Vytenis ANDRIUKAITIS

In a world with so much wealth, how is it possible that so many people have little or no access to healthcare? Or that different socioeconomic backgrounds, genders, or nationalities, mean poorer health for some? As a doctor, Social Democrat and Commissioner for Health and Food Safety, I find this unacceptable.

Undoubtedly, there has been movement in the EU and worldwide to address the issue of access to healthcare. Back In 2015, the UN adopted the Sustainable Development Goals, agreeing to “ensure healthy lives and promote well-being for all at all ages”. On signing the European Pillar of Social Rights a year later, with health at the core, we in the EU made a commitment to address inequalities.

However, the picture remains mixed, as our ‘Health at a Glance: Europe 2018’ report shows. On the one hand, the number of Europeans reporting care needs unmet for financial reasons has decreased. On the other hand, people with lower education levels live six years less than those with higher educa- tion levels. So what can we concretely do to make health more equitable? Where does this action need to take place?

Universal access to healthcare and medicines – Utopia?

These two issues are undeniably the corner- stone. Good health should not depend on the price you can pay, and access to medicines should not be dictated by your country of res- idence. These must be our overarching goals in EU healthcare, and I believe they are achieva- ble with enough impetus in the right direction.

Although the responsibility for access to medicines remains with Member States, a European approach means that innovations are accessible and affordable to all citizens. And investing in EU-wide health-related

Most chronic diseases are due to preventable lifestyle risk factors, which affect disadvantaged groups the most. So why do OECD countries spend only 3% of their health budgets on prevention?

research means that we can pool our knowledge and make even more innova- tions. Take for example rare diseases: a fragmented approach means that each country alone has a small pool of data and expertise. Through the European Reference Networks (ERNs), we grow our database and create an ecosystem for collaborative research, enabling us to treat these dis- eases equally across the EU.

A stronger focus on health in the EU

Clearly, all of this depends on cross-border cooperation. As we saw above, a European approach allows us to benefit from the wealth of knowledge across the Union, which is particularly important for smaller coun- tries, who may not otherwise have these resources at their disposal.

Let us never forget that the EU was founded on the values of solidarity and equality. During the current period of change and unrest, we must remember these values and not turn our back on them. Because as a Union, we are responsible for the health of every EU citizen, regardless of their nationality.

Shift the focus from fighting disease to ‘health in all policies’

Another hugely important area is that of chronic diseases, because they are by far the leading cause of mortality in the EU. Frustratingly, most chronic diseases are due to preventable lifestyle risk factors, which affect disadvantaged groups the most. So why do OECD countries spend only 3% of their health budgets on prevention? I have asked every Minister and National Parliament

this question over the past four years. We are never going to make gains in healthcare with an ageing population and rising multi-mor- bidity without making this paradigm shift.

Let us not fool ourselves: Health Ministers cannot make the shift I am talking about alone. Health must be embedded in policies across all sectors, because only this holistic approach can tackle health determinants at the root. Education, for instance, is a key social determinant of health. The success of all public health interventions (includ- ing prevention policies) depends entirely on it, because how can we expect people to change their behaviours if they do not understand their implications?

Misinformation in health

Education is intrinsically linked with misinformation, which has far-reaching effects in health, as shown by recent measles out- breaks caused by vaccine hesitancy due to false information. People with lower education levels are the most vulnerable to misinformation. Clearly, in parallel with the European Commission’s fight against disinformation, we need to empower people, giving them accurate information by putting health at the centre of education policies.

And finally, achieving these goals is of course impossible without investment. We often forget that health is an asset. It is valuable for the individual but also means a healthy workforce, productivity, and economic benefits. By investing in this asset, we create a healthier society all round.

This list is in no way exhaustive, but it gives an idea of what we must do to achieve equitable healthcare. Social standards in the EU are among the highest, but we cannot become complacent. I am proud to say that health is at the heart of the European Pillar of Social Rights, and on signing it we made a collective commit- ment at European level to address inequalities.

Now, let us make good on that commitment. Because health is a right. Not a privilege.