I met Fiona Godfrey, former Secretary General of the European Public Health Alliance (EPHA), at the workshop ‘Transforming HIV responses in Europe’ during the European Health Forum Gastein (EHFG) 2019. I knew immediately this was a lady I wanted to speak to! She has ideas how we, in the European Union (EU), can use our establishment to improve the health of our population, even if perhaps it may seem like, unrightfully so, the EU has no mandate on health.
Véronique Bos (VB): During the workshop ‘Transforming HIV responses in Europe’ I was triggered by the need from the room to advocate for health together and to cooperate with different patient groups. What do you think we can learn from each other?
Fiona Godfrey (FG): The infectious disease groups are inclined to be more radical activists when compared to the non-communicable disease (NCD) groups. Partly because NCD organisations, such as the cardiology and oncology networks, tend to be larger and often more conservative but also because the urgency is different. As Robbie Lawlor, HIV advocate at ACT UP Dublin, communicated loud and clear: if they had not of acted radically – they would be dead. I would like to see a little more activism in the NCD community. We know we can have an impact. For example, we can be proud of the steps forward in Tobacco control made possible by the WHO Framework Convention on Tobacco Control (FCTC) and the impact it has had when we acted on a global level.
VB: Do you have examples in which advocating on the EU level is a better than from the standpoint of a member state?
FG: A very good example, which is close to my heart as I have an affected family member, are the rare disease platforms. Even the bigger member states lack the capacity to provide the necessary expertise and access to treatment. The cross-border health directive is great in this regard and makes a significant difference for patients with rare diseases. Another way to make a difference is to affect the lives of the many. The EU could do much, much more on mass population intervention measures to protect health. It is a common belief that the EU has no legal base for health interventions. That is nonsense. How do we address the tobacco industry? By regulating the internal market. How can we tackle obesity? In part by regulating under the internal market and other legal bases.
Health politicians often speak of ‘health in all policies’, but it must be admitted, we health professionals, are not the best advocates ourselves. What have we done in taxes? Finance? Agriculture? Progress is being made, but we must do more.
There are some good potential multisectoral examples like the ‘Farm to Fork’ initiative mentioned in the mission letter from Commission President Von der Leyen to Health Commissioner Kyriakides. Let’s do more of that. It is partly a resource issue: advocates for public health are already spread too thin, we are afraid this wider range will have us spread even thinner.
VB: In a time of activism is advocating for health enough?
FG: Yes and no. We are too nice, we have let the EU and member states get away with things they should not have been allowed get away with. I believe we have been much too lenient in our approach towards the diet and alcohol platforms. The ‘let’s all work together’ approach has been failing but we stuck with it for various reasons. We have been at this for a long time. It is time to ask ourselves some difficult but critical questions: what are we doing? Why are we doing this? What has it achieved? Let’s look at our outcomes: has the European population benefitted from this way of working together? We succeed in getting the odd European Parliament resolution adopted, but how are we really actively changing people’s lives? We are in a bubble and need to step outside of it.
VB: The theme of the EHFG was ‘A Healthy Dose of Disruption – Transformative change for health and societal wellbeing’. What do you think we should disrupt?
FG: I think we should take a good look at how to disrupt our own organisations and mindsets. I have been watching the hearings in the European Parliament of the Commissioners-Designate and there seems to be an understanding that change is necessary. Directorate Generals will have to work together within the Commission and with civil society. Let us see how that translates into better health and societal wellbeing in the EU. We are at a crossroad: if we do not change our policies on health and the planet, do we, the EU, have a mandate at all?
Interview taken by Young Gasteiner Véronique Bos, PhD Candidate Amsterdam University Medical Centres and HealthPros fellow, the Netherlands.