Xavier Prats: “When it Comes to Joining Efforts for Problems that Become Bigger Every Day, There is a Lot of Scope for European Action”

 The Director General for Health and Food Safety of the European Commission, Xavier Prats, visited ISGlobal on January 19, to meet with the institution’s senior managers and researchers. During the meeting, organized by the Policy and Global Development department, the European Commissioner shared experiences and results on topics of common interest. One of the key issues on the agenda was the future contribution of ISGlobal to European activities focused on tackling antimicrobial resistance. Other topics, including the European Reference Networks, women and health, and migrant’s health were also discussed. Prats also expressed his interest in ISGlobal’s model of private-public governance as an innovative example of academic, university and philanthropic collaborations that can be expanded across Europe.

At the end of the meeting, he kindly agreed to answer the following questions.

What is the current state of health of European citizens, and what are the trends for the future?

The health of European citizens is better than it has ever been- Alexander the Great, Julius Caesar, Karl Marx, Humboldt… they all had 35 or 40 years of life expectancy, and this started increasing at the beginning of the twentieth century. In terms of life expectancy and, above all, in terms of healthy life expectancy, there has been a dramatic improvement. Today, if you are a 65 year-old citizen in many European countries, you still have 12 years of healthy life ahead of you. Another example: today, the chances of survival after going into a hospital with a heart attack have improved by 40% as compared to beginnings of the century. Medicine has done fantastic things and can do much better in the future.

But, as we live longer the challenges are greater, especially if you consider health in terms of inequality. If you see the differences in health linked to educational levels, occupation, the place where you live, they are quite extraordinary. Therefore, we have to do better not only in keeping an ageing population healthy but also in reducing inequalities in health.

Are these inequalities on the rise, or decreasing?

We see that in absolute terms the health of citizens has improved, but inequalities have actually increased. Technology is expensive and might be an incentive for more inequality but it also gives the opportunity for providing better healthcare, and that is the challenge. We have to make sure that health assistance is more patient-centered and based on outcomes rather than on outputs, which is what we usually measure in the field of healthcare.

We are used to doctors asking patients “what’s the matter with you?” but the real question is “what matters to you?” That’s what we should work on.

Can you give us a concrete example where common European health policies have been successful?

The best example is what we have done with the European Reference Networks. We have a number of rare and complex diseases in Europe that affect almost 30 million European citizens. No single hospital, country, or discipline can deal with these rare diseases alone, therefore this represents a big added value for European actions. It has taken 10 years, but last December the EU approved 24 European Reference Networks that bring together different hospitals, patients, institutions that can help address these rare diseases.

In my view this is a perfect example that, in some areas, Europe can do a lot. Not so in other areas- EU has no right or legitimacy in telling countries how to organize their health systems; this depends on values that are not to be decided by European Institutions. But when it comes to synergies and joining efforts for problems that become bigger every day, there is a lot of scope for doing more.

What lessons have we learned from the past Ebola and Zika outbreaks?

The first lesson, that should be very familiar to ISGlobal, is that health and epidemics are global. Every time a crisis passes we tend to forget that. Ebola and Zika were strong reminders that we are not alone, that we cannot put borders or walls, and that we should deal with global challenges together. This is not only a policy lesson, but also an ethical one. 

But there is another lesson. The Ebola crisis showed us that healthcare systems, the public health authorities, our societies, were pretty unprepared for a big crisis. I must say that many efforts have been made since in terms of coordinating different situations and sharing information on time between different countries and stakeholders, and I hope that by the next crisis we will be able to say that we have learned our lessons.

What are the main public health challenges in Europe for the coming years?

Certainly, the most important challenge is the one that comes with dealing with an ageing society. It’s good that people live longer and healthier lives, but this creates complications. Multi-morbidity and chronic diseases become more important and we need to adapt the skills of the workforce, not just doctors but also nurses and caregivers. We need to adapt to a society that is changing profoundly in its demographics.

The other challenge I would mention is making a better use of technology and its potential. We are on the brink of a transformational moment in the field of healthcare, where technology is about to have the same impact than it has already had in other sectors. This can be an enormous opportunity to provide more care and to solve another key challenge in Europe, which is the sustainability of our healthcare systems.

Do you think that public/private partnerships may be a way forward to tackle these challenges?

I think that European healthcare systems share a common sense of need for universal healthcare access. Now, how you provide the access, and how you make sure that you deliver value for money is really a critical question. And value for money, in the field of healthcare, is not a matter of economic efficiency but a matter of ethics, because the obligation and objective of any healthcare system is to give maximum quality of care to as many people as possible.  I can see no reason why not to look at constructive partnerships in the public and private sector while making sure we maintain the transparency and the difference in the respective roles. This is another challenge for the future, and I’m very impressed by the good work ISGlobal is doing in this respect.