Making Europe healthy

Abstract

Markos Kyprianou, the new EU commissioner for health, has a sense of humour. When the 44-year-old lawyer was teased about his girth during recent commissioner hearings, he said he was enjoying the delights of Brussels since quitting his post as finance minister of Cyprus. Fighting Europeans' fatness is one of the main remits of his portfolio. Health might be one of the weakest portfolios in terms of actual powers—and commensurately given to a figure from the third smallest member state—but for Europeans, it is one of the most important issues. If Kyprianou's strategy—which aims to reduce obesity, smoking, and drinking, improve food labelling, and ban vitamin supplements in foods high in fat and salt—succeeds, he will have made a lot of lives better. And from an individual voter's point of view, such an achievement may even top the value of the much-touted benefits currently offered by the EU. Health commissioners had, until the mandate of outgoing incumbent David Byrne, very little clout among their commission colleagues. The job had virtually no powers, but Byrne, using “smoke and mirrors”, created a job with a high profile and much influence. Fiercely antismoking, he used the post to push for smoking bans in public places across Europe. Though bans are a national competence, his office led the battle for public opinion, using a number of EU-wide directives in areas that were EU remits—such as enlarged health warnings on cigarette packets and EU-wide antismoking campaigns. The commission's high-profile spats with Phillip Morris, in which the company was fined €1 billion for collusion in smuggling cigarettes across Europe's open borders, may also have played a part. During Byrne's term, his home country of Ireland pushed ahead with its own public smoking ban. The Irish government liaised closely with Byrne to give feedback on the experiment to other countries. Norway has now joined Ireland; Scotland has just announced plans for a ban; and other countries may soon follow. In the new constitutional treaty, which might not come into force until 2009, there will be a new horizontal clause stating that all new EU policies must take into account a high level of human health protection. But until the constitution is ratified, Kyprianou will have to emulate Byrne's nifty footwork—using persuasion rather than the rulebook—to force through a health agenda. Independent observers at the commissioner hearings in late September say Kyprianou has a lawyer's deft way with argument and a ready charm, so is likely to be able to push the health angle at the weekly Wednesday meetings of the 25-strong commission. Some predict he will build alliances with Stavros Dimas, the environment commissioner, and a fellow Greek speaker. Environment and health issues often have the same demands. His supporters claim that facing the powerful banking sector in Cyprus—an offshore paradise—as finance minister has given him the necessary skills to take on the big food and alcohol lobbies. However, critics counter that the banking lobby in Cyprus is far weaker than the food and alcohol lobbies, so his previous performance offers no guide. Some argue that Kyprianou's job will actually be harder than Byrne's because while fighting the tobacco lobbies had the sympathy of the public, its position is far more ambiguous when it comes to food and alcohol. A representative for one NGO said: “Health is to some extent a job for a Don Quixote. It is a battle you never quite win. You tilt at windmills.” Another, Tamsin Rose of the European Public Health Alliance, said: “You have to think long term on Europeans' health. It is also a job that will take 20 years.” The struggle for Europe's opinion against the food and alcohol industries is a long war, but Kyprianou's immediate battle will be with his fellow commissioners over the 2007–13 budget allocation, debated last week among Europe's finance ministers. He arguably missed a trick when asked by MEPs during the parliamentary confirmation hearings whether he thought the health budget allocations for the last spending round, negotiated 4 years ago, were sufficient. He replied yes—which missed a gift opportunity to express dissatisfaction with the EU's health-care spending: at 14 cents per person, it is small change compared with the €800 a year in subsidies a cow receives from the EU's common agricultural policy. Finally, there is the question of whether, as a Mediterranean, he really understands the scourge of alcohol on northern European societies. He has repeatedly shrugged off questions on the apparent contradictions of two EU policies—the single market and its commitment to health—in the way that Britons and especially Scandinavians are able to import cheap alcohol from the continent under single-market laws and then wreck their health with it.