14 July 2022
Asthma , COPD

In a much-awaited launch, the European Commission presented on 22 June the final guidance document of the Healthier Together – EU NCD Initiative, the first EU-driven proposal in a decade aimed to address the non-communicable diseases (NCDs) epidemic in the EU.

The NCD guidance document is the outcome of a 6-month long consultation with Members States and stakeholders. It outlines policies and approaches to help countries address the burden of NCDs, while assisting the EU in achieving its WHO NCD targets by 2025 and the health-related Sustainable Development Goals by 2030.

The initiative focuses on five main strands defined by disease-area: Cardiovascular; Diabetes; Chronic respiratory diseases; Mental health and neurological disorders; and health determinants (cross-cutting strand). Meanwhile, the actions under the EU NCD Initiative will be developed in synergy with the Beating Cancer Implementation Roadmap that is being rolled out in parallel.

EFA has welcomed the initiative and proactively engaged with the Commission and other stakeholders throughout the consultation process, bringing the voice of patients living with allergy, asthma and COPD on issues related to the care aspects of their conditions, as well as on risk factors that trigger and/or worsen them.

Chronic respiratory diseases (CRDs): spirometry, education and management as the basis, but with limited buy-in by Member States

In relation to chronic respiratory diseases, the NCD initiative identified the following main priority areas, by order of importance: 

  • Improved care and management of chronic respiratory diseases to prevent exacerbation and acute events;
  • Early detection of chronic respiratory diseases, with a focus on the use of spirometry in primary care settings;
  • Ensuring (access to) high-quality CRD care and self-management support, by raising awareness and educating patients through e-learning and peer-support groups, as well as with the introduction of basic tele-health and more advanced tele-monitoring using digital tools and devices.

Overall, the support of the EU Member States of the chronic respiratory diseases interventions is low, as at this moment only seven Member States out of 27 have demonstrated clear interest on actions to improve the care and management of CRDs, and only six would like to invest on the prevention of onset and progress of CRDs. Worryingly, little to no Member State interest has been communicated towards raising awareness, establishing early detection programmes, and ensuring high-quality CRD care.

With our response to the consultation, EFA has been successful in driving and shaping many CRDs-related points in the final NCDs guidance text, both linked to the policy focus areas, as well as in relation to the best practices to have ideas implemented. On the one hand, some examples that stem from EFA’s information to the European Commission are the importance of spirometry for diagnosis, the strong reference to disease self-management and therapeutic education, and the digital opportunities.

On the other hand, EFA has been long advocating for more attention to the centrality of allergy care to prevent and manage CRDs. It is an EU milestone that the NCD guidance acknowledges Regretfully, allergy in general falls out of this initiative despite food and contact allergies and atopic dermatitis being among the most prevalent NCDs in childhood.

Health determinants: lifestyle factors in the spotlight, as climate change hazards fall behind

The priorities identified on health determinants included actions to reduce tobacco, alcohol consumption, unhealthy eating, and physical inactivity (misleadingly presented as ‘lifestyle choices’), while also referring to the creation of healthy living and working environments.

EFA considers the proposals to address health determinants fall short at offering a cohesive vision that draws links with other non-health EU policies and enables coherence to global and fatal threats to health. Strikingly, despite the important actions proposed, we regret to see that the document largely overlooks the currently tangible climate change effects on health and the related risks for chronic respiratory diseases patients and other major NCDs.

Of particular interest for EFA are the following areas:

  • Prevention of tobacco use, both in the general population (supported by 13 Member States) and among the youth (supported by 17 Member States). Proposed priorities include actions towards a tobacco-free generation by 2040; improving the enforcement of EU legislation at the national level; supporting the implementation of the Framework Convention on Tobacco Control (FCTC); addressing the commercial determinants of tobacco; promoting tobacco cessation; and limiting youth access to such products.
  • Reduction of air pollution, both outdoors and indoors. The guidance document discusses the risks posed by air pollution on respiratory health. The updated WHO Air Quality Guidelines is referred to as the example to follow. Moreover, a welcome focus is given to indoor pollution, especially from the perspective of exposure second-hand smoke. Overall, air quality is acknowledged as a key risk factor that must feature in a Health-in-All-Policies approach.
  • Creation of healthy living and working environments (supported by 16 Member States), including health promotion and disease prevention interventions in certain settings e.g. communities, schools, workplaces.

Overall, EFA welcomes the participatory approach of the EU NCD Initiative and the focus the European Commission has decided to give to chronic diseases in the aftermath of the C0VID-19 pandemic. However, as regards chronic respiratory diseases, we urge the Commission to define concrete proposals that will facilitate uptake by the Member States, while adopting a more coherent approach on health determinants: one that addresses needs and risks in a holistic patient-centric way and breaks existing silos among EU policies.

EFA remains actively engaged in this NCD process and will bring our expert patient knowledge to inform and implement this initiative. Over the next years, the Commission plans to continue working together with stakeholders and Member States to update the guidance document.

For more information, you can access the EFA response to the NCD Healthier Initiative consultation.