The Amsterdam treaty ensures 'health protection' in all policy areas. After bringing down the Commission, MEPs want to go further, reports Tony Sheldon

Fresh from its fight with the European Commission, the European Parliament now has its sights set firmly on health policy.

MEPs have already endorsed plans for 'fundamental changes' to the EU's participation in health and, following last week's mass resignation by the commission, some believe the time is ripe to push for more.

Heading the charge is Clive Needle, Labour MEP for Norfolk. Though the chaos has 'left things in limbo', he predicts there will be an EU commissioner for health by the end of the year.

Mr Needle, author of a report replying to the commission's paper on the 'development of public health policy', balances evangelising zeal with a worldliness learnt from the struggle for practical EU public health policies.

He writes of the 'need for rigour' in choosing programmes for which the EU is the 'appropriate level' while avoiding the 'danger' of 'a shopping list of worthy targets that cannot be tackled in a meaningful way by EU involvement'.

Mr Needle consulted widely, and this bore fruit when MEPs voted for his report by 482 to 34 earlier this month. The commission itself is thought to view the report as pragmatic and effective.

His plans would put health at the heart of decision-making, with a commissioner running a Brussels-based directorate general of health, whose 'core' work would be the 'integration of health across all other policy areas'. Currently, the EU's public health unit is housed in Luxembourg, away from the centre of decision-making, and forms part of former Irish commissioner Padraig Flynn's directorate of employment, industrial relations and social affairs.

The commission launched its consultation paper last April. It recognises both 'the greater role envisaged' for public health in the Amsterdam treaty and the need for a different approach to existing programmes.

The paper calls for policy based on three strands of action:

'improving information' based on common health indicators for all 15 member states;

creating an EU-wide 'surveillance, early warning and rapid-reaction capability' to counter threats to public health;

tackling factors affecting health, or 'health determinants', through promotion and disease prevention.

The Amsterdam treaty strengthens the EU's legal powers by making the far-reaching claim that a high level of human health 'protection' shall be 'ensured in the definition and implementation of all' policies.

The EU's remit now extends to 'improving public health, preventing human illness and diseases, and obviating the sources of danger' to health.

Yet despite good intentions, the commission paper's disappointed many MEPs. Mr Needle talks of using his report as a way of 'breaking out' of past restraints on policy.

'It is time for bold thinking,' he told MEPs. Reflecting the commission's plans, his 'vision' would see an end to existing vertical programmes to fund specific disease prevention like cancer and AIDS, and be replaced by 'horizontal strands' integrated into other policies.

He calls for a single health directorate, so that 'health truly becomes an integral part of the EU process'. This would mean health impact assessments of commission programmes; an end to the 'nonsensical' position of supporting tobacco producers through subsidies while trying to combat cancer and cardiovascular disease; and a coherent food policy. But such changes would mean challenging the powerful agricultural lobby.

Speaking in a personal capacity, Andrew Hayes, president of the European Public Health Alliance, points out that MEPs recently voted to support a three-year renewal of subsidies to tobacco farmers.

He welcomes the Needle report, but says the commission and the council of health ministers remain ambivalent when faced with a choice between health and commercial interests. 'Vested interests, such as those of tobacco farmers, can lead otherwise sane politicians to stand on their heads.'

Lesley Armitage, of Birmingham University's health services management centre, who is on secondment to EPHA, also welcomes Mr Needle's emphasis on integration. She says by its own admission the commission has failed to 'police' this aspect of the Maastricht Treaty, though there is 'considerable potential' to influence health through laws on water quality, transport or agricultural produce.

Mr Needle's report has now been forwarded to the commission and Council of Ministers to be considered when drawing up legislation.

With the chaos in the wake of the commissioners' resignations, legislation may now have to wait until next year, but Mr Needle stresses his report calls for 'urgent action'. He hopes to see recommendations on health impact assessment in the commission's work programme for 2000. He expects internal management changes 'virtually straightaway, whoever the president of the commission is'.

European Parliament, Report A4-0082/99.

Communication from the Commission COM(1998)230 final.