A new approach to NCD control in Europe


Interview with Marianne Takki, Policy Coordinator, DG Sante, European Commission

“I’m here to tell everyone about the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases, and explain to organisations and other health stakeholders how the approach works.”

At the European Health Forum Gastein 2018, Marianne Takki was present to discuss the activities and role of the European Commission in non-communicable diseases (NCDs) prevention and control.

MD: You mentioned that the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases[i], which the European Commission established this summer (2018), is a totally new approach. What is so different about this approach compared to how the Commission worked on NCDs earlier?

MT: Previously, there were several disease-specific expert groups at the Commission, such as on rare diseases, cancer control, and mental health. The outputs of these groups were not effectively taken forward. We [the Commission] realised that, for plans and recommendations to be useful to someone, implementation needs to be the focus of all planning. Now, with the new steering group that officially started in July 2018, the member states are involved from the beginning. The aim of the steering group is not to create aspirational statements, nor develop new policies: instead, the steering group will address what we already have. This approach puts health in all policies into practice.

“The Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases, which is established by the European Commission in July 2018, is a new approach to non-communicable disease control in Europe. This approach is about health in all policies being integrated into practice.”

Through the best-practices portal – which is a part of this new approach – we make sure that the member states know which NCD interventions are available and which can be implemented. Preferably, these practices are already implemented in a country or region and, with some adaptation, can be implemented in other places. The best practice portal is more than just a collection of best practices, it also includes an evaluation, for which the assessment criteria are established by the steering group. Finally, the Commission provides funding to member states for the implementation of best practices

MD: NCDs are now on the political agenda, but winds might change. How can we keep NCDs on the national and European agendas?

MT: Commitment of member states is realised by having regular prioritisation exercises, where member states prioritise their own needs. There are already many agendas out there, such as the sustainable development goals (SDGs), so the steering group aims to support member states in achieving the targets and goals that are most challenging for them.

MD: What can we expect from the steering group in the future?

MT: Until today, the Health Programme was the main funding for health projects. But now, while we are moving towards the next multi-annual financial framework of the EU (2021-2027), this will change. The steering group will be the main mechanism. I’m here [at the European Health Forum Gastein] to tell everyone about the steering group and to bring forward our approach, so that it becomes clearer to organisations and other health stakeholders. It is a new approach and we are taking baby steps in the beginning. The positive feedback that we have received from the member states since the launch of the steering group is a clear indicator that we are using the right approach.

In the next multi-annual financial framework, health is incorporated in the ESF+ programme, within the so-called health ‘strand’ or ‘cluster’. As stated in the proposal for the ESF + programme, article 29 in particular, the steering group would mainly be responsible for the health strand, including the work plans, prioritisation, strategy and implementation of the public health activities in the EU.[i] We are aiming for a more upstream decision-making process in the future. This would mean that the steering group can steer financial resources based on member states’ health objectives.

By the way, 7.7 billion euros are set for health research in Horizon Europe [the new research cluster]. I don’t think people see the opportunities here.

The first formal meeting of the steering group – chaired by Martin Seychell – was held on 6th of November 2018. We also plan a joint meeting between the steering group and the current Horizon 2020 research programme committee in Brussels in early spring 2019. This is to facilitate discussions between the stakeholders from research and health on ministerial level and the different Commission services on where the synergies are. This is one concrete future step in making sure that our policies are aligned, and our objectives are in synergy.

This interview was conducted by a Young Gasteiner Maaike Droogers

[i] Article 29 of ‘Proposal for a Regulation of the European Parliament and of the Council on the European Social Fund Plus (ESF+) COM/2018/382’ suggests that the steering group could have an important role in the future ESF+ health strand. Available here, https://eur-lex.europa.eu/resource.html?uri=cellar:a39e5630-640f-11e8-ab9c-01aa75ed71a1.0003.02/DOC_1&format=PDF.  

[i] Webpage of the Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases is available here: https://ec.europa.eu/health/non_communicable_diseases/steeringgroup_promotionprevention_en

Commercial determinants of health and the global financial markets (P3)

Think bigger and think smarter!

Let´s make informed decisions and learn and change the market the healthier way! 

The final day in Gastein is coming to an end and we are at the Closing Plenary, where the focus is on the commercial determinants of health and the global financial markets.

In his opening speech, the EHFG President Clemens Martin Auer reminded us to think bigger, think smarter and be bold and bright, and with this good reminder we dived into the plenary. Martin McKee, the moderator, took over and gave us an insight into the plenary where the focus was on MONEY, investments, markets and of course health.

I have to use some of the space in this short blog to share the story of Dr. Bronwyn King (founder and CEO of Tobacco Free Portfolios) and her amazing journey. She started her talk by showing a short video about a Dutch patient who is suing a tobacco company for attempted murder and grievous bodily harm, and then explained her personal story, that started only about 8 years ago when she found out that her pension fund was being invested in tobacco stocks, and as a radiation oncologist who was trying to save the lives of patients often suffering from lung cancer that was usually related to tobacco use, she could not believe it and had to take action. Now, to cut a long story short, she took on the tobacco industry: this has lead to stocks dropping as well as to many pension funds, banks and other commercial organisations divesting from tobacco stocks. It truly was amazing to hear from a person who is so personally involved and it really made you sympathise with her cause. I think it is important for all the Young Gasteiners like myself, as well as for other figures in public health, to see and hear that there are individuals out there making a difference. But this is only the start, there is more to do and we need to move forward.

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The value of evidence in outcomes-based healthcare (L7)

A Young Gasteiner’s musings on the applications of big data in health

This blog post relates to the ‘The value of evidence in outcomes-based healthcare’ workshop held at the European Health Forum Gastein on the 5th October 2018.

This lunch workshop was organised by IMI Big Data for Better Outcomes (BD4BO), a European research programme that aims to support the transformation of healthcare systems by means of big data. The programme is a collaboration between the European Union, the European Federation of Pharmaceutical Industries and Associations, academia and civil society.

In his introduction to the BD4BO project, Shahid Hanif (Head of Health Data and Outcomes, Association of British Pharmaceutical Industries) described four key enablers required to unlock the potential of big data in improving health outcomes, access, safety and research:

  • Defining a standard set of outcomes with demonstrated value
  • Access to high-quality outcomes data
  • Using data to improve the value of healthcare delivery
  • Increasing patient engagement through the use of digital solutions

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Tackling uncertainties for rare diseases (L6)

Go fast or go far?

I am a medical doctor by trade. As all medical doctors will know, the first commandment of being a medical doctor is ‘first, do no harm’. But a very close second is the mantra that evidence is the holy grail, and the holy grail of evidence is the RCT. But what if an RCT is simply not possible, for example if the disease you are studying simply does not have enough patients to conduct one? That is where Real World Evidence (RWE) comes in. Real World Evidence refers to information collected outside of a clinical trial, for example from electronic medical records, and it can help address evidence gaps in the field of rare diseases.

There are about 7000 rare diseases, defined as diseases that affect fewer than 1 in 2000 people. People with rare diseases are often overlooked when it comes to SDG3. To quote Helen Clark, former prime minister of New Zealand: “No country can claim to have achieved universal healthcare if it has not adequately and equitably met the needs of those with rare diseases.” The small number of patients in these diseases, sometimes as few as 50 or 60 worldwide, makes it very hard to generate evidence the traditional way. This leads to heart-breaking examples where drugs or technologies with possible major impact are developed, but access cannot be guaranteed due to the uncertainties surrounding them. We need to address these evidence gaps. Continue reading

Man vs Machine (L5)

AI is risky but rewarding

Gastein this year has overflowed with optimism about the opportunities presented by the use of AI in healthcare. But many people have deep concerns.

This session, organised by Acumen Public Affairs, was a first for the EHFG: a ‘Cambridge Union’-style debate – there is no need to talk of that other place. This means that two speakers propose a motion, which is voted on by the floor. They then speak in favour for ten minutes and two other speakers respond and argue against the motion. The debate is then opened to questions and comments from the floor, to which both sides get a chance to respond. Finally, the proposing side get five minutes to give their closing remarks, followed by the opposing side, and there is a second vote.Brian O’Connor and Rachel Dunscombe proposed the motion: ‘AI in healthcare: the rewards outweigh the risks’. Tamsin Rose and Martin McKee spoke against, and David Rose and his very loud bell kept everyone to time. Continue reading