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
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.
Joint statement on the new WHO Air Quality Guidelines
To protect public health and the environment from the harmful effects of air pollution, ECDA joined forces with our member the European Respiratory Society in calling on policymakers to engage with the new WHO Global Air Quality Guidelines 2021 and implement ambitious clean air policies without delay.
In a new statement released on 22 September, over 100 organisations - representing public health experts, specialist healthcare professionals and patients - highlight their support for the recently published Guidelines and call on countries to use them as a guide for effective air quality and emission reduction policies around the world.
In particular, to:
- Revise clean air legislation to lower the limit values for PM2.5 and NO2 in air pollution hot spots and align them closely with the WHO AQGs 2021.
- Combine fixed limit values with binding policies for a continuous reduction of the average pollution levels in all places, and not only in pollution hot spots, to achieve progressive lowering of exposures of the entire population.
- Invest, implement, and effectively monitor and enforce clean air policies to protect and improve public health and feed into efforts for climate neutrality.
Air pollution is a major cause of mortality and disability in the EU and globally. It is linked to major chronic diseases including lung and heart diseases, diabetes, cancer; as well as infant mortality, and emerging evidence points to harmful effects on pregnancy, cognitive development in children, dementia and mental health, as well as an increased risk of dying from COVID-19.
There is no safe level of air pollution, as evidence has shown there are harms to human health even at the lowest observable levels of exposure.
Read the full joint statement here.
Implementing Europe’s Beating Cancer Plan means turning goals for improved chronic disease prevention into reality
Today, on the occasion of the last day of the European Week Against Cancer and the World No Tobacco Day, the European Chronic Disease Alliance (ECDA) issues a statement on the implementation of the Europe’s Beating Cancer plan and prevention measures.
The statement emphasises the importance of realising the preventive actions set out in the Plan without delay – to protect millions of Europeans from cancer and other major chronic diseases that share common risk factors. Prevention is central to protecting and improving people’s health and well-being. It is also the most cost-effective way of addressing the growing prevalence of chronic diseases in the EU.
Helping Europeans ‘Commit to Quit’: The EU should strive for reaching the ambition of less than 5% of the EU population using tobacco by 2040. Further, robust EU legislation that enhances tobacco control, but also addresses novel tobacco and emerging products like e-cigarettes and heated tobacco products; and ensures proper enforcement at national level is essential. The review of the EU Tobacco Products Directive is a unique opportunity to embed provisions in that regard.
Reducing alcohol consumption in the EU: Notably, new mandatory requirements for alcoholic beverages (set out in the Europe’s Beating Cancer Plan) to indicate the list of ingredients, and provide nutrition declarations and health information labelling, should be implemented in full and without dilution. The introduction of excise taxes and other pricing policies, such as Minimum Unit Pricing, is needed to decrease the affordability of alcohol. Increased harmonisation of these rules throughout EU countries should be promoted.
Protecting Europe’s current and future generations: stronger regulatory policy action to tackle the exposure to marketing and advertising of unhealthy food products and drinks is needed on broadcast media, digital media and through the sponsorship of events, particularly those aimed at young people. This should go hand-in-hand with addressing cross border sales challenges and enforcing mandatory harmonised labelling with evidence-based easy-to-understand information.
Implementing the Europe’s Beating Cancer Plan means working in collaboration with all relevant actors within and beyond the cancer community, to maximise the benefits and impact of the Plan in other disease areas and co-morbidities.
Read the full statement here.
Extending the mandate of the ECDC towards an integrated public health approach: Joint letter from health organisations
Organisations from across the health spectrum call on the EU Council to extend the mandate of the EU agency to other areas of public health, as a response to the learnings of the COVID-19 pandemic and a forward-looking approach to improving public health in Europe that enhances multidisciplinary collaboration.
In a letter published today, a group of organisations (representing patients, healthcare professionals and medical societies, industry, public institutes and broader health advocacy groups) calls on the Council to consider the expansion of the mandate of the ECDC to other areas of public health that are linked to the current mission of the Centre, notably to cover the interconnections between communicable and non-communicable diseases. The letter is issued ahead of the Council Working Party on pharmaceuticals and medical devices that will discuss the Commission’s proposal to strengthen the Agency.
The COVID-19 pandemic has further highlighted how interconnected disease areas are and how dismantling silos in healthcare leads to better results.
If Europe is to focus on greater strategic autonomy and be a geopolitical force that remains the healthiest region of the world - yet burdened by large health inequalities, it needs an excellent Centre for preventing and controlling diseases, a more effective ECDC that is all inclusive and that can collect and present information that is decisive for national health authorities, policymakers as well as healthcare professionals and the broader medical and scientific community.
To truly safeguard the health of Europeans, there is a need for an integrated approach to health challenges and threats.
The potential of increasing ECDC’s scope of work to other areas of public health has been highlighted in the 2019 independent evaluation of the Centre. The European Parliament further asked in a resolution of July 2020 that ECDC be empowered to tackle the gaps in chronic disease epidemiology.
The ongoing revision of the ECDC mandate is a unique opportunity to act change. It is time to break siloes, both across medical disciplines and with regards to EU vs national efforts, in order to increase sustainability and efficiency of EU-level activities while protecting public health in Europe.
Read the joint letter here
Co-signatories:
- All.Can
- BioMed Alliance
- European Chronic Disease Alliance (ECDA)
- EU4Health Civil Society Alliance
- EU Health Coalition
- European Health Union Initiative
- EuroHealthNet
- European Public Health Alliance (EPHA)
- European Public Health Association (EUPHA)
- European Diabetes Forum (EUDF)
- Self Care In Europe (SCiE)
- Senior International Health Association (SIHA)
Europe’s Beating Cancer Plan provides hope for chronic disease prevention
The European Chronic Disease Alliance (ECDA) welcomes the prevention pillar of Europe’s Beating Cancer Plan, published on 3rd February 2021, that places prevention at the heart of the EU’s fight against cancer and other chronic diseases.
ECDA supports the targets and measures set out in the plan, which are expected to significantly help to improve the health of all EU citizens. Goals for a tobacco-free generation, and commitment to action in the areas of food and alcohol labelling are much required. Together they have the potential to unlock enormous progress in Europe’s agenda of disease prevention and should be implemented swiftly.
Cancer and co-morbidities present a significant challenge across Europe. In 2020, 2.7 million EU citizens were diagnosed with cancer and 1.3 million died from it, accounting for the second cause of death in the EU after cardiovascular diseases.
In a statement published today on the occasion of the World Cancer Day, the Alliance particularly emphasizes the importance of:
- Prevention: a crucial pillar that can have a far-reaching impact
- Harnessing the benefits of early detection and diagnosis
- Systemizing multidisciplinary and integrated care for better health outcomes
- Supporting an improved quality of life for patients and their families
It is ECDA’s view that the plan in its current form is a strong basis to successfully improve the prevention and control of cancer and other chronic diseases in Europe.
While the plan is focused on the response to cancer, ECDA encourages the European Commission and policymakers to keep an inclusive mindset in the implementation and roll out of the plan, in order to maximise its benefits and impact in other disease areas. This will be particularly crucial for all proposed actions and initiatives that are linked to or have consequences on cancer co-morbidities – in all sections of the plan.
ECDA remains committed to supporting the implementation of the plan - in particular the prevention pillar - in cooperation with other stakeholders; and re-emphasizes that it will be important to monitor and track the implementation of the flagship initiatives and supportive actions set out in it.
Read the full statement of the ECDA here.