Thursday 7 January 2010

What did the Swedish Presidency do for your future health?

I was asked to comment on the Swedish Presidency by a journalist recently and after having given it some thought, looked at some of the material released this last 6 month and talked to a couple of people I must come to the conclusion that there have been no major achievements impacting the life of European healthcare consumers and professionals. But that we might see some changes anyway.

So why didn’t the Swedish Presidency rock the boat more? I see 2 major reasons for this besides the Swedes being Swedes – more about this in my LÁnglophone column from early autumn.

1. The first reason being structural: We had a rather weak EU commission since it was to be exchanged, for long waiting to be relieved. Also it didn’t help that the presidency in waiting (Spain) was working quite active and successfully against several of the Swedish key issues. Not so surprising given that the ministers do come from very different political backgrounds. We saw this division for example in the case of the Directive for Patient Rights. More concretely this meant that the Spaniards managed to gather a blocking minority partly by promising better deals during their presidency. I.e. that under their presidency governments would not have to hand over so much power to the patients.

2. The second reason is the Swine Flu - Now I think media and politicians alike over reacted – 1. – but no matter what you think about the focus on this issue one cannot deny that quite a lot of time and efforts by key healthcare people have been spent on this unexpected situation, time and focus that otherwise would have been spent on other issues. But what I can see the efforts around the Swine Flu showed that when needed the international community really can act fast and united. If the learning’s from this is used well by those that would like to see more international co-operation on health issues we might see surprising effects in other areas as well.

In one area where for example I do not think Industry expected or even still really understands what happened with is the info issue, i.e. the EU commissions' proposal for Information to Patients – a part of the Pharmaceutical package. It seems like still some analysts believe that if only industry says ok to pre-vetting then the issue is solved. It’s because they have not understood that the Swedes themselves have put the very controversial issue on hold not because they agree with countries like Spain or France who thinks that the EU Commission proposal is to liberal – Quite the opposite. The issue the Swedes have with the proposal is that their constitution on freedom of speech doesn’t allow for censorship – governmental pre-vetting of information. If Industry thinks this is ok sort of doesn’t help:) Makes me happy that my government stands up for principles.

Still, in some areas there have been achievements: On MRSA for example where the commission now has been asked to come forward with a proposal for new incentives for development of new antibiotics by 2012. Small steps have also been taken concerning organ donation and alcohol policies etc. And on organ donation Spain will probably do all they can to find a solution. Spain is best in the class and will probably take the opportunity to shine in this field.

Another achievement that might be considered a big step forward for public health is the council recommendation to the Member States to introduce smoking restrictions in public places. But I think this was a given and something they just could not loose. I firmly believe that smoking will be banned altogether. It just doesn’t make sense to let people destroy their health and our common healthcare budgets by allowing smoking. Would we have an insurance system where the fees could be adapted to smoking habits or they paid themselves for their healthcare I think they should be free to kill themselves? But as long as I pay…

A small issue but with high importance is that the Swedes managed to get the council to support the European Court of Auditors very critical report on DG Sanco's work with the Public Health Program 2003-2007. This is important for all future efforts on EU level. Targets for all efforts needs to be set. There will have to be focus. We can already see the effects in for example the Work program published by DG Sanco in December. In short the budget is tighter, the focus clearer and the demands on output orientation higher. And warnings are raised that last year already only 20% of the applications where granted – this year it will be even fewer. Having previously seen some excellent but also some very, very basic work being funded in all possible and impossible areas I think this is great step forward.

On a final note most interesting is maybe that now finally the Swedes are free to say what they want. For quite some time also before their presidency they have been diplomatic in the hope that this would enable them being good chairmen. Now they will have no such restrictions and I would hope this means they can finally really take a stance for patient’s rights to choose etc. This is areas where the current government back home in Sweden has been very active. I would think the Spaniards will have quite a match with the Swedes since they do have quite different views on who should be in power in healthcare. Sometimes it's said that health issues we can all agree upon but when one looks at the Swedish and Spanish health policies it becomes quite obvious that one country thinks that the patients are taxpayers and should be in charge and that the other country believe that it’s the role of the government to ensure best possible care for all.


  1. Thank you so much for this Swedish Presidency overview!!! I really hoped the cross-border directive would see the light during the 6 Swedish months, but it wasn't meant to be. We all know it won't happen during Spanish Presidency... :)

  2. And hardly under the Belgian or Danish. The Hungarian might be the needed window of opportunity.

    Then it do also comes down to how good a commissioner Dalli turns out to be.