Supporting the Global Week for Action on NCDs in Europe
On 5-11 September, the chronic disease community marks the Global Week for Action on NCDs. The 2023 campaign focuses on financing for NCDs.
At European level, this week is an opportunity to celebrate the recent launch of the 'Healthier Together' EU NCDs initiative and its important focus on investment in the field of prevention and actions to address the common risk factors of chronic diseases.
- The pandemic has exemplified the importance of investing in the prevention and management of chronic diseases, and health promotion measures to support a healthy population.
- ECDA calls for the collection of comparable, harmonised and robust data on NCDs at EU level, in particular health economic data, which is vital to strengthen health systems to better respond to chronic diseases and inform policy decisions.
- Screening and early detection followed by early action can help tackle disease progression and prevent or delay the onset of disease and life-threatening complications. ECDA reiterates the call for greater efforts to improve secondary prevention and take a holistic approach to chronic diseases considering the many clinical links they share.
- Underlying social conditions and health inequalities can lead to disease onset and have long lasting effects on health. Strategies needs to take into consideration the specific needs of children and vulnerable groups who are disproportionally affected by chronic diseases and the impact of risk factors.
During the Global Week for Action on NCDs, ECDA encourage Members of the European Parliament, EU member states and the European Commission to show their support and commitment to greater action on chronic diseases.
More information on the week here.
Read ECDA position on the Healthier Together EU initiatives, including recommended priorities for action.
ECDA Endorses the Oslo Declaration to reduce alcohol-related harm
Alcohol-related harm is a major public health concern in the EU. The WHO European region has the highest level of consumption of alcoholic beverages, responsible for 1 in every 10 deaths annually, almost 1 million deaths in total.
Alcohol is a risk factor for many chronic diseases. Approximately 268,000 deaths and almost 8 million Disability-Adjusted Life Years (years of life lost) attributable to alcohol consumption in the EU in 2019 are related to non-communicable diseases.
Increased prevention efforts are vital to reverse the burden that alcohol consumption presents for our societies. ECDA welcomes the Oslo Declaration, which recognises these risks and calls for greater EU support in preventing alcohol consumption. It would bring significant health, economic and societal benefits, and is integral to managing and reducing the prevalence of major NCDs.
To reduce alcohol-related harm, the Oslo Declaration identifies seven policy recommendations:
- National governments and the EU should regulate alcohol based on the WHO’s evidence-based Global Alcohol Action Plan to achieve its ambitious targets by 2030.
- National governments should cooperate to implement the evidence-based WHO Best Buys and SAFER recommendations, focussed on price, availability and marketing of alcohol.
- EU level regulation should reflect public support for mandatory ingredient, nutrition declaration and warning labels on alcohol products, so empowering properly informed consumer decisions.
- National governments and the EU should make sure that health policy-making processes are protected from alcohol industry interference.
- National governments should tax alcohol products related to alcohol content. This should be index-linked and increased regularly in line with economic and health indicators.
- National governments should restrict or ban the marketing exposure of alcohol products, particularly to young people and children and other vulnerable groups.
- Governments should recognise and support the pivotal role of civil society organisations in preventing and reducing alcohol harm.
The European Chronic Disease Alliance (ECDA) welcomes the publication of this initiative, which we have encouraged since the 2011 Reflection Process on Chronic Diseases.
"It is a pleasure to see an ambitious, integrated plan come to life in Europe, as presented by the European Commission today”, comments Prof Raymond Vanholder, Acting Chairman. It could represent a radical progress in particular for cardiovascular disease, diabetes, chronic respiratory disease, mental health and neurological disorders, which are specifically covered with tailored plans.
Prevention is a key priority of the initiative, through a horizontal health determinants strand, and is embedded in the disease-specific strands which paves the way for positive change in the years ahead. The robust actions set out to address socio-economic determinants, including alcohol and tobacco use are welcome, in particular when it comes to protecting children and tackling health inequalities.
ECDA recommends that the following areas be further integrated into plans, to maximize the potential of ‘Healthier Together’:
- Collection of comparable, robust data on NCDs at EU level–notably health economic data, to outline the cost effectiveness of prevention strategies and stimulate investment in the area –ensuring synergies and integration with European Health Data Space plans. Building an integrated EU NCD registry fully operational within the European Health Data Space by 2030, bringing together existing registries, data collection efforts and ongoing projects would be a major achievement for Europe and reflect further the EU added value of action in the field of health.
- Support for targeted risk reduction strategies/primary prevention programmes that focus on co-occurring risk factors to impact multiple NCDs. With an ageing population and the rising prevalence of NCDs, it is important to focus efforts on preventing disease resulting from concomitant risk factors and addressing the impact of exposure to multiple risk factors on people’s health.
- Enhancing awareness and education about NCDs and risk factors through intergenerational collaboration. There are examples of good practice in this area from France, which could be replicated at EU level, involving younger generations of health professionals.
- Improving monitoring and early diagnosis of co-morbidities and complications in at-risk populations, using novel diagnostic tools. This should also include support for more harmonized screening strategies across Europe to detect early-on complications resulting from COVID-19 infection or ‘long’ COVID-19; which will come as a collateral damage of the pandemic and are expected to bring important challenges and costs for health systems.
- Supporting more integrated, multi-disciplinary collaboration to prevent and manage co-morbidities, multi morbidity and complications –for instance by building NCD networks of excellence/European expertise networks, based on the model of the ERNs.
- Including NCD management plans as part of crisis planning to ensure continuity of care–Healthier Together can be an opportunity to develop adaptable frameworks/approaches for member states to improve and/or setup crisis preparedness and management plans for healthcare systems to avoid future disruptions in NCD care delivery and be better equipped to respond to future crises –recognizing the specificities of national health care systems. These should also take stock of good practices identified in the context of the COVID-19 pandemic. Plans should include education and training modules for healthcare professionals; and may help create an “EU NCD specialists emergency reserve ”appropriately trained and ready to be deployed to provide care for people living with NCDs in any EU member state or neighboring country in crisis time of any nature (humanitarian crisis, war, pandemic, environmental disaster e.g earthquake, nuclear accidents etc).
ECDA is committed to working with the European Commission and all stakeholders to strengthen and implement ‘Healthier Together’, towards a chronic disease-free Europe that places attention on protecting our future generations from the detrimental impact of major, well known and mostly preventable risk factors; and that also anticipates “newer” health determinants, including environmental ones (exposome). Meanwhile, a “fit for the future” vision should be embraced, one that recognizes the need for holistic health approaches and integrated actions between the area of non-communicable diseases and other such as infectious diseases.
Other general ECDA recommendations:
- Scope of ‘Healthier Together’:
- Add value to and/or include other chronic diseases (beyond major NCDs as defined by WHO), such as kidney, liver, gastro-intestinal diseases, allergy and auto-immune diseases
- Address the interlinks between chronic diseases (beyond disease-specific strands): disease-disease interactions, co-morbidities and complications
- Respond to the specific needs of certain population groups, including children and older populations (multi-morbid) as well as other vulnerable groups, with dedicated actions
- Goals of ‘Healthier Together’:
- Reduce the prevalence of NCDs in Europe towards 2030 (not only mortality), with success indicators for the various age groups and at-risk populations; and better protect Europeans from co-morbidity
- Help achieve the UN SDGs targets for NCDs in Europe and exceed them, taking stock of the important learnings from COVID-19
“The priority areas of ‘Healthier Together’ are welcome, notably the focus on prevention and health determinants, and co-morbidities. They have the potential to bring a new impetus across Europe and change the lives of the millions living with a chronic disease, while protecting the general population and younger generations. ECDA supports the shift to a comprehensive and pragmatic EU approach to chronic diseases, which it has encouraged for many years. We remain committed to working with the European Commission and all relevant stakeholders towards a chronic disease-free Europe and making this initiative and its implementation one of Europe’s greatest achievements in public health” – Prof. Raymond Vanholder, Acting Chairman, ECDA
Read the full statement here
Picture: property of the European Commission
ECDA contribution: Evaluation of the EU legislative framework for tobacco control
The European Chronic Disease Alliance (ECDA) welcomes the evaluation of the tobacco control policies covering product regulation, advertising, promotion and sponsorship; including current legislation (such as the Tobacco Products Directive (TPD), Tobacco Tax Directive).
Despite advances in the past decades, much remains to be achieved to realise a ‘tobacco-free generation’, as per the Europe’s Beating Cancer Plan.
Alignment with UN and WHO tobacco reduction targets is essential, but the EU should firmly strive for reaching the ambition of less than 5% of the EU population using tobacco by 2040. This would be a major achievement for public health across Europe and would save the lives of millions of Europeans, considering that tobacco use is the cause of around one fourth of all cancers and a major risk factor for all other main chronic diseases.
ECDA recommendations in the context of the EU consultation can be found here.
Healthier Together initiative on NCDs: ECDA input
In December 2021, the European Commission announced a new initiative to frame action on chronic diseases at European level: "Healthier Together". ECDA has taken part in the consultative process led by the European Commission from January to June 2022.
In this context, ECDA developed a paper outlining recommended priority areas for action, to support the European Commission's and member states work.
Please find below a summary of ECDA's proposed priorities:
- Collection of comparable, robust data on NCDs at EU level - Building an integrated EU NCD registry fully operational by 2030 within the European Health Data Space, including health economic data.
- Primary prevention, focusing on:
- Co-occurring NCD risk factors
- Creating healthier living environments through “whole system” approaches
- Alcohol consumption prevention and control, addressing inequalities
- Social and socio-economic determinants of health in children - including marketing of unhealthy food/drinks and alcohol beverages
- NCD educational/awareness initiatives that build on intergenerational collaboration
- Secondary prevention, early detection and screening of NCDs and comorbidities, in particular:
- Early detection and screening of co-morbidities/complications in vulnerable groups
- Harmonised screening strategies to detect early-on complications resulting from COVID-19 infection or ‘long’ COVID-19
- Integrated, multi-disciplinary collaboration to prevent and manage co-morbidities, multi-morbidity and complications - including setup of NCD networks of excellence or European expertise networks for prevention and control of co-morbidities and complications, based on the model of the ERNs
- NCD management plans as part of crisis planning to ensure continuity of care
Other general recommendations:
Scope:
- Add value to and include other prevalent chronic diseases, such as kidney, liver, gastro-intestinal diseases, allergy and auto-immune diseases
- Address the links between chronic diseases (beyond disease-specific strands): disease-disease interactions, co-morbidities and complications
- Respond to the specific needs of certain population groups, including children, older populations (multi-morbid) and other vulnerable groups, with dedicated actions
Goals:
- Reduce the prevalence of NCDs in Europe towards 2030 (beyond mortality), with indicators for various age groups and at-risk populations; better protect citizens from co-morbidity
- Help achieve the UN SDGs targets for NCDs in Europe and exceed them, taking stock of the important learnings from COVID-19
ECDA stands united with Ukraine and calls for protection and continuity of care for Ukrainians
The European Chronic Disease Alliance strongly condemns the military invasion of Ukraine, expresses its stunning shock at the suffering being imposed upon innocent people, and is appalled by the violent attacks taking place against healthcare facilities and healthcare professionals. We stand together and in solidarity with the people of Ukraine.
Whilst only the Government of Russia can bring an end to the violence, we in Europe must do all we can to help the needs of those in Ukraine or fleeing Ukraine for safety, including those with medical needs associated to chronic disease. ECDA encourages the European Union and other international bodies to pursue ongoing efforts to help protect civilians in Ukraine, refugees fleeing the war, medical staff working on the ground to help those with vital needs as well as other healthcare professionals and humanitarian teams providing support in neighboring countries.
The most vulnerable require coordinated medical relief and services, especially as Ukrainian refugees pass into neighboring countries. ECDA would like to stress the importance of:
- addressing shortages of medicines to Ukraine and surrounding countries
- supporting patients’ access to information in their own language about how to maintain their treatment during this time and/or access specialists to receive care and/or participate in clinical trials
- removing barriers to the export of medical aid to Ukraine
- putting in place effective screening procedures at border crossings to identify those requiring assistance with their medical treatment
- setting up mechanisms to assist health systems in neighbouring countries to gain better access to the medical records and clinical history of Ukrainians seeking safety outside their country
- addressing the psycho-social needs of all Ukrainians leaving the country, including those requiring medical assistance
ECDA members have provided support so far through donation funds, the creation of Ukrainian language resources for those living with chronic diseases and the set-up of support networks. They will continue to provide assistance and help as the situation evolves.
A united international front must be retained to bring all pressure to bear on Russia to end the invasion; and offer protection in the best possible way to people in need during this time. We stand with Ukraine.
Bruegel policy contribution recommends the extension of the ECDC mandate to NCDs
In the policy contribution "Does Europe need a Health Union?" published in February 2022, Former DG SANTE Director General Anne Bucher suggests that the EU "could benefit from closer integration in some areas and be more effective in delivering a high level of health protection", including in the area of non communicable diseases.
The paper recommends that for chronic diseases, the EU "taps the economies of scale of research and knowledge organised at EU level, and puts in place systems for the surveillance of non-communicable diseases and consolidation of scientific knowledge. This could be achieved through an extension to non-communicable diseases of the European Centre for Disease Prevention and Control mandate".
This contribution was prepared at the request of the French Presidency of the Council of the European Union for the informal meeting of health ministers in February 2022.
ECDA welcomes this series of recommendations, which align with ECDA's position on the importance of extending the ECDC mandate to chronic diseases and to improve chronic diseases monitoring and surveillance in Europe, through an integrated EU system.
Update of the recommendation on cancer screening: ECDA position
ECDA fully supports the update of the 2003 guidance, which should allow to improve the early detection of cancer and potential complications across Europe; and support implementation of screening guidelines and cost-effective and evidence-based solutions for early diagnosis.
Improvements in cancer screening and diagnosis are critical to effectively enhance cancer management and survival in Europe; and prevent or address early-on cancer co-morbidities as well as cancer-related complications, which present a significant challenge.
Extension of screening to other types of cancer
The update of the recommendations and extension of screening to other types of cancer should be based on new, solid scientific evidence and good practice screening policies in Europe. The 2020 WHO report on cancer provides related guidance. ECDA supports the extension of screening notably to liver, lung and gastric cancer.
- Liver cancer is the sixth-most common cancer and the third-most frequent cause of cancer-related death globally. Detection of liver cancer at an early stage could reduce mortality to a maximum of 5 years of life lost relative to the general population. Chronic liver diseases caused by viral hepatitis, alcohol or fatty liver disease are the most important risk factors for developing liver cancer. Extending the Recommendation to liver cancer for high-risk population groups living with chronic liver diseases makes sense and is endorsed by all clinical stakeholders. These patients are identifiable, have a high risk of liver cancer, and can be offered curative treatment if their liver cancer is diagnosed early. Furthermore, liver cancer detection tools are easily available and affordable.
- Concerning lung cancer, there is compelling international scientific evidence demonstrating that Low Dose Computed Tomography (LDCT) for lung cancer screening is effective, beneficial and feasible. More specifically, evidence shows that national screening programs using LDCT in asymptomatic high-risk Europeans could detect cancer at an early stage when treatment is most likely to be successful. Such screening programmes would save lives and improve the survival and quality of life of Europeans. In addition, LDCT for lung cancer screening satisfies all the criteria on the introduction of screening set out in point 6 of the current Council recommendations on cancer screening and is in accord with the WHO principles of early disease detection.
- As for gastric cancer, although rates are lower in Europe and tend to decline, around 136,000 Europeans are diagnosed with gastric cancer every year. Approximately 90% of all gastric cancers are related to H. pylori infection. According to latest studies around 40% reduction in mortality is achieved by eradicating H. pylori among healthy individuals. Well-designed H.pylori screen and treat implementation strategies should be recommended with thorough monitoring and outcome data collection. Population-based screening for H. pylori does not seem appropriate for all European countries. However, it should be considered in the countries with higher incidence of gastric cancer and in all other countries in the individuals considered at increased risk for gastric cancer.
Improving participation in screening
The initiative should help improve the participation to screening programmes. Harmonisation of protocols and research on finding the most appropriate target populations would be very beneficial.
Taking a bold vision on cancer screening
Further, other major chronic diseases can be risk factors for certain types of cancer, or enhance disease progression. The interactions between cancer and other chronic diseases require to establish protocols for the screening and management of complications on the long term, as these may occur only after several years in patients. The earlier detection and state-of-the-art management of other major chronic diseases that cause cancer should be integral to strategies to detect and control cancer.
ECDA's response to the public consultation on the update of the cancer screening recommendations is available here.
Joint call to MEPs to protect the strength of the BECA report during plenary vote
On the occasion of World Cancer Day and ahead of the plenary vote on the report developed by the BECA committee expected on 15 February, eleven European health organisations call on MEPs to adopt the report with no weakening of its recommendations on cancer prevention.
In a joint letter initiated by ECDA, the organisations express again their continued support to the report of the special committee on “Strengthening Europe in the fight against cancer” and ask MEPs to adopt it without compromising its content.
It is of long-term importance that the report maintain its level of ambition and strong language, in particular when it comes to the main, well-known and preventable risk factors of cancer and other major chronic diseases.
Every year in Europe, millions of deaths and lost years of "healthy" life are attributable to alcohol consumption, tobacco use, poor nutrition, lack of physical activity and air pollution, responsible for cancer and other major chronic diseases. There is no safe level of alcohol consumption, exposure to tobacco, nor to poor air quality. It is our shared duty to put in place all measures to ensure that our current and future generations are protected from the dramatic impact of these modifiable risk factors, which present a considerable health and economic challenge; and underlie health inequalities.
One of the key learnings of the COVID-19 pandemic is that it is high time to efficiently promote and protect public health; and put Europeans’ health and wellbeing first and above commercial interests.
Health is a fundamental right embedded in the EU treaties, specifically in article 168 of the Treaty on the Functioning of the European Union, and a collective responsibility within the European Union. It is the backbone of strong and sustainable economies and societies.
The promise of the Europe’s Beating Cancer Plan to reduce suffering caused by cancer and other chronic diseases - including cancer co-morbidities and complications - must not be compromised.
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Co-signatories:
- Association of European Coeliac Societies (AOECS)
- Association of European Cancer Leagues (ECL)
- European Alcohol Policy Alliance (Eurocare)
- European Chronic Disease Alliance (ECDA)
- European Institute of Women's Health (EIWH)
- European Public Health Alliance (EPHA)
- European Public Health Association (EUPHA)
- EuroHealthNet
- Oral Health Foundation
- Smoke Free Partnership
- Safe Food Advocacy Europe (SAFE)
ECDA statement on the new EU NCDs Initiative
A bold move to address one of Europe’s biggest health challenges
ECDA statement on the new EU NCDs Initiative
The European Chronic Disease Alliance (ECDA) welcomes the announcement by the European Commission of a new strategic approach to address major non-communicable diseases in Europe in a systematic and ambitious way, which includes a focus on health promotion and disease prevention.
Chronic diseases represent a major health challenge across Europe, in every EU country. Their high prevalence has continued to exponentially grow over the past decades, fueled by under-investment in the area of prevention. It is expected to keep growing as a result of an ageing population and increased exposure to the well-known major risk factors and ‘newer’ determinants, without proper political and financial attention.
The COVID-19 pandemic continues to have a significant, unprecedented impact on patients with chronic diseases, while it also affects people without any pre-existing conditions, resulting in the onset of chronic diseases and complications. It has underscored the clinical links between communicable and non-communicable diseases; and the need for holistic responses. In the current situation, a longer term collateral damage at individual, public health and socio-economic levels is no longer questioned. This “syndemic” has further exacerbated the importance of stepping up the prevention and control of chronic diseases and the need for significant commitment in the area with comprehensive strategies.
Against this background and building on the EU4Health programme, the European Commission’s new vision to improve the response to chronic diseases is much welcome. The co-creation element will ensure that the expertise of the medical profession, patients and all other crucial experts helps define a strong and robust roadmap, expected in June 2022. The priority areas identified by the European Commission encompass the key areas of knowledge & data, health promotion and disease prevention including screening, diagnosis and treatment, and quality of life for patients. They have the potential to bring a new impetus across Europe to change the lives of the millions living with a chronic disease while protecting the rest of the population and younger generations.
For this initiative to be successful, the following aspects warrant consideration:
- an inclusive approach that goes beyond traditional siloes, addressing the interlinks between chronic diseases and fostering integrated, multidisciplinary care
- emphasis on the specific needs of children with dedicated actions
- prioritising health economic data collection and analysis efforts, to provide comparable evidence that can inform policymaking at all levels
- a bold vision and inclusive mindset to add value to other chronic diseases, such as kidney, liver, gastro-intestinal diseases, allergy and auto-immune diseases and the many more
ECDA supports the shift to a comprehensive, structured and pragmatic approach on chronic diseases, which it has favoured since its inception and further encouraged during the 2011 EU Reflection Process. ECDA will remain committed to work with the European Commission and all relevant stakeholders towards a chronic disease-free Europe and making this new initiative and its implementation one of Europe’s greatest achievements in the field of public health.
The full statement is available here.