EU action for health
3.5 Health systems values
What has the EU done to shape health systems thinking, or at least the impact of EU policies on health systems? The EU has produced a number of key statements that guide its policies and enable or constrain new initiatives. In healthcare, the 2006 statement on health systems values has helped to shape the place of health systems as a distinctive policy concern with shared moral values that should influence policy. The European Pillar of Social Rights covers a wide range of policies, most with health relevance, and also explicitly focuses on health systems values. Both help to influence broader EU policy such as the Semester by making it clear what values, besides fiscal sustainability, the Member States agreed. They are separate from the extensive law and policy discussed in chapter 4, the second face, which focus on healthcare providers and purchasers in the internal market rather than health systems.
3.5.1 2006 statement on health systems values
The 2006 Council Conclusions on Common values and principles in European Union Health Systems130 is in part a creature of its time, reflecting a specific agree-ment by Member States under the UK presidency that contemporary efforts to incorporate healthcare into the general internal market for services (e.g. with the first proposed Services Directive) were inappropriate and did not reflect the core values of their healthcare systems. The existence of the statement undercut any new efforts to assimilate healthcare with the principles regulating other sectors and also shape broader discussions of health policy, including in the Semester.
3.5.2 Effective, accessible and resilient health systems
The next key statement of values and priorities came from the EPSCO Council in late 2013 Conclusions, and was followed by the Commission with a 2014 Communication.131 The Council Conclusions were a wide-ranging statement of health values and priorities, and the value of health as a general European priority.
It was, among other things, a response by health ministers to the reinforced fiscal governance system’s inroads into health policy (see chapter 5), reiterating the importance of health and health systems and encouraging the EU in a supportive role. The Commission translated this request into the 2014 Communication.
These two documents superseded the 2006 Council conclusions. It sets out three Commission goals in the area of health systems: “1. Strengthen the effectiveness of
130 Council Conclusions on Common values and principles in European Union Health Systems (2006/C 146/01).
131 Council conclusions on the “Reflection process on modern, responsive and sustainable health systems”
Brussels, 10 December 2013; Commission Communication on effective, accessible and resilient health systems, April 2014 COM(2014) 215.
health systems 2. Increase the accessibility of healthcare 3. Improve the resilience of health systems.” While many of the actions necessary to achieve this are by design to be taken at the member state level, the Communication lists a variety of EU actions from Health Systems Performance Assessment (HSPA) to Health Technology Assessment (HTA) that contribute to member states’ policies and effectiveness. Most of the topics covered by this Communication are discussed throughout chapter 3 and in section 4.3.
Box 3.5 The European Pillar of Social Rights
The Pillar of Social Rights builds upon 20 key principles, structured around three categories:
I. Equal opportunities and access to the labour market II. Fair working conditions
III. Social protection and inclusion
I. Equal opportunities and access to the labour market 1. Education, training and lifelong learning
2. Gender equality 3. Equal opportunities
4. Active support to employment II. Fair working conditions
5. Secure and adaptable employment 6. Wages
7. Information about employment conditions and protection in case of dismissals 8. Social dialogue and involvement of workers
9. Work–life balance
10. Healthy, safe and well-adapted work environment and data protection III. Social protection and inclusion
11. Childcare and support to children 12. Social protection
13. Unemployment benefits 14. Minimum income
15. Old age income and pensions 16. Healthcare
17. Inclusion of people with disabilities 18. Long-term care
19. Housing and assistance for the homeless 20. Access to essential services
3.5.3 The European Pillar of Social Rights
The European Pillar of Social Rights (EPSR) was declared by the Council, Parliament and European Commission in 2017.132 It has twenty principles – twenty rights – in the categories of “Equal opportunities and access to the labour market”, “Fair working conditions” and “Social protection and inclusion”.
As ever with EU health policy, it is tempting to turn directly to the category of
“social protection and inclusion” and look for the healthcare principle, but almost all of these rights affect health and many can be affected by healthcare systems.
Homelessness, for example, is both a major public health problem (a short period of homelessness can have lasting and diverse negative health effects) and is often caused by failures in healthcare, especially to do with mental health treatment.
“Work–life balance” is categorized as being about “fair working conditions”, but the evidence is impressive that supporting parents in their work reaps health benefits for everybody in the family. “Fair working conditions” also includes an explicit right to a healthy workplace, for workplaces and work practices are indeed a key source of ill- or good health and employers do not always provide them without regulation. “Gender equality”, for a third example, is in “Equal opportunities and access to the labour market” but is a key determinant of the well-being and health of all genders.
That said, there is healthcare content, the simple: “Everyone has the right to timely access to affordable, preventive and curative health care of good quality.”
It is complemented by a commitment to long-term care: “Everyone has the right to affordable long-term care services of good quality, in particular home-care and community-based services.” It is worth underlining that the EPSR is, by the standards of most political systems, both ambitious and concrete.
Even if its main effect is to limit contradictory policy initiatives within the EU and empower advocates within the Member States, that is significant, and its ambitions are impressive.133
3.5.4 Charter of Fundamental Rights
The Charter of Fundamental Rights became part of EU constitutional law when the Lisbon Treaty entered into force in 2009. It brings together rights that had been in EU law, including the Social Charter, and in member state constitutional law. It was drafted and proclaimed by the EU institutions in 2000, and then
132 European Commission. Proclamation of the European Pillar of Social Rights. 16 November 2017.
Brussels: European Commission.
133 For the political background of the EPSR, as a case study in how the EU approach to social policy has changed in the last decade, see Sabato S, Vanhercke B (2017). Towards a European Pillar of Social Rights:
from a preliminary outline to a Commission Recommendation, in B Vanhercke, S Sabato and D Bourget, eds. Social policy in the European Union: state of play, pp. 73–96.
was incorporated into the Lisbon Treaty. The rights listed in the Charter are fundamental and justiciable under EU law, and applies to infringements of rights by EU law or member states implementing EU law. It incorporates the separate European Convention on Human Rights, which is not EU law.