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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