|Summary of public health relevant EU-level actions and their perception as achievement, failure or missed opportunity|
|Treaty||Inclusion of the health mandate as enshrined in Article 129 of the Treaty of the European Union.||Missing implementation of a connection/share of power between economic and social EU policy.|
|Directorate general for health and consumers (DG SANCO)||Existence and persistence of DG SANCO.||DG SANCO is not strong enough to push health in other DGs.||DG SANCO set-up: Missing link to social policy.|
|Public health programme.||Public health did not become a key aspect of EU policy.|
|Sustainability development strategy: DG SANCO is not playing an active role in the marketing of the strategy.|
|Cooperation||Cooperation between EU, WHO and OECD.||Missing connection and joint forces between EC and WHO.|
|EC agencies||Development of agencies: ECDC, EFSA, EMA, EMCDDA.|
|ECDC||Legislation on infectious disease control.||ECDC mandate should include responsibilities in risk management of infectious diseases.|
|European Programme for Intervention Epidemiology Training (EPIET).||ECDC profile should cover also non-communicable diseases and SDoH.|
|EMA||Coordination of the approval of efficacy, safety and quality of drugs.||Cost-effectiveness of pharmaceuticals is not taken into account.||Problem of not being able to tackle pharmaceutical pricing.|
|Reversal of the approval of already approved drugs not handled on EU-level.|
|EFSA||Control of health claims of food products.||EFSA mandate should include/be stronger on health promotion aspects of nutrition (e.g. regulation of advertisement of unhealthy food products).|
|Food safety Directive.|
|Health in All Policies (HiAP) approach||Health mandate assures that health protection should be guaranteed in all EU policies.||HiAP and Health Impact Assessment have never been implemented fully (tick box exercise).|
|Leads to the discussion of health in other sectors.|
|Lifestyle factors||Common tobacco legislations in Europe (WHO Framework Convention of Tobacco Control; tobacco product-; tobacco advertising Directive).||The tobacco regulations could have been designed stronger (e.g. more harmonized realisation of smoking prohibition on public places).||Tobacco regulation has some aspects of failure since a strict, general ban is not reached.|
|Food safety measures and regulations on health claims.||Missing political will to tackle obesity and related life style factors like unhealthy food products.|
|Health Research Programme||EU health research budget and outcomes of the programme.||Missing integration of the research programme and EU health research outcomes in public health.|
|EU budget||Largest budget proportion shifted in the Multiannual Financial Framework 2007–2013 from agriculture financing to the funding of cohesion and sustainable growth policies.|
|Health research budget.|
|The use of Structural Funds for investments in health (2007–2013).|
|Internal market provisions||Internal market rules as source for legislation should be more attentive to health concerns.||Internal market provisions cause problems if member state regulation is more protective regarding health threats than EU regulation.|
|Patients’ rights directive||The patients’ rights Directive in general.||Negotiations on patients’ rights Directive failed to include a strong emphasis on the development of common standards.|
|Effect on cross-border cooperation.|
|Gives legal certainty to policy makers.|
|Common Agriculture Policy||Policy field which starts to recognize health, e.g. in its white paper on the CAP after 2013 (2009/2236(INI)).||Unrecognized potential for health of the CAP by public health sector.|
|Health information||Health life years as indicator in the Lisbon strategy.||Missing health information system.|
|Lack of morbidity data.|
|Different public health topics|
|health inequalities||EC communication: solidarity in health: reducing health inequalities in the EU.|
|HTA||Strengthening of the HTA approach in the EU.||Coordinating cross-country level health technology assessments.|
|Rare diseases||Coordinated management of rare diseases.|
|Tuberculosis||Existing drug resistance of tuberculosis as indicator for lacking disease management.|
|Health of minorities||Health of minorities (e.g. Roma) as part of the European agenda.|
|Social care||Social care is hardly seen as EU competence.|
|Environment (and health)||Environmental standards set by the EU.||Missing follow-up process on the Environment and Health Action Plan (2004–2010).|
|Information to patients||Blocking of direct to consumer advertising of prescription-only pharmaceuticals.|
|Governmental issues||White paper on governance (2001) increased transparency.|
|More standardisation of methods (evaluation of indicators, outcomes, policies) and common language.|
|Increased understanding of the public health community about the impact of EU policies on public health.|
|Industry involvement||Cooperation with industry influences the health research agenda and policy-making.|
|Evidence-based policy-making: the interest of the industry is against public health.|
ECDC: European Centre for Disease Prevention and Control.
EFSA: European Food Safety Authority.
EMA: European Medicines Agency.
EMCDDA: European Monitoring Centre for Drugs and Drug Addiction.
HTA: Health Technology Assessment.
DG: Directorate General.
SDoH: Social Determinants of Health.
EC: European Commission.
OECD: Organization for Economic Cooperation and Development.
WHO: World Health Organization.
Rosenkötter et al.
Rosenkötter et al. BMC Public Health 2013 13:1074 doi:10.1186/1471-2458-13-1074