Gaining health : analysis of policy development in European ...

Chapter 6
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goods”, including food. There is huge unused potential for
creating environments conducive to a healthier lifestyle for
the workforce, patients, their families and the local community
in the health care setting.
A radically different Europe
Of the 53 Member States in the WHO European Region,
27 are members of the EU, 3 are already candidates and a
further 3 or 4 are potential members (15). In addition, the
four European Free Trade Association (EFTA) countries
have a special relationship with the EU and participate in
the Public Health Programme and the network for epidemiological
surveillance. A further 16 countries are included
under the European Neighbourhood Policy, and the Russian
Federation is associated through a strategic partnership.
In one way or another, therefore, most of the countries in
the WHO European Region are linked to the EU. While
this provides opportunities for intergovernmental and
cross-border collaboration, it will be important to avoid a
two-track Europe of EU-related members and “the rest”
on health issues. Furthermore, there are more global and
international players on the health scene in Europe and
international cooperation for health in Europe needs a new
concept with a new innovative division of tasks, rethinking
the niche of each organization.
Globalization
Globalization was initially seen as a threat that might be
avoided. More recently, it has been accepted as a general
framework of world development with deep consequences
for the world economy, consequent to changes in trade,
communications technology and transportation. Cultural
and physical borders are disappearing, radically increasing
the movement of people, goods and ideas.
Potentially, globalization has both positive and negative
effects on health, the impacts of which need to be carefully
monitored and if possible controlled. The issue is one
of trying to achieve socially responsible globalization (16).
There is a burgeoning literature on the potential importance
of globalization for health, but little consensus on the
channels through which health is affected, or what should
be the policy responses, although there have been a number
of attempts to provide conceptual frameworks (16–18).
In the globalization discussion, NCD have not always
been given the high visibility of communicable diseases or
problems caused by the quality (rather than the nutritional
value) of food products. It has been suggested (19) that
to have an impact on NCD, greater use could be made of
“hard law” conventions such as the WHO FCTC and “soft
law” resolutions such as the Millennium Development Goals
(MDG).
NCD are conspicuously lacking in the MDG. This is despite
the fact that, for example, a World Bank report estimates
that reducing the levels of CVD, injuries and violence in the
Russian Federation to those of the EU would improve life
expectancy by more than ten years, as compared to a gain
of less than one year for reducing infant, child and maternal
mortality to EU levels (20). This poses a real challenge
for the next review of the MDG to include a substantial
reduction in NCD, making them relevant for improving the
health status in the European countries with the shortest
life expectancies.
Potential partners in the global economic scene
Through activities of the Global Economic Forum and the
action of certain companies, the concept of corporate social
responsibility (CSR) is already quite well-developed and
offers opportunities for combating NCD. Firms the world
over, from car makers and petroleum companies to mobile
phone makers, electronics companies and supermarkets, for
example, want to boost their CSR image (21). Conferences,
web sites and magazines such as that of Ethical Corporation
(www.ethicalcorp.com) spread the message.
Pointers to the future