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SANT European Parliament
Segui le sue seduteOlivér Várhelyi
We also know that around one in 10 children and young people is living with obesity. The Safe Hearts Plan is our strategic response to this challenge. We adopted it last December as part of a broader health package, as you all know. And as you also know, this package has two other parts: the revision of the rules on medical devices and the Biotech Act. Together, they are tools that will help implement also the Safe Hearts Plan.
Medical devices are key to preventing, diagnosing, and treating cardiovascular disease, from blood pressure monitors to new AI-powered diagnostics. And biotechnology is also opening new possibilities and more personalized approaches. Biotech companies are already exploring therapies that could restore heart tissue after a cardiac event. They are using biomarkers to target gene therapies to different patient groups and addressing inherited risk factors for cardiovascular diseases. But of course, the core of this work is the Safe Hearts Plan.
Our goal is very clear. We need to reduce premature cardiovascular-related mortality by 25% by 2035. It underlines that health promotion, prevention, and early detection are the most cost-effective way to reduce the burden of cardiovascular diseases. To tackle one key factor, we are working to update the EU's tobacco legislation by end of this year. As tobacco and nicotine use remains a serious concern, especially among young people, including the growing use of e-cigarettes.
And when it comes to vaping, the use among young people is twice as high as among the whole population. So, it is high time to act. This week, we are launching three new initiatives to support the prevention of cardiovascular diseases. First, today we adopted a proposal for a Council recommendation on cardiovascular health checks. The proposal will support Member States in developing and implementing health checks at national and at local levels.
More than one in six young people reported smoking cigarettes in the previous month. And among them, around one in five started with e-cigarettes.
Cardiovascular health checks are recommended for 35 to 64 years old people, carried out every five years as a minimum, and more frequently where the risk profile warrants so. The objective is very simple: identify risks before they become a disease. The proposal also looks at how checks can reach all communities, particularly high-risk and underserved groups, and advocates for a gender-specific approach. And it's points to the potential of data-driven and AI-based tools to reinforce risk assessments and checks. Second, and this is the reason why I'm here today, I'm also launching the first-ever EU Screening Week.
This is about encouraging Europeans to know three simple but very important numbers: their blood pressure levels, their cholesterol level, and their blood sugar level. I'm very pleased that we have around 800 health check points free of charge this week available for all Europeans. Events that will take place across all Member States throughout this week in communities, workplaces, pharmacies, clinics, and also online. This is a genuinely European mobilization. Health professionals, patient organizations, public health organizations, and many other partners are helping us bring this message directly to the citizens and reach as many people as possible.
EU Screening Week is the kickoff of the EU-wide Know Your Numbers campaign that will be carried out until spring 2027. So, honorable members, I would like to invite you as well to help us carry that message, be ambassadors for prevention in your constituencies, your Member States, and here in the Parliament. And most importantly, I want to invite you to know your numbers as well. Here in Brussels, you can get checked at the health check stations outside, for example, the Berlaymont. It's open to everyone to come, get checked, and get to know your numbers.
And you can see all the screening points on our interactive map on the EU Screening Week Commission website. So, honorable members, ahead of World Heart Day, I want to thank all of you in the SANT Committee for your support and the commitment and devotion that you attach to this topic. And I'm sure that together we can make prevention a much stronger part of European health policy and we can help much more Europeans to stay healthier for much longer. Thank you.
Adam Jarubas
Thank you so much, dear Commissioner, for your presentation. Now I open the floor to MEPs, and we're starting with Bartosz Arłukowicz, EPP, please.
Bartosz Arłukowicz
I will speak Polish, please use the headphones.
Panie komisarzu, z wielką uwagą wysłuchałem pana wystąpienia na temat planów dotyczących opieki kardiologicznej. Panie komisarzu, chciałbym dopytać o taką rzecz, bo w tym planie przyjętym w grudniu 2025, Safe Hearts Plan, przyjęliśmy takie założenie, że do 2035 roku, 2035, Komisja Europejska podejmie działania, żeby zmniejszyć śmiertelność z powodu chorób sercowo-naczyniowych o 25% względem roku 2022. Jakby doceniam bardzo te inicjatywy informacyjne, profilaktyczne, to wszystko jest bardzo, bardzo ważne, to, że będzie można tutaj obchodzić ten dzień serca. Chciałem zapytać o konkrety, jakie Komisja Europejska podejmuje w tej sprawie, czyli mówiąc wprost o pieniądze. Chciałbym zapytać, jakie plany finansowe w związku z tym założeniem tego planu sercowego Komisja Europejska podejmuje, komu i jakie środki zaplanowała w perspektywie finansowej i jakiej.
I mówiąc tutaj o konieczności nowego sprzętu i wielu działań innych, chciałbym wiedzieć, w jaki sposób Komisja Europejska planuje wesprzeć narodowe ośrodki walki kardiologicznej. Mówiąc wprost, pytam o pieniądze. Czy ten plan się przekłada na jakiekolwiek pieniądze, czy tylko politykę informacyjną, że to groźne jest?
Vytenis Povilas Andriukaitis
Thank you, Bartosz. Vytenis Andriukaitis.
Thank you very much indeed, dear Commissioner, dear Chairman. I would like to speak in Lithuanian. Gerbiamas komisare, pirmiausia leiskit pasveikinti jus su šiom iniciatyvom. Tai yra labai savalaikiai. Informacinė kampanija Europos Sąjungos lygiu išties gali stimuliuoti ir šalių narių aktyvumą, nėra abejonės.
Mums reikalinga sinergija. Mums reikalingas bendras veikimas. Ir tai, ką jūs dabar inicijuojat, žinok savo būklę, Know Your Numbers, yra tikrai sveikintina. Tačiau, gerbiamas komisare, noriu atkreipti dėmesį, kad apskritai, jeigu nagrinėsime šalių narių profilaktikos arba prevencijos programas ir kiek pinigų skiriama prevencijai, mes matysime, kad prevencija yra pelenės vaidmeny, Cinderella, liaudiškai kalbant. Ir tai, kad šiandien jūs turėtumėt pakviesti šalis nares, kad jos galėtų naudoti nemedicinines intervencijų priemones ir įtraukti jas į kompensuojamų instrumentų sąrašą.
Yra šalių narių, kurios kompensuoja tam tikrą rinkinį nemedicininių priemonių, kurios yra preventyvios: ėjimo, dietos, gyvenimo būdo skatinimo ir apmokymų. Bet tos šalys yra pavienės. Todėl mano pasiūlymas būtų, kad ištiesų prevencija taptų ne tokiu minkštu pasisakymu, bet turėtų stiprią dimensiją Europos Komisijai spaudžiant šalis nares ir prašant iš jų ištiesų pateikti jų planus, nes Komisija turi instrumentą koordinuoti, turi instrumentą paremti ir turi instrumentą pakeisti: coordinate, supplement and enforce.
Tai mes turime pagalvoti, kaip padaryti, kad šalių narių pastangos, žinant kokie milžiniški darbo jėgos praradimai ir žinant, kad tai yra išvengiamos mirtys, pabrėžiu, išvengiamos mirtys, ne šiaip sau. Tai yra išvengiamų mirčių skaičiai yra milžiniški ir šitoj vietoj prevencija vaidina milžinišką vaidmenį. Bet jeigu mes nesuprasim, kad reikia spaust šalis nares, kad reikia sveikatos ministrų tarybų lygiu inicijuoti jų aktyvų pasikeitimą planais ir įtraukti prevenciją į kompensuojamos vaistų sąrašus, mes ilgai vargsim su šita problema. Todėl aš didžiai sveikinu jūsų visas iniciatyvas, pritarsiu, pats tikrinu tą sveikatą savo čia, man kaip kardiochirurgui visiškai suprantama, bet patikėkite, finansiniai instrumentai šiandien yra numeris vienas, nes aktyvios išvengiamos mirtys yra katastrofa Europos Sąjungai, žinant, kad Europos Sąjungos demografija mažėja.
Gerald Hauser
Danke Herr Vorsitzender, geschätzter Herr Kommissar. Um es relativ kurz zu machen, wir unterstützen selbstverständlich sämtliche Maßnahmen der Früherkennung und der Prävention von Herzkreislauferkrankungen. Also alles was da passiert ist positiv. Aber wir müssen uns auch einmal anschauen, welche Faktoren auch zu den Herzkreislauferkrankungen führen. Und ich habe heute hier ein amtliches Dokument der Republik Österreich mitgebracht, eine Anfragebeantwortung für jedermann nachzu- und jede Frau nachzuvollziehen.
Ich sag das, das war die Anfragebeantwortung 2469 vom 12. September 2025. Die Fragen hat die SPÖ Gesundheitsministerin in Österreich, die Frau Corinna Schumann beantwortet, also nicht wir, sondern ein Mitglied der österreichischen Bundesregierung. Und wir haben also in dieser Anfrage Fragen zur Myokarditis gestellt. Und die Antwort, die wir von der SPÖ Gesundheitsministerin bekommen haben, ist in Wahrheit erschreckend. Zu den Fakten aus dieser Anfragebeantwortung heraus, noch einmal ein amtliches Dokument der Republik Österreich.
Im Jahr 2020, wir wissen alle am 13. März 20 wurde die weltweite Pandemie ausgerufen. Und interessant war, dass im Jahr 2020, wo es noch keine Impfungen, wo es noch keine Covid-Impfungen gegeben hat, wie die wurden erst Ende Dezember 2020 eingeführt, ist die Zahl der stationären Aufenthalte jener Personen, die an Myokarditis in Österreich erkrankt sind, zurückgegangen auf 244. Das bedeutet, dass an sich Corona keine negative Auswirkung auf Myokarditis hatte. Jetzt hat's dann die Impfungen gegeben und als Konsequenz oder als Folge dieser Impfungen sind die Myokarditen angestiegen um ein Drittel. Ich zitiere aus der Anfragebeantwortung.
Noch einmal 2020 244 stationäre Fälle, also das waren die schweren Fälle, die im Krankenhaus behandelt wurden. 2021 384 Fälle, 2022 436 Fälle, 23 433 Fälle und 2025 473 Fälle. Das heißt seit 20 plus 40 Prozent. Und es wurde auch in dieser Anfrage an die Frau Minister die Frage gestellt, ob sie einen Zusammenhang zwischen den Covid mRNA Covid-Impfungen und den explodierenden Zahlen der Myokarditis sehen.
Sie wissen ja, plötzlich und unerwartete Todesfälle sind vielfach auf die Myokarditis zurückzuführen. Ich zitiere aus der Anfragebeantwortung. Sie sagt, dass einige der oben angeführten Fälle von Myokarditis auf die Covid-19-Impfung zurückzuführen sind, kann nicht gänzlich ausgeschlossen werden. Das heißt, in diesem offiziellen Dokument sagt die österreichische Gesundheitsministerin, das kann nicht ausgeschlossen werden. Und deswegen, Herr Kommissar, wichtige, entscheidende Fragen.
Kennen Sie die Zahlen auf EU-Ebene? Wie schaut's da aus? Wie viele Fälle von Myokarditis, Perikarditis gibt es vor und nach Einführung der Impfungen? Gibt es da also belastbare Zahlen? Wie schaut auch die Evidenz aus?
Gibt es diesen Zusammenhang zwischen den Impfungen, wie hier in dieser Anfragebeantwortung festgestellt, und der steigenden Zahl von Myokarditen? Und auf eines möchte ich auch noch hinweisen. Seit dem Jahr 2021 steht die Myokarditis als Nebenwirkung in den Beipacktexten der Impfungen. Das heißt, es ist offiziell in den Beipacktexten der Impfungen angeführt, dass die Myokarditis eine Nebenwirkung der Impfung sein kann. Also alles Fakten, alles Fakten, die zu prüfen sind.
Und auch hier muss man helfen. Ich bin schon, ich komme schon zum Ende. Ich komme zum Ende, nur ein Satz. Der Herr Kommissar hat gemeint, wir müssen also Todesfälle verhindern. Bitte schauen Sie sich auch diese Fakten rund um die Myokarditis an.
Aurelijus Veryga
Thank you, Mr. Chair, dear Commissioner. First of all, I would like to welcome Commission's attention to cardiovascular diseases through the Save Hearts plan. And for sure, these diseases remain one of the Europe's greatest health challenges. But Europe is not starting from zero. We have several decades, actually more than 50 years of scientific knowledge and practical experience in the prevention of NCDs.
And I would like to mention just two initiatives like North Karelia project in Finland, which was launched in 1970s, that demonstrated how population level interventions targeting smoking, blood pressure, cholesterol and nutrition could significantly improve cardiovascular health. Later, the WHO CINDI program developed an integrated approach to non-communicable disease prevention across several European countries. So my first question is simple. If we have known so much for so long, why is implementation still so difficult? And how does the Commission intend to address these implementation gaps in the next MFF, because successful interventions need to be scaled up and sustained?
I also welcome the fact that vaccination is recognized in the health check context, because respiratory infections such as influenza can have serious cardiovascular consequences, particularly for older people. But at the same time, vaccination schedules, target groups and recommendations still vary considerably between member states. And my question would be if there is also an intention to develop more common European guidance on target groups and vaccination schedules while respecting national competences?
And finally, I would like to raise the issue of data and technology. Private technology companies today collect enormous amounts of health-related data through smartwatches, phones, and other wearable devices. They collect data on heart rate, physical activity, sleep, and many other parameters. So my question is, is the Commission considering a structured cooperation with the technology companies, researchers, and healthcare systems so that with appropriate safeguards for privacy, consent, and data protection, these large datasets could be analyzed? Thank you.
Martin Häusling
I want to make my speech in German, so... Ja, Kommissar, vielen Dank fürs Kommen und auch wichtig ist, dass Sie nach dem Bericht, den wir ja vor im Parlament verabschiedet haben, jetzt auch was folgt. Das haben wir uns in dem Bericht ja gewünscht, dass wir nicht einen Bericht verabschieden im Parlament und der bleibt folgenlos. Ich hätte mir auch gewünscht, dass wir über diesen Bericht zu Herz-Kreislauf-Erkrankungen auch eine Aussprache gehabt hätten im Parlament, leider war das nicht möglich, weil Sie haben ja die Zahlen genannt, angesichts der Dimension, die wir haben in Europa, 1,7 Millionen Tote und 240 Milliarden Euro Schäden infolge dieser Todesfälle und der Krankheiten, müssen wir uns intensiver damit beschäftigen. Die Maßnahmen, die Sie hier vorgestellt haben, die begrüßen wir uneingeschränkt, dass wir Checkpoints, 800 Checkpoints einrichten, um die Vorsorge mehr auszubauen.
Das war auch ein wesentlicher Punkt unseres Berichts, den wir hier verabschiedet haben, dass wir die Vorsorge stärken. Und dass wir in dem Bericht auch festgestellt haben, es gibt große Unterschiede in den Mitgliedsländern. Wir müssen also alles sozusagen auf das höchste Niveau bringen. Und wir hatten, das gehört auch zur Wahrheit dazu, im Vorfeld in der Runde der Schattenberichterstatter doch erhebliche Diskussionen um das Thema Alkohol, Tabak, E-Zigaretten. Ich hätte mir gewünscht, dass wir in dem Bericht etwas stärker diese Punkte angesprochen hätten.
Meiner Meinung nach wird Alkohol in vielen Bereichen doch noch zu sehr verharmlost. Rauchen, tun wir da wirklich alles, was nötig wäre, um Rauchen in der Europäischen Union noch mehr zu bekämpfen? Sie haben das auch angesprochen, das Thema E-Zigaretten. Da müssen wir endlich was ergreifen. Es kann ja nicht sein, dass immer noch so getan wird, als wenn Menschen mit Rauchen aufhören, dann zu E-Zigaretten greifen, dass das dann gesünder wäre.
Das hält sich, und ich glaube, wir müssen klarmachen, das ist keine Alternative, ganz im Gegenteil, es ist teilweise sogar schädlicher. Deshalb meine Frage: Werden Sie die Punkte noch mal aufgreifen, die wir in dem Bericht gerade bei Thema Alkohol, Zigaretten und E-Zigaretten, Tabak, werden Sie da noch mal das aufgreifen, weil ich glaube, wir brauchen da auch eine stärkere Aufklärung, stärkere Prävention und auch Maßnahmen der Europäischen Union gerade bei E-Zigaretten. Ich finde, wie gesagt, gut, dass wir diese Screening-Woche machen. Ob 800 im Endeffekt ausreichen, 800 Checkpoints, die wir diskutieren müssen, ist aber immerhin ein guter Anfang. Und ich glaube, wir alle können uns wünschen, dass wir die Vorsorgemaßnahmen verstärken, dass wir alle europäischen Länder auf ein hohes Niveau bringen.
Und auch da bei dem Bericht wurde deutlich, sage ich ja auch noch mal, es gibt große Unterschiede auch sozusagen in der sozialen Analyse sozusagen. Ärmere Bevölkerungsgruppen haben oftmals weniger Zugang zur Prävention. Auch da müssen wir drüber nachdenken und das ändern. Vielen Dank.
Adam Jarubas
Okay, thank you, colleagues. I know that there are some indications yet, but we know that the Commissioner must be going in a moment, so I cannot give you the floor again. So, Commissioner, could you comment to the questions posed by MEPs, please?
Olivér Várhelyi
First of all, thank you very much for the exchange. Let's go one by one.
So how are we going to achieve the reduction of mortality by 2035 with 25%? This is, I think, deserves a broader discussion because this is exactly the kind of target that will also make it necessary that we start designing the healthcare budgets and the healthcare systems in a different way. Currently, the Member States on average spend 80% of their healthcare budgets on care, while they are investing roughly on average 3% only to prevention. Every euro spent on prevention saves at least seven euros, this is the modest projection, seven euros in care. So if we want to make the European healthcare system sustainable, we will have to invest into prevention.
Otherwise, with all the budgetary restraints the Member States are facing, the system will not, will not be sustainable, meaning it will no longer be able to provide universal coverage for everybody in Europe. And this is why this target that we have set ourselves should also create an incentive in the Member States to invest into prevention more. Without investing in prevention, this target is not achievable. But it also means, and that brings me to the next question, whether we have additional funding and how will it be financed in the next MFF and do we have new money or not. First of all, we have seen that with the recovery funds, we have managed to convince the Member States to invest much more in healthcare.
Over 40 billion euros from recovery has been invested into health infrastructure, also primary care. But it needs to, it needs to continue. It needs to continue from the cohesion funds, it needs to continue from the structure funds. So it is much more than just financing European public health policy, it is also a transformation of the healthcare systems that will need to be supported from the other community policies. Then to Mr. Andriukaitis, how do we reinforce the measures at national level which are already dedicated to prevention and how do we create the best practice to be applied by everyone, if I can paraphrase your question, Mr. Andriukaitis.
I think that today you have seen the first very important step by our proposal for a Council recommendation creating the same standards and protocols when it comes to health checks, preventive health checks in cardiovascular. We do not have that currently in Europe. This is the first step to do it and there are Council recommendations to follow one after the other every year to implement the Safe Hearts plan so that we will have a prevention system in Europe that creates the very high and equal level of possibility to prevent cardiovascular diseases. And yes, I agree with you that for example the promotion of movement, the problem related to food and ultra-processed food, these are all issues that we will need to, we will need to tackle still this mandate. Then to Mr. Hauser, I don't know this letter that you are referring to, so it's very hard to respond to it, maybe you can share it and then we can take a look.
What I can tell you is that the vaccines that have been authorized by the EMA are still being followed by the EMA for all side effects and all other events that could be attributed to these vaccines. And the findings of the EMA continue, continue to make it very clear that there is no cardiovascular risk related to the COVID vaccines that have been authorized by the EMA and that have been used in the member states. And this is something that we, we devote a very high attention to, but again, if you share what you have, we will take a look at that as well. To Mr. Vediga, how are we going to finance this in the next MFF? Well, this house is part of the discussion, so I, I have high hopes that you will help us.
But it is very clear that the Safe Hearts plan and the screening week and the No Your Numbers campaign, they are not for only this mandate. They are here to stay, they have to be long-term policy. Cardiovascular diseases are the single biggest cause of death in Europe still, and this is why we will continue all these actions together with the other major public health priorities like the Europe Beating Cancer Plan or the reference networks, and I could go on with everything that we have, that we have at hand because they are providing a valuable contribution I see already on the ground, meaning that we through them we are bringing treatment to Europeans who have not had this opportunity. But now we need to do it with cardiovascular. Then on your next question on vaccination and the relationship with cardiovascular diseases, the good news is that we are coming with a proposal for a recommendation next year, same time next year, and, and we will continue with all the recommendations that we have proposed in the Safe Hearts plan.
On data use, you know that we are now finalizing the implementing rules and regulations of the European Health Data Space, and I hope to be able to conclude them rather rapidly because it is very clear that we need this European Health Data Space to function much faster than it was foreseen and also at a very high quality. So we need to ensure privacy, we need to ensure that patients will always continue to have full control over their personal data, but we also need to make sure that Europe is going to be the place where the secondary use is going to develop new technologies and new treatments which get to the patients much faster than anywhere in the world. And finally to Mr. Heisling, yes, I agree with you that prevention has to be mainstreamed across the board. And it's not only about the cardiovascular, but the cardiovascular area maybe is the one where we can see the good use and also the benefit of prevention the fastest. This is the area Mr. Vediga already explained where we can save 80% of lives.
And this is where we can work together to actually show the difference. And on smoking and e-cigarettes, I think it is very clear the timeline that we are working on. And it should still be this year when we will come with all the proposals that we have discussed in this committee several times. Thank you.
Adam Jarubas
Thank you, Commissioner. Thank you for your work. We appreciate that you delivered your promise from hearings by presenting this Save Heart program. Now, what colleagues said, it is time for taking concrete actions, more collaboration with the states, more money for this. I received two requests for a very short comment: Bartosz Arłukowicz and Vytenis Andriukaitis, please.
Bartosz Arłukowicz
Dobrze, że pan komisarz został jeszcze na chwilę, bo mam tutaj krótki przekaz do pana komisarza. Ja już to mówiłem w czasie posiedzenia naszej komisji i będę to powtarzać za każdym razem, panie przewodniczący i panie komisarzu. Za każdym razem, jak będę słyszał tego typu szurów szczepionkowych jak pan Hauser. Wiem, że ciężko jest przetłumaczyć na język angielski słowo szur, w związku z tym pomogę państwu. Szur znaczy ktoś skrajnie niekompetentny, kierujący się teoriami spiskowymi.
Uważam, że tego typu wypowiedzi są skandaliczne, trzeba na nie reagować i oczekuję od pana komisarza nie tego, że pan będzie oczekiwał od nich dokumentów o tych bzdurach, które opowiadają i straszą ludzi, tylko będzie pan w sposób jasny negował te wszystkie kłamstwa szurowate, które oni rozprzestrzeniają w przestrzeni publicznej, dumnie się nazywając patriotami, co jest po prostu skandalem. Co do samego, ostatnie zdanie, co do samego programu kardiologicznego, z wielką uwagą wysłuchałem tego, co pan mówił. Panie komisarzu, z całym szacunkiem, ja naprawdę pana wspieram i rozumiem też trud miejsca, w którym pan się znajduje. Ale zapytałem o pieniądze, pan mówi o wydatkowaniu, zmianie struktury wydatkowania środków narodowych, a tak naprawdę ze strony Komisji powiedział pan o tym, że trzeba się zdrowo odżywiać i dobrze się ruszać. To jest przekaz na poziomie lifestylowej telewizji śniadaniowej.
Jeśli chcemy coś zrobić konkretnego, to powinniśmy podjąć konkretne działania i chciałbym wiedzieć, jakie one są, bo to, że trzeba się zdrowo odżywiać i ruszać, to my wszyscy wiemy.
Adam Jarubas
Vytenis, and in a moment Gerald Hauser. In a moment, if I may, Vytenis, okay?
Gerald Hauser
In aller Kürze, es war eigentlich von jedermann und jeder Frau klar erklärt. Ich habe aus einer Anfragebeantwortung der sozialistischen Gesundheitsministerin zitiert. Ich habe nicht meine Meinung wiedergegeben, ich habe zitiert, ja. Das müsste eigentlich jedem Parlamentarier klar sein, was es heißt, aus einer Anfragebeantwortung zu zitieren. Erstens.
Zweitens, so was als Dummheit darzustellen, ist gelinde gesagt der Weg der Volksparteien, die europaweit, der europaweit die Wähler davonrennen, weil sie die Meinungsfreiheit, die Bürgerrechte nicht zulassen und auch hier in diesem Haus andere Meinungen, die ihnen nicht ins Konzept passen, als Dummheit bezeichnen. Das ist letztklassig.
Vytenis Povilas Andriukaitis
Vytenis Andriukaitis, please, and we finish this part. Aš norėčiau pasakyti, kad man teko miokarditą gydyti daug metų. Esu kardiochirurgas ir tai buvo mano kasdienė duona. Taip pat noriu pasakyti, kad reikia mokėti skaityti atsakymus, nes atsakymus perskaityti irgi reikia žinių. Ir trečia, aš manau, kad viešai skleidžiant, o po to filmuojant ir siunčiant per socialinius tinklus šitą konspiracijų teoriją, jūs darote didelę meškos paslaugą savo žmonių sveikatai.
Jūs ją tiesiog, jūs jai tiesiog kenkiat šitais pasisakymais. Todėl reiktų iš tiesų matyti ir pasakyti labai aiškiai, kad mokslinis pagrindimas turi būti sekti po kiekvienos tokios replikos ar išsišokimo, nes priešingu atveju jie toliau plečia konspiracijų teoriją ir kenkia žmonių sveikatai ir didina mirčių skaičių.
Adam Jarubas
Dear Commissioner, please. I know it's hard to comment this discussion, but please keep it shortly and we're going further.
Olivér Várhelyi
Well, first of all, on the COVID vaccines again, we trust the work of the EMA. And so far, the EMA has not signaled any such side effects, and the EMA is constantly monitoring any side effect that emerges. So I think we have the best science available, and not only science, but also enforcement of the science and the rules. So I think it is very clear, but again, since this is, it seems to be an information from one of the federal government ministers from Austria, I'm happy to take a look to see what is in this response and whether this actually confirms what has been presented to us by Mr. Hauser. Now to Mr. Arlukowicz, yeah, maybe I skipped a specific answer to this.
How are we going to finance this? This is a thorny question because as you know, it is under this MFF, it is to be financed from the EU4Health program. This year we are allocating 20 million euros for the SafeHarts plan implementation. This is, how shall I put it, a very modest amount, to be very fair, if not insufficient. But what we try to do is to involve as many partners as possible.
This is what you see, for example, with the screening week. We are engaging with non-governmental organizations, we are engaging with pharmacies, we are engaging with doctors, hospitals, everybody to come and pool the resources that we have. In the next MFF, I hope to have more funding available for this program as well, as it will evolve. More funding basically from the health part of the competitiveness fund, pillar four of it, where we have 22.3, we have proposed 22.3 billion euros for biotech and health, and it is going to be financed from that. But it means also that we need more public funding also from the member states, and that was my point.
Because without their significant increase in investment into prevention, we're not going to be able to change the landscape for Europeans. And finally to Mr. Andriukaitis, I think as a professional in this area, he knows best how to interpret these data, so I don't want to, I don't wish to comment on that. Thank you.
Adam Jarubas
Thank you so much, Commissioner, thank you for your time. We've just finished this point, we appreciate your time and your engagement in this issue. Thank you.
Dear colleagues, we continue our agenda, healthy lifestyle influence on disease prevention, a public hearing. I'd like to ask our experts to take the seats in the podium, please. Dear colleagues, let's now move to the next point, which is the public hearing entitled Healthy Lifestyle Influence on Disease Prevention. In today's hearing, we need to learn how to value prevention as a public health tool and how good dietary practices and healthy lifestyles help to strengthen population health and to reduce health inequalities within the European Union. To discuss this, we have invited leading experts from the ground, linking experience of public institutions, medicine, and science.
A warm welcome to all speakers. So let us start with the first panel. Our first two speakers are Milena Simeoni, Director of Public Health Salus European Initiative in Milano, and Professor Robert Barouki, Director of Public Health at Inserm in Paris. I will first give the floor to the speakers of the first panel for a maximum of eight minutes each. They will be followed by a first round of reaction from the MEPs.
Mrs. Simeoni, the floor is yours for eight minutes, please.
Milena SIMEONI
Ringrazio la Commissione SANT per l'invito e per ragioni di tempo rinvio alla dichiarazione di interessi e per gli studi citati agli approfondimenti riportati nelle slide finali. Intervengo come presidente della Fondazione Internazionale LUMEN, capofila dell'iniziativa europea SALUS per la centralità della promozione della salute sistema. In linea con la Costituzione dell'OMS e con la Carta di Ottawa, riteniamo che la promozione della salute sia un diritto fondamentale di ogni cittadino e che sia necessario creare le condizioni affinché i cittadini europei possano aumentare il controllo sulla propria salute e migliorarla. Ma dobbiamo domandarci se stiamo davvero creando queste condizioni. Non ancora, secondo noi, fatichiamo a dare allo stile di vita la centralità che aveva già nella medicina ippocratica con la diaita, come elemento fondamentale per il mantenimento della salute.
Oggi viviamo un paradosso. Nella regione europea dell'OMS si registrano ogni anno circa 1,8 milioni di morti evitabili per malattie non trasmissibili prima dei 75 anni.
Di questi circa il 60% è legato a cause prevenibili. Nell'Unione Europea solo circa il 3,7% della spesa sanitaria è destinato alla prevenzione, ma non disponiamo di un dato europeo relativo alla spesa per la promozione della salute. Salus propone di renderla misurabile e comparabile tra gli Stati membri. Le prove riportate nella slide mostrano risultati rilevanti per alimentazione, attività fisica, meditazione, cessazione del fumo e inquinamento ambientale. E questi sono solo cinque dei molti determinanti modificabili sui quali possiamo agire per costruire una società in salute.
Ma ogni individuo è un sistema complesso e irripetibile. Nella vita reale questi determinanti agiscono ed interagiscono contemporaneamente. Cosa accade allora quando agiamo su più determinanti? Una recente analisi di 109 RCT del 2025 mostra che la combinazione ottimale degli interventi multidominio rimane incerta. Dobbiamo quindi comprendere quali combinazioni funzionano meglio, per chi, con quale intensità e con quali effetti complessivi.
A nostro avviso è una sfida di ricerca europea. Per questo proponiamo di valorizzare e sviluppare una ricerca multidominio personalizzata, capace di osservare anche gli effetti sistemici e le loro interazioni. Nel nostro RCT in corso sulla naturopatia nella profilassi dell'emicrania centrata sulla promozione della salute, come accade in molti altri studi, oltre all'endpoint primario osserviamo cambiamenti in altri indicatori di salute che, pur non avendo valore confermativo, offrono informazioni sulla complessità individuale. Per svilupparla, questo tipo di ricerca su scala europea, riteniamo inoltre sia necessario mettere in rete ricercatori, professionisti e organizzazioni di diversi paesi. Verso questi obiettivi stiamo sviluppando una piattaforma Data Salus.
Ma come ci ricorda Einstein, è la teoria che determina ciò che possiamo osservare. Senza un cambio di paradigma che ponga al centro la promozione della salute sistemica, non ci cureremo tutti i giorni della salute, non nutriremo tutti i giorni la salute, ma continueremo a cercare solo di limitare la malattia o di curarla. È il suo partner ufficiale la promozione della salute. Salute, equità e sostenibilità sono parte della stessa sfida. Le condizioni economiche, sociali e ambientali influenzano concretamente la possibilità di adottare stili di vita salutari.
Nel 2019 solo un cittadino europeo su otto raggiungeva le cinque porzioni quotidiane di frutta e verdura, con una quota che cresceva con il reddito, dal 10,8% nel quinto più povero al 14,8% nel più ricco. Lo studio EPIC, 500.000 persone osservate per molti anni, associa un maggior consumo di frutta e verdura a circa il 10% in meno di mortalità totale. Le disuguaglianze possono essere modificate e la promozione della salute divenire concretamente accessibile a ogni cittadino. A livello pubblico la promozione della salute deve agire nei diversi contesti della vita e su più determinanti. Per questo è necessaria un'azione sinergica tra politica, istituzioni pubbliche e private ed enti di comunicazione.
Il North Karelia Project ne offre un esempio. Nel primo decennio di questa azione integrata in Finlandia su più fattori, dal '69 al '79, la mortalità coronarica negli uomini dai 30 ai 59 anni si è ridotta del 24% nella regione di intervento e a fronte di un 12% osservato invece nell'intera Finlandia. Ma le strategie di livello di popolazione per essere efficaci devono anche essere accompagnate da strategie a livello individuale, perché conoscere e voler cambiare non significa necessariamente riuscire a cambiare.
E ne abbiamo fatto esperienza sicuramente tutti quanti. Serve quindi anche un accompagnamento individuale con professionisti capaci di motivare, personalizzare e sostenere il cambiamento nel tempo. Salus ha cercato di capire come strutturare professionalmente questo accompagnamento. Nel position paper del 2019, partendo dal lavoro dell'IUHPE sull'Health Promotion Practitioner, abbiamo individuato un ambito ancora da sviluppare: un accompagnamento individualizzato e sistemico sui determinanti diversi di salute. In Italia questo percorso ha portato alla stesura di un DDL, oggi in attesa di presentazione, per riconoscere la promozione della salute sistemica come ambito distinto dalla cura con proprie finalità, competenze e confini.
Proponiamo quindi il promotore della salute sistemica, una figura socio-educativa non sanitaria che accompagni e motivi le persone a tradurre conoscenze e intenzioni in cambiamenti sostenibili, che sia pervasivo, che possa contaminare la società intera per essere a disposizione di tutti. Sebbene le prove riportate nella slide non riguardino il promotore della salute sistemica, esse mostrano che interventi strutturati di accompagnamento possono incidere sui comportamenti e su alcuni indicatori di salute e in specifici contesti anche sull'utilizzo e sui costi dei servizi sanitari. Per definire le competenze di questo profilo possiamo valorizzare quelle pertinenti dell'Health Promotion Practitioner e del naturopata con diploma federale svizzero, nel rispetto dei confini con l'ambito sanitario. Proponiamo una formazione professionalizzante non universitaria con standard comuni. In diversi paesi europei esistono già enti di formazione non universitaria con esperienze e competenze pertinenti.
Il modello svizzero mostra che una formazione professionale superiore non universitaria può essere rigorosa e riconosciuta. Esistono inoltre professionisti non sanitari e sanitari con competenze pertinenti da riconoscere e, ove necessario, integrare. In Italia ne sono un esempio tra i non sanitari alcuni dei professionisti delle discipline bionaturali. Mentre il riconoscimento professionale chiaramente resta agli Stati membri, all'Unione Europea chiediamo un quadro comune di competenze che ne favorisca la comparabilità. C'è infine un patrimonio specifico che l'Europa può valorizzare nella promozione della salute sistemica: la medicina tradizionale europea.
La strategia OMS 2025-2034 riconosce il potenziale contributo delle medicine tradizionali alla promozione della salute. Proponiamo quindi di includere la medicina tradizionale europea in questa agenda di ricerca per valutarne scientificamente il contributo e valorizzarla come patrimonio europeo. Medicina tradizionale che la Svizzera ha riconosciuto insieme a quella cinese e a quella ayurvedica. Ed infine il motto di Salus è "compone et collabora". Un principio da applicare secondo noi a tutti i livelli dell'esistenza, che si traduce concretamente in tre ponti: un ponte di promozione della salute sistemica che collega e affianca prevenzione e cura, un ponte tra professionisti con competenze diverse che integra saperi e prospettive complementari, un ponte tra etica ed economia affinché le convenienze economiche siano allineate al bene comune.
Non proponiamo di sostituire ciò che esiste, ma di colmare un vuoto: affiancare al sistema imperniato sulla diagnosi e sulla cura della malattia un sistema capace di accompagnare ogni cittadino europeo nella costruzione della propria longevità sana. Grazie.
Adam Jarubas
Thank you so much, Mrs. Simoni, for your presentation. Professor Barouki, the floor is yours, please.
Robert Barouki
Thank you. Well, thank you very much for inviting me. I think I will focus my talk on the evidence. I mean, it's so important to provide what is the evidence telling us that lifestyle is so important for health. So, I will be talking mostly about the exposome.
And just to define the exposome, it's a, it's the integrated compilation of all physical, chemical, biological, and psychosocial influences that affect biology and therefore health. It is the complement of the genome. I mean, we have spent a lot of money on the genome and we know a lot about the genome. The exposome are the determinants, you know, collects the determinants of health that are the complement of the genome. I mean, and their property is that they are modifiable.
They can be prevented in a way. So, this is, the exposome is very complex. I mean, it's all exposures over the lifetime and you can divide it into ecosystems exposures, I mean, where do we live, what is our environment, etc. The lifestyle, this is what we will be talking about a little bit later. Social exposome also is very critical and obviously the physical, chemical, and biological exposome.
Okay. So, the lifestyle is one of the components of the exposome. I mean, traditionally it's here you can see it, physical activity, sleep behavior, diet, I will back to this, smoking or no smoking, drug, alcohol use, etc. So, this is the topic, but be aware that this is, this cannot be separated from the other components of the exposome. There is a lot of relationship between all these exposome.
My view of the lifestyle exposome is expressed here. Again, diet, alcohol, tobacco, this is the same, physical activity and sleep. But I think we should add nowadays social interactions as part of the lifestyle and we know how much isolation is an issue. And we can add, you know, our behavior against the digital component, I mean, the time we spend with screens and we are not spending with the others. So, this is important and as I said, around this lifestyle exposome, there are the other parts of the exposome and there are significant interactions.
Here also is you can study people, these effects in large cohorts, I will get back to this also, and you can define lower risk lifestyle pattern and higher risk lifestyle patterns depending if you smoke, you drink alcohol or you are isolated or not. I mean, all these are very important. So, this is what is done in science. Just a focus on diet, I would like to stress how important ultra-transformed food, how bad they are for health. This has been studied in a number of studies in human and also experimentally.
And it's not only about what the food are consist of, just you know on the nutrition base, but all the additives, everything, all the other chemicals that are part of the food that are added to the food. And this kind of complex mixture in ultra-transformed food is probably what is causing all these effects on health such as diabetes, obesity, cardiovascular disease, etc. So, this is an example of one of the major lifestyle component. Oops. The, I would like to show you this study, it's a little bit complex, sorry for that, just focus on the upper left graph here and where a large cohorts, and it's so important to have very large cohorts because otherwise you cannot draw significant conclusions.
I mean, you need large cohorts because of that. Where people have been studied according to five lifestyle factors, either they have low, you know, risk factors or they have high or they have intermediate basically.
And if you compare, this, what was studied is the life expectancy at 50, at the age of 50, how much more you can live after the age of 50. And if you compare in the in the upper left graph, I mean, the those that have, you know, very high risk factors, the five high risk factors, as compared to those that have the five low risk factors, you have 12 years in difference. The latter live 12 years more than than the former. I mean, so that's extremely significant and very important. And the next study is also very important because it's nice to study life expectancy, but what is best is life expectancy free of major diseases like cancer, cardiovascular disease, and diabetes.
And also in the left graph, you can see for women, for example, that in the yellow color, those that have low risk factors, the five low risk factors, and those that have the five high risk factors, there's also a difference of approximately 10 years difference where people live 10 years more without major diseases. So this is really very hard data and very significant showing that lifestyle is important. And just to let you know that in this case, some of the other lifestyle factors that I mentioned, like isolation or screen, have not been included in this kind of study, and they are now included in the studies that are being done, but in those cases, you need really a very large cohort. Another important factor is, do these lifestyle behaviors, differences in lifestyle behaviors, explain social inequalities? So you do the same kind of studies, but you can separate the groups into either people that have high socioeconomic status, medium socioeconomic status, or low socioeconomic status.
And basically what you find in this kind of studies is that first, lifestyle factors that I mentioned earlier explain only a fraction of the social inequalities, and because even in, for example, low socioeconomic status people, you still have the difference if they have different lifestyle factors. If they smoke or if they drink, etc. And even in the high socioeconomic status people, you still have this difference. So it means that lifestyle does not explain everything on social inequalities, so there are other factors like economic factors, social factors, and you have to have interventions there to also solve this issue. That's I think a really important point in this, sorry.
Okay. So what can we do? I mean, there are a lot of things. This is an interesting paper by the people in cardiovascular disease. It reminds us what the topic of today.
And what in in this paper, scientists have explained what could be done at different ages to support a healthy, you know, life, especially towards cardiovascular disease. Even in school, you could start at school, you could start do it also at college and later on in the workplace or by interviewing and and speaking to people to recommend a really good cardiovascular health. And this is done on, you know, more or less on a on a social point of view, and it's really important to decrease social inequalities because the everybody is concerned and everybody is told the same thing and these recommendations go for for everybody.
Another way of also fighting against these differences in socioeconomic status and response to recommendations is having very simple scores that tell people, for example, when they want to buy food, whether this is good for you or bad for you and they don't have to read a large list of compounds that they don't know anything about. Nutri-Score is a very simple score and it immediately tells you whether this is nutritionally is good food or not a good food and this is really important especially for lower socioeconomic people with lower socioeconomic background. Okay, I would like to leave you with some take-home messages, well maybe not take-home, maybe take it to the Commission maybe messages. Lifestyle exposome strongly contributes to life expectancy and to lifespan free of major disease. This is very important so we have to do we can do something about that.
Now a healthier lifestyle exposome tends to partially decrease social inequalities but it does not explain the differences. A healthy lifestyle does not totally eliminate social inequalities in health and there are other measures, other interventions that should be done on a more social and political level to help people with a lower socioeconomic status. Thank you very much.
Adam Jarubas
Thank you Professor Barouki, thank you for a very interesting presentation. Now I open the floor to MEPs and from what I know Vytenis Andriukaitis is first please.
Vytenis Povilas Andriukaitis
Ačiū labai už pranešimus ir esu jūsų sąjungininkas. 2013 metais, 14 metais Lietuvoje mes įvedėme Lietuvos sveikatos mokslų universitete Lifestyle Medicine specialybę ir universitetas ėmė ruošti gyvensenos medicinos specialistus, kurie turi paskirtį dirbti su individais, ypač tais, kurie turi milžinišką rizikos faktorių ir medikamentinis gydymas jiems nepadeda, jiems reikia keisti kitais gydymo instrumentais. Taip pat mes turime visuomenės sveikatos specialistus, kurie turi populiacinius projektus, dirba su bendruomenėmis, savivaldybių bendruomenėmis irgi tame pačiame farvateryje. Mano klausimas būtų toks: ar nemanote, kad Europos Sąjungos lygiu reikia parengti gyvensenos ir rizikos veiksnių valdymo strategiją, kuri būtų kuri aprašytų daugelį instrumentų, kuriuos galima būtų rekomenduoti šalims narėms naudoti jų programose? Kitaip sakant, strategija, kuri aprašytų visą arsenalą instrumentų ir rekomenduotų šalims narėms, kad jos pagal savo specifiką, kultūrą, geografiją ir taip toliau imtų naudoti jos ją į savo gyvensenos medicinos instrumentus ir į prevenciją ir profilaktiką.
Taip pat akivaizdu, kad reikia atskirti du sektorius: negalima ligų gydymo sektoriui užkrauti gyvensenos medicinos, nes gyvensenos medicina labai sudėtinga atskira sritis, kuri ir turi būti vystoma lygiagrečiai šalia šalia ligoninių ir konkrečiai ligų gydymo. Kaip jūs manote, ar reikėtų mums būtent ta kryptim keisti paradigmą ir imtis tokios strategijos?
Marie-Luce Brasier-Clain
Merci de vos présentations. Il y a effectivement une double peine qui touche les populations modestes. Elles souffrent davantage d'obésité et de pathologies chroniques car les aliments sains sont plus chers que les produits industriels surchargés. Et il est normal de vouloir corriger ces disparités. Mais comment?
Certains pensent que cela relève de choix individuels, d'autres qu'il faut agir sur le contexte socio-économique, d'où des taxes et mesures comportementales qui n'ont d'ailleurs pas fait toutes leurs preuves. On a vu par exemple le Nutri-Score pénaliser injustement des produits d'appellation au profit de produits industriels reformulés. On a aussi vu des campagnes d'information nutritionnelle aggraver les inégalités de santé en manquant leur cible. La solution réside probablement dans un entre-deux. S'attaquer à l'offre de l'industrie agroalimentaire, agir dès l'enfance par la sensibilisation à l'école, oui.
Mais il est plus contestable de vouloir créer des taxes et de la fiscalité comportementale comme levier de santé publique au risque de pénaliser des classes sociales déjà défavorisées, surtout en période de crise. Et si on suit cette logique de taxation, il faut alors l'étendre aux importations de pays tiers qui ne respectent pas, pardon, les mêmes standards que nous. N'oublions pas que les inégalités de santé sont profondément liées à l'accès aux soins, notamment les déserts médicaux et la précarité globale. Taxer ne va pas régler ces problèmes de fond. J'ai deux questions.
La taxe soda en France a incité les industriels à substituer le sucre par des édulcorants de synthèse moins taxés. Or, des travaux, y compris de l'Inserm, ont depuis associé la consommation de ces édulcorants à une hausse du risque de cancer et de maladies cardiovasculaires. Ne peut-on pas y voir un exemple des effets de report provoqués par des comportements de substitution et comment y remédier? Et sur les mesures visant à subventionner les produits sains pour les rendre accessibles aux plus bas revenus, comment s'y prendre concrètement?
Aurelijus Veryga
Dėkoju, pirmininke. Dėkoju pranešėjams už tikrai labai įdomius pranešimus ir ypač už pavyzdžius iš konkrečių šalių. Jūs paminėjot Šveicariją ir aš labai džiaugiuosi, kad mano kolega Vytenis Andriukaitis paminėjo Lietuvos praktikas su gyvensenos medicinos specialistais. Man tuo metu teko dirbti universitete ir tą programą rengti, magistro studijų programą. Ir viena iš idėjų, dėl ko atsirado tokia programa, tai yra jūs labai teisingai paminėjot rizikos veiksnius.
Jų yra ne vienas: rūkymas, fizinis aktyvumas, mityba. Dažnu atveju vienas žmogus turi kelis rizikos veiksnius. Ir bėda ta, kad jeigu mes jį siunčiam pas tris ar keturis skirtingus specialistus, tikėtina, kad jie tarpusavy niekaip nebendraus, nesikeis informacija. Ir žmogus, kuris nori mesti rūkyti, tuo pačiu priaugęs svorio, kažkas jam nepavyks: arba susitvarkyti su mityba, arba sėkmingai mesti rūkyti. Tai gyvensenos medicinos specialistai tam ir buvo sukurti.
Ir labai svarbu, kad jie būtų sistemoje, tai yra, kad jie bendradarbiautų su šeimos gydytoju, kad keistųsi informacija, kad būtų žmogus referuojamas iš šeimos gydytojo tam specialistui ir gautų šeimos gydytojas atsakymą, kaip sekasi jo pacientui.
Tai mano klausimas būtų, ar jūs nematytumėt poreikio bendrai nustatyti gaires tokių specialistų rengimui Europos Sąjungoje, kad tai nebūtų tiktai šalių narių tokios skirtingos gal praktikos ir kad jie būtų integruoti į sveikatos sistemas, būtų tarpusavy pripažįstami Europos Sąjungoje ir mes turėtumėm tokį, na, bendrą supratimą, kaip kaip būtų galima šitas problemas spręsti. Ačiū.
Tilly Metz
Oops. Thank you very much, Chair. Health is shaped by the environment in which people live, work and grow older. So when we talk about healthy lifestyles, we should always look at the risk factors we can avoid as individual but also as society as well. We also know that Europe is ageing and with that we are seeing an increasing burden of chronic diseases that affects not only life expectancy but importantly also the quality of life.
Many of the factors that shape this burden are outside the health sector. Let's speak about air pollution, it was mentioned, is a very clear example as it contributes to cardiovascular and respiratory diseases and our diet too, as we saw, and the safety of our food also has an important impact. This is why really, and with the example of the exposome, why the One Health principle is particularly relevant for me. We need to look at the conditions that shape health as a whole: the air we breathe, the food we produce and consume, the environments we live in and the way our societies are organised. So let me be clear also, healthy choices therefore cannot depend only on individual responsibility.
We need healthier environments in which the healthier choice is the easier, is more affordable and more accessible. WHO itself points to measures such as reformulation, fiscal policies and front-of-pack labelling as part of the approach and thank you for mentioning also the Nutri-Score. And this brings me to the political responsibility we have here. We have the evidence. What we need is the political courage to act on it.
So reducing exposure to known risk factors requires regulation, not only information campaigns. The precautionary principle must remain at the heart of this approach and we should stop in that context deregulation. Economic interest should never become a reason to ignore or postpone action where the evidence tells us that people's health is at risk. So here is my question. How do we make sure that responsibility for living a healthy life does not fall disproportionately on those who have the fewest opportunities to make healthy choices and how can a One Health approach help us to address this inequalities concretely?
Thank you.
Christophe Clergeau
Thank you, Tilly. Christophe Clergeau, please.
Oui, merci Monsieur le Président, merci Madame, Monsieur pour vos présentations. Du coup, j'aurais trois questions. La première est une question à Madame Simeoni. Quand vous travaillez sur votre approche holistique du bien-être et de son amélioration, du coup, est-ce que vous vous fondez sur les travaux sur l'exposome tels qu'ils ont été présentés par Robert Barouki et qui permettent de comprendre en amont les facteurs de dégradation de la situation de santé? Ça, ça m'intéresserait de savoir quel pont on peut faire entre vos deux approches.
La deuxième question pour Monsieur Barouki. Vous avez montré qu'on avait toujours des impacts des conditions économiques et sociales de vie indépendamment des choix en termes de comportement individuel.
Est-ce que vous avez les mêmes études par rapport à ce que disait Tilly Metz sur la dimension environnementale, le cadre de vie, l'air intérieur, la pollution, les produits auxquels on est exposé qui permettrait de montrer de la même manière que on doit absolument traiter la dimension environnementale en même temps qu'on traite la dimension de lifestyle? Et puis dernière question, mais là elle peut être pour tout le monde, Monsieur Varhelyi est parti, mais Monsieur Varhelyi aime beaucoup insister sur l'idée que on a des données et que si on équipait les individus avec les données, on pourrait prescrire ce que devrait être leur bon comportement et que ce bon comportement pourrait améliorer leur situation de santé. Des fois il parle même d'importer des États-Unis des logiciels extrêmement performants qu'on retrouverait ou des applications sur son smartphone pour savoir le matin qu'est-ce qu'on doit faire dans la journée. Ma question c'est, c'est pas, c'est forcément utile d'une certaine manière comme type d'outil, mais est-ce que s'appuyer sur le digital pour prescrire les comportements a aussi des contre-effets sur la santé elle-même ou pas dans le rapport qu'on a à ses propres choix et à sa propre santé?
Michele Picaro
Thank you chair, thanks to the speakers, now I'll speak in Italian. Presidenti, colleghi, ringrazio gli autorevoli relatori di cui conosco tra l'altro l'impegno e la professionalità della dottoressa Simioni. Diciamo spesso alle persone che devono mangiare meglio e muoversi di più. È un consiglio giusto, ma pensiamo a una famiglia che fa spesso la spesa con un budget limitato oppure a un ragazzo che consuma il pasto principale a scuola. Le abitudini sane dipendono spesso anche dalla possibilità che offriamo loro.
È partendo dalle situazioni come queste che la prevenzione diventa prevalentemente una scelta politica. Possiamo intervenire sulla qualità delle mense, sull'educazione alimentare e sugli spazi in cui bambini e adulti possono fare attività fisica. E dobbiamo farlo soprattutto dove le difficoltà economiche e le diseguaglianze sanitarie si fanno sentire sempre di più. È anche l'obiettivo di equità indicato dal nuovo piano nazionale della prevenzione italiano. In questo percorso l'Italia può portare in Europa la propria esperienza con la dieta mediterranea.
Non vorrei però che questa restasse un'espressione che tutti condividono nei convegni mentre poi pragmaticamente diventa sempre più difficile seguirla nella vita di ogni giorno. Per capire come possiamo passare dalla parola ai fatti, la mia domanda agli esperti è questa: se i dati dimostrano che la dieta mediterranea offre vantaggi rispetto ad altri modelli alimentari, dove dovrebbe intervenire per prima la politica europea? La seconda domanda: nei programmi per le scuole, nelle regole per gli acquisti delle mense o nel sostegno alle filiere, quali sono le possibilità che possano renderli più accessibili questi percorsi e con quali risultati concreti potremmo misurare se stiamo raggiungendo le famiglie che hanno più bisogno?
Nicolás González Casares
Gracias, este es un debate muy interesante y muy pertinente, los condicionales sociales, medioambientales afectan mucho a la salud y a veces hay que tomar decisiones coherentes basadas en la ciencia y consistentes. Luego volveré sobre esto. Pero una cuestión a la señora Simioni, esto del systemic health promotion officer ya existe. Ya existe desde hace mucho tiempo, se llama enfermera. Las enfermeras son los profesionales que tienen que guiar la educación para la salud.
Tengamos más enfermeras, démosles más posibilidades de actuar, pero ya existe, se llama enfermera.
Y creo que esto debemos tenerlo en cuenta porque son las que más saben de educación para la salud. Creo que no hay por qué sustituir a las enfermeras en sus competencias tratando de crear algo nuevo. Démosle, por ejemplo, más responsabilidad en el ámbito escolar. Volviendo a los estilos de vida y a los condicionantes. En este Parlamento hace cuatro años aproximadamente aprobamos el informe BECA para luchar contra el cáncer.
Acabamos de aprobar una estrategia de prevención o de ayuda a la salud cardiovascular. Y en ella se habla de los estilos de vida. Yo aquí he escuchado muchas palabras muy bonitas, pero en esas estrategias está, por ejemplo, que solo se tenga en cuenta el consumo de alcohol cuando es dañino, pero no todos los consumos de alcohol. ¿Qué opinión les merece que las estrategias del Parlamento Europeo vayan contra la ciencia? O ¿qué opinión les merece que la Comisión Europea haya dejado sin actuar prácticamente cinco años en lo que tiene que ver con los nuevos productos del tabaco que están enganchando a sustancias nicotínicas con elementos que incluso se introducen con aspecto, digamos, digital o tecnológico para enganchar a niños?
Esto es consistencia, coherencia y sobre todo ciencia. Entonces, hagámosnoslo mirar nosotros mismos porque no estamos cumpliendo con todo lo que decimos que vamos a cumplir.
Valentina Palmisano
Thank you, chair. I will speak Italian. Grazie, un sentito ringraziamento ai relatori per la presentazione e per i preziosi spunti di riflessione su un argomento così fondamentale anche perché è assolutamente importante mettere al centro dell'agenda europea la prevenzione primaria e la promozione di stili di vita sani, anche se purtroppo molto spesso invece ci concentriamo più sul trattamento della malattia piuttosto che, appunto, sugli stili di vita e sulla prevenzione. Lo ha già riportato la relatrice Milena Simeonova, ma mi piace citare nuovamente questi numeri che mi sembrano assolutamente importanti: circa 1,8 milioni di decessi sono evitabili ogni anno prima dei 75 anni solo in Europa a fronte di un'allocazione delle risorse sanitarie che vede invece destinare alla prevenzione solo una quota marginale. Accogliamo inoltre con grande interesse la visione sistemica e l'attenzione all'equità sociale che sono anche promosse dal modello Salus che è stato appunto riportato dalla relatrice Simeonova.
E quindi il fatto che l'accesso ad alimenti di qualità e a stili di vita sani non deve essere, come dire, proposto come un privilegio, ma deve essere trattato come un diritto e come tale quindi garantito a tutti. E quindi vengo alle domande. Affinché questa prospettiva diventi una scelta poi politica e concreta, vorrei sapere quali strategie di promozione della salute ritenete che siano prioritariamente da promuovere a livello europeo per garantire il massimo impatto sulla salute dei cittadini con il miglior rapporto costo-beneficio per i bilanci sanitari.
Come poi possiamo evitare, come dicevo prima, che la promozione degli stili di vita aumenti le diseguaglianze raggiungendo soprattutto le persone che sono già più informate e benestanti? E in ultimo, in particolare alla relatrice Simoni che ha citato appunto il promotore della salute sistemica, quali competenze dovrebbe sostenere questo promotore per sostenere quindi motivazione, alfabetizzazione sanitaria e cambiamento degli stili di vita, mantenendo però confini chiari rispetto invece a diagnosi, prevenzione e terapia. Grazie.
Adam Jarubas
Thank you Valentina. Now I give the floor back to our expert to address the question posed by the members for three minutes each. Let's try. Who first? Mrs. Simoni, please.
Milena SIMEONI
Grazie. Apertura sola? Allora. La prima domanda è questa questione del ponte. Per noi il ponte è proprio un simbolo, come avete visto nelle slide, l'obiettivo è unire e comporre e smetterla di dividere litigando per linguaggi.
Per noi l'idea è che l'individuo è una complessità e come l'individuo è una complessità noi dobbiamo essere una complessità che agisce insieme per la salute. Come faccio a fare questa cosa? Per esempio mi sono occupata di ricerca, mi occupo ancora di ricerca e chiaramente lo faccio con l'ambito scientifico e porto la mia capacità di osservare in un modo sistemico e la scienza porta la sua capacità di misurare e di portare a definizione dei risultati che possono essere raccontati. Quello che ritengo è che un professionista debba aver fatto un percorso formativo. Per avere una visione sistemica bisogna aver acquisito delle competenze.
Non sono competenze analitiche. Sono proprie maggiormente del nostro emisfero destro e quindi quando noi siamo abituati invece a descrivere le cose solo analiticamente ci è difficile guardare all'individuo nella sua complessità. Per quello secondo me non ci deve essere contrapposizione tra questi due modi di vedere ma in realtà rappresentano come il nostro cervello all'interno di noi è fatto di queste due grandissime parti, una più analitica e l'altra più sistemica. E quindi il ponte lo creo tutti i giorni lavorando, lavorando con le istituzioni, portando, facendo convegni dove portiamo, uniamo scienza e filosofia, visione olistica e visione sistemica e non ultimo abbiamo costituito un comitato tecnico-filosofico-scientifico fatto da più di quaranta membri che sostiene l'intergruppo parlamentare promozione della salute in Italia che è composto da quattordici parlamentari. Spero di aver risposto.
Allora. Per esempio quello che si diceva è sappiamo tante cose, le persone cambiano lo stesso. E quindi si dice è importante dare dati. Non è importante solo dare dati. Ognuno di noi quante volte si è detto domani mattina camminerò trenta minuti tutti i giorni e non smetterò mai.
Non mangerò più le patatine fritte piuttosto che qualsiasi altra cosa, mi preoccuperò di smettere di guardare uno schermo alle undici di sera.
Ma poi non è facile cambiare. E dobbiamo prendere atto che non è facile cambiare. E aiutare le persone a cambiare non è sufficiente avere la conoscenza. Bisogna avere una capacità motivazionale che accompagna l'individuo nel cambiamento perché il cambiamento non è una cosa scontata. Non è noi pensiamo che sia esattamente un dato come gli altri, ma non è vero.
Il cambiamento fa una grandissima la motivazione fa una grandissima differenza. L'empatia, la capacità di creare un rapporto con l'altro. E l'onorevole diceva gli infermieri. Io non penso che sia una questione di professione sì e professione no, ma di competenze. Esattamente di competenze.
Per svolgere la capacità per avere la capacità di motivare al cambiamento, cosa molto difficile, bisogna avere delle specifiche competenze. Se queste competenze ce l'ha l'infermiere, benissimo. Se ce l'ha il medico, benissimo. Se ce l'hanno altri professionisti che già da anni agiscono in questa direzione e che si occupano di promozione della salute da tantissimo tempo, personalmente da più di 30 anni, bene. Anche questi avranno la loro dignità e porteranno all'interno di un sistema che è in grado di collaborare anziché di continuare a fare lotta.
Secondo me possiamo solo migliorare perché uniamo competenze differenti, visioni differenti e al centro mettiamo il cittadino e la promozione della salute. Non credo di aver risposto a tutti. Penso di aver superato il mio tempo. Mi spiace.
Robert Barouki
Yes, thank you. I think many of the questions end up with the issue of whether is it an individual choice or are there social and economic factors that are there. And we need I mean, we can make hypothesis for this, but we need science because sometimes you can test this into and I think what I what I showed a little bit earlier was showing that in fact, it is to a certain extent individual. Of course you can smoke or not smoke, you can drink or not drink, but also it's not enough. I mean, there are more social and economic.
If you live in a place where there are no green areas, maybe you are less likely to do physical activity. If there's a lot of noise, you are less likely to sleep well, etc. So there is a close interaction between what the individual can do and you know, what the what the social status is. And that's what science I mean, what we can do here, what I can provide is what can the science give you as information for you to take the best decision at the European level. I think it is it is right at the European level.
So this is why I think we we need to work more on the exposome. I mentioned a number of times the the exposome because you know, you probably know how much work has been done on the genetics. And it's we know now for sure there are evidence I could have shown you that that many diseases are more determined by the exposome than by the genome. Others are more in the you know, determined by the genome, but many many diseases are more determined by exposome. And this is split into lifestyle, but also social factors, but also environmental and you mentioned this.
And there are examples from the literature, scientific literature showing that the same people undergoing for example a lot of air pollution, if they are in a high socio-economic status or lower, they will end up reacting differently. I mean, so environment is important, but also it depends also on the on the social status. So I don't want to put it all on the individual and it's certainly not on the individual. It's a little bit on the individual also, but I want also to say that there are other larger factors that are important, whether they are social or environmental for example. And I think I totally agree with what was said.
It's training is important and many professionals, not only doctors, many professionals are involved not only in the health business. I mean, even educational business, it's so important to be doing something at the school level, college level, I mean to to support this healthy lifestyle in general. So what I want also to say is that science is dynamic.
I mean, we we provide scores or whatever or decisions. Of course, they may not be perfect from the start. I mean, they have to change because our knowledge changes. We know now that, you know, we we've put a lot of emphasis on fat at one point, but we know now that sugar is not so good. I mean, and we should put more emphasis on sugar and salt because of hypertension than we used what we used to do in the past.
So science is dynamic. You cannot put a decision on based on science once and for all for all the lifetime. You have to revise what you're doing. And we as scientists know that sometimes we are not doing really well and and but we can correct ourselves and try to do better in in when when we revise it. But for that, we need to have the tools that are important.
I mentioned very large cohort. I think these are extremely good tools because instead of having so many scientists doing small cohorts on their own and we cannot take any conclusion at the end, it's better to do it all in in a way. And I think the European level is is the right level for this. I think I should stop here.
Adam Jarubas
Thank you so much, Professor. Thank you all for a fruitful discussion on the first panel. We will now move directly to the second panel of this public hearing. For this panel, we welcome Mrs. Alba Gil, who is senior policy officer at the Association of European Cancer Leagues in Brussels, and Mr. Gianluigi Giannelli, gastroenterologist and scientific director of Saverio de Bellis Research Hospital from Italy. As for for the first panel, I invite colleagues who would like to take the floor for indicating to me and the secretariat.
Now, I would like to give the floor to our first speaker of the second panel, Mrs. Gil, you have the floor for eight minutes, please.
Alba Gil
Thank you, Chairman. Honorable members, I represent the Association of European Cancer Leagues, and we are the voice of national and regional cancer organizations in Europe. Our vision is a cancer is a Europe free of cancer, and it's a future that is in the horizon, and we know what to do to get closer to that. We have heard how NCDs burden is increasing, and we have heard how how the pressure on the economic systems is increasing. We have also heard how 60% of the of all the deaths that account for NCDs are avoidable.
Cancer is on track of becoming the leading cause of death by 2035. It is already the the leading cause of death in some countries, such as Belgium, Netherlands, and Spain. The other cause of death we we know it's the cardiovascular diseases. And when it comes to the healthcare systems, as you can only imagine, this puts a massive pressure on the healthcare systems. Only cancer, and these are these data are only for cancer, we don't take into account cardiovascular diseases, diabetes, and other and other main diseases.
We know that in 2023 cancer costed 120 billions of euro, which is around 300 euros per EU citizen, and it accounts for almost 7% of the total health expenditure. If we take into account that this data is only for cancer, without taking into consideration cardiovascular disease, we come to the conclusion that the cheapest and the most affordable measure is to keep people healthy in the first in the first sight instead of of treating them.
Oratore 29
And this is of course without taking into account the the labor market impact that cancer has. When we look closer at cancer, the most common cancer for women is breast cancer, for men is prostate cancer, and then we have colorectal and lung cancer. These are also correlating with the most deadly cancer, which is lung cancer, and we are very aware that the main risk factor is tobacco. One in five deaths globally to cancer are caused by one single product, which is tobacco. And here I must remind the chamber that we have a golden opportunity to curb these numbers with the taxation, tobacco taxation directive, tobacco product directive, and tobacco advertisement directives.
The good news is that over 40% of all the cancer cases are preventable. The commissioner said that identifying risk before they become a disease is is a key factor, and indeed it is. And for cancer we have identified very well the risk, and the risk are tobacco, alcohol use, unhealthy diets, and then air pollution, harmful chemicals, unhealthy unhealthy diets again. And what is important here to take into account is that we need policies that aim at keeping population healthy instead of treating the population which is already which is already ill. For example, talking about food and cancer, we see that weight is a massive risk factor for cancer.
And if you look at the slides, you can see that you can identify breast and colorectal cancer, which were the most common cancers that we have nowadays. And here we have also the the link between diets and cancer, and we have that unhealthy diets usually they are characteristic for having less fruits and vegetables, which are which are protective for cancer. They have lower whole grain income, which is intake, which is preventive for cancer. And then they are high in in unhealthy in unhealthy red meat and ultra-processed meats. And also alcohol.
And I'm happy to hear that some MEPs raised the the question. When it comes to alcohol and cancer, honorable members, we know since the 80s that there is no such a thing as safe level of drinking alcohol. We know that drinking alcohol is linked to several types of cancer. And again, here you can see the breast cancer and colorectal cancer, which is the most common cancer for men and for women. Therefore, wording like harmful consumption or level exceeding scientifically established health recommendations, this is deeply misleading and this is deeply problematic because it implies that there is a harmful a safe consumption of alcohol, which there is no.
And when it comes to awareness and since we are talking about lifestyle and information, please let me remind you that between 80 and 90% of women don't know that alcohol causes breast cancer, which is the most common for us. And the fact that the Europeans Beating Cancer Plan has not been fully implemented, that the health warnings for alcohol is not in place, this prevents around 80 and 90% of women to take informed choices of the risk that they want to take when they drink alcohol.
And of course, and of course, we, this chamber is very aware of the, sorry, of the joint actions that we have had around cancer and the European Commission's Europe's Beating Cancer Plan, and indeed the BECA report with the BECA committee that we had in the last term. And this includes many of the aspects that we have been talking for, for behavior change, EU fruit school, food of labeling, and so on. And here the European Code Against Cancer has played a massive role, and it is 14 recommendations that are addressed to citizens on how they can reduce their individual risk of cancer. And if we take a closer look, linked to diet, we have overweight and obesity, physical activity, diet, and alcohol, and many of the policies have been already mentioned. And the most important part of this European Code Against Cancer, the fifth edition, is that for the first time it includes policy recommendations addressing the fact that lifestyle and individual choice, and we have heard about it, is not enough.
Blaming individuals, pointing at individuals, and expecting that people make healthy choices when the context is as it's designed for us not to make it, that is not enough. And we need policies that support healthy environments and healthy choices. And here these policies are very in line with the WHO best and quick buys, and many of them can be tackled also within a political term, which is interesting for everyone in this chamber. And for example, we have heard unhealthy food marketing for kids, public procurement, taxes. Taxes is the most relevant policy when it comes to shaping consumption.
Sorry, I'm fighting with the sticker. And when health literacy and health information meets its ultimate limitation is when it comes to children. Children nowadays are largely exposed to unhealthy environments. We have heard about vapers, we know about tobacco, ultra-processed foods is yet another example. And I hope we agree that we cannot expect children to make informed choices when we have their favorite cartoon advertising the food or the product, the unhealthy commodity that they should not be taking.
Sorry. Now, and this has already been mentioned and it's worth repeating: mortality, cancer prevalence, cancer survival is directly linked to socioeconomic status. We know that the lower the socioeconomic status, the more exposed we are, the less chances we have to have access to treatment, to medicines, to healthcare systems, to social security that pays as well we are away from work, and so on and so forth. And here I want to emphasize that promoting health and preventing disease is not a wish list, it's a legal mandate. And it's a legal mandate that is founded in the European treaties, and I'm finishing, and it's a legal mandate that has as a mean the single market and that could and that should have all the resources and all the policies available within the competence of the Union, because at the end of the day, the reality is that one in five Europeans are in risk of poverty, are in risk of developing not only cancer but all NCDs, and are in risk of falling behind in a Union that should not allow that.
Adam Jarubas
Thank you. Thank you, Mrs. Alba Gil. In the meantime, the group of visitors hosted by MEP Voiculescu came to us. Cordially welcome. Professor Giannelli, the floor is yours, please.
Gianluigi Giannelli
Thank you. Good morning everybody, good afternoon everybody, and let me thank first organizers for this invitation. The title of my presentation is investing in health before disease. And this is because I want to make one point very clear. If we want a sustainable healthcare system, we must keep people healthy before they become patients.
Oops. Let's start first with Italy, and this is a case study for a broader European challenge. In particular, I want you to take a look of these three numbers. 43% of the Italian adults aged 16, well, I have to say that this is quite challenging for my eyes, but 43% of the adult people actually live with overweight or obesity. One in ten is actually obese.
And probably the most striking number is 92.6% eat fewer than five portion on the fruit and vegetables in a day. So these are the statistic of lifestyle today, but actually they will be the chronic disease burner tomorrow. So the first question we should ask is who should we reach and when? If you take a look on the graph on your left side, it is telling that overweight is increasing percentage from during age. So in the youngest group, 18 to 34 aged people, it is 21.5%, reaching 39.3 in the oldest one, 50 to 69.
The same does also hypertension, that goes from 2.2 in the youngest group up to 35 in the oldest one. And diabetes that is less than 1% in the youngest group up to 8.7 in the oldest one. So what this graph is telling us is that actually we do have a window where we can make action. And this is exactly when the slope of the curve become steeper and we have time to make an action. But obesity is also more present in people with lower economic situation and with poor education.
So the take-home message of this slide is that prevention must start before disease, but also is a matter of health equity. Last year Italy has been the first country in the world to adapt a law recognizing obesity as a progressive and relapsing disease. This has been such a milestone achievement that has been reported also on Nature Medicine, that is one of the most influent recognized journal in the international scientific community. So the next coming year, the government will pour 1.7 million euro by year. However, only in Italy, the government spends about 1.6 billion of euro only for glucose-lowering drugs.
So such a difference is a tremendous difference, and this is because our healthcare system, I have to say as all the healthcare system in the world, are structurally designed to spend after disease appeared, rather than to invest in prevention. So we spend more likely in downstream rather than spend in upstream. So let's see how a primary prevention can look like.
Oratore 32
This is a model we have built in our institute and this focuses on three main activities: physical activity, nutrition and primary care. Going from an individual relationship with the trainer to a group and finally to autonomy. The same is with the nutrition with the individual counseling to group counseling and to maintenance. In this model, the primary care should provide selection of patient safety and continuity through the all program. So we have a model going from the less revision at every step with the will that at the end people can maintain what they have learned.
We estimated that for a 12-month program the cost is 3,000 euro per people. So the real question is: can we afford to invest in a program like this? But actually I turn around the question: can we afford not to? Because if you take a look of this graph you see two different curves, the red one and the green one. The red one is the cost...
So the red line is the cost of keeping 100,000 adults aged 50 with obesity enrolling approximately 4,000 patients every year. And the green line is the cost of the same patients if we adapt also the program. So this model is telling us that over 25 years is estimated in 180 millions euro what the healthcare can save over time. So let's go from evidence into policy. Once again this is something we have experienced in our institute: live better, diet and physical activity can improve measurable metabolic outcomes.
But also is a matter of age better because high adherence to a Mediterranean dietary patterns is associated with longer survival. And also this has an impact on the use of healthcare better because higher Mediterranean diet adherence is associated with the shorter hospital stay and the lower cost. We have calculated that for one point of the Mediterranean diet adherence that can be calculated by an international recognized score takes 0.3 day less each hospitalization and 36 euro less and overall 13% of death less. So this goal is not just to add years to life but rather health to years. Once again let me show you the experience we have done in the Bellis in many years, in particular last year.
We have set up an healthy cooking masterclass where patients with chronic liver disease in the picture, I'm just not as a patient over there, can learn how to cook with healthy suggestion let's say but still providing very tasty and excellent food with the help of some professor. On the right side you see that is a picture with some patients that have been enrolled in a research program working in a small group with two or three patients with one trainer and that trainer is a researcher in the institute. We also organize one day a walking for the health to promote the healthy lifestyle and last year we had 2,000 participant and the next year will be the 11th October so the all of you are welcome to come over in Castellana.
And so my last slide is the take-home message. For the last decades, the European community has put a lot of effort to improve diagnosis and treatment of chronic disease, in particular to cancer, achieving actually fantastic results. It's time now to take this new challenge and to invest before disease. Nutrition education, healthy food environments, physical activity, and primary care community are the four points that could be taken in the agenda. This is because prevention is not a cost for the healthcare, but is an investment for its sustainability.
Thank you for your attention.
Adam Jarubas
Thank you so much. Dear colleagues, I open the short block of discussion. Please keep, please try keep one minute time each. Vytenis Andriukaitis as a first, please.
Vytenis Povilas Andriukaitis
Ačiū labai. Labai dėkoju už informatyvų pristatymą, kuris mane įtikina dar kartą prisiminti European Code Against Cancer, 5th edition, organizacijos International Agency for Research on Cancer. Ir jeigu pasižiūrėsite labai gerą, labai gerą, kaip sakyti, prezentaciją, ir ten parašyta: štai paspausit physical activity, paspausit policy, ir iškart politikų instrumentai. Diet, policy, politikų instrumentai. Alcohol, policy, politikų instrumentai.
Viskas yra akivaizdu. Mano klausimas: ar jūs nenorėtumėt prisidėti prie to, kad Europos Parlamentas aprobuotų prevencijos strategiją štai štai tokiu pavyzdžiu, nes visi rizikos veiksniai galioja ir kardiovaskulinėms ligoms, ir vėžiui, ir diabetui, ir nutukimui, ir daugeliui kitų. Ne, jie didžioji dauguma Lancet paskelbtų rizikos veiksnių taip pat tie patys adresuojami ir mental health. Tai mano klausimas: ko mums trūksta, kolegos, ko trūksta? Mokslo, žinių, duomenų?
Būdamas komisarų pasirašiau Code European Code of Cancer dar 2015 metais. Deja, įgyvendinimas yra daugiau negu nulinis. Todėl aš agituoju šį Parlamentą imtis iniciatyvos, priimti prevencijos strategiją. Duomenų pakanka.
Viktória Ferenc
Thank you very much. Thank you for the presentations. And I think we can all agree that prevention must start before the disease. I'm here. Before the disease, so we can, we have to start with the prevention.
And in particular, nutrition information has a key role to play in the area of prevention. We are talking more and more about ultra-processed food and how we can help consumers recognize healthier choices as part of nutrition education. So my question would be, to what extent do you consider the current evaluation system such as the Nutri-Score to be adequate in terms of prevention? It is not a problem to try to classify a compound food into a single, into a single category or score based on just a few nutrients? There are also new research approaches that look much more broadly at the composition of a food and its impact on health.
These approaches show that in the future we may be able to understand more precisely what makes food different from one another from a health perspective. So I would like to ask how can we incorporate scientific evidence into consumer information in such a way that it actually helps people to develop healthier diets and thus helps prevention? Thank you.
Adam Jarubas
Thank you. Michele Picaro is calling somewhere. Michele Picaro, the floor is yours, please.
Michele Picaro
Thank you very much, chair. Thank you very much for the speakers. Grazie per un e il validissimo contributo che avete dato. Saluto con grande piacere il professor Giannelli, italiano, la professoressa Gill. E vorrei, diciamo, fare una riflessione partendo da un dato che quando parliamo di sostenibilità dei sistemi sanitari, la prima domanda è spesso dove trovare le risorse per curare chi è malato.
È una domanda fondamentale, ma credo che dovremmo porcene un'altra anche. Come possiamo oggi per fare in modo che le persone possano non ammalarsi? Per questo evidenzio la scelta del governo italiano che ha rafforzato la prevenzione con il nuovo piano nazionale 2026-2031 che presta attenzione proprio alle differenze tra i territori e per il 2026 prevede 50 milioni di euro aggiuntivi per le attività di prevenzione. Nella vita di tutti i giorni prevenzione significa anche educazione alimentare a scuola, un medico di famiglia che aiuta a riconoscere un rischio e la possibilità di fare attività fisica vicino casa. Sono cose semplici da descrivere ma richiedono organizzazione e continuità, soprattutto devono arrivare anche a chi oggi ha meno accesso a queste opportunità.
Allora vorrei chiedere agli esperti e mi avvio a conclusione, grazie presidente, se dovessimo scegliere da dove cominciare, quali interventi di prevenzione primaria finanziereste per primi e quali risultati dovremmo misurare per capire se stanno migliorando la salute delle persone e riducendo nel tempo la pressione sui sistemi sanitari.
Tilly Metz
Thank you very much. We know that we need to reduce the consumption of products high in added sugars, salt and unhealthy fats. We need to invest in education, we need to invest in communication from school to adult life. And the same applies also to alcohol. We know that alcohol is a risk factor for cancer and other non-communicable diseases and there is no safe level of alcohol consumption when it comes to cancer risk.
So promoting healthier, more plant-based diets can bring benefits both for human health and for the environment. So I will be very short. My question is really how to move from an approach where we are only telling the people to live healthier towards actually creating consumer environments that make healthy choices easier, particularly for children and also for people living with health inequalities. Thanks.
Oliver Schenk
Mit Blick auf die Uhr mache ich es ganz kurz. Ich habe eine Frage zu den Instrumenten. Was ist aus Ihrer Sicht das richtige oder der richtige Instrumentenmix, um diese Dinge einzuführen? Wenn wir über Steuern reden, haben wir großen Protest. Wenn wir über Verbote reden, haben wir großen Protest.
Wenn wir über Nudge-Effekte reden, dann haben wir die Debatte über Manipulation der Gesellschaft. Gibt es etwas, wo Sie Erfahrung haben, was am wirksamsten umzusetzen ist?
Leire Pajín, please.
Leire Pajín
Gracias, presidente. Quiero empezar diciendo que solo uno de los datos que la señora Gill ponía encima de la mesa nos debería hacer actuar. El hecho de saber que el 40% de los cánceres son evitables debería hacernos más que reflexionar. Y en ese sentido quiero apuntar tres ideas. La primera es que tenemos que fortalecer los sistemas de salud y no dejarlos caer, como estamos viendo en algunas regiones de España, especialmente en los sistemas de atención primaria, que son quienes están promocionando la salud y haciendo esta tarea de la que hablábamos.
En segundo lugar, tenemos que legislar y regular para proteger a los más vulnerables y ser valientes en la legislación del tabaco y del alcohol, ya se ha dicho aquí. Y en tercer lugar, tener una visión de una única salud y ser transversales. No podemos culpabilizar al final a los ciudadanos de sus comportamientos. No podemos pedir una alimentación sana si los alimentos saludables no están al alcance de todos y no podemos pedirle a los ciudadanos que paguen por su propia salud. Por eso creo que deberíamos invertir más en salud, que es inversión y no gasto, y tomarnos muy en serio los diferentes determinantes sociales de la salud.
Gerald Hauser
Danke, Herr Vorsitzender. Also heute haben wir darüber gesprochen, was wir tun müssen, damit die Menschen gesund bleiben. Und im Wesentlichen haben wir gehört, dass eine gesunde Ernährung und gesunde Lebensweise, sprich also mehr Sport und so weiter. Aber ich darf das jetzt einmal auf den Punkt bringen, sehr einfach, sicher reduziert. Menschen, die Geld haben, sprich wo die sozioökonomischen Faktoren gegeben sind, die haben zumindest die Chance, sich gesund zu ernähren und auch dementsprechend Sport etc. zu betreiben.
Aber der Großteil der Menschen hat ja nicht einmal mehr die Chance dazu, weil zwischen 50 und 75 Prozent der Menschen in Europa mit dem derzeitigen Leben Probleme haben, sich das Leben zu finanzieren. Und die entscheidende Frage, die heute eigentlich nie angesprochen wurde, ist: Was müssen wir tun, um genau diesen Menschen zu helfen? Ich habe also hier drei konkrete, drei konkrete Vorschläge. Erstens einmal eine gesunde Jause. Bitte vergessen Sie nicht, der mehrjährige Finanzrahmen soll von 1,2 Billionen auf 2 Billionen angehoben werden, unglaublich viel Geld.
Da muss es doch möglich sein, den Kindern europaweit, EU-weit eine gesunde Jause zu geben. Zweitens, kostet wenig: mehr Sport in den Schulen. Das ist eine Frage des Stundenplanes. Und drittens, das ist sozioökonomisch sehr korrekt: Schauen wir doch darauf, dass Schulsportwochen für alle Kinder möglich sind. Auch da stellt sich die Frage der Leistbarkeit, und da kann das Geld der Europäischen Union endlich einmal sinnvoll eingesetzt werden.
Adam Jarubas
Thank you. Aurelius Veryga? No. Christophe Clergeau, please, shortly, if I may ask you, please.
Christophe Clergeau
Oui, une nouvelle contre-vérité de Monsieur Hauser puisque tous les orateurs ont indiqué que la question des comportements individuels et la question sociale étaient indissociables, donc on en a parlé. Moi, je voudrais demander au président de la commission que cette commission dise à nos collègues d'ITRE qui sont en train de négocier le fonds de compétitivité qu'on a besoin des 10 milliards pour financer les politiques de santé publique européennes. Ce que tout le monde a dit, que le coût de la non-action était très élevé et qu'il y avait un besoin urgent d'investissement massif. Donc là, il faut encore qu'on fasse notre rôle de député au sein de ce Parlement. Et j'ai une question aux différents orateurs.
Est-ce que vous êtes favorables à l'interdiction de la publicité sur les produits hautement transformés en direction des enfants aux heures où les enfants sont devant la télévision ?
Nicolás González Casares
Gracias. Ha habido, han salido puntos muy interesantes. Algo que venía a refrendar lo que decíamos antes: no podemos ir en contra de la evidencia científica cuando hacemos estrategias que tienen que ver con la promoción de la salud, porque lo que acabamos es trasladando un mensaje equivocado a la ciudadanía y no consiguiendo nuestro objetivo final, y es mejorar los estilos de vida y una mejor salud. No se trata de un hecho de prohibir, no, al final es una decisión individual, pero debe ser una decisión individual informada, porque la industria, buena parte de la industria, tiene los recursos y dedica los recursos para que esa decisión no sea informada.
Y lo que tiene que hacer la salud pública, lo que tenemos que hacer los que regulamos, es contraponer la balanza y conseguir dar a la ciudadanía toda esta información perfectamente basada en la evidencia científica. Cuando caemos en esas trampas, cuando no decimos la verdad en cuanto al alcohol, cuando no decimos la verdad en cuanto al tabaco u otras otros condicionantes y pervertimos el discurso diciendo esto es lo que quieren es prohibir, lo que estamos es robando oportunidades a un niño, una niña, a un adolescente o a un adulto de tener una vida más larga, más longeva y más saludable. Y creo que esa es nuestra responsabilidad y por eso no caigamos en esa trampa de ustedes quieren prohibir. No, yo quiero la mejor información para poder proveer a la ciudadanía de evidencia científica. Gracias.
Adam Jarubas
Thank you. I now give the floor back to our experts for two minutes each.
Oratore 29
Challenge accepted. So many of the of the questions that has been raised here and thank you very much everyone for your questions, the answer would be food environments. We can shape the context under which decisions are made and we can protect vulnerable populations, not by putting more pressure on them like you should choose better, but making the the healthy choice the easiest, the more affordable, the more available, the the most promoted. And here we have mentioned unhealthy food kids for marketing. It's not about banning.
It's about giving a plain floor and fair floor where we all can develop as as citizen. And this is the ultimate goal of the social contract where we are allowed and we should be allowed to develop as citizens, besides commercial interest. Children should not be treated as as commercial targets. They should be treated as as citizens that they are developing. On the front of package nutritional label and thank you for your question, I would say that the the important part here would be to to stick to the World Health Organization guidelines on the front of package and that would be that they are colored, that they they inform good and not that good choices, that they are gradient.
Nutri-Score fits under this classification and Nutri-Score is already implemented in several member states and it's already recognized by citizens. It's one of the tools. That would be my my my take. And Mr. Andriukaitis, on the European Code Against Cancer, if we wish to see the policies implemented, that's that's what I do as a living and I hope that one day the European Parliament, the European Commission and the member states, you will put in place policies that prevent cancer because cancer is not only preventing from laboratories and researches, cancer is preventive from this very house and cancer is preventive from the from Schuman and cancer is preventive also from the Council. So thank you very much for your question.
Oratore 32
Thank you. Okay, I'm I'm not sure I'll be able to answer all the question in in a decent time. Let's say that we need to to run in different directions. For sure science has already explained how important is a lifestyle. Nevertheless, science is never enough.
For example, I could I want to give you two data. The first one is a paper published a couple of months ago where in US they have provided healthy food to people in a very very low economic situation and because of it they have registered a lower number of access to the emergency care and a lower number of hospitalization.
And the second is that we when we should when we should start to provide some lifestyle counseling. I would say when we at school at school age. However, we know that because there are publication on that, according with the dietary pattern of a woman during pregnancy, the microbiota of the fetus is different and this is and this will already affect somehow the capability to gain or not to gain weight during adult lives. So it means that for sure we need to keep treating people, but also we need to have a serious and heavy plan to prevent obesity that is I would say the bottleneck of all the chronic disease. In my region, Apulia, although we are in the middle of the Mediterranean Sea, our region has is the third region in Italy for number of children with obesity.
And this is something that has to make us think about because it's not just a matter of suggest diet, suggest physical activity, but the social context definitely is relevant. For example, I want also to put the attention on the time that children pass on smartphone or other electronic device rather than going in the street and play any kind of of a physical activity. Also about spot about alcohol and tobacco. What I've seen so far is there are only some spot suggesting non drinking too much if you then will drive and this is for sure that is a very good message. However, I never have seen spot regarding tobacco that as has been said already is the most important risk of lung disease.
So I believe that we need to start at school, we need to start what they cook, what they cook also at home and to improve a lot the physical activity in particular for those people that not have access to provide gym or to provide sport activity for they for their son. Thank you.
Adam Jarubas
Thank you, Professor. Thank you all for this timely, very relevant discussion. Let's give the applause to our expert. I would like to thank especially all the invited speakers for being here with us today in Brussels and sharing their views on the topic of disease prevention, which is so important in this turbulent time. Thank you so much.
Dear colleagues, let's now move to the vote. First, adoption of the draft report of the EURORDIS action plan. Short information about replacement. Mr. Maranle replaces Nikos Papandreou. Thomas Kubin replaces Andre Knotek.
Asger Christensen replaces Tine Bosse. Contrim de Figueiredo replaces Veronika Stikhonova. Benedetta Scuderi replaces Ignazio Marino. Rudy Kennes replaces Katarina Martins. And Susanna Borvendeg replaces Christine Anderson.
Before proceeding with the vote, I give the floor to the rapporteur Nicolas Gonzalez Casares for a one-minute statement. Nicolas, the floor is yours, please.
Nicolás González Casares
Gracias, presidente. Hoy votamos el plan de acción europeo sobre las enfermedades raras, un trabajo que no es de un grupo ni un eurodiputado, sino del conjunto de las aportaciones de todos a través de más de setecientas enmiendas. Gracias a los shadow rapporteurs por vuestro trabajo, generosidad durante estos meses. Es un trabajo de todos. Es un trabajo para treinta millones de personas que viven en Europa con enfermedades raras, so thank you colleagues for your support.
Y a las personas que viven con una enfermedad rara y a sus familias. No estáis solos. Europa os ha escuchado y damos un paso firme para que ningún diagnóstico llegue tarde. Os pido un apoyo sólido, que sé que lo vamos a tener, para entregar un mensaje claro a la Comisión, un mandato claro para las enfermedades raras. Gracias.
Adam Jarubas
Thank you. One replacement more, Mr. Pedura replaces Mrs. Palmisiano. Okay, dear colleagues, let's now proceed to the vote. First, let's do a testing vote by roll call. I open the vote.
I close the vote. Okay, thank you. We're voting by first by raising hand. Compromise amendment one, who is in favor? Against?
Abstention? Adopted. Compromise amendment two, who is in favor? Against? Abstain?
Adopted. Compromise amendment three, in favor? Against? Abstain? Adopted.
Compromise amendment four, in favor? Against? Abstain? Adopted. Compromise amendment five, who is in favor?
Against? Abstain? Adopted. Compromise amendment six, in favor? Against?
Abstain? Adopted. Compromise amendment seven, in favor? Against? Abstain?
Adopted. Compromise amendment eight, in favor? Against? Abstain? Adopted.
Compromise amendment nine, in favor? Against? Abstain? Adopted. Compromise amendment ten, in favor?
Against? Abstain? Adopted. Compromise amendment eleven, in favor? Against?
Abstain? Adopted. Compromise amendment twelve, sorry twenty, sorry, compromise amendment twenty, in favor? Against? Abstain?
Adopted. Compromise amendment twelve, in favor? Against? Abstain? Adopted.
Compromise amendment thirteen, in favor?
Compromise amendment 12. In favor? Against? Abstain? Adopted.
Compromise amendment 13. In favor? Against? Abstain? Adopted.
Compromise amendment 14. In favor? Against? Abstain? Adopted.
Compromise amendment 15. In favor? Against? Abstain? Adopted.
Compromise amendment 16. In favor? Against? Abstain? Adopted.
Compromise amendment 17. In favor? Against? Abstain? Adopted.
Compromise amendment 18. In favor? Against? Abstain? Adopted.
Compromise amendment 19. In favor? Against? Abstain? Adopted.
Compromise amendment 21. In favor? Against? Abstain? Adopted.
Compromise amendment 22. In favor? Against? Abstain? Adopted.
Final vote by roll call vote. I open the vote. I close the vote. Adopted, congratulations to the rapporteur. Dear colleagues, let's now move to the next point of today's meeting, which is the adoption of the draft report of the Europe's Beating Cancer Plan.
Before proceeding with the vote, I give the floor to the rapporteur, Vlad Voiculescu, for one minute please.
Vlad Vasile-Voiculescu
Thank you, Chair. Cancer kills 1.3 million Europeans every year, and about half of these cancers are preventable. Half of them. The Europe's Beating Cancer Plan is one of the most important pillars of the European Health Union, indeed the most important healthcare strategy we have until now. The report strengthens every dimension of it: stronger prevention, earlier detection, fairer access to treatment, better support for survivors, and real accountability through measurable targets.
But a plan without funding is obviously a promise without credibility. This report also demands dedicated resources in the next EU budget and a structured annual dialogue with the Commissioner to ensure that the plan actually delivers real results for real patients. Before we vote, I want to thank my team and every shadow rapporteur in the room today. Your presence here and also the presence of many young civil leaders joining us today, mulțumesc, their presence is also a reminder of why this report matters. You also represent the generation that will live with the consequences of what we decide here today, and your health must be at the center of our ambition.
Colleagues, let us give this report the broad, united vote that Europe's cancer patients deserve. Thank you.
Adam Jarubas
Thank you, Vlad. Let's now proceed to the vote. We're starting with the raising hand vote. Compromise amendment one, who is in favor? Against?
Abstain? Adopted. Compromise amendment two, who is in favor? Against? Abstain?
Adopted. Compromise amendment three alternative compromise by roll call vote. I open the vote. I close the vote. Rejected.
Compromise amendment three roll call vote. I open the vote. I close the vote. Adopted. Compromise amendment four, who is in favor?
Against? Abstain? Adopted. Compromise amendment five, who is in favor? Against?
Abstain? Adopted. Compromise amendment six, who is in favor? Against? Abstain?
Adopted. Maybe let's do it a little bit slower. Compromise amendment seven, who is in favor? Against? Abstain?
Adopted. Compromise amendment eight, who is in favor? Against? Abstain? Adopted.
Compromise amendment nine, who is in favor? Against? Abstain? Adopted. Compromise amendment ten, in favor?
Against? Abstain? Adopted. Compromise amendment eleven, in favor? Against?
Abstain? Adopted. Compromise amendment twelve, roll call vote. I open the vote. I close the vote.
Adopted. Compromise amendment alternative citations. Who is in favor? Against? Abstain?
Rejected. Compromise amendment citations, who is in favor? Against? Abstain? Adopted.
Compromise amendment alternative recitals by roll call. I open the vote.
One is missing. Maybe intentionally. I close the vote. Rejected. Compromise amendment recitals by roll call.
I open the vote. I close the vote. Adopted. Final vote by roll call. I open the vote.
I close the vote. Adopted, congratulations to the rapporteur. Dear colleagues, any other business? None foreseen. Dear colleagues, I close today's meeting.
Our next meeting will take place on 15 October. Thank you all. I invite coordinators to stay for the coordinators' meeting here in a moment. Thank you so much.