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EPHA 2015: Protecting and improving public health and well-being in all policies. [EPHA] [671370] - Operating Grant
Project abstract

EPHA is a leading NGO advocating for better health for everyone living in Europe. Our mission is to bring together the public health community to provide thought leadership and facilitate change; to build public health capacity to deliver equitable solutions to European public health challenges, to improve health and reduce health inequalities. Our key role is to promote health in the European Union at the highest levels of policy making across the European Commission, the European Parliament and the European Council.

80 million people still live in poverty in the EU, and poor living conditions, low income, poor employment conditions and unhealthy diets due to being unable to afford to buy healthy food are all key determinants of health. In addition, many of the key determinants of health lie outside of the control of individual citizens, such as how healthcare systems are managed, how food production in the EU is organized and how trade regulations enable or discourage healthy food choices and how pharmaceutical policies and the cost of medicines are regulated, for example.

EPHA's proposal for an operating grant under a Framework Partnership Agreement covers core operating costs for actions that contribute to the four objectives of the Third Health Programme. EPHA's workplan covers 4 strategic aims: improve overall population health and healthy life years, strengthen European health systems for better patient outcomes and reduced inequalities, and support institutional and policy frameworks that promote health and to strengthen and increase effective public health.

Health in all Policies, prevention-promotion-protection, reducing health inequalities and solidarity are central tenets of EPHA's workplan and are reflected in our approaches to working inter alia on food systems, trade and EU governance. Decreasing health inequalities is a core value that we endeavor to mainstream in all activities. Actions in the 2015 workplan reflect the final year of EPHA’s current strategic plan, and this year will be crucial for setting the 2016 to 2020 strategy.

Summary of context, overal objectives, strategic, relevance and contribution of the action

EPHA is a leading NGO alliance advocating for better health for everyone in Europe. EPHA represents over 100 member groups, representing diverse civil society interests in all aspects of public health, including patients, health professionals, disease specific groups, organisations campaigning on health determinants and groups working with disadvantaged communities. Our joint mission is to bring together the public health community to provide thought leadership and facilitate change; to build public health capacity to deliver equitable solutions to European public health challenges, to improve health and reduce health inequalities.

The added value of EPHA comes from the convening power of our diverse membership speaking with one voice from over 100 different organisations and our strong commitment to a bottom-up, participatory approach to policy influencing and reducing inequalities. The breadth of our strategic aims, strategic objectives and specific goals serves to ensure the EPHA’s voice as a champion of health equity and public health in Europe is heard in all aspects of EU policy making where legislative and non-legislative processes will affect European population health.

As always, EPHA puts a strong emphasis on civil society capacity-building in public health. Reduction of health inequalities across Europe is at the heart of all the work of the Alliance. Health in all Policies (HiAP), prevention-promotion-protection, reducing health inequalities and solidarity are central tenets of EPHA's workplan and are reflected in our approaches to working for HiAP inter alia in food systems, trade and economic governance policies. Decreasing health inequalities is a core value that we endeavor to mainstream in all activities.

EPHA's proposal for an operating grant under a Framework Partnership Agreement covers core operating costs for actions that contribute to the four objectives of the Third Health Programme. EPHA's workplan covers the following strategic aims:

Aim 1: To improve population health and increasing healthy life years
Work on prevention of non-communicable diseases (NCDs) is core to EPHA’s activities. Unhealthy diets, harmful alcohol consumption and smoking are the primary risk factors responsible for the burden of NCDs in the EU and our work focused on improving the policy environment to tackle these issues while keeping a strong focus on reducing inequalities. The links between agricultural policy, diets and environmental health were addressed in an extensive paper analysing the new Common Agricultural Policy from a public health perspective and providing observations and recommendations on how to mainstream health into this policy, including in discussions with policy-makers at the EU institutions, WHO and OECD. The text of the paper was published in the AIMS Public Health open source journal. A side event of the EPHA Annual Conference addressed specifically the issue of obesity-related chronic diseases while providing a platform to an obesity patient to explain her pathway towards becoming obese, effects of treatments and the emotional difficulties of living with obesity. EPHA also undertook a review of the legal challenge to a highly promising alcohol control policy - Minimum Unit Pricing - as introduced in Scotland but subsequently challenged and brought before the European Court of Justice. Further on the legal side, a strategic capacity-building session was organised for EPHA members and special invitees with two leading European legal scholars on pathways, opportunities and limitations for tackling NCDs (primarily diet, alcohol and tobacco based) in the EU legal order.

EPHA takes a particular interest in mental health across all of our work areas, as a founding member of the Alliance for Mental Health in All Policies (together with Mental Health Europe, AIM, AEIP and GGZ). In 2015, we contributed to the strategic direction and action planning of this Alliance, including hosting a seminar on ment

Methods and means

With regard to EPHA’s methods and means, we undertake many horizontal activities as an Alliance across all work areas. For example, during 2015, we continued to:
• host monthly Policy Coordination Meetings (PCMs) with our members
• facilitate in-depth Working Group meetings on specific topics
• organize capacity-building seminars for our members and other civil society organisations
• hold our Annual Conference, in 2015 on the theme of HiAP and Governance for Health
• organize EPHA’s Annual General Assembly, where the main focus was sign-off of the 2016-2020 Strategic Plan, new communications approach and improved financial management practices
• provision of regular policy updates across all health-relevant policy areas, via our monthly newsletter, news feeds, workshops and seminars, briefings for members and publication
• offer capacity building opportunities, including our Professional Development Programme trainings for members, our Roma Health Fellowship programme for Roma health advocates and traineeships for students of public and global health
• coordinate coalition meetings with diverse stakeholders on key campaigns
• advocacy approaches to policy-makers (at EU, national and international institutional levels),
• joint communications with members
• provide public health inputs to policy-makers including position papers, policy briefings
• present EPHA’s expertise at events in Brussels and around Europe, including at EPHA member events
• contribute to expert and advisory groups, in 2015 this included for example the TTIP Advisory Group, the e-Health stakeholder group and the Patients and Consumers’ Working Party of the EMA
• provide responses to EU public consultations
• actively participate in key European civil society alliances including: Social Platform, Civil Society Contact Group, Better Regulation Watchdog, Health and Environment Alliance (HEAL), Mental Health in All Policies Alliance. In 2015 we also joined the Semester Alliance and Green Budget Europe.

In general, EPHA engages with European level policy processes with an impact on public health and health inequalities. We endeavour to provide evidence-based inputs to support pro-public health decision-making and policy-making in Europe. This includes, for example, policy research, working groups within and beyond the membership of the Alliance, publication of reports and position papers, policy recommendations, public speaking, public events, conference and seminars, publication of articles, press and social media actions, inputs to public consultations, and expertise in Expert Groups, advisory groups and consultative bodies, as well as participation in a range of civil society alliances active at European level.

EPHA hosts regular meetings of Alliance members, to share intelligence, develop and coordinate positions of the public health community and ensure a balanced representation of members’ views in our outputs, especially considering health inequalities and vulnerable groups. This gives EPHA a unique viewpoint and valuable insights to inform policy-decisions in the interests of protection and improvement of public health for all across Europe. EPHA also provides an important capacity-building role for civil society groups representing under-represented communities with particular health concerns, such as Roma, people with mental health issues and their families, women, children, older people, or people in institutions such as prisons. EPHA has a strong membership base in Central and Eastern Europe, as well as beyond the borders of the EU in the wider WHO European region.

Work performed during the reporting period

As always, EPHA puts a strong emphasis on civil society capacity-building in public health. Reduction of health inequalities across Europe is at the heart of all the work of the Alliance. Health in all Policies (HiAP), prevention-promotion-protection, reducing health inequalities and solidarity are central tenets of EPHA's workplan and are reflected in our approaches to working for HiAP inter alia in food systems, trade and economic governance policies. Decreasing health inequalities is a core value that we endeavor to mainstream in all activities.

In addition to the actions outlined in the above section, EPHA released 168 publications and articles during 2015. These include articles published in our newsletter, which is circulated ten times per year, as well as announcements for events that EPHA hosted or co-organised. In addition to EPHA publications, we were also successful during 2015 in increasing media coverage of our positions and analysis of policy developments (particularly Politico, Euractiv), as well as doubling our social media presence (twitter).

Of our many events, the biggest in 2015 was our Annual conference (ca. 300 registrations), please see details and the final report at Other noteworthy events included a conference, in cooperation with the Latvian Presidency, EPF, EFPIA and EGA in Riga on universal healthcare, and a two-day conference in Brussels on TTIP, food and health. In total, EPHA (co-) organized fifteen public events, with an estimated total attendance of 930 people.

2015 also covered the review period for the EPHA strategic plan, which ran from 2011-2015. A review of the plan was conducted, in consultation with the membership and approved at the 2015 Annual General Assembly in September. This already had an impact on our work in the latter part of 2015, with a strategic refocusing on a more targeted number of key campaigns and an overhaul of our communications strategy and tools.

Participation in EU actions:
During 2015, EPHA participated in meetings of the DG SANTE Health Policy Forum, including the working group developing proposals for the development of an online Platform. At the HPF meeting, EPHA gave a speech on the previous Forum constellation and deliverables, as we previously hosted the Forum Secretariat.

EPHA is founding member and active participant of the European Platform for Action on Diet, Physical Activity and Health as well as its Advisory and Working Group on Monitoring of Commitments. EPHA is constructively engaged in improving the functioning of the Platform to which it presented a number of recommendations.

EPHA also participated in the European Alcohol and Health Forum until May 2015 when it, together with a large number of other health stakeholders, decided to leave the forum. This was due to an absence of monitored public health / NCD reduction goals or requirements in relation to the voluntary forum commitments.

EPHA is member of the EU Expert Group on Cancer Control, where we work closely with our membership to provide expertise.

EPHA applied in 2015 to renew its mandate for the High Level Forum for a Better Functioning Food Supply Chain and is member of the EFSA Stakeholder Group.

EPHA provided feedback to the following public consultations:
- Review of existing legislation on the structures of excise duties on alcohol and alcoholic beverages
- EU Roadmap for the evaluation of Regulation (EC) No 1924/2006 on nutrition and health claims on food with regard to nutrient profiles
- Consultation on Directive 2010/13/EU on audiovisual media services (AVMSD)

EPHA was a project partner in the ENS4Care project on eHealth. Our role included review and dissemination of the project guidelines.

EPHA also actively participated in the meetings of the eHealth Stakeholder Group and in the European Medicines Agency’s group for patients and consumers (PCWP).

A project on continuous professional development (part of the work on the European A

The main output achieved so far and their potential impact and use by target group (including benefits)

In relation to our objectives for 2015, EPHA’s main outputs included:

1.1 Support the follow up of recommendations made by the EP and Commission (2014) to tackle the burden of chronic diseases
EPHA produced a checklist for its members outlining which legal questions need to be posed before advocating for legislative measure in the EU. The guideline contains the “EU legal test” covering the Principles of Conferral, Subsidiarity and Proportionality. The latest European case law is used to interpret these principles. The guideline also addresses opportunities for a human rights-based approach to health at EU level. We also organized a capacity-building workshop for members on legal approaches to health determinants and NCDs, particularly looking at coherence with internal market legislation.

In close coordination with our members and other NGOs, we supported the action of member states and the Luxembourgish EU Council Presidency in calling for a renewed European Alcohol and Health Strategy.

1.2 Ensure a public health approach to CAP reform
EPHA prepared a peer reviewed paper on the CAP and health “A CAP for Healthy Living”, published in AIMS Public Health open source journal in December 2015. The paper deals with the links between agriculture and diets as well as environmental health and analyses the incentives in the new CAP, that came into force in January 2015, from the point of view of public health. This report presents observations and recommendations for ways to enhance coherence between the CAP and public health. It deals with the application of the Health in All Policies obligation, sustainable diets, CAP and alcohol and tobacco subsidies and the CAP and environment and rural development. The draft paper was sent to various stakeholders for comments with very positive reactions. It also opened an exchange of ideas with DG AGRI on health in all policies.

1.3 Document actions relating to the implementation of the Tobacco Products Directive and legal action related to the Scottish Minimum Unit Pricing case
Minimum Unit Pricing is a highly promising measure to tackle alcohol-related harm, in particular in terms of reducing health inequalities. In 2012 Scotland adopted a minimum pricing scheme which was challenged in court by a number of alcohol producers. The challenge against the scheme relied primarily on EU law on the internal market and the Common Market Organisation for agricultural products. The case was eventually referred to the European Court of Justice. EPHA produced a briefing paper on Minimum Unit Pricing highlighting the developments and the relevance of the Scottish case for the future of alcohol and general public health measures introduced by Member States. EPHA hosted a press conference, together with SHAAP and the British Medical Association on the Advocate General’s recommendation in September 2015, which generated important press coverage (as the recommendation was mis-represented by the alcohol lobby).

1.4 Raise awareness among EPHA members of the health benefits of access to green spaces in urban areas
EPHA gave inputs to a study undertaken by the Institute for European Environmental Policy for DG Environment on the health benefits of green spaces. We also exchanged views with the European Environmental Bureau and Friends of the Earth Europe on the issue, also in the context of the UN Sustainable Development Goals. EPHA encouraged our members to support the civil society campaign around the EU nature directives consultation highlighting physical activity and the role of green spaces in mental wellbeing. The consultation gained huge public support, including from the health community.

EPHA delivered more action than foreseen in the workplan on mental health, particularly as a founder of the Alliance for Mental Health in All Policies. The Alliance was officially launched during a side event of EPHA’s Annual Conference in September. This group has since been successful in bringing

Achieved outcomes compared to the expected outcomes

In terms of results in EU policies, there are several examples of EPHA’s contributed to a positive evolution, for example:
- DG Trade’s position on TTIP: initially did not mention public health (but rather confused it with workers’ health and safety), but public health is now mainstreamed throughout key points in the EU’s negotiating positions and horizontal chapters and is regularly reiterated by negotiators as a fundamental principle that will not be compromised. This development is thanks to EPHA’s continued active commitment to the TTIP Advisory Group (together with our members EHN and EASL), written and verbal inputs and coordination with other experts and civil society groups.
- European Parliament votes on air quality standards (National Emissions Ceilings): Together with our coalition of medical societies, public health and environmental groups, our advocacy contributed to a strong majority in favour of more stringent air quality standards in both the ENVI committee and Plenary vote of the European Parliament.
- EPHA has supported and provided input (over a longer time) to DG SANTE work towards an NCD strategy or framework, in preparation for 2016. We have called for this to include action on alcohol policy, to replace the Alcohol Forum which health organisations left during 2015 due to lack of progress on health goals or indicators over several years.
- Together with our expert member organisations, notably Cancer Research UK and RCP, we supported the adoption of a compromise in the Data Protection Regulation which will ensure that more stringent requirements do not undermine medical research.
- We supported national implementation and the gradual positive evolution of NCD control policies, including the Tobacco Products Directive and Minimum Unit Pricing for Alcohol, together with many of our member groups, e.g. SHAAP, Alcohol Action Ireland, Alcohol Focus Scotland, Smokefree Partnership, European COPD Coalition, European Respiratory Society, European Association for Study of the Liver, Eurocare, the Slovenian Coalition for Tobacco Control and Public Health, ASH UK, etc.
- For example, we generated media interest in the ECJ Advocate General’s position on MUP by hosting a press conference together with the British Medical Association and SHAAP. This was important to counter the false spin from the alcohol industry in their interpretation of the ECJ position. Several member states are now forging ahead on policies to tackle tobacco use, harmful alcohol use and unhealthy food to tackle NCDs and broader costs to society.
- EPHA supported the communications strategy and dissemination of OECD’s report on policy evaluation for effective alcohol control in spring.
- On the European Semester, we have highlighted via analysis and advocacy that implementation of some of the Country Specific Recommendations has exacerbated health inequalities, whilst missing the opportunity for double dividend of health promoting fiscal measures. As a result (as well as actions of other civil society organisations, which we partner with in the Semester Alliance), the European Commission is considering a social pillar to ensure that macroeconomic convergence policies do not compromise social or health protections.
- The Alliance for Mental Health in All Policies, of which EPHA is a founder member, has entered into a dialogue with DG Employment on safeguarding mental health at work.
- EPHA has entered into dialogue with DG Agriculture about how public health considerations and impacts could (for the first time) be systematically factored into a future reform of the Common Agricultural Policy, including first discussions of health-harmful subsidies.
- As a result of our work on food during 2015, EPHA has been invited as a recognized thought-leader to become a partner in the IPES Food (multiyear) process, which will include policy labs developing proposals for a sustainable and healthy food system from 2016.
- Through our particip

Dissemination and evaluation activities carried out so far and their major results

Evaluation: Our specific objectives under each aim were achieved. In relation to the OPG and annual organizational workplan, EPHA undertakes regular progress monitoring and evaluation – with at least quarterly meetings of the team, in addition to weekly operational team meetings. The quarterly OPG review meetings check progress against the work plan, deliverables and milestones. Throughout 2015, we hosted monthly board meetings and monthly member meetings (PCMs).

Dissemination: The EPHA website address is In 2015, we published 168 items, including reports, briefings, analysis and position papers, comment pieces and articles.

Our reports, briefings, position papers, web articles and newsletter articles are widely read by our members and other stakeholders. Particularly after the revamp of the monthly newsletter (including article themes, brevity, format and delivery) from mid-2015, we received positive feedback from members and other stakeholders that it more closely corresponds to their needs and expectations. The latter part of 2015 our improved communications tools were reflected in increased coverage of our positions in Brussels media.

With regard to our analytical reports on the European Semester process and the impacts, risks and opportunities for public health, we have received specific positive feedback from DG SANTE. Our briefings on air quality and TTIP impacts on health were particularly welcomed by MEPs. Our inputs to DG Trade via the TTIP Advisory Group have also been appreciated, indicated by the fact some wording has been taken up in more recent negotiating texts, particularly on exclusion of publicly funded health services and the ‘right to regulate’ in the public (health) interest. Our report on the CAP and health impacts appears to have been welcomed by DG AGRI, as it resulted in invitations for a number of direct meetings to further discuss integration of health impact assessment into future reviews.
From Sept-Dec 2015, we improved our social media presence. Not least via a live tweet action from our annual conference in September, we doubled our number of twitter followers.

With regard to dissemination of invitations to events, we noted a positive trend in attendance of our workshops and seminars (eg. TTIP conference, Health Workforce seminars, PDP trainings), as well as the annual conference (ca 300 registrations) – which indicates that we are reaching our target audiences and that the themes and quality of the discussions are appreciated.

Outreach estimates: +/– 10,000 per month: 3000 newsletter recipients + 5000 social media followers (twitter, facebook, linkedin)