Europe faces significant challenges in the area of public health. While it is widely recognised that health is a human right and a prerequisite for economic growth, health expenditure is projected to continue its increasing trend, mainly due to socio-demographic changes – the ageing population, increase in chronic diseases, co-morbidities and long-term care needs – as well as due to the impact of exogenous factors, such as environmental disruptions, climate change, or communicable diseases. These factors have the potential to exacerbate costs, which are primarily shouldered by the Member States. There is a critical need to promote the sustainability of health systems and to harness the sector’s potential to catalyse economic growth – better health systems can lead to healthier citizens and wider socio-economic benefits.
While healthcare remains mainly a responsibility of the Member States, Article 168 of the Treaty on the Functioning of the European Union requires that ‘a high level of human health protection be ensured within all EU policies’. EU public health policy and law has developed over recent decades, following the ‘Health in all policies’ approach, through a range of interventions to support the single market and to promote the health of EU citizens, while respecting the prerogatives of the Member States and the national public health systems. The unprecented global health impacts of the COVID-19 pandemic have fostered a reinforced cooperation between the Member States and a stronger role for the EU in protecting citizens’ health.
Milieu’s track record in public health includes several studies on the pharmaceutical legislation, the integration of public health concerns into other EU policies, such as Cohesion Policy and biodiversity protection, the analysis of third-country legislation on public health, the provision of expertise to the European Parliament on a wide range of topics, and support to the European Commission on policy and legislation.
Pharmaceutical legislation and shortages prevention (DG SANTE, HERA)
For several years, Milieu has been supporting the European Commission’s Directorate-General for Health and Food Safety (DG SANTE) in future-proofing the EU’s pharmaceutical legislation. This includes supporting the analysis of the EU’s general pharmaceutical legislation’s provisions on shortages (Study Future-proofing pharmaceutical legislation, 2021- Publications Office of the EU) and the Evaluation and Impact Assessment of the EU’s general pharmaceutical legislation (Study in support of the evaluation and impact assessment of the EU general pharmaceuticals legislation, 2023- Publications Office of the EU). Currently, Milieu asists the European Commission’s Health Emergency Preparedness and Response Authority (DG HERA) on a Study on a possible Critical Medicines Act, aiming to prevent and mitigate shortages of medicines critical to the health of European citizens.
Public health workshops and studies for the European Parliament (EP)
Since 2010, Milieu has been supporting the European Parliament in the organisation of workshops on a wide range of public health topics. These workshops gather top experts in the respective fields from around the EU and beyond to provide expertise and policy support for members of the Parliamentary Committee on Environment, Public Health and Food Safety (ENVI), the Subcommittee on Public Health (SANT) and the former Special Committee on COVID-19 (COVI). For each event, Milieu identifies the experts with the most relevant profiles, prepares background research, press releases, and a final workshop summary. Topics of the recent workshops and studies include: environmental determinants of health; health disinformation; obesity; COVID-19 and long COVID; EU preparedness and response; antimicrobial resistance; novel tobacco products; robots in healthcare; the sustainability of health systems; complementary and alternative therapies for patients; auto-immune diseases; health promotion and primary prevention; the role of education and sport in the fight against cancer; the case of glyphosate in the EU’s pesticides risk assessment system, and others.
Studies on legislative alignment checks of the EU public health acquis for non-EU countries (DG SANTE, 2018-2024)
Countries that wish to join the EU need to align their legislation with that of the EU in all enlargement chapters. Milieu is supporting DG SANTE in assessing the alignment of national laws in 13 non-EU countries (enlargement candidate countries and micro-states) with the EU public health acquis (i.e. medicines for human and veterinary use, medical devices, cross-border healthcare, tobacco control, substances of human origin, and serious cross-border health threats including communicable diseases). The results of this work allow DG SANTE (and DG NEAR) to provide recommendations to these countries and to in-house experts for EU negotiations, as well as to prepare the annual country reports.
Animal health: Animal welfare during transport (DG SANTE, 2023)
The wellbeing of animals while being transported has been a long-standing issue. The trade of live animals is a global phenomenon, with the EU being a major market for their transport. During the journey, which usually takes a few hours but can also take days or even weeks, animals face numerous stresses (e.g. limited space, heat exhaustion). In addition, transporting live animals also poses serious risks for animal and human public health due to the possible spread of diseases. Milieu led a study to support the impact assessment accompanying the proposal for a revision of the EU legislation concerned with the welfare of animals during transport (Transport Regulation). The proposed revision aimed to reduce the numerous animal welfare problems linked to long journeys and repetitive (un)loading, by setting new rules and using digital technologies. The study carried out by Milieu explored the expected economic, social, environmental and animal welfare impacts of the actions proposed by the Commission through in-depth research and consultations. It can be found at Study supporting the impact assessment accompanying the revision of the EU legislation on the welfare of animals during transport – Publications Office of the EU. On the basis of the results of this study, a proposal for a new regulation was issued by the European Commission in December 2023. More information at https://food.ec.europa.eu/animals/animal-welfare/eu-animal-welfare-legislation/animal-welfare-during-transport_en.
The health and social benefits of nature and biodiversity protection (DG ENV)
The protection of biodiversity is not only an environmental goal, it also impacts people’s health and well-being in many ways. This includes the provision of space for outdoor recreation and activity for healthy lifestyles; improvement of living and working environments; mitigating stress from heat, noise and air pollution and others. Realising these requires awareness by stakeholders and policy-makers, as well as collaboration across sectors.
Milieu’s main role in this undertaking was the mapping and analysis of stakeholders via surveys and in-depth interviews. This led to the identification of good practices, as well as needs and obstacles to be overcome to improve stakeholder collaboration and governance. Based on the findings, the final study identified opportunities for further developing and increasing health and social benefits as well as practical tools for the mapping of social values and health benefits that could be linked to nature and the environment.