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Recommendation 1959 (2011) Final version
Preventive health care policies in the Council of Europe member states
1. The Parliamentary Assembly notes
that over the last century Europe has recorded extraordinary progress
in health and longevity. European health systems are appreciated
worldwide for their equity and their ability to make treatment available
to the people free of charge or at a reasonable cost. At the same
time, our global consumer society has brought about new illnesses,
such as obesity, heart disease, cancer, diabetes and mental health
issues, and new health inequalities have emerged.
2. Population ageing will have serious consequences for individuals,
communities and states, altering disease patterns and affecting
the viability of health systems. Chronic conditions are projected
to be the leading cause of disability throughout the world by the
year 2020. Some warning voices state that the present generation
of children might be the first to have a lower life expectancy than
their parents. Worrying data show for instance that diabetes in
children has significantly increased in the past ten years. If not
successfully prevented and managed, these chronic conditions will
become the thorniest problems faced by our health care systems.
3. The health promotion lessons of the past thirty years have
often been forgotten, overlooked or disregarded in public policy
implementation. Today’s European health systems reward and nurture
a therapeutic culture in which the goal is primarily to fix what
goes wrong. As a consequence, the competent authorities face a strong
and steadily growing demand for an increase in the capacity of health
systems to meet the needs of an ageing population and improve care
quality. The existing knowledge of what ensures health, the so-called
health determinants, that is, societal changes as well as the exponentially
rising rates of chronic diseases, indicate that national health
systems need to shift course and apply a new mindset to health.
4. The Assembly draws attention to the fact that inequalities
in access to health care and health education and information still
exist, with a well-educated part of the population who enjoy easy
access to the resources allocated and disadvantaged groups who experience
greater difficulties. Some types of health inequalities have obvious
spillover effects on the rest of society, for example, the spread
of infectious diseases, the consequences of alcoholism and drug
abuse, or acts of violence and crime. The real issue is therefore
how to secure access to the available resources by all population
groups, irrespective of socio-economic status.
5. The Assembly considers that disparities in health are partially
avoidable to the extent that they stem from identifiable policy
options exercised by governments, in particular education, regulation
of business and industry, nutrition, agriculture, chemical production,
environmental protection, road traffic, transport and alcohol, tobacco
or drug consumption. It follows that health inequalities are, in
principle, amenable to interventions by public authorities.
6. Governments that care about improving the health of the population
must incorporate to a much greater degree considerations of preventive
health care policies in their policy setting process. There is a
critical window of opportunity for European governments to make
an important difference that can affect the lives of millions of
Europeans by strengthening preventive and participatory medicine
approaches.
7. Current knowledge of the social determinants of health, and
of the fact that an improvement in general health represents an
additional asset to economic growth, is so well established that
it is rarely questioned. The Assembly nevertheless regrets that,
despite calls for better prevention policies and despite all the recommendations
and a number of statutory and legislative advances, there is still
little reaction to known or emerging health risks, in particular
those relating to non-communicable diseases. Health promotion policies require
long-term vision and the implementation of strategies and concrete
measures, which are rarely among national policy priorities.
8. The Assembly therefore urges Council of Europe member states
to examine and evaluate their preventive health care strategies,
paying renewed attention to the social determinants of health and
health inequalities and focusing on the advantages of improving
health, and to renew their commitment towards the health goals of
the World Health Organization (WHO).
9. Furthermore, the Assembly asks the Committee of Ministers
to invite member and observer states of the Council of Europe to:
9.1. define minimum standards of
access to health care based on fundamental human rights and sound
public health policies and practices, bearing in mind that the right
to health applies to the whole population, including all migrants,
irrespective of their migratory status;
9.2. work towards the promotion of better health and the closing
up of “health gaps” as a shared goal across all sectors of public
authority action, and incorporate a concern for impacts on health
into the policy development process of all sectors and agencies,
by adopting the “health in all policies” approach;
9.3. strengthen risk prevention and reduction mechanisms of
environment-related health hazards due to air, water, food, noise
and soil pollution and promote the positive health effects of access
to a good quality environment, as stressed in Assembly Recommendation
1863 (2009) on environment and health: better prevention of environment-related
health hazards;
9.4. improve early screening and detection mechanisms for diseases
and health conditions, including HIV/Aids, and tuberculosis, to
enable illnesses to be treated promptly and to provide the means
by which each individual may be oriented to complementary services
and support; furthermore, actively co-operate with WHO and the global
surveillance system in order to halt the expansion of infectious diseases;
9.5. promote a comprehensive sex and health education, including
abstinence, to prevent the spread of sexually transmitted diseases;
9.6. promoteuniversal
screening for non-infectious diseases and for risk factors at key
ages or in specific situations, for the prevention of health conditions
related to certain genetic or environmental risks;
9.7. incorporate preventive heath care policies explicitly
in poverty reduction strategies and in relevant socio-economic policies
so as to tackle inequalities in access to health information and
protection, risk exposure and access to care which lead to major
inequalities in the emergence and outcome of diseases, paying particular
attention to the situation of vulnerable people in Europe;
9.8. support a good start in life for families and young children
by strengthening preventive health care before pregnancy and for
mothers and babies in pre- and post-natal, paediatric and school
clinics, and through improvements in the educational levels of parents
and children;
9.9. intensify the efforts to make health education a priority
for public health policy and in particular make sure that they form
part of the school curricula, using new technologies in this context;
9.10. develop independent research, based on scientific criteria,
free from the influence of economic pressure groups, in particular
the food, pharmaceutical and tobacco industries;
9.11. ensure transparent decision making and accountability
in all food regulation matters; support sustainable agriculture
and food production methods that conserve natural resources; develop
a strong food-for-health culture in order to foster people’s knowledge
of food and nutrition;
9.12. pay attention to the risks of stigmatisation when planning
campaigns on nutrition and healthy body weight, which could have
unintended negative consequences for overweight people or people
at risk of developing body-image and eating disorders;
9.13. encourage the private sector, as well as the media, to
increase their commitment to health issues and make the most high
risk industries aware of their responsibilities through negotiation,
encouraging transparency and fostering a culture of corporate social
responsibility, in particular with regard to the less-privileged
segments of the population;
9.14. work with the food and advertising industries to encourage
the inclusion of key data, facts and figures on non-communicable
diseases and to ban advertising of harmful products; make recommendations
for reductions in levels of saturated fat and added sugar and increased
marketing of reduced-/low-saturated fat and reduced-/low-/no-sugar
versions of certain food products;
9.15. promote the development of indoor and outdoor facilities
for physical recreation, especially gymnasia, pools, playing fields
and ice rinks; reinforce support for sport programmes, in particular
those accessible to the whole population, irrespective of age, sex
and origin, and encourage the private sector to accept more social
responsibility for extending the use of their facilities to less-privileged
people;
9.16. strengthen integration between care and prevention by
enlisting the support of health professionals; furthermore, support
health education as a key element of initial and continuing medical training,
including in particular nutrition, health and human rights education,
and introduce health literacy as a key indicator of good hospital
care;
9.17. deal with the wider social context that influences a problematic
use of alcohol, tobacco and drugs (including psychotropic medicines
whose regular use also presents risks of addiction) and support addiction
policies within a broad framework of social and economic policies;
9.18. actively support WHO’s efforts in establishing an international
framework to deal with the harmful use of alcohol, following the
example of the WHO Framework Convention on Tobacco Control;
9.19. promote educational campaigns to increase awareness of
the gravity and underlying causes of road traffic accidents, deaths
and injuries;
9.20. adopt appropriate measures to enable elderly persons to
lead independent lives and to continue to live in their usual surroundings
as long as they wish and are able to, and provide mental health programmes
for any psychological problems in respect of the elderly, together
with adequate palliative care services;
9.21. devote special attention to mental health, including the
prevention of mental disorders and suicide; promote well-being,
including a good work-life balance and support the social integration
of highly marginalised groups such as refugees, disaster victims,
the socially excluded, the mentally disabled, the elderly and frail,
women and children suffering violence and the very poor;
9.22. formulate, implement and periodically review a coherent
national policy on occupational health and safety in consultation
with employers’ and workers’ organisations;
9.23. develop “soft” mobility and healthy and environmentally
friendly transport policies, such as public transport, car-sharing
and carpooling initiatives, with a view to creating pedestrian-
and bicycle-friendly towns, in co-operation with local and regional
authorities;
9.24. encourage the participation of civil society organisations,
such as patients’ and consumers’ associations, registered charitable
bodies and non-governmental organisations, and actively support them;
9.25. set up evaluation systems and promote the standardisation
of data, information collection and relevant indicators, in accordance
with the WHO recommendations.
10. Finally, the Assembly calls on the Committee of Ministers
to:
10.1. review, update and compare
Council of Europe member states’ national and international preventive
health care policies and health promotion strategies, in co-operation
with the European Union;
10.2. review and compare policy implementation and encourage
the member states to increase the resources allocated to preventive
health care and health promotion policies, and to ensure their sustainability;
10.3. examine the role played by national, European and international
organisations engaged in health promotion policies and explore plans
for a more strategic interaction based on each organisation’s area of
specialisation;
10.4. engage in constructive dialogue with the European Commission,
with a view to strengthening solidarity in health and reducing health
inequalities in Europe by focusing in particular on non-European Union
countries, in close co-operation with WHO;
10.5. instruct a committee of experts to elaborate a draft recommendation
based on the elements above within the next two years.