EUGLOREH project
THE STATUS OF HEALTH IN THE EUROPEAN UNION:
TOWARDS A HEALTHIER EUROPE

FULL REPORT

PART II - HEALTH CONDITIONS

9. MAIN HEALTH ISSUES AND TRENDS FOR DIFFERENT AGE AND GENDER POPULATION GROUPS

9.2. Children and adolescents (age 1-18)

9.2.5. Control tools and policies

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9.2.5. Control tools and policies

 

 

Control tools and policies are provided for specific diseases in Chapter 5 and for specific health determinants in Chapter 10.

 

Healthcare and services

 

Obviously, neither infants, nor young children can be appropriately accommodated in general adult hospital beds. Similarly, a hospital setting requires other support for children including play areas, and education for those of school age admitted for more than a few days. Nurses need specialist training, while there are other characters such as play therapists that play an important role in the child health service. There are several initiatives for Baby Friendly Hospitals (UNICEF, 1991), and for the rights of children to appropriate hospitals in Europe (EACH, 1988). Yet the implementation of these structures is not formally monitored, and is far from universal.

 

Special provisions need to be made in primary and community care. Across the different countries of Europe, with the subsidiary principal of health services, there are many different means of providing primary and community care for children. In some countries there are specialist primary care doctors specifically for children, whereas in other countries the primacy of seeing the child in the context of the family treated by a physician who knows them all, is paramount. However, whilst the preferred pattern of service delivery is a national prerogative, the lack of a common definition of paediatrics or of the educational curriculum required for paediatric nursing is more difficult to accept. In a context in which the European Commission is able to provide scientific support to Member States in many aspects of health and healthcare, there seems to be scope for considering impartially and scientifically the packages of skills necessary for the healthcare of children, and the minimum standards required at least for invasive facilities and trauma departments.

 

More than 50% of the medicines prescribed for children have not yet been tested and authorised for use by children. The European Commission acknowledges this and notes that more research and authorisation needs to be done for what concerns meningitis, tuberculosis,AIDS, arthritis, diabetes, asthma, psychiatry, anaesthetics and malaria. The European Commission has recently adopted the Regulation of the European Parliament and the Council on medicinal products for paediatric use, with the objective of research, development and authorisation of medicines for use in children.

 

Policies

 

EU policy for children and young people’s health has been limited due to the fact that Member States are largely responsible for the implementation of healthcare in their respective countries. EU focus has been on data collection, health promotion and education.

 

In order to strengthen its actions in favour of children and young people, the European Commission issued a CommunicationTowards an EU strategy on children’s rights” (European Commission, 2006a). The Communication reflects the first comprehensive strategy to strengthen the protection of children, both within and outside the Union, against neglect, paedophilia, trafficking, sex tourism and forced labour. It proposes a wide action plan, with four major objectives:

 

- To identify priorities for future EU action

- To improve EU policieseffectiveness vis-à-vis the Rights of the Child

- To increase cooperation with stakeholders

- To help children to enforce their rights

 

The European Union has already taken many actions to protect the rights of the child. For example, in the last few years, around thirty directives, framework decisions or green papers have been adopted under several EC policy areas and with children as principal target, notably related to family reunification, parental responsibilities, trafficking in human beings, sexual exploitation, children in armed conflict, safety of toys and the paediatric use of medicinal products.

 

In addition, the Commission provides funding through a dozen community programmes for actions in favour of children and young people, notably concerning violence, a safer use of the Internet, trafficking in human beings, sexual tourism, participation of young people in the functioning of democracy and access of Roma children to education.

 

In 2000, the Commission reported on the health status of young people (European Commission, 2000), but only those over the age of 15. The Commission’s 2005 Public Health Work Plan, defined within the framework of the Community Action Programme in Public Health 2003-2008 (European Parliament and Council, 2002), refers to issues that influence children and young people. These include childhood immunisation programmes; prevention of cigarette sales to children and adolescents; information activities related to under-age drinking; work on obesity and prevention; development of strategies to address risky sexual behaviours among young people; and prevention of mother-to-child transmission of HIV/AIDS.

 

The European Commission's Communication on the Rights of the Child (European Commission, 2006a) represents a formalised framework of the Commission's future work to protect the interests of children and young people and promote their role in society. This supports the UN General Assembly’s adoption in 2002 of a resolution entitled “A World Fit for Children”. The resolution encompassed seven main objectives, among which the provision of care for every child and the combating of HIV/AIDS.

 

In response to the growing problem of obesity, the European Commission launched the EU Platform for Action on Diet, Physical activity and Health in 2005, bringing key stakeholders together at EU level to initiate Europe-wide action (European Commission, 2006b). A White Paper on Nutrition was published in May 2007 focusing on obesity and physical activity and on proposals on how the EU will address these issues (European Commission, 2007) An assessment of the available data measuring nutritional and physical activity behaviour of children, commissioned by the EU, is currently being published (Alexander et al, 2008)

 

WHO Member States adopted The Global Strategy on Infant and Young Child Feeding in May 2002. This strategy recommends exclusive breastfeeding for six months and continued breastfeeding, with appropriate complementary feeding, up to two years and beyond. Unfortunately, data on its impact is limited and patchy, suggesting that despite high profile support this has not had any effective local impact.

 

Health21, the health for all policy framework for the WHO European Region, addresses the social and economic factors that influence health and lead to disparities among different population groups. It calls for action: ‘the health gap between socioeconomic groups within countries should be reduced by at least one fourth in all Member States by substantially improving the level of health of disadvantaged groups’ (WHO, 1999).

 

WHO/Europe’s programme on child and adolescent health and development: this programme works to promote the health of children, adolescents and young people in the WHO European Region. Its main aim is to assist Member States in the European Region to design and carry out health programmes that are in line with the health-related articles of the United Nations Convention on the Rights of the Child, and help to achieve the United Nations Millennium Development Goals. A major current initiative is the European Strategy for Child and Adolescent Health and Development (WHO 2005a), which provides a strategic approach and related toolkit, to enable each Member State to produce a national strategy based on sound evidence-based policy, and framed according to a life-course approach, using cross-sectoral planning. Each Member State committed itself to report back on their progress to the WHO Regional Committee in autumn 2008.

 

Children's Environment and Health Action Plan for Europe (CEHAPE): This plan addresses the environmental risk factors that most affect the health of European children (WHO, 2004). It was developed at the request of WHO Member States and adopted by European Ministers at the Fourth Ministerial Conference on Environment and Health (2004) on "The future for our children". This action plan highlights the main commitments on children's health and environment and focuses on four regional priority goals (RPGs) for Europe:

·          RPG I: ensure safe water and adequate sanitation

·          RPG II: ensure protection from injuries and adequate physical activity

·          RPG III: ensure clean outdoor and indoor air

·          RPG IV: aim at chemical-free environments

Also largely devoted to protect and promote children’s health is the EUEnvironment and Health Action plan 2007-2010 (European Commission, 2004)