Tag Archives: Health policy

Pure air for Europe

Pure air for Europe

Outline of the Community (European Union) legislation about Pure air for Europe


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Environment > Air pollution

Pure air for Europe

Document or Iniciative

Directive 2008/50/EC of the European Parliament and of the Council of 21 May 2008 on ambient air quality and cleaner air for Europe.


This Directive lays down measures aimed at the following:

  • defining and establishing objectives for ambient air quality * designed to reduce harmful effects on health and the environment;
  • assessing the ambient air quality in Member States on the basis of common methods and criteria;
  • collating information on ambient air quality in order to monitor long-term trends, in particular;
  • ensuring that such information on ambient air quality is made available to the public;
  • maintaining air quality where it is good and improving it in other cases;
  • promoting increased cooperation between the Member States in reducing air pollution.

Member States shall designate the competent authorities and bodies responsible for evaluating the quality of ambient air, approving measurement systems, ensuring the accuracy of measurements, analysing assessment methods and cooperating with other Member States and the Commission.

Air quality assessment

This Directive establishes a system for the assessment of ambient air quality in relation to sulphur dioxide, nitrogen dioxide and oxides of nitrogen, particulate matter (PM10 and PM2,5), lead, benzene and carbon monoxide as well as ozone.

Member States shall establish areas or zones (urban, suburban, rural, rural background) throughout their territory, and assess and manage the air quality.

This Directive sets thresholds for assessment for each pollutant, criteria for the assessment method (in particular the siting of sampling points), reference methods for measurement, limit values * for the protection of human health and the environment, the target and the obligation of reducing exposure for the population to PM2,5, information thresholds * and alert thresholds *, critical levels * for the protection of vegetation and the list of information to be included in action plans for improvement in air quality.

Each Member State shall set up at least one measuring station and may, by agreement with adjoining Member States, set up one or several common measuring stations.

Air quality management and action plans

Where the levels of pollutants in ambient air are below the limit values specified in this Directive, Member States shall maintain the levels of those pollutants below the limit values and shall endeavour to preserve the best ambient air quality, compatible with sustainable development.

Where, in given zones or agglomerations, the levels of pollutants in ambient air exceed any limit value or target value *, plus any relevant margin of tolerance in each case, Member States shall ensure that air quality plans are established for those zones and agglomerations in order to achieve the predefined limit value or target value.

In the event of exceedances of those limit values for which the attainment deadline is already expired, the air quality plans shall set out appropriate measures, so that the exceedance period can be kept as short as possible and can include additional specific measures to protect sensitive population groups. Measures similar to those laid down in short-term action plans may be considered.

Where there is a risk that the levels of pollutants will exceed the alert thresholds, Member States shall draw up action plans indicating the measures to be taken in the short term in order to reduce the risk or its duration. These actions plans can in particular suspend activities which contribute to the risk of exceedance (motor-vehicle traffic, construction works, the use of industrial plants etc.). In addition, these action plans may include specific measures aimed at the protection of sensitive population groups, in particular children.

Where thresholds are exceeded due to transboundary transport of air pollutants, the Member States concerned shall cooperate and coordinate their work in order to remove the exceedance.

Public information

Member States shall ensure that up-to-date information on ambient concentrations of the pollutants covered by this Directive is routinely made available to the public and the bodies concerned. Where alert thresholds and information thresholds are exceeded, Member States shall publish:

  1. information on the exceedance or exceedances observed (place, type of threshold, time and duration of the exceedance, highest concentration observed);
  2. forecasts for the following hours and days;
  3. information on the type of population concerned, possible health effects and recommended behaviour;
  4. information on preventative measures and measures to reduce the emissions.

Member States shall also make available to the public annual reports for all pollutants covered by this Directive.


Member States shall lay down the rules on penalties applicable to infringements of the national provisions adopted pursuant to this Directive and shall take all measures necessary to ensure that they are implemented. The penalties must be effective, proportionate and dissuasive.


This Directive repeals and replaces Directive 96/62/EC on ambient air quality assessment and management, Directive 1999/30/EC relating to limit values for sulphur dioxide, nitrogen dioxide and oxides of nitrogen, particulate matter and lead in ambient air, Directive 2000/69/EC relating to limit values for benzene and carbon monoxide in ambient air, Directive 2002/3/EC relating to ozone in ambient air and Decision 97/101/EC establishing a reciprocal exchange of information and data on air pollution within the Member States.

Key Terms of the Act
  • Ambient air: outdoor air in the troposphere, excluding workplaces as defined by Directive 89/645/EEC.
  • Limit value: a level fixed on the basis of scientific knowledge, with the aim of avoiding, preventing or reducing harmful effects on human health and/or the environment as a whole, to be attained within a given period and not to be exceeded once attained.
  • Target value: a level fixed with the aim of avoiding, preventing or reducing harmful effects on human health and/or the environment as a whole, to be attained where possible over a given period.
  • Information threshold: a level beyond which there is a risk to human health from brief exposure for particularly sensitive sections of the population and for which immediate and appropriate information is necessary.
  • Alert threshold: a level beyond which there is a risk to human health from brief exposure for the population as a whole and at which immediate steps are to be taken by the Member States.
  • Critical level: a level fixed on the basis of scientific knowledge, above which direct adverse effects may occur on some receptors, such as trees, other plants or natural ecosystems but not on humans.


Act Entry into force Deadline for transposition in the Member States Official Journal

Directive 2008/50/EC [adoption COD/2005/0183]



OJ L 152 of 11.6.2008

Health and well-being of young people

Health and well-being of young people

Outline of the Community (European Union) legislation about Health and well-being of young people


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Education training youth sport > Youth

Health and well-being of young people

Document or Iniciative

Resolution of the Council and the Representatives of the Governments of the Member States, meeting within the Council of 20 November on the health and well-being of young people [Official Journal C 319 of 13.12.2008].


Even though the health of Europe’s young people is considered to be in general rather satisfactory, concerns remain regarding nutrition, physical activity, alcohol abuse, as well as sexual and mental health. In this context, it is essential to promote a healthy lifestyle, to adopt preventive measures and to take gender issues into consideration.

Several aspects related to living conditions pose a risk to young people’s health and well-being. To ensure the healthy development of young people, their physical and social environments should be wholesome. This aim is best achieved by giving further support to parents.

The extent of social inclusion and level of education of young people is closely related to their health and well-being. Hence, it is important that young people are kept well informed of the advantages of a healthy lifestyle and that they are encouraged to become more responsible and autonomous with regard to their own health.

In order to ensure that youth health policy is efficient, the state of play should be assessed to provide better tailored strategies that take into consideration the needs of and differences among young people. The strategies should be based on a comprehensive and cross-sectoral approach. Youth health policy should involve the local, regional, national and European levels and be developed in close partnership with a wide range of stakeholders.

Consequently, the Council is inviting Member States to:

  • mainstream the “youth” dimension into all initiatives that are related to health issues and implement appropriate measures for youth health policy;
  • allow all relevant stakeholders, including young people themselves, to participate in developing and implementing the initiatives related to health issues;
  • support young people’s access to both cultural and physical leisure-time activities;
  • consider youth health issues in information and the media programmes and policies;
  • promote youth workers’ and organisations’ training on health issues and prevention measures.

The Commission is also invited to ensure the mainstreaming of the “youth” dimension in all initiatives related to health issues, as well as to include all stakeholders and the young people themselves at all stages of development of the initiatives on youth health policy.

Finally, the Council is inviting Member States and the Commission to collaborate, in order to:

  • expand knowledge of youth health issues by increasing research into and regular reporting on the topic;
  • include data on youth health and well-being into the Commission’s triennial report on young people’s situation in Europe;
  • inform the public about issues that affect the health of young people;
  • promote exchanges at the local, regional, national and European levels on best practice related to youth health;
  • promote the use of existing European Union (EU) instruments in the development of youth health-related projects;
  • encourage stronger collaboration on youth health issues among young people, youth organisations and other relevant stakeholders as well as civil society.


The White Paper on youth of 21 November 2001 recognised the importance of health in empowering young people, fostering their social inclusion and developing their active citizenship. The European Youth Pact, adopted in March 2005, further emphasised the need to mainstream the “youth” dimension, in particular issues related youth health, to other relevant European policies.

The EU Role in Global Health

The EU Role in Global Health

Outline of the Community (European Union) legislation about The EU Role in Global Health


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Development > Sectoral development policies

The EU Role in Global Health

Document or Iniciative

Communication from the Commission to the Council, the European Parliament, the European Economic and Social Committee and the Committee of the Regions – The EU Role in Global Health [COM(2010) 128 final – Not published in the Official Journal].


The Commission presents principles to improve action undertaken by the European Union (EU) as regards protecting world health.

Health protection in non-Member States of the EU aims mainly at preventing health risks and reducing inequality of access to care. In addition, action in this area must take into account a number of social, economic and environmental factors.

Improving global governance

The Commission recommends better coordination of the different action undertaken by States or groups of States, at:

  • global level, in order to defend a single position within the World Health Organization (WHO) and the United Nations (UN);
  • regional level, to develop exchange and networks between neighbouring States;
  • national level, to support public policies and the control of public funding, as well as interaction with other areas (such as education, youth empowerment, the family, etc.).

Developing universal health coverage

Universal coverage of health services should be established in the poorest countries. In this regard, the EU should increase its public development aid (PDA), but also reinforce its effectiveness and predictability. The Commission also recommends:

  • concentrating aid to serve the most fragile populations and countries;
  • strengthening the effectiveness and equity of health systems, as well as their functioning in terms of workforce, access to medicines, infrastructure, logistics and decentralised management;
  • having recourse to global initiatives and existing international financial institutions, but also to innovative funding.

Increasing policy coherence

Key issues in health policy should be taken into account in other areas, such as:

  • trade, in particular with regard to intellectual property rights, access to essential medicines, opening up generic medicine competition and combating counterfeiting;
  • managing migration, which should not undermine the availability of health professionals in developing countries;
  • defence and security, in order to better address fragile contexts and to provide an early response to international health risks;
  • food safety, food aid and nutrition, through public policies and the monitoring of nutritional status in the population;
  • climate change – the objective of health protection should be taken into account when allocating new funding.

Particular attention should also be paid to the fields of education and youth.

Research and innovation

Access to health services, medical technologies and medicines should benefit all. Research and innovation strategies should therefore be directed towards:

  • strengthening the research process overall – innovation, implementation, access, monitoring and evaluation;
  • collecting comparable data and statistics at global level, by collaborating with national and international organisations working on world health (WHO, OECD, etc.);
  • improving the dissemination of factual information, including risks, and the safety of food, feed, pharmaceuticals and medical devices.

Optimising skills

The EU must put in place mechanisms to optimise:

  • European action in EU countries and external countries, particularly within a platform to exchange information and through the development of common positions between EU countries and the Commission;
  • monitoring of European aid and implementation of the EU Code of Conduct on Division of Labour in the area of health;
  • dialogue between the key global players, in partnership with UN agencies and international financial institutions.


The adoption of the Millennium Development Goals (MDGs) in 2000 has led to progress being made with regard to reducing global poverty. However, progress in developing countries is still uneven and often insufficient.

The international community has therefore enhanced its efforts regarding the three MDGs relating to health (reducing child mortality, improving maternal health, and combating disease – in particular HIV/AIDS and malaria).

Alzheimer’s and other dementias: European initiative

Alzheimer’s and other dementias: European initiative

Outline of the Community (European Union) legislation about Alzheimer’s and other dementias: European initiative


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Health determinants: lifestyle

Alzheimer’s and other dementias: European initiative

Document or Iniciative

Communication from the Commission to the European Parliament and the Council of 22 July 2009 on a European initiative on Alzheimer’s disease and other dementias [COM(2009) 380 final – Not published in the Official Journal].


This Communication lays down milestones for a European initiative on Alzheimer’s disease and other forms of dementia.


Dementia is a neurodegenerative disease which affects mental ability such as memory, thinking and judgement, even causing a deterioration in personality.

The most common types of dementia are:

  • Alzheimer’s disease (50 to 70 % of cases);
  • dementia caused by successive strokes (30 % of cases);
  • Frontotemporal dementia;
  • Pick’s disease
  • Binswanger’s disease;
  • Lewy-Body dementia.


Obstacles hindering the introduction of a European initiative to combat forms of dementia involve:

  • the lack of prevention and early diagnosis of the disease;
  • the lack of epidemiological data which limits understanding of the mechanisms of the disease;
  • the lack of exchanges of good practices between Member States;
  • the image and negative impact of the disease on the population.

First objective: prevention and early diagnosis of the disease

Preventing the disease or making an early diagnosis can delay the development of the disease. However, these risk factors are not the same according to the different forms of dementia. It is, for example, easier to detect vascular dementia than Alzheimer’s disease since risk factors for vascular dementia are already well known:

  • high blood pressure;
  • high cholesterol levels;
  • smoking.

Member States already have avenues to explore regarding the development of effective prevention of the disease. In particular:

  • the promotion and stimulation of physical and mental activities throughout life;
  • the control of the vascular risk factors mentioned above.

In order to meet this objective of prevention and early diagnosis, Member States shall put in place the following actions:

  • promote cardiovascular health and physical activity;
  • produce recommendations to inform the public;
  • include older people in a flexible retirement regime to allow them to remain active.

Second objective: to improve epidemiological knowledge

The European Commission proposes to collect data on the impact of these diseases through the “European Collaboration on Dementia (EuroCoDe)” project. The framework of the “Health” programme may also be used to prepare new criteria for early diagnosis. The Seventh Framework Programme for research and technological development (FP7) may also offer an effective research framework for Alzheimer’s disease and other forms of dementia.

It is also necessary to harmonise existing research frameworks both at European and national level in order to prepare coherent policies. To this end, actions include:

  • using the European Health Examination Survey to provide new Europe-wide data on the prevalence of people with early cognitive deficiencies;
  • launching a pilot Joint Programming approach to combat neurodegenerative diseases.

Third objective: exchange of good practices

Exchange of good practices may take place through the Open Method of Coordination (OMC) for social protection, social inclusion and long-term care. Moreover, the Commission may provide information on how ongoing Community programmes can finance these exchanges.

The OMC can help to define quality frameworks for medical and care services for people affected by the disease.

The European Union Disability Action Plan 2003-2010 (DAP) can also be used to support patients’ organisations.

Fourth objective: to respect patients’ rights

The Commission intends to establish a European Network for the protection of the rights and dignity of people with dementia. This Network would be responsible for working on issues related to the dignity, autonomy and social inclusion of patients.


7.3 million Europeans between 30 and 99 years of age were suffering from dementia in 2006. According to the “Dementia in Europe Yearbook” report (2008) , the total direct and informal care costs of the disease amounted to EUR 130 billion for the European Union in 2005. Coordinated action at European level would reduce these figures and combat this major health problem.

Health and safety for temporary workers

Health and safety for temporary workers

Outline of the Community (European Union) legislation about Health and safety for temporary workers


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Employment and social policy > Health hygiene and safety at work

Health and safety for temporary workers

Document or Iniciative

Council Directive 91/383/EEC of 25 June 1991 supplementing the measures to encourage improvements in the safety and health at work of workers with a fixed-duration employment relationship or a temporary employment relationship [See amending act(s)].


The European health and safety at work standards apply to all workers, including temporary workers, whose employment relationships are defined by:

  • a fixed-duration contract concluded directly between an employer and a worker under which the end of the contract is determined by objective conditions (date, completion of a specific task, etc.);
  • a temporary employment contract concluded between a temporary employment business and a worker for the purpose of carrying out a task in an undertaking under its supervision.

Directive 89/391/EEC on health and safety at work and the sectoral directives (concerning manual handling, in particular) apply to this type of employment contract.

Informing workers

Before employment commences, the undertaking must inform the temporary worker of:

  • the occupational qualifications or skills required;
  • the special medical surveillance provided for by national legislation;
  • the specific risks that the job may entail.

Workers’ training

Before undertaking an activity, the temporary worker must receive training on the characteristics and risks of the job. This training must be adapted to the worker’s level of qualifications and professional experience.

Medical surveillance

European Union (EU) Member States may prohibit the recruitment of temporary workers for work which:

  • is dangerous to their health and safety;
  • requires special medical surveillance over a long period.

If Member States do not use this option, they must ensure that appropriate medical surveillance is in place. If necessary, this surveillance may continue after the end of the temporary contract.


The undertaking receiving the temporary worker shall be responsible for the conditions governing the performance of the work, in particular with regard to safety, hygiene and health. Member States may also decide to extend this responsibility to the temporary employment business.

The persons or departments responsible for ensuring that the preventive health rules are complied with must be notified of any assignment of temporary workers.


Act Entry into force Deadline for transposition in the Member States Official Journal

Directive 91/383/EEC



L 206, 29.7.1991

Amending act(s) Entry into force Deadline for transposition in the Member States Official Journal

Agreement on the European Economic Area – Protocol 1 on horizontal adaptations


L 1, 3.1.1994

Directive 2007/30/EC



OJ L 165, 27.6.2007

Successive amendments and corrections to Directive 91/383/EEC have been incorporated in the basic text. This consolidated versionis for reference purpose only.

A Strategy for Europe on nutrition, overweight and obesity related health issues

A Strategy for Europe on nutrition, overweight and obesity related health issues

Outline of the Community (European Union) legislation about A Strategy for Europe on nutrition, overweight and obesity related health issues


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Health determinants: lifestyle

A Strategy for Europe on nutrition, overweight and obesity related health issues

Document or Iniciative

White Paper of 30 May 2007, “A Strategy for Europe on Nutrition, Overweight and Obesity related health issues” [COM(2007) 279 final – Not published in the Official Journal].


The purpose of this White Paper is to set out an integrated approach to contribute to reducing ill health due to poor nutrition, overweight and obesity.

In order to tackle this public health problem, the Commission is in favour of the mainstreaming of nutrition and consumption policies, including in the areas of sport, education and transport. It is also vital to take into account the socio-economic dimension of the problem, as it is disadvantaged groups who suffer most from obesity. According to the Commission, Community measures to tackle obesity must be based on four pillars:

  • a clear reduction in high-risk behaviours (poor nutrition, lack of physical exercise);
  • the actions described are intended to work across government policy areas and at different levels, using a range of instruments including legislation, public-private partnerships and dialogue with civil society;
  • the participation of the private sector, for example the agri-food industry and civil society, as well as local stakeholders;
  • the systematic evaluation and follow-up of these measures to find out what is working well.

A partnership-based approach

The Commission is promoting initiatives such as the European Platform for Action “Diet, Physical Activity and Health”, launched in March 2005. Over almost two years, the members of the Platform have started more than 200 initiatives to promote better nutrition and physical activity in the EU. Ideas based on the creation of a clear and reliable system to monitor undertakings and a local approach have been developed.

The involvement of local stakeholders (associations, SMEs) is one of the keys to the success of the strategy. In order to create a group dynamic, it is vital to create multilateral partnerships linking as many players as possible at all levels. The national authorities would be responsible for coordination, in order to ensure the relevance of the measures in the field of public health. The Member States would also be responsible for encouraging the media to take part in developing common messages and campaigns.

The Commission will create a high-level group on health, nutrition and physical exercise in order to promote the exchange of practices and improve links with governments. This group’s task will be to ensure that the Member States exchange ideas and good practices in all of their government policies. The European Platform will facilitate communication between the various sectors, and the mandate of the European network on nutrition will be extended to support the group’s work.

Better-informed consumers

Food and lifestyle preferences are often the product of the environment where a person grows up. In the light of this, the Commission would like to encourage three aspects:

  • improving information for consumers, in particular by way of nutritional labelling, the overhaul of which is currently being studied by the Commission. Another related aspect is that of the rules concerning claims made by the manufacturers of food products, in order to monitor the reliability of the scientific and nutritional information communicated by manufacturers;
  • promoting codes of conduct for advertising and marketing where the message is intended to influence eating habits, especially those of children;
  • developing specific education and information campaigns (e.g. on poor nutrition and overweight) for vulnerable groups, in cooperation with the Member States and the stakeholders concerned.

More accessible healthy food

The Common Agricultural Policy (CAP) can be used by the Commission to achieve its public health objectives. Reform of the common market organisation for fruit and vegetables is one of these tools: the Commission will encourage the distribution of surplus production to public educational establishments and children’s holiday centres. The Commission has other promotional tools at its disposal, thanks to reform of the common organisation of the market, such as campaigns targeting young consumers or the creation of a project to encourage the consumption of fruit at school, co-funded by the EU.

Encouraging physical activity

The Commission defines physical activity as a whole range of activities from organised sports to “active commuting” and wants the Member States and the EU to take proactive steps in this area, including steps relating to sustainable urban transport.

Priority groups and environments

Obesity is increasing significantly among children, particularly those from the most disadvantaged socio-economic groups. Nevertheless, local activities targeting children (0-12 years) in the areas of nutritional and physical education have proved to be effective. These two disciplines are thus priorities in the new Lifelong Learning Programme (2007-2013).

The role of research

Research plays a major role in combating obesity, so the Commission wishes to find out more about the determinants of food choices, in particular by way of the health and nutrition strand of the seventh EU research framework programme.

Monitoring policies

The Commission has decided to step up the monitoring of data on obesity and overweight at three main levels:

  • at macro level, to obtain coherent and comparable data on universal indicators of progress in the context of the European Community Health Indicators (ECHI) associated with diet and physical activity;
  • at Member State level, to assess the current activities and their impact;
  • at the level of the individual programmes.

The Commission would, however, like to point out that all the actions proposed will complement and support existing measures in the Member States.

Involvement of the private sector

Private-sector players can help to promote healthy eating habits among consumers, e.g.

  • by promoting healthy foods by making them more accessible and affordable: the food industry also has a role to play in adjusting the ingredients of its products (salt, fat and sugar content);
  • by informing consumers, retailers and enterprises and contributing to voluntary initiatives at national level;
  • by encouraging physical exercise. Sports organisations could work with the public health sector to create advertising and marketing campaigns to promote physical activity;
  • by targeting priority groups. An appropriate non-commercial partnership between schools and the private sector could be created. It would also be a good idea for companies to contribute to promoting healthy lifestyles among their staff at the workplace;
  • by copying good practices, in particular those of civil society organisations working in the fields of health, youth and sports whose methods have proved to be effective.

International cooperation

The Commission is currently collaborating with the World Health Organisation (WHO) to develop a nutrition and physical activity surveillance system for the EU27 as one of the follow-up actions of the European Charter on Counteracting Obesity adopted in Istanbul on 16 November 2006.

Exposure to environmental tobacco smoke

Exposure to environmental tobacco smoke

Outline of the Community (European Union) legislation about Exposure to environmental tobacco smoke


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Health determinants: lifestyle

Exposure to environmental tobacco smoke (Proposal)


Proposal for a Council Recommendation of 30 June 2009 on smoke-free environments [COM(2009) 328 final – Not published in the Official Journal].


This Proposal sets out the measures to be taken with a view to implementing Article 8 of the WHO Framework Convention on Tobacco Control (pdf ). Ratified by 26 EU Member States, the Article requires signatories to provide effective protection from exposure to tobacco smoke in:

  • indoor workplaces;
  • indoor public places;
  • public transport.

Targeting priority groups

Children and adolescents should be protected as a priority. To this end, Member States should establish or reinforce strategies to reduce the exposure of this high-risk group to second-hand tobacco smoke.

Complementing smoke-free policies

Smoke-free policies should be complemented by supporting measures such as measures relating to cessation of tobacco use or treatment for tobacco dependence.

Other supporting measures may be introduced in the area of information, such as the use on tobacco packages of photographs and warnings about associated health risks. Other information may also appear, such as the contact details of services supporting the cessation of tobacco use.

Developing a targeted strategy

Existing tobacco control strategies, programmes and plans should be reviewed and monitored regularly in order to protect the population from tobacco smoke in public and private settings. These strategies, programmes or plans should be supported by implementing tools.

National focal points should be established within six months after the adoption of the Recommendation, to promote the exchange of information and best practices between Member States.

Member States are strongly encouraged to work together to establish joint definitions, criteria and applications in order to pursue a coherent strategy throughout the Community.


In 2007 the European Commission initiated consultation within the framework of the Green Paper “Towards a Europe free from tobacco smoke“. That consultation revealed that the majority of Member States favoured comprehensive smoke-free policies in all enclosed workplaces and public places. This position is explained in part by the figures on the effects of ETS on health. In 2008, 6000 people died in the EU following exposure to ETS, including 2500 non-smokers. Exposure to ETS also generates high economic costs which could be avoided.


Proposal Official Journal Procedure

COM(2009) 328 final


Environment and health strategy

Environment and health strategy

Outline of the Community (European Union) legislation about Environment and health strategy


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > Health determinants: environment

Environment and health strategy

Document or Iniciative

European environment and health strategy of 11 June 2003 [COM(2003) 338 final – Not published in the Official Journal].


Key elements and implementation of the strategy

The objective of this strategy is to integrate the information on the state of the environment, the ecosystem and human health. The ultimate objective is to establish a framework to help produce a better understanding of the cause-and-effect relationships between the environment and health and to make available the information needed to develop an integrated Community policy. Other objectives of the strategy are to identify and reduce any new health threats caused by environmental factors and to strengthen the Union’s capacity for policymaking in this area. As the acronym indicates, the strategy is based on science, focuses on children, aims at raising awareness, uses legal instruments and includes continuous evaluation.

The plan is to implement the strategy incrementally in successive cycles. The first cycle, from 2004 to 2010, will focus on the link between environmental factors and:

  • childhood respiratory diseases, asthma and allergies;
  • neurodevelopmental disorders;
  • childhood cancer;
  • disruption of the endocrine system (glands which secrete hormones).

The strategy will pave the way for a Community information system for assessing the overall impact of the environment on human health and the cause-and-effect links and for developing an integrated policy on the environment and health. In the first cycle three pilot projects will be launched to develop a method for putting in place a European system for integrated environment and health monitoring. These projects will focus on three priority pollutants for which data collection and monitoring are already well underway: dioxins, heavy metals and endocrine disrupters. The possibility of developing a harmonised European bio-monitoring system for children will also be considered during the first cycle.

Other research activities will be undertaken in order to gain a better understanding of environment and health issues.

Additional efforts will be made to reduce exposure to environmental hazards. These will concentrate on air quality, heavy metals, electromagnetic fields and a healthy urban environment in particular.

Implementation of this strategy will demand full stakeholder involvement. The Commission will set up technical working groups plus a consultative group on environment and health. Three regional conferences were planned up to 2004. In spring 2004 a major stakeholder conference was held to define the action plan for 2004-2010, which set out the goals and action for the first cycle as the Commission’s contribution to the Fourth Ministerial Conference on Environment and Health in Budapest held in June 2004.

Previous activities on environment and health

Hitherto the political responses on environment and health have taken no account of the interaction between the two. Nevertheless, the Union has already put in place legislation on health hazards, such as chemicals, endocrine disrupters, pesticides, air and water pollution, noise, waste, industrial accidents and ionising radiation.

A Community action programme on public health, covering the period 2003-2008, has been under way since 1 January 2003. Other activities are in progress on tobacco control, food safety, electromagnetic fields, radiation protection and health impact assessment.

Research on the environment and health has been included in the European Framework Programmes for research and development activities since 1995.

The Community also has a strategy on health and safety at work.

The Union is participating in international activities such as the European Charter on Environment and Health and the “Healthy Environment for Children” project, both in collaboration with the World Health Organisation. It is also helping with the preparations for the next pan-European Ministerial Conference on Environment and Health, which will be held in Budapest.


Communication of 9June 2004 from the Commission to the Council, the European Parliament and the European Economic and Social Committee – “The European Environment & Health Action Plan 2004-2010” [

COM(2004) 416

final – Not published in the Official Journal].

The European Environment & Health Action Plan 2004-2010 is designed to reduce the burden of disease caused by environmental pollution. The added value of the action plan is that it will improve information and understanding and step up coordination between the health, environment and research sectors.

The plan provides for 13 actions geared towards the following objectives:

  • better information on the environment-health link;
  • stepping up research activity in Europe, particularly on the four priority health effects: asthma/allergies, neurodevelopmental disorders, cancer and endocrine disruption;
  • setting up mechanisms to improve risk assessment, as well as a system for early detection of emerging issues such as the effects of climate change on health;
  • drawing conclusions from the improved information and action, via awareness-raising campaigns, better risk communication, and training and educational activities.

Cross-border healthcare: patients’ rights

Cross-border healthcare: patients’ rights

Outline of the Community (European Union) legislation about Cross-border healthcare: patients’ rights


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Public health > European health strategy

Cross-border healthcare: patients’ rights

Document or Iniciative

Directive 2011/24/EU of the European Parliament and of the Council of 9 March 2011 on the application of patients’ rights in cross-border healthcare.


This Directive makes provision for the introduction of a general framework to:

  • clarify patients’ rights with regard to accessing cross-border healthcare provision *;
  • guarantee the safety, quality and efficiency of care that they will receive in another EU Member State;
  • promote cooperation between Member State on healthcare matters.

This Directive does not concern:

  • long-term care services;
  • public vaccination programmes.

Member States’ responsibilities

Each Member State shall designate one or several national contact points for cross-border healthcare. These contact points shall consult with patient associations, healthcare providers and healthcare insurers. They are responsible for providing patients with information on their rights when they decide to take advantage of cross-border healthcare and with the contact details of the other contact points in the other Member States.

The Member State of treatment
* organises and provides the healthcare. They are responsible for ensuring the quality and safety of the healthcare provided, in particular by implementing control mechanisms. They also ensure the protection of personal data and equal treatment for patients who are not nationals of their country. The national contact point in the Member State of treatment shall provide patients with the necessary information.

Following the provision of care, it is the Member State of affiliation
* who takes care of the reimbursement of the insured person on the condition that the treatment received is provided for under reimbursable care in their national legislation.

Procedures for reimbursing cross-border care

The Member State of affiliation shall ensure that the costs incurred by an insured person who receives cross-border care shall be reimbursed, on the condition that the person has the right to the type of care received. The amount of the reimbursement is equivalent to the amount which could have been reimbursed by the statutory social security system if the care was provided in their country. It must not exceed the actual costs of the care.

The Member State of affiliation may reimburse related costs, such as accommodation and travel costs.

An insured person may also receive reimbursement for services provided through the means of telemedicine.

With regard to certain cross-border healthcare *, the State of affiliation can implement a system of prior authorisation in order to avoid the risk of undermining the planning and/or financing of their health system. It must provide this authorisation automatically if the patient has the right to the healthcare in question and when this healthcare cannot be provided on its territory within a time limit which is medically justifiable. However, the State of affiliation may refuse to grant prior authorisation to a patient in very specific cases (as detailed in the Directive *).

If a patient requests prior authorisation and the conditions are met, authorisation must be granted in accordance with the Regulation relating to the coordination of social security systems, except if the patient requests to be treated under the framework of this Directive.

Administrative procedures relating to the provision of healthcare must be necessary and proportional. They should be implemented in a transparent manner, within fixed deadlines and based on objective and non-discriminatory criteria. When processing a request for cross-border healthcare, Member States must take into account the patient’s medical condition and the urgency of the specific circumstances.

Cooperation on healthcare

Member States will cooperate on the implementation of the Directive. In particular, they will support the creation of European reference networks of healthcare providers, which aim to facilitate the mobility of expertise and access to highly specialised care through the concentration and joining up of available resources and expertise.

Member States shall recognise the validity of medical prescriptions issued in other Member States if those medicines are authorised in their country. Measures must be taken to help health professionals mutually recognise and verify the authenticity of prescriptions.

Member States are also encouraged to cooperate in the treatment of rare diseases through the development of diagnostic and treatments methods. The Orphanet database and European networks can be used in this respect.

E-health systems or services also enable the provision of cross-border care. This Directive provides for the establishment of a network of national authorities responsible for ‘e-health’ with the aim of improving the continuity of care and guaranteeing access to high quality healthcare.

Lastly, the creation of a network of authorities or bodies responsible for evaluating health technologies will facilitate cooperation between the national competent authorities in this field.


This Directive is in line with the Court of Justice jurisprudence following the Kohll and Decker judgement delivered on 28 April 1998 and which established the right of patients to be reimbursed for medical treatment in a Member State other than their own. It does not bring into question the Regulation principles on the coordination of social security systems, in particular the principles regarding equality between resident and non-resident patients of a Member State and the European Health Insurance Card.

Key terms of the act
  • Cross-border healthcare: healthcare provided or prescribed in a Member State other than the Member State of affiliation.
  • Member State of affiliation: the Member State where the patient is an insured person.
  • Member State of treatment: the Member State on whose territory cross-border healthcare is actually provided.
  • Care that may be subject to prior authorisation: 1. Care which is subject to planning and requires: (a) either overnight hospital accommodation of at least one night, or (b) that requires the use of highly specialised and cost-intensive medical infrastructure or medical equipment; 2. involves treatments presenting a particular risk for the patient or the population; 3. is provided by a healthcare provider that could give rise to serious and specific concerns relating to the quality or safety of the care.
  • Reasons for refusal to grant authorisation: 1. In the case of patient-safety risk; 2. In the case of a safety risk to the general public; 3. When there are serious and specific concerns relating to the healthcare provider regarding the respect of standards on quality of care and patient safety; 4. when this healthcare can be provided on its territory within a time limit which is medically justifiable.


Act Entry into force Deadline for transposition in the Member States Official Journal

Directive 2011/24/EU



OJ L 88, 4.4.2011

Telemedicine systems and services

Telemedicine systems and services

Outline of the Community (European Union) legislation about Telemedicine systems and services


These categories group together and put in context the legislative and non-legislative initiatives which deal with the same topic.

Information society > Interaction of the information society with certain policies

Telemedicine systems and services

Document or Iniciative

Communication from the Commission to the European Parliament, the Council, the European Economic and Social Committee and the Committee of the Regions of 4 November 2008 on telemedicine for the benefit of patients, healthcare systems and society [COM(2008) 689 final – Not published in the Official Journal].


Telemedicine systems make it possible to transmit medical information at a distance by means of Information and Communication Technologies(ICTs). They are intended for exchanges between health professionals or between health professionals and their patients.

They are used for the diagnosis,treatmentandfollow-up of patients. As a result, these systems help to improve the quality and effectiveness of care. They are currently used in medical monitoring and radiology for the electronic transmission of information or images.

Telemedicine is of major importance in the context of an ageing European population. In particular, its use makes it possible to optimise the resources available to health centres and to increase exchanges of information between professionals. It is also an economic sector with great potential for development.

The Commission proposes a series of strategic actions at European and national levels in order to extend the application of telemedicine.

The Commission is to adopt guidelines intended to demonstrate the benefits, effectiveness and cost-effectiveness of telemedicine services to users, systems and health authorities. These guidelines should be based on scientific studies and the results of pilot projects, particularly in the context of the Competitiveness and Innovation Programme.

The Commission encourages Member States to work together to identify their needs and priorities in the area of telemedicine. Their national strategies are to be presented at the 2010 Inter-Ministerial Conference on Health.

The Commission is to develop a clear legal framework for medical acts carried out by means of telemedicine systems. By 2011, Member States should adapt their regulatory frameworks applicable to licensing, professional liability, jurisdiction and the administrative practices relating to reimbursements. Privacy and patient safety must be guaranteed.

The Commission is to establish a European platform of support to facilitate exchanges of information between Member States. It is also to publish an analysis of the Community legal framework applicable to these services.

All European patients should benefit from telemedicine services through the development of broadband connections. In addition, it is necessary to improve interoperability and network standardisation for the development of the cross-border provision of healthcare services in the single market.

In 2011 the Commission is to present a strategy paper on the interoperability, quality and security of telemonitoring systems.


This Communication follows consultation held in 2007 and 2008 with health professionals, patients and representatives of undertakings in the sector. It is part of the European e-Health Action Plan aimed at improving the quality of health care through the use of new technologies.