Europe has in many ways led in the prevention of non-communicable diseases (NCDs). Indeed, some of the best examples of mortality decline in NCDs globally are to be found among EU countries. Europe has also generated many innovations that are emulated worldwide. The classical North Karelia project in Finland has become proverbial for its success in reducing coronary death rates and is still widely cited as a leading example.
This drive for innovation still persists today. For instance, in the field of tobacco control, the EU itself became a party to the WHO's framework convention. This increased the potential for unity in Europe against tobacco, even if this was sorely tested in recent negotiations for the tobacco products directive.
Individual member states are also developing innovative approaches to NCD prevention. For example, Ireland is working for the adoption of standard (or plain) packaging of cigarettes. Finland has enacted a law to make the whole country smoke-free by 2040. France imposed a tax on soft drinks in 2012, in an effort to raise revenue, mitigate the impact of obesity, while nudging behaviour towards healthier diets. And the United Kingdom showed how public and private interests can work together for public health, with a successful national salt reduction programme.
"Not only has the EU generated its own programmes in alcohol control, cancer, and, more recently, in chronic diseases, and childhood obesity, but the united voice of the member states has also influenced the UN political declaration on NCDs"
Finally, the EU has also been active internationally in strengthening the priority given to NCDs in the global political agenda. Not only has the EU generated its own programmes in alcohol control, cancer, and, more recently, in chronic diseases, and childhood obesity, but the united voice of the member states has also influenced the UN political declaration on NCDs, the global action plan and monitoring framework on NCDs, and the WHO European health policy, Health 2020.
The epidemic of NCDs is indeed not inevitable in Europe if we take into account the current epidemiological trends, the established evidence base, the enthusiasm for innovation in the field, and the ever-stronger political and legal mandate. On the other hand there are many areas where danger lurks and a few of these need to be highlighted.
Health 2020 prioritises health inequity and work to address its social determinants. For all the material gains in mortality made in the last four decades, there are surprisingly few examples of countries that have narrowed the health divide. The incidence of NCDs and their consequences remain disproportionately concentrated on those who are poorer, less educated, unemployed, or with less power in society. Indeed the ability to even measure and report on these differences remains rare in many EU member states.
The adage that we need to create supportive environments "to make healthy choices the easy choices" has never been more strongly supported by the evidence. Paradoxically, there are signs that the appetite for state intervention is diminished in Europe. For instance, in a recent review of food and nutrition policies in the EU, policies based on awareness raising and guideline development were much more prevalent than more effective policies that require regulation (such as the control of marketing or standardising on effective food labelling).
Finally, the burden of NCDs is growing on health systems due to ageing populations, multi-morbidity, and the need for person-centred care posed by chronic diseases. At a time when there are more people with NCDs than ever before and their needs are more sophisticated, financial crises are constraining national investment on health, and thus the impact of NCDs on individuals and households may become more dire than it has been in the past.
Europe's past in the field of NCDs may be glorious, but the future should not be taken for granted.