Finger on the pulse

The Commission’s director-general for health on why health is so important to economic recovery.

Paola Testori Coggi was the driving force behind the European Union’s “farm to fork” food-safety policy, put in place after the BSE crisis of the 1990s. Now, as the European Commission’s director-general for health and consumers, her remit is much broader, from the headline-grabbing issues of food and consumer scares to Europe’s slow-burning health challenges. 

The landscape for European health policy has changed since she took up her post a year ago. The health issue that received most attention during the Barroso I Commission, the cross-border patients’ rights directive, has now been agreed.

Meanwhile, an organisational shake-up at the start of Barroso II has added pharmaceuticals and medical devices to the responsibilities of her directorate-general, known as DG Sanco. But the principal shift in the context is the state of the economy.

For Testori Coggi, this has made it crucial to link health with budget sustainability and economic recovery. “There is a new awareness under the Barroso II Commission…to have a [health] system that not only guarantees safety, quality and universality, but also one that guarantees efficiency,” she says.

So her department will, in the coming months, be advising governments on reforming healthcare systems to boost economic competitiveness. The national reform programmes that governments are obliged to draw up under the EU’s peer-review system of economic governance, known as the European Semester, includes a chapter on health.

National concerns

Testori Coggi believes that there is more recognition than ever of the importance of health to a strong economy, citing conclusions of EU finance ministers in December 2010. “Health can really contribute to the goals that have been set out in the EU’s 2020 objectives,” she says, listing increased employment, spending on research, reducing people at risk of poverty and increasing the staying-on rate in schools.

But health has always been an area where national governments staunchly defend their autonomy. So the narrative of the new director-general avoids the “h” word: asked whether there is more “harmonisation” in EU policy, she says that member states are increasingly using “a co-ordinated methodology” and working together.

Fact File

A healthy career path

Paola Testori Coggi is DG Sanco to her fingertips. A biologist by training, she worked her way up through the ranks. Before her appointment as director-general in April 2010, she was a deputy director-general at DG Sanco, and prior to that was director for safety of the food chain, where she wrote the agenda-setting white paper on food safety that led to a shake-up of Europe’s food safety system, including the creation of the European Food Safety Authority. 

Earlier jobs included working in the cabinets of Italian European commissioners Emma Bonino and Filippo Maria Pandolfi. Her rise to the top job makes her one of just six women out of 35 director-generals in the Commission.

“They [the member states] face common challenges: new diseases, increase in diseases, increased costs, the ageing of the population. They realise that the challenge is so big that you need to work more together.”

Legislative tools

The efforts of Barroso I to leverage some integration of EU health policy via the cross-border healthcare directive were substantially weakened by national governments. But Testori Coggi insists that she was satisfied with the outcome: “This directive is the basis on which we can really push the member states to co-operate and to exchange in a more systematic and constructive way.”

National governments will continue to control healthcare systems, but DG Sanco has some powerful legislative tools on public health, such as food labelling laws and the possibility to introduce advertising restrictions on unhealthy products.

Testori Coggi’s predecessor as director-general championed a voluntary approach, by creating groups where industry executives and health charities came together to agree voluntary commitments – the platform on diet, physical activity and health, and the forum on alcohol and health.

She has decided not to chair these groups, delegating that task to a trusted adviser. “We are pushing them to focus more on results… through commitments that are monitored,” she says. The platforms have to be more than “just commitment… but commitment that is relevant for our purposes”.

In particular, she wants to see more action to tackle binge drinking among teenagers and young adults, noting that alcohol abuse is the leading cause of death among 15-30-year-olds.

She would also like to see more efforts to reverse the trend of obesity among children, because “by investing in children you change the trend”.

DG Sanco has a small budget, and Testori Coggi is not looking for an increase. She sees lawmaking and exhortation as powerful tools: “Our money is more to push for co-operation and establishing the way in which member states can establish best practice.”

Health priorities should, she says, continue to feature in the larger EU budgets for research and structural funds, but EU spending on public health will target fewer projects more closely linked to EU priorities. Her preferred tone is efficiency and EU-added value.