What are the different institutions of the European Union and what is there role in reducing health inequalities in Europe?
The COVID-19 pandemic has put health high on the European agenda. It is clear that an international approach to public health is essential. The European Union helps Member States improve and protect public health, as well as work together to address common problems and threats. Reacting to the pandemic and crisis, the EU has taken several new initiatives and made funding available to limit the spread of the virus and to facilitate a quick and sustainable recovery from the crisis.
European treaties and health
The Treaty on the Functioning of the European Union (TFEU, the Treaty of Lisbon) provides a legal basis for the EU health policy and the division of competences and responsibilities on public health between the EU and its Member States. The EU has an important role to play in improving public health, preventing and managing diseases, mitigating sources of danger to human health, and harmonising health strategies between Member States.
The EU’s health policy has three strategic objectives:
- Fostering good health.
- Protecting citizens from health threats
- Supporting dynamic health systems
In order to achieve those objectives, the Treaty lays down four main areas that explicitly address health from a legal point of view:
Articles of the the Treaty on the Functioning of the European Union relevant to health and health inequalities
- Article 168: Public health (protection of public health and health promotion)
- Article 114: Approximation of laws (aligning national laws to comply with the EU law)
- Article 191: Environment (protection of human health)
- Articles 153, 156: Social Policy (protection of workers’ health and safety, and prevention of occupational accidents and diseases)
- Article 169: Consumer protection (protection of consumer health and safety)
- Article 9: sets out a principle for defining and implementing EU policies and activities to “take into account requirements linked to the promotion of a high level of employment, the guarantee of adequate social protection, the fight against social exclusion, and a high level of education, training and protection of human health.”
- In the Treaty on European Union (Maastricht Treaty), Article 3.1. states: 'The Union's aim is to promote peace, its values and the well-being of its peoples'. Article 3.3. states that 'It shall combat social exclusion and discrimination, and shall promote social justice and protection, equality between women and men, solidarity between generations and protection of the rights of the child.'
EU action in the field of health complements national policies and initiatives to ensure health protection in all EU policies (a ‘Health in All Policies’ approach). However, as laid out in the Treaty of Lisbon, EU Member States have the primary responsibility to organise national health systems and for the delivery of health care.
Through the ‘Health for Growth’ strategy and its action programme (2014-2020), as well as and a body of secondary legislation, the EU has tried to implement comprehensive health policy. The EU4Health Programme will continue to provide funding 2021-2027.
References, and more information:
- European Parliament, Fact Sheets on the European Union: Public health (accessed 15 February 2021)
- European Parliament Research Service, EPRS Ideas Papers. Thinking about future EU policy. EU public health policy (2020). (Accessed on 15 February 2021)
- Scott L. Greer, Nick Fahy, Sarah Rozenblum, Holly Jarman, Willy Palm, Heather A. Elliott and Matthias Wismar (2019). Everything you always wanted to know about European Union health policies but were afraid to ask, Second edn., European Union Observatory on Health Systems and Policies / WHO
- The European Commission's Directorate for Health and Food Safety (DG SANTE), overview
"All European citizens have the same right to health. NextGenerationEU's resources will therefore target the resilience of our health systems."
European Commission President Ursula von der Leyen, Committee of the Regions Speech 2020
The European Commission promotes the general interest of the EU by proposing and enforcing legislation. It implements the decisions of the European Parliament and the Council of the EU. It also acts as the guardian of the Treaties, as well as how the EU budget and funding are spent. The Commission consists of a team of Commissioners, one from of each Member State. It is organised into departments known as Directorates-General (DGs).
In 2013, the European Commission published its ‘Report on Health Inequalities in the European Union’. The report describes the main actions that the Commission has taken between 2000 and 2013 to implement its 2009 Communication ‘Solidarity in Health: Reducing Health Inequalities in the EU’. This Communication set out the Commission’s actions at that time to address health inequalities. It was issued by the Commission’s Directorates General for Health and Food Safety (DG SANTE) and Employment, Social Affairs and Inclusion (DG EMPL).
Further Commission Communications on 'Investing in health' (2013) and on ‘Effective, accessible and resilient health systems’ (2014) had health inequalities as one of (in)direct objectives. Bi-annually, the European Commission and the Organisation for Economic and Social Cooperation (OECD) issue ‘Health at a Glance: State of Health in the EU’ studies and reports, which describe health inequalities.
The European Health Union and the European Green Deal
Since 2013 there has been no dedicated Commission Report or Communication on health inequalities. However, in light of the COVID-19 crisis, the European Commission is working to build a strong European Health Union. Its aim is to better protect the health of Europe's citizens, equip the EU and its Member States to better prevent and address future pandemics, and improve resilience of Europe’s health systems.
The European Green Deal is the European Commission’s overarching plan to make the EU’s economy more sustainable, with a target of net-emissions by 2050. The aim is also to make this transition “just and inclusive for all”; if initiatives are implemented to achieve this, it can contribute significantly to reducing health inequalities across Europe.
Directorate-General for Health and Food Safety - DG SANTE
DG SANTE develops and carries out the Commission's policies on food safety and public health. It has developed a specific web page on social determinants and health inequalities.
DG SANTE established a Steering Group on Health Promotion, Disease Prevention and Management of Non-Communicable Diseases in 2016. The Steering Group is made up of one member per Member State. It advises the European Commission on developing its activities. It also supports Member States in achieving the voluntary global targets of the UN/WHO on noncommunicable disease and the Sustainable Development Goals by facilitating the implementation of evidence-based best practices across EU countries.
The EU Health Policy Platform brings together umbrella organisations representing European stakeholders in the fields of public health and healthcare. It serves as a tool to discuss, share knowledge and good practices. The platform facilitates the work of expert groups and Joint Actions. It also facilitates the work of Thematic Networks that bring together stakeholder organisations to work on specific topics. These networks produce joint statements to lead the work of the Commission.
DG SANTE and its Executive Agency are responsible for setting up annual work programmes through which EU’s priorities and health-related actions are implemented, with help from various EU funding mechanisms and programmes, notably the EU Health Programme. The newest EU Health Programme – EU4Health – will be implemented between 2021-2027 (see section on EU funding).
Directorate-General for Employment, Social Affairs and Inclusion - DG EMPL
Being active in the areas of employment, social affairs and inclusion, DG EMPL’s work touches upon many of the determinants of health.
An important tool which serves as a compass for how and in which direction the EU should orient its social inclusion policies is the European Pillar of Social Rights. The Pillar contains 20 principles organised in three chapters: equal opportunities and access to the labour market; fair working conditions; social protection and inclusion. Principle 16 of the Pillar refers to health: “Everyone has the right to timely access to affordable, preventive and curative health care of good quality”. In 2020, the European Commission issued a Communication on ‘A Strong Social Europe for Just Transitions, outlining building blocks for delivering on strong foundations for social rights in the EU. An overview of information and updates on social protection systems across the EU are available on the European Social Policy Network (ESPN) website.
The European Employment Strategy (EES) is a set of common objectives and targets for employment policy. Its main aim is the creation of more and better jobs throughout the EU. It is part of Europe 2020 growth strategy and it is implemented through the European Semester.
Every EU worker has certain minimum rights at work. These relate to health and safety at work, equal opportunities for women and men, protection against discrimination, labour law.
Today technological developments, global and demographic changes, change the skills we need in the way we work, learn, take part in society and lead our everyday lives. Having the right skills is important for individuals to adjust to these changes and ensure their well-being while contributing to society, productivity and economic growth. The European Skills Agenda of 1 July 2020 sets out a five year action plan with 12 actions to help equip people in Europe with better skills.
The European Parliament (EP) represents people’s interests regarding EU law-making. Members of the European Parliament (MEPs) are directly elected by voters in all Member States. It is an important forum for political debate and decision-making at the EU level and ensuring other EU institutions are working democratically.
The Parliament is a co-legislator, it has the power to adopt and amend legislation and decides on the annual EU budget on an equal footing with the Council. It supervises the work of the Commission and other EU bodies and cooperates with national parliaments of EU countries to receive their input. It is organised around various policy domains of which several are of (id)direct relevance to health inequalities.
The European Parliament’s ENVI Committee is a working group of 81 MEPs that works on the environment, public health and food safety. Another relevant Committee is EMPL (employment and social inclusion).
European Parliament resolutions and reports on health inequalities
In March 2011 the European Parliament adopted the resolution Reducing health inequalities in the EU. The document underlines the need to:
- make a more equitable distribution of health part of our overall goals for social and economic development;
- improve the data and knowledge bases (including measuring, monitoring, evaluation, and reporting);
- build commitment across society for reducing health inequalities;
- meet the needs of vulnerable groups; and
- develop the contribution of EU policies to the reduction of health inequalities.
In 2013 the European Parliament published a report on the Impact of the crisis on access to care for vulnerable groups. The report highlights that inequalities across in access to care have increased due to the financial crisis that hit the EU in 2011. It also invites Member States to take actions to tackle this issue.
In 2015 the European Parliament adopted the resolution Reducing inequalities with a special focus on child poverty. The resolution recommends investing in early childhood education and care as a measure to reduce inequalities at a young age and prevent the risk of poverty and exclusion in adulthood. This lays the foundations for successful lifelong learning, social integration and employability.
In 2021, a report on Reducing inequalities with a special focus on in-work poverty was adopted. It recommended actions in the field of healthy and affordable (social) housing, health and safety at workplace including prevention of occupational injuries and mental health problems, health and social protection of essential workers.
The European Parliament has an in-house research department and think tank which is called the European Parliament Research Service (EPSR). In 2020 the EPSR published a report named Addressing health inequalities in the European Union - Concepts, action, state of play.
The European Council and the Council of the European Union
The European Council is the EU institution that defines the general political direction and priorities of the European Union. Its role is to provide the impetus for the EU's development, but it does not exercise any legislative function. The council represents the Member States’ governments. The heads of state or government of the member states, together with its President and the President of the Commission.
The Council of the EU (often referred to as the “Council”) represents the member states' governments. It is where national ministers from each EU country meet to adopt laws and coordinate policies. The Council of the EU has five main roles:
- Negotiate and adopt EU laws
- Coordinate member state’s policies
- Develop the EU’s common foreign and security policy
- Conclude international agreements
- Adopt EU budget
Council resolutions, statements and conclusions are adopted after a debate during a Council meeting. While they do not intend to have legal effects, they are usually used to express political position or commitment. The Council of the EU addressed health inequalities in several conclusions in the last years, across different policy sectors as well.
- The 2020 Council Conclusions on the Farm to Fork Strategy
- The 2020 Council Conclusions on Council Conclusions on Demographic Challenges – the Way Ahead
- The 2020 Council Conclusions on Improvement of Air Quality
- The 2019 Council Conclusions on the ‘Economy of Well-being’
- The 2019 Council Conclusions on A New EU Strategic Framework on Health and Safety at Work: Enhancing the implementation of Occupational Safety and Health in the EU
- The 2018 Council Conclusions on integrated early childhood development policies as a tool for reducing poverty and promoting social inclusion
- The 2017 Council Conclusions on health in the digital society – making progress in data-driven innovation in the field of health
- The 2014 Council Conclusions on the economic crisis and healthcare
- The 2014 Council Conclusions on nutrition and physical activity
Presidencies of the Council of the EU
The presidency of the Council rotates among the EU Member States every six months. The country holding the presidency is responsible for driving forward the Council’s work on EU legislation and ensuring the continuity of the political agenda, legislative processes and cooperation among states.
Holding the Presidency, a Member State sets forth a programme of priorities to be achieved.
- Under the 2019 Finnish Presidency, the Council reached conclusions on the ‘Economy of Wellbeing’
- The 2018 Austrian Presidency published a report on Connecting food systems for co-benefits: How can food systems combine diet-related health with environmental and economic policy goals?
- The 2016 Dutch Presidency produced a report on Integrated approaches to combating poverty and social exclusion. Best practices from EU Member States.
- The 2014 Italian Presidency: Note: “Investing in Health: the ‘Missing Dimension’ of the Europe 2020 strategy”.
- Under the 2011 Polish Presidency, the Council reached conclusions on closing health gaps within the EU through concerted action to promote healthy lifestyle behaviours.
- The 2011 Hungarian Presidency adopted the Council Conclusion “Towards modern, responsive and sustainable health systems”.
- The 2010 Belgian Presidency organised a high-level conference titled Reducing health inequalities from a regional perspective: what works, what doesn’t?. It also held a high-level conference on environmental health and social vulnerabilities.
- Under the 2010 Spanish Presidency, the Council reached conclusions on equity and Health in All Policies: Solidarity in health. It organised a high-level conference titled Moving Forward Equity in Health, and produced a report on monitoring social determinants of health and the reduction of health inequalities.
- The 2009 Swedish Presidency reached Council Conclusions on the topic of healthy and dignified ageing, as well as organising a conference on the topic.
- Under the 2006 Finnish the Health in All Policies approach was introduced. The Council reached conclusions on HiAP, a high-level conference was organised, and the presidency produced a report titled Health in All Policies: Prospects and Potentials.
- The 2005 UK Presidency held a summit on tackling health inequalities. It also published two reports titles Health Inequalities: Europe in Profileand Health Inequalities: A Challenge for Europe.
The European Investment Bank
The European Investment Bank is the European Union’s public lending institution, whose shareholders are the Member States of the European Union.In short, the EIB is the European Union’s bank and therefore works closely and increasingly with the other EU institutions to implement EU policy. The EIB makes loans directly to project promoters (public, private, not-for-profit)-primarily above €25 million. When smaller loans are involved, the EIB opens credit lines for financial intermediaries (often, national or regional banks) who then provide cheaper loans to enterprises (public, private, not-for-profit). This is done through the European Investment Fund (EIF). The EIB is active in healthcare, having – according to their statistics – helped to improve healthcare services for 27.3 million people in 2018. They work on three main principles which guide the selection of projects for financing:
- Enabling universal access to effective, safe and affordable preventative and curative health services;
- Providing sustainable health services;
- Projects with the highest expected economic value for society, taking into consideration outcomes and impacts, such as health outcomes, employment creation and social gains.
European Economic and Social Committee
The European Economic and Social Committee (EESC) is an EU advisory body that is the voice of organised civil society in Europe. It is made up of representatives of workers' and employers' organisations and other interest groups. The EESC issues opinions on EU issues to the European Commission, the Council of the EU and the European Parliament, thus acting as a bridge between the EU's decision-making institutions and EU citizens. This way, it gives interest groups a formal say on EU legislative proposals. More information on the role and tasks of the EESC is available here.
European Committee of the Regions
The European Committee of the Regions (CoR) is an EU advisory body composed of locally and regionally elected representatives coming from all 27 Member States. The CoR is the voice of regions and cities in the EU, giving them a formal say in EU law-making. This enables them to share their opinion on EU legislation that directly impacts regions and cities,ensuring that the position and needs of regional and local authorities are respected. More information of the CoR's roles and tasks is available here.
European Court of Auditors
The European Court of Auditors' (ECA) mission is to contribute to improving EU financial management, promote accountability and transparency, and act as the independent guardian of the financial interests of the citizens of the Union.
The EuroHealthNet Policy Platform
EuroHealthNet’s policy platform helps organisations understand and anticipate policy changes at the European level, and to help make their voices heard on the European stage.
To find out more about the work of the platform and about being part of the platform visit our website.