability of health systems”, which, put in simple terms, indicates the paramount importance of wiser and more focused budgeting in the health portfolio.
Mr Dalli believes that “to secure sustainability we must focus on prevention… we need to bring prevention to the forefront; health-care systems need to develop from ‘sickness treating systems’ to ‘health promotion and health management systems’. His concern is that at present “alarmingly, 97 per cent of health spending across Europe goes on treatment as compared to only three per cent on prevention” and urges the rest of the European Union organisations to help and support him to “strive to redress this imbalance by convincing all stakeholders that prevention is an investment offering very high future returns in health”.
We all hope they will.