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Su~ of Information on the Infonnal Health Ministers Meeting on 29 November 1984 A. Generalities 1. The Health Ministers met 2 9/ 1 1/ 8'4 in Brussels under the Irish Presidency of Mr. Barry Desmond, Irish~Health Nlinister. The Italian delegatiom being in the chair in the first half of 1985 has announced that it would call another meeting in 1985 (Venedig) if there was sufficient substance matter to be discussed. 2. The Commission did not succeed with its proposal to set up a Public Health Cbmnittee comparable with, the Camnittee on Education set up by the "Council and the Fducation Ministers meeting with the Council" (for explanation of this legal construction, see my memerandtun of 20 November 19841. Several delegations questioned the existence of Conamunity powers in the public healthidomairn, but all thought that cooperationiin this field on concrete problems would be useful. It would however be necessary to define these problems clearly and to:avoidldouble work with other international organi,sationL- . However the initiative must cone frcxn the Ccrtunissionw The Ministers themselves did not propose any precise subject for cooperation. The Comtnission therefore finds themes which are: - useful for cooperatiom in the framework of the ten~as opposed to tY-,, framework of WHO, IIA or the Council of Europe; - promise at EC level useful results; - may be covered by the Treaties if conmon provisions are envisaged. 3. Mr. Richard supported'the initiative to set up a Public Health Cooperation CoRUnittee but noted that he would leave the Comnission soom and was not in a position to make undertakings on behalf of the new Conrnission. Cbservers noted that the Comnnssion officials from D.G.V looked embarrassed. They

are now aware of the need for the new Ccnun.iission to assess priorities and: of the fact that this assessment determines in particular the.ntimiber of staff'at the disposal of D.GIV for activities in the public health sector. They fear that their remoteness in Luxembourg fromi which they seem to have suffered over the past years will not favour their position in the future. They also know that the justification of priorities depends entirely onithem: they must produce convincing ideas and proposals, but they have produced nothing for the Health Ministers meeting which just took place. The old Comnission technique to glance ideas from national administrations, from Ministers or other sources did not work: the Ministers hadInothing new to offer. 4. The already existing Public Health Working Party of the Council willl carry on discussions in the health field. B. Costs of the health system 5_1 The Ministers did not discuss the CoRanission, communication but it resulted' from their interventions that they all had to cope with the problem of containing the cost of the health systems. They feel that cooperation could' he3ip thern so,l've these protlems. 5.2 Mr. Richard referred to the meditmn-term social action programne adopted on 22 July 1!984' (Q7 C 175 of 4 July 1984, p.1) containing the follow"uag passage: The Ministers responsible are invited to examine the means employed to control trends in health expenditure on the basis of a periodical report fronm the Commission. The latter will examine with the Member States the possibilities for co-operation in the field of health. He announced that the CoYUni.ssion would subinit its first periodical report in the near future. 6. The report will how-ever not be,sufficient for iinitiatingicooperation. The Comnission must propose concrete themes for discussion. The UK Minister mentioned e.g. the question of'the formation of prices for pharmaceuticals,, other Ministers the cost of hospitals.

C C. Drugs 7. Mr. Desmond'did discuss the drug situation in Ireland rather briefly, contrary to what had been eacpected: All Ministers are rather hesitant in bringing this qnaestion up in the E3C' framework as it is already being dealt with by the Pompidou Corrmittee. The efficiency of the Cornzzittee's work is diversely appreciated. Observers note that the absense of palpable results is partially due to the lack of funds. The work is not financedd by the bu3get of the Council of EYarope but by individual state contributions which are apparently unsufficient. It has however been mentioned that the PompidoulComnittee has set up an action programme.which could give new impetus to the initiative. The progranme covers not only drug supply but now also the demand for drugs. 8. Ministers have expressed the opinion that the ~.1, as such cannot make a useful contribution to combat drugs. The thene is therefore likely to vanish completely from the DC list of initiatives. D. Tobacco - &-roking 9. All Ministers emphasised their preoccupations and spoke about their national problems and activities. The following~points have allegedly been mentioned without this list beingi completed: Ireland . the percentage of young people who smoke is the highest ever, absolutely and in compa.rison with other age groups;. France . has undertaken campaigns against smoking, especially in respect to the young, and (surprisingly) a high percentage of doctors are smokers;. Belgium . try to reduce cigarette advertising, but newspapers and and weeklies imported from the UK and the Netherlands (and Ireland France) respectively contain a great deal of publicity for cigarettes. 10. The problem of advertising encountered much interest. However Belgium and Irelandlare very specific cases, and their problems are not new.

_ 4 _ I have e.g. reported last year and the year before on the problem~raised in rellation between Ireland and the UK where Ireland envisaged to prohibit the import of,certain press products containing cigarette advertising not compllying with the Irish law on cigarette advertising. The Comnnssion abandoned the stu3y of the question whether such a prohibitation would be justified or constitute an illegal barrier to trade because none, of the countries and no economic operator eventually insisted on a Commission reaction. Certain Commission services would evidently like to take this problem up. One still remembers the "Rramer papflr"' which never became an official document. The Ctmunission's recent canumanication, on television advertisingi refers to this problem. The problem will therefore be discussed in any case. I3owever at EC level it is not very likely to be discussed primarily by the Health Ministers. They may however provide an additional motivation for discussing the theme. E. Health Card 11. The usefulness of the health card identifying for the cases of emergency treatments, special health risks of the bearer has not,been contested. The introduction of the card might be the subject of a recommendation to the Member States. The question must still be thoroughly studied. F'. Protection of dialysis Patients 12. The Ministers are inclined to:eventually adopt a recomrendation to the Member States as regards d'ialysis, (toxic effects of altanirjun in kidhey dialysis. The substance matter and the possible contents of the, reconunendation raise difficult technical questions which~ need' thorough examina tion. Zbacicology 13I.TheMilnisters have noted that a great number of initiatives havee been~ taken at international level in~ the dbmain of toaticology. The EC.also have adbpted sectorial measures (e.g. classification and packaging of t C

5 toxic substances, pharmaceutical products, food additives, protection at the, wor}tplace against toxfic substarnces) . • The Ministers felt that the BC should continue its action where it is necessary for the functioning of the ccnuron market and contribute to the action of other international organisation where this is useful and!with- out provoking double work. ~