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Stephen  Bevan

‘Health’ is just an incomplete diagnosis…

Authors: Stephen Bevan Director of Research

11 December 2015

It’s one of those strange paradoxes that one of the most talked about topics in the European Commission these days is also one where it has the least influence over what happens in individual Member States. In the last two weeks I’ve spoken at three separate events on the big challenge of chronic ill-health in Europe’s (ageing) working population where this paradox was evident. Just this week there were two events on mental health at work.

The first, hosted by the European Brain Council (EBC), was chaired by the ever-enigmatic Mary Baker, it’s immediate past President. The EBC has made great strides in raising awareness of conditions such as Parkinson’s Disease, Dementia and Stroke. The event on mental health – with a focus on depression at work – brought together employers, clinicians, NGOs, researchers and policy-makers and made a solid attempt at focusing on good practice. It also examined what more the EU might do to improve access to support and evidence-based interventions. This is where the perils of policy ‘silos’ became especially evident. DG Santé (the Commission Directorate which looks after Health) has great knowledge and expertise on public health, health policy and the health of consumers & citizens. However, it cannot tell Member States what to do in terms of Health Policy, nor can it mandate uniformity of interventions. From a UK perspective this is generally seen as a good thing – we don’t take kindly to interference in the NHS and often we think we’ve more to teach others than we have to learn from them. The downside of DG Santé’s minimal ‘competence’ in health policy matters is that those member states with less developed health systems – where spending on health as a percentage of GDP is in low single figures, where doctors and nurses have been fleeing to work in Germany, Italy & the UK and where corruption is commonplace – stand to gain considerably by the EU requiring them to comply with even basic measures to improve health outcomes.

This issue of working age health is even more complex in Brussels. Responsibility for the health and safety of workers falls to DG Employment which, compared with DG Santé, has more ‘teeth’ and can mandate regulatory change (eg Working Time; Temporary & Agency Workers; Asbestos exposure at work etc). Sadly, DG Employment can only get involved in cases where health conditions are attributed or caused by work itself, which tends to edge it towards the ‘Health & Safety agenda. Within these constraints I have to day that, through the EU Occupational Safety and Health Agency (EU-OSHA) in Bilbao, it does this very well. However, if you are of working age have depression, MS, Cancer, heart disease, arthritis or dementia neither the Health nor Employment Directorates have much to offer by way of policies or practical support – even if your work exacerbates your condition.

Of course regulation can only ever play a small part in improving workforce health, and there is an increasing amount of sharing on good practice and innovation across the EU which the Commission works hard to promote. This was clear in the second event, organised by Mental Health Europe and held in the European Parliament itself. The MEPs who attended the session were very well-informed and keen to learn and share good practice. There were delegates from many Member States, all with great stories to share and innovations to promote. Yet, at the end of it all, my fear is that a Bulgarian school-teacher or Maltese construction worker who develop clinical depression or angina and have to give up work are likely to be left to take their chances with their health systems and social insurance regime rather than being able to benefit from the insight gained by more progressive and rehabilitation-focused systems in Scandinavia or the Netherlands.

In the background to this debate, and across the EU, we are expecting the workforce to retire later while, at the same time, living with more chronic ill health. In pointing out the gloomy inevitability of looming ill-health in later life for all of us, Mary Baker quipped that Health is no more than an incomplete diagnosis and that we should value our good health while we have it. After rubbing shoulders with the great and the good in Brussels this week, I can’t help feeling that the EU’s diagnosis of the looming workforce health challenges of the next few decades – and its ability to act - are also troublingly incomplete.