158th CoR Plenary Session (29-30 November 2023)

Rapporteur: BANASZAK Adam Commission: NAT
The Opinion aims to reiterate that the management of health systems is decentralised in the majority of EU Member States ; although the degree of decentralisation may vary, in most countries regions and cities have a vital role to play in the design, delivery or financing of healthcare services.

On 11 November 2020, the European Commission put forward a proposal for a regulation on serious cross-border threats to health. In the light of lessons learned from the coronavirus crisis, it aimed to strengthen the EU's health security by revising Decision 1082/2013/EU (the 'Cross-Border Health Threats Decision'). The proposal was presented in a package that also included proposals to strengthen the European Centre for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA), as first steps towards a European health union (these regulations were adopted on 24 November 2022 and 25 January 2022 respectively).

The failure to prevent the recent pandemic (COVID-19) and the difficulties in managing it resulted in immense loss of human health and life as well as unprecedented disruption of societal activities worldwide. This created momentum for the reform of the global health architecture. To prevent a repetition of the crisis, the World Health Organization (WHO) member states launched two parallel government-led processes to introduce targeted amendments to the International Health Regulations (IHR) and draft a new, legally binding pandemic agreement (WHO CA+). The EU, which is an informal observer without voting rights in the WHO, has been a key player in both processes.

On 30 November 2022, 12 years after the adoption of the first strategy on the EU's role in global health in 2010, the European Commission unveiled the EU global health strategy with the overarching goal of improving global health security and ensuring better health for all. The document takes stock of lessons learnt from the pandemic and guides EU action in an evolving landscape of threats and opportunities, including towards reasserting responsibility for attainment of the United Nations Sustainable Development Goals (SDGs) – currently unfinished business. The strategy constitutes the external dimension of the European health union and is a cornerstone of the Global Gateway strategy.

Over time, EU investment in health research has been aimed at increasing knowledge and transfer of knowledge into innovation, for better health. To this end, several instruments have been developed, but the impact of these efforts is hampered by fragmentation and a lack of synergy between strategies at different levels. Inequalities in health and research across Member States need further measures. Policies can take inspiration from successful health research organisation and policies inside and outside the EU, for more coherence and throughput to implementation.

Quality improvement initiatives take many forms, from the creation of standards for health professionals, health technologies and health facilities, to audit and feedback, and from fostering a patient safety culture to public reporting and paying for quality. For policy-makers who struggle to decide which initiatives to prioritize for investment, understanding the potential of different quality strategies in their unique settings is key. This volume, developed by the Observatory together with OECD, provides an overall conceptual framework for understanding and applying strategies aimed at improving quality of care .

Cities and population health are intrinsically interlinked. Historically cities have systematically metamorphosed in response to threats posed to health and other kinds of security. Key attributes of urban built environment; the type and quality of housing, physical morphology (density, land use heterogeneity, configuration and design, locations of destinations and accessibility) as well as the quality of infrastructures (public transport, parks, sidewalks and boulevards) and level of services supported (recreational facilities, healthcare, food outlets/pubs and restaurants, supermarkets and groceries, places of worship etc) govern the relative locations of housing, jobs and services, and shapes population-level mobility, mixing and socialnetworks.