EU action on health benefits us all

It is over 30 years ago that the European Community passed one of the first pieces of legislation in the world to control asbestos and provide adequate protection to workers.

Despite this, even today, asbestos remains the UK's biggest workplace killer.

All 28 Member States of the European Union (EU) are required to implement its legislation, past and present, as are the 3 countries of the European Free Trade Association. The impact of the asbestos legislation was much wider than just the EU as it helped the International Labour Office to establish its Convention on asbestos, which now applies to 187 countries around the world.

The importance of protecting the health and safety of workers has long been recognised by governments, employers and trade unions.

This came to the fore in 1986 when the decision was made by Mrs Thatcher and the other Heads of State to set up an internal market to allow free movement of goods, persons, services and capital. This had also been demanded by business leaders who wanted the laws to be harmonized among countries.

In agreeing the internal market, the Heads of State realized that national laws on health and safety were often barriers to trade and that European Community legislation was needed.

Employers also recognized that adequately protecting their employees’ health and safety could leave them at a financial disadvantage unless legislation was passed that produced a level playing field.

This legislation established minimum safety and health requirements for a maximum number of workers while allowing Member States to go further. Particular attention was paid to limiting the impact on small and medium sized enterprises.

Framework legislation was passed which aimed to establish an equal level of protection for all workers. Legislation was also agreed on other important health and safety issues, including dangerous substances and dangerous work places.

For example, certain cancer producing chemicals have been banned, others are subject to strict control measures, and exposure limits set for a number of other chemicals. Specific legislation was also introduced for mines, quarries, off-shore drilling platforms (following the Piper Alpha disaster), and fishing vessels.

In transposing this legislation into their own national laws, all the Member States have upgraded their legislation, some considerably.

In all these policy initiatives, the Commission has benefitted from the input from representatives from U.K. employers, trade unions and the government, in particular experts from the Health and Safety Executive.

Europe would be a poorer place if this high level of expertise was no longer available.

The internal market has also made travel to, as well as living and working in another EU country much easier. Doctors, dentists and nurses are able to move between countries as are other health professionals.

When travelling to another EU country, most people have probably taken with them the European Health Insurance Card.

This is a free card that gives access to state-provided health care during a temporary stay in any of the EEA countries, under the same conditions as the people in that country.

If a person travels to another EU country and falls ill there they can now get a cross border prescription, so that they can receive their medication when they return home. If they have been prescribed a medicine by their own doctor before travelling and they run out whilst on holiday this prescription allows them to continue their medication.

Usually the same type of medicine is available across the EU because it has been approved at national or EU level before it is put on the market. The European Medicines Agency in London oversees this process to ensure that all medicines available on the EU market are safe, effective and of high quality. If a medicine subsequently proves to be dangerous, sales are suspended or the marketing permit is withdrawn.

Free movement can apply also to donated blood, tissues, cells and organs. In 2011 there were 30 000 organ transplants, many of them using an organ from a different country. To protect recipient’s health, all donated human material has to respect EU standards of quality and safety to prevent the transmission of disease.

Sometimes a person wants to travel to another country for treatment. This is possible under the terms of the European Cross-border Healthcare Directive that clarifies the rights of EU citizens who wish to have treatment elsewhere. 

Environmental pollution knows no boundaries. This has led to drinking water and bathing water standards, as well as air pollution standards, all of which impact on health.

Likewise, the nuclear safety standards protect the health not only of workers but also of the general public.

Treatment under the NHS is a matter for the UK government and is outside the scope of EU activities, because of the principle of subsidiarity. This means that nothing should be done at EU level if it can be done better at national or local level. Public health is an area where the separation is clearly spelled out in the Treaties. They explicitly state that it is up to national governments to organize health care and ensure that it is provided.

The role of the EU is to complement the work of the Member States and encourage and support cooperation between them.

It can help prevent physical and mental illnesses, dangers to health and the fight against major health scourges. It can also, carry out research to improve European healthcare and has set aside almost €7.5 billion to spend on it between 2014 and 2020.

Sometimes, all the Heads of State agree that they want particular actions undertaken, even though some of these actions may be outside the scope of the Treaties.

This occurred in 1985 when President Mitterand of France proposed to the other Heads of State that Europe should have its own action program on cancer. This was rapidly agreed, including by Mrs Thatcher, and each Head of State agreed to nominate an expert to help the European Commission to draw up the program. The experts proposed that the aim of the program should be to reduce by 15% the number of deaths from cancer, which in 1985 totalled 770000 in the European Union, then comprising 12 Member States.

Cancer constituted the second commonest cause of mortality, after cardio-vascular disease. The experts considered that a reduction in smoking consumption would go a long way towards achieving the aim of the program, and made this a priority for action. This led to legislation on tobacco, including the labelling of cigarette packets.

The experts drew up a ten-point code for general distribution including a recommendation to eat more fruit and vegetables, now widely accepted. Other recommendations were made such as regular mammography of older women, and on cervical cytology.

The initiatives taken by the European Union in the field of tobacco helped the World Health Organization (WHO) to establish its Framework Convention on Tobacco Control, which was the first global health Treaty.

The EU continues to work closely, with the WHO in order to help to improve health.

Scotland is no stranger to International Treaties. In 1295 the “Auld Alliance” Treaty was signed by John Balliol of Scotland and Philip IV of France. It impacted on Scottish architecture, its cuisine, its language, and its law.

Furthermore, Scots often attended French universities, which continued until the Napoleonic Wars. This Treaty underlines the benefits of working with just one country.

The European Union with its 28 countries offers so much more, and exists for the good of its people not only in health but also in other fields.


William Hunter OStJ, FRCP, FRCP(Edin), FFOM, Hon FFPH, MB, BS, LRCP, MRCS