Priorities for public health action in the European Union
International Journal of Integrated Care, 1 March 2001 - ISSN 1568-4156
Book review
Priorities for public health action in the European Union
Edited by Olivier Weil, Martin McKee, Marc Brodin, Daniel Oberlé
European Commission, Employment and Social Affairs, 1999,
Winfried J. de Gooijer

The twelve chapters of this book deal in a very detailed way with public health items like alcohol, tobacco, illicit drugs, health surveillance, quality in health care, ageing, mental health, environment, food and nutrition and contamination of food.

Taking the view that policies regarding public health so far have been reactive, responding to strong vested interests or the concerns of individual politicians, the authors argue that the European Commission, having responsibility for initialising action, now must prioritise its work. Next to this, many public health professionals consider the Commission's importance in the field of public health remote. They are, it is argued, unaware of the European dimension to their work or have no obvious way in which their concern can be fed into the decision making process.

The Commission is beginning to recognise this weakness and the potential value of involving the European public health community in the development of policies that subsequently will have to be implemented. Regarding this, the book reports the results of a study undertaken to identify a set of European public health priorities, agreed by representatives of the national public health societies in the European Union member states. It provides a snapshot of how public health professionals view ten of the leading challenges to health in Europe and the strategies required addressing them.

The editors came to this result by using a framework for identifying public health priorities consisting of several steps.

The first step was the identification of a representative of one of the national public health associations in each of the member states. Subsequently, these representatives were asked to collect the views of at least 30 of their members. A standard questionnaire was developed and respondents were asked to suggest priorities for EU action, basing their choices on four criteria, being

  • An emergent issue in one or more countries which could become a major public health problem at a European level;

  • A public health problem existing in several or all countries of the European Union;

  • A public health problem for which action by the EU could contribute to convergence of national or local policies, with beneficial consequences;

  • A subject in regard to which community action would produce a more effective response than national or local ones alone.

As a result a very large number of topics was proposed with a marked diversity between countries. A ranking of the two most frequently cited priorities per country showed that items like inequality in health, ageing and lifestyle matters (working conditions, smoking, alcohol, drugs), be it defined differently, were generally seen as important matters for public health action.

The next step was that the different items were discussed intensively in working groups, illuminating in reports that will enter into the decision making process in the European Union. In fact, the book is a reproduction of these reports. Going through it, leaves the reader with several impressions. Firstly there is an awful lot going on regarding public health in Europe. There are very many associations, organisations, government departments, professional organisations and individuals involved in different abuses, prevention and health promotion activities. Secondly, there is a need for attuning and co-ordination regarding all these activities in order to prevent double work and overlap. Many of the suggestions of the working groups are an invitation to come to some mapping of what is going on in Europe. Finally, and most importantly, the reports make clear that there is still a lot to be done when it comes to European action in public health.