The Swedish presidency has identified a number of health priorities. I’d like to reflect on the following:
1. patient mobility directive,
2. e-health cooperation, and
Patient mobility adds cross-border health risk as people with diseases move around. Zoonoses, diseases caught from animals (and it is worth remembering that animals catch diseases from humans, for instance pigs have caught H1N1 from humans in Canada), are spread by mobility. Perhaps the most dangerous animal other than humans for disease transmission are bats, flying in a 3d world, social animals with rather exotic immune systems. I’m all for patient mobility and see within this considerable opportunities to offer patients greater choice, drive quality improvements in national health systems, and so on.
E-health cooperation is important. However, cooperation between health systems at some level is actually quite mundane:cross-border access to electronic health records, an EU-recognised prescription and cross-border dispensing, smart card for health and so forth. This has been the focus but real national progress is still weak, perhaps constrained by fear of unrestrained cross-border care itself. E-health works when location doesn’t matters, that the patient matters more than where the hospital or doctor is located. Underlying e-health are some really disruptive forces, such as unpicking the cartel-like behaviour and favoured position of particular health professions, and replacing professionally defined service structures with ones that reflect patient preferences, giving patients real power and control over health information, indeed, fully empowered patients and health consumers might actually drive the objectives of health policy, something that might upset the privileged role of the policy elites that gather for their usual policy pow-wows.
But, e-health for Europe means something a bit different, hence my inclusion of flu. Cross-border vigilance of zoonoses becomes possible by bringing together satellite or similar sensor networks, real-time data transmission, and really useful mapping for visualisation.The current flu pandemic is really only one in name; there are far worse diseases currently ravaging human populations, killing more people in a day than the current flu has so far in total. With climate change for instance, they are coming to a neighbourhood near you, and animals, insects, snails, and other hosts migrate north.
Of course, it goes without saying that such technical capabilities must be put into some context — why would we want to do this anyway?
Simply put, such a system enables free movement of people around Europe within a system of disease monitoring and decision-making that aligns the problems and necessary resources better. Our public health models, we have learned with the current H1N1 pandemic shows that containment strategies don’t work. Despite Treaty powers at national levels, health issues in a cross-border world transcend the ability of member states to act in a fully autonomous way, when their actions/inactions may affect the health of others (recall the UK and BSE crisis).
So, while each of these three threads is in and of itself worthy of significant hyperactive attention, the real opportunities lie when they are put together, seeing the linkages amongst the parts.
Perhaps one of the lessons that might come from the Swedish presidency is an understanding that in the modern world, the really important issues are complex, almost chaotic.