Cancer and the Slovenia's EU Presidency

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Abstract

Slovenia decided to present cancer as the main public health topic of its Presidency to the Council of the EU because of its increasing importance in terms of incidence and survival rates, the challenges it represents in organization of health care, its delivery and financing as well as in the need for international collaboration and in ensuring the base for long-term care and sustainable and publicly funded research. The comprehensiveness of cancer needed to be addressed from different angles.

Purpose of health policy or idea

The main objectives were:

1. to address and revise the existing health policy approaches at the EU level
2. to re-promote the European Code against Cancer, which is still seen as a good platform
3. to launch discussions on the comprehensiveness of the problem of cancer
4. to propose joint activities in the domains where EU is welcome and appropriate

Obviously, a EU policy in any domain has a limited scope and a rather limited space for very precise actions. On the other hand, room for EU-led activities has broadened and has recently been encourages by some public health actions, notable in tobacco control.

The main expected outcome of these activities is a joint statement of the health ministers of the 27 member states on cancer at their informal meeting in Slovenia 17-18 April 2008.

Main points

Main objectives

Preparation of an outline ofi the key actions of public health intervention and other initiatives in the field of health care in the domain of cancer.

Through a process of validation of the four pillars of the future action - primary prevention, screening, research and integrated care - the complexity of cancer care should be reaffirmed and the need for EU involvement at specific points noted. Mainly, it would be in the field of primary prevention and its enhancement and the recommendations related to screening. It is also expected that more funding would be made available at the EU level for academic research thus keeping it independent from the direct involvement of the industry. Integrated care, though not regulated by the EU bodies, still remains an important tool for addressing the variety of patient needs in the management of cancer.

Type of incentives

As the European Commission cannot regulate the financial aspects of health care delivery in the EU, financial incentives for the implementation were not part of the topic. The main indirect positive financial incentive would be the financing of academic and other independent research in the field of cancer through research projects through the support of the DG Research (7th Framework Program) and the Public Health Program of DG SANCO. On the other hand, agreement on the joint regulation of tobacco control and of other positive lifestyle enhancements would certainly represent a non-financial incentive. One of those is also the application of the European guidelines for the early detection of some cancers, for example cervical cancer, breast cancer and colon cancer.

Groups affected

Patients, National governments and regulatory bodies, Cancer planning and treatment agencies

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

Political and economic background

Cancer has been a priority issue in EU health policy for many years. Unfortunately, it ended as such in 2003 after the end of the previous public health programme, which still extensively supported cancer research, especially applicative. Slovenia, as one of the new member states, also did not have any more access to the previously successful funding for cancer research. Becoming the first new member state to hold the Presidency to the Council of the EU, it had the opportunity to provide the right environment and means to open this important discussion. The fact of the broader EU is important with the topic of cancer also for two additional reasons:

1. lifestyle factors favoring cancer are much more problematic in the central and eastern member states of the EU than elsewhere,

2. sustainability of health systems in some new member states may become seriously challenged with the pressure for new expensive diagnostic equipment and therapies

Furthermore, the discussions on the health services directive promoted more profound discussions on the topic of cross-border care, not only the care driven by patient preferences, but also by professional preferences or, even, need. The idea of developing centres of reference, which would be focal points for treatment of rare cancers, provide a favorable environment for research and serve as training centres for broader parts of the EU, is definitely interesting and worth considering.

In the process of evaluation of cancer care, another issue is very important and that is of having sustainable and quality controlled data to be able to monitor and follow-up patient care, its outcomes and its quality.

Complies with

EU regulations

Adherence to the EU guidelines on screening and the development of joint EU policies on certain environmental factors (such as exposure to tobacco smoke)

Other

Introduction of cancer registers

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

Slovenia has a long-standing tradition in the epidemiology of cancer as its national cancer register was established in 1950. Furthermore, Slovenia was one of the first countries to introduce routine pap smear screening in daily gynaecological practice. These two factors contributed to the successes in some aspects of cancer care in Slovenia, especially in the monitoring and quality control of cancer care and in the reduction of morbidity and mortality due to the invasive cervical cancer.

The Ministry of Health (MoH) of Slovenia wanted to contribute to the European debates on cancer control and on cancer research and to promote wider European collaboration in cancer research and care. These factors, together with the identified shortcomings of the previous approaches and of the withdrawal of some successful European initiatives (such as funding of cancer research by the EU), provided the base for the development of the frame for the Slovenia's priorities in the field of cancer. The stress should be on four pillars of comprehensive cancer care:

1. primary prevention - reducing the impact of different negative lifestyle factors,

2. screening - providing organised screening programs across Europe as the successful means to reduce cancer morbidity and mortality,

3. research in cancer - providing opportunities for more efficient and effective cancer care and independent evidence to support interventions,

4. integrated care - including the whole cycle of the disease, including, palliative and terminal care and rehabilitation.

Initiators of idea/main actors

• Regierung

• Wissenschaft

Approach of idea

The approach of the idea is described as:
renewed: Renewal of the European code against cancer and of the European Public Health Programme in the field of cancer

Stakeholder positions

The idea was to facilitate discussions and to identify the possible problem areas while still developing the final documentation, including the book on cancer - 'Responding to the challenge of cancer in Europe'. Stakeholders generally expressed a lot of (positive) interest in the topic, ranging from patients to industry and including national governments and regulatory bodies. The professional background was formulated through a consultative process of a brainstorming session and a policy dialogue, for which points of discussion and more extensive background materials were prepared. The leadership in the process stayed with Slovenia, assisted by the European Observatory on Health Systems and Policies, the London School of Hygiene and Tropical Medicine and Prof Jose Maria Martin-Moreno.

Actors and positions

Regierung
Patients	sehr unterstützend		stark dagegen
National regulatory bodies	sehr unterstützend		stark dagegen
National treatment and resource centres	sehr unterstützend		stark dagegen
Wissenschaft
Research community	sehr unterstützend		stark dagegen
Research centers	sehr unterstützend		stark dagegen

Actors and influence

Regierung
Patients	sehr groß		kein
National regulatory bodies	sehr groß		kein
National treatment and resource centres	sehr groß		kein
Wissenschaft
Research community	sehr groß		kein
Research centers	sehr groß		kein

Positions and Influences at a glance

Adoption and implementation

Slovenia's MoH prepared a series of consultations at the EU level, which were to provide smoothening of the positions of the most extreme positions. The first of these consultations was a brainstorming session in Brussels which was meant to co-ordinate a common position on the proposed documents and the framework of the approach Slovenia took in dealing the issue of cancer. That was followed by a process of preparation of the original standpoints that ended with the policy dialogue which involved all the member states of the EU and provided the panel for an open discussion. Finally, these findings were presentated at the Conference on cancer which took place in Slovenia on 7 and 8 February 2008 and then elaborated for the adoption at the informal meeting of health ministers on 17 and 18 April 2008.

Monitoring and evaluation

The adopted conclusions will be monitored through the regular procedures and processes customary within the European Commission. It is expected that the adoption by the Council would make the policy binding to the Member States which would then be obliged to report regularly on the progress. The preparation of an action plan will be launched.

Review mechanisms

Halbzeitevaluation

Expected outcome

After a period when cancer had not been the top of the (public) health agenda, there are now again both the political will and the professional determination to provide for a more stable and organised framework for cancer control, embracing the four aspects proposed by the Slovenian presidency - primary prevention, screening, integrated care and research. For the latter, it is important that significant resources are planned for the funding of the different EU initiatives, programmes and projects. 

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

References

Sources of Information

1. Coleman MP, Alexe D-M, Albreht T, McKee M (eds.). Responding to the challenge of cancer in Europe. Ljubljana: Institute of Public Health of the Republic of Slovenia, 2008.
2. European Code against Cancer - third version.
3. Annexe 2: Europe Against Cancer Programme. In: Integrated Work Plan 2002 for the Public Health Programme. European Commission, 2002.

Author/s and/or contributors to this survey

Tit Albreht

Empfohlene Zitierweise für diesen Online-Artikel:

Tit Albreht. "Cancer and the Slovenia's EU Presidency". Health Policy Monitor, April 2008. Available at http://www.hpm.org/survey/si/a11/5