Council of Ministers: Health

Dear Delegates,

I am Yixuan, a junior History major in Jonathan Edwards college.  Coming from Singapore, I was thrilled to see snow in New Haven until that winter wonderland degenerated into a blizzard. On campus, I’ve served on the secretariats of Yale Model United Nations XLII, YMGE 2016, YMUN Taiwan, chaired for YMUN and SCSY, and have loved the passion and energy that delegates bring to these conferences. I love dancing with the Yale Ballroom Team, watching really trashy horror flicks and imagining life after retirement.

I am thrilled to welcome you to the Austrian cabinet and Council for Health this year. I hope that through this experience, you will gain a more in-depth understanding of the complexities involved in problem-solving and diplomacy, which lie at the heart of every Model UN conference. Most importantly, I hope we remember that we are never debating in a vacuum—these are real-world issues that have a very palpable human impact. It is with this in mind that we feel truly empowered with the knowledge and strength to make some sort of difference.

Again, I am excited to meet all of you this November! If you have any questions or concerns - or if you just want to chat about college in general - please don’t hesitate to reach out to me any time at yixuan.yang@yale.edu.

Looking forward,

Yixuan Yang

Council Composition

Austrian Federal Minister of Health

Estonian Minister of Health and Labor

French Minister of Social Affairs & Health

German Federal Minister of Health

Greek Minister of Health

Hungarian Minister of Health, Social & Family Affairs

Italian Minister of of Health

Lithuanian Minister of Health

Polish Minister of Health

Spanish Minister of Health

Swedish Minister of Health & Social Affairs

United Kingdom Parliamentary Under Secretary of State for Public Health

The Council of Health Ministers is an organ that falls under the Council of Europe. The Council of Europe was founded on May 5, 1949 by the Treaty of London, which was signed by Belgium Denmark, France, Ireland, Italy, Luxembourg, the Netherlands, Norway, Sweden, and the United Kingdom. Today, the Council of Europe is made up of 47 member states, including all EU member states and 19 other European nations. Soon after the founding of the the Council of Europe, the Council of European Ministers was created in 1952 to allow Ministers of different member-states of the European Union to “meet to adopt laws and coordinate policies.” As a result, the composition of the Council is variable. The Council of Health Ministers is a subsidiary of the Council of Europe, and it is within this organ that we will focus.

Established in 1954, the Council of Health aims to “create conditions which would safeguard and improve the health of European citizens.” Each European member state appoints a senior health official to serve on the Council of Health for a two year term. In addition, the Council also hosts non-voting observer nations and organizations. At this time, Canada, the Holy See, Japan, Mexico, the United States, Belarus, Bosnia and Herzegovina, the Federal Republic of Yugoslavia, the World Health Organization (WHO), and the International Federation of Red Cross and Red Crescent Societies have observer status.

The Council of Health works closely with the World Health Organization and the EU, as the three bodies hold regular “tripartite” meetings. The Council emphasizes the need for cooperation among member nations and health organizations to better the health of all Europeans. While it works on a wide range of health-related issues, it puts special emphasis on bioethics, disability treatment, organ transplantation and blood transfusion.

The Council of Health bases its strategy on an integrated approach of medical developments on the one hand and values of the individual on the other. Its activities are aimed at the democratization and humanization of health services.

The Committee of Ministers is the policy-enacting body of the Council of Europe. The Council of Health Ministers, along with all other subsidiary Councils within the Council of Europe, form policy recommendations that are then approved and implemented by the Committee of Ministers. In this way, each subsidiary Council can provide the Council of Europe with informed policy suggestions based within their sector of expertise.

The Council of Health Ministers sees health care as a basic human right. The organization is in a unique position to merge the “agendas of health, human and patients rights.” It aids member states in formulating health policy, standardizing patient services, guaranteeing access to care for all Europeans (with a focus on minorities, vulnerable groups, and rural populations), and ensuring that healthcare in Europe is accessible, ethical, and patient-oriented.

Health ministers on the Council have a number of responsibilities. Officially, the Council of Health has been commissioned by the Council of Europe to carry out the following tasks:

i. contribute to the strengthening of social cohesion by promoting equitable access to health care services, including prevention, that are safe and of appropriate quality;

ii. promote improved functioning of health care services that are patient-oriented and at the same time are respectful of the democratic, ethical and human rights dimensions of the provision of health care, taking into account a comprehensive health and human rights approach;

iii. promote patients rights, citizen participation and protection for vulnerable persons;

iv. develop European cooperation between member states on the promotion of human rights and enhancing health of European populations in its various aspects, in particular in the light of the replies given by the Committee of Ministers to relevant recommendations adopted by the Parliamentary Assembly and the work of the Ministerial conferences, through joint studies on common problems, sharing of information, knowledge and expertise and, where appropriate, by recommendations, and other instruments (such as reference tools, implementation guides);

v. review, in co-operation with the relevant committees of the Council of Europe, ethical and regulatory issues arising in the area of health policy, in particular the identification of policies, benchmarks, and good practice examples for patient-oriented care, with a view to improving policy and practice in the member states through reports, seminars, conferences and targeted dissemination and assistance activities;

vi. prepare, on the basis of an analysis of good practice, recommendations and other instruments (reference tools, implementation guides) offering member states innovative and practical advice in the fields concerning equity of access to care of appropriate quality and services which meet the needs of the population of member states;

vii. ensure dissemination of recommendations and other outcomes and undertake evaluations of their impact in member states, and in this context assist member states in monitoring and evaluating the implementation of selected recommendations;

viii. contribute to the preparation of the Council of Europe Conferences of Health Ministers and ensure the follow-up thereto, having regard to the relevant decisions of the Committee of Ministers;

ix. co-operate actively with other relevant international bodies, particularly the World Health Organisation (WHO), as well as with the European Union;

x. work with and support the activities of Council of Europe bodies dealing with health issues, notably the Parliamentary Assembly and the Conference of INGOs of the Council of Europe, in compliance with the terms of reference given by the Committee of Ministers and within the framework of the Strategic Approach to the (public) health and related activities; and

xi. while taking account of the progress of this work, prepare proposals under its responsibility for the Programme of Activities for the coming years, bearing in mind the criteria set out in document CM(2006)101.

While the Council of Health works to improve the health of all European citizens, health care is not the same across the board. In order to offer the best service, the Council must tailor its approach to the different groups it works with. The following two sections serve to identify how the Council has molded its method to work with vulnerable groups such as children and those with disabilities.

The sections below provide information on other focuses of the Council of Health.

Bioethics

The Council of Health describes bioethics as “the necessary balance between progress and respect for human dignity.” New technologies and advances in medicine today such as stem-cell research, antenatal diagnosis, in vitro fertilisation, and cloning, have led to a number of ethics related issues. Therefore while the Council strives to promote the “freedom of research” it does so without compromising the “protection of individuals.”Facilitating Donation: Blood and Organ

Facilitating Donation: Blood and Organ

Another project of the Council of Health is promoting the donation of blood and organs. The Council of Europe estimates that nearly 70,000 Europeans are currently waiting for a transplant. The Council works closely with the European Committee on Organ Transplantation, a “steering committee” that focuses its activities. For blood donation, the Council has identified three focuses: “the achievement of self-sufficiency; the protection of the health of blood donors and recipients; and the non-commercialisation of substances of human origin by voluntary and non-remunerated donation.” Working with groups such as the World Health Organization, the Council is active in promoting organ and blood donation to help patients across Europe.

Consumer Health

The Council of Health has a duty to protect consumers. By implementing safeguards around items such as cosmetic goods and food packaging, the Council of Health can create standards to protect consumer safety.

Counterfeit Medicine

Although this is fairly recent issue, the Council of Europe recently adopted a resolution aimed at combating counterfeit (fake) medicine. A crime that kills hundreds of thousands of people every year, the counterfeiting of medicine is a dangerous issue that affects 10% of the international medicine market. Counterfeit medicine can be toxic, lack important ingredients or contain the proper ingredients but at incorrect concentrations. Such medicines are illegal and potentially fatal.

The Council of Health has emphasized the standardization of medicine and created programs for testing medicines currently on the market. The “MEDICRIME” Convention implemented in 2010, aims to “combat counterfeit and illegal medicines and healthcare products, including those being offered on the Internet.”

To find a more specific example on the role of the Health Council in times of crisis, please find two short case studies below:

Case Study: Counter-Ebola

Following the 2014 Ebola outbreak in West Africa, EU Health ministers convened multiple emergency meetings. This is a classic case of the difficulties in coordinating health policy in times of crisis. While ministers agreed that it was imperative to improve screening measures at major checkpoints, there was no consensus on whether travelers from West Africa should be screened upon arrival in their home country. For instance, France, Britain and the Czech Republic moved to screen all passengers from West Africa, while other member states were hesitant to do so.

Case Study: Fighting Alcohol Abuse

Member states likewise diverged on their approach to alcohol abuse. While leaders such as the Estonian Health Minister believed that the onus lay primarily with member states, others--such as Luxembourg, Latvia, Poland, Sweden and Finland--have stressed the importance of an EU-wide alcohol policy. The exact measures to be taken also faced significant debate, with some believing that alcohol labelling had to be improved, while others feared the economic ramifications of stringent alcohol policies.

In a crisis situation, cooperation among the Ministers of Health will be of utmost importance. The following section will provide suggestions on how the Council has reacted to risks in the past, and the tools it may use in further crisis. In all situations, maintaining the health of all citizens of the EU must be our main focus.Mental Health

Mental Health

Mental illness is a serious and persistent issue facing all European countries, today. Nearly 165 million Europeans, or 38 % of the population, suffer from a brain disorder such as depression, anxiety, insomnia or dementia each year. Of those struggling with mental illness, only about one third receive therapy or medication.

Mental illnesses not only affect individuals, but also have larger societal effects. Indeed, the effects of mental illnesses cause a huge economic and social burden in European countries. These effects have been measured in the hundreds of billions of euros. Mental illnesses, and particularly mental illnesses going without treatment, have the potential to cause the affected individual to face challenges working, keeping interpersonal relationships, and maintaining healthy lifestyles. In these ways, mental illnesses have the potential to have serious, lasting effects for individuals and families, in communities, and at local and national levels.

Mental illnesses are a major cause of death, disability, and economic burden worldwide and the World Health Organization predicts that by 2020, depression will be the second leading contributor to the global burden of disease across all ages.

While mental disorders are not obvious through regular observations of individuals, the Council of Health must prioritize the decrease in individuals suffering from mental disorders. The Council must investigate the causes of such high rates of mental disorders in European countries, and advocate on behalf of policy, regulation, and education that has the potential to lower these rates. For example, regulations requiring more commitment from EU member states to increase services available to individuals seeking mental counseling or treatment may decrease the burden of mental illness across Europe. Similarly, campaigns that educate the public about mental disorders and aim to lessen the stigma surrounding them will help to encourage those living with mental illnesses to seek care.

As you consider ways to address these issues, remember that any suggested reforms ought to be feasible in all European member nations.

Sustainable Health Care

Traditional sources of funding health care in Europe have been branded obsolete and unaffordable. The need for innovation has never been stronger and while some countries, such as the Netherlands and Switzerland, are embracing change, others are resisting any significant overhaul. Indeed, the notion of free, state-backed health care is ingrained in the psyche of most Europeans.

The statistics paint a bleak picture. According to the Organization for Economic Cooperation and Development, the European Union will see an increase in health expenditure of 350% by 2050, whereas at the same time the economy is only set to expand by 180%.

Some work has already been done to estimate the real impact on future expenditures. Friedrich Breyer, a professor of economics at the University of Konstanz in Germany, calculates that in Germany alone between 2020 and 2030 there will be a huge spike in the number of elderly people alongside an enormous drop in young and working-age people. "This will mean a dramatic increase in individuals' payroll tax contribution rates to health care to 20.7% in 2030 and over 23% in 2040," he says. This compares to just 11.4% in 1980.

Soaring costs in health expenditure have made it necessary to explore other ways of financing health systems. No longer do governments plan to rely almost entirely on taxpayers' money. The Council of Health Ministers must discuss examples that have and have not worked not just within the European Union, but also in other healthcare systems across the world. The recommendations of the Council of Health Ministers must consider the structures of health care in all member countries and must be applicable to all. Also, this is not an issue that can simply be solved overnight, the Council of Health Ministers must look in the long term for a feasible solution

A Migrant Crisis

Ongoing and widespread conflict in Syria and surrounding areas has resulted in the largest refugee crisis since the Second World War. As a result of the Syrian Civil War, 4.3 million Syrians are refugees, and 6.6 million others are displaced within Syria, today. Most Syrian refugees remain in the Middle East -- primarily in Turkey, Lebanon, Jordan, Iraq, and Egypt. Is is estimated that around ten percent of refugees have traveled to Europe. As the Syrian Refugee Crisis has progressed, many states continue to absorb displaced Syrians. Some of these states are ill-equipped to do so, and the influx of refugee populations has created economic, political, and humanitarian challenges within receiving countries. The protracted displacement of these refugees has created an international security crisis, as refugees continue to be marginalized and radical groups have recruited from refugee camps.

European Union nations received a total of 1,321,560 asylum claims from Syrian refugees in 2015, alone. Of those applying for asylum in Europe, nearly one million are from Syria. The next-highest number of asylum seekers to the EU are coming from Afghanistan, with over 150,000, followed by Iraq with roughly 125,000 and Kosovo with nearly 75,000. Albania, Pakistan, Eritrea, Nigeria, Iran, and Ukraine follow close behind.

In the midst of a crisis such as the Syrian Civil war, refugees suffer from both physical and mental stress, families are separated from one another and without safe housing, health and public service infrastructure in the country is depleted or destroyed. In these situations, children go for long periods of time without education, and adults go for long periods of time without work. Funding deficiencies, language barriers, and slow bureaucratic processes in governments and NGOs all serve to complicate the process of addressing these needs.

As the number of refugees traveling into Europe increases, so will the need for health services available for these refugees and the need for preparation for the possible health dangers of a growing, changing European population. For example, a large wave of immigrants into the European Union may cause an increased strain on the European nations’ health systems or the introduction of a foreign pathogen.

Political Unrest

Political unrest can have a profound impact on the delivery of social services in a country. Not only can unrest impede the operation of the institutions and providers delivering healthcare, but it can also prevent citizens from taking advantage of health care services. When facing political unrest, a government may devote a large number of its resources to maintaining stability in its political system and reducing the risk of conflict. This means that funds and resources usually devoted to health service delivery can be reduced in times of political unrest. This reduction will primarily affect those in the lowest income quintiles, who may not be able to access health services in the private sector, which may have been affected less by the unrest.

To combat the negative effects that political unrest can have on quality of care and service deliver, a government can prioritize neutrality between political parties or adversaries when it comes to social service delivery, decentralization of services, and the strengthening of community-based clinics that people may feel more comfortable accessing in times of unrest and conflict.

Economic Instability

Despite pressures for greater expenditures on health, many countries do not devote the informal recommendation of the World Health Organization of 5% of Gross Domestic Product (GDP) to health spending. With health spending already receiving less funding than other areas of the budget, with economic instability comes the threat of even further reduced health spending in many countries. Public health care delivery in areas like family planning and contraceptives services and mental health services are sometimes seen as expendable, and the first to be reduced in times of economic stress. The council on health must consider the ways that it can ensure that health remains a priority, even in times of economic stress.

Austerity

When facing economic hardship, a country may choose to use austerity measures in an attempt to lessen its debt by reducing public expenditures. Following the Global Economic Turndown of 2008, many countries turned to austerity measure in attempts to reduce budgetary deficits and debt. In the European Union, these include the United Kingdom, Greece, and Spain. The effectiveness of these measures remains a topic of fierce debate today. The effects of reductions in government spending under austerity will be similar to those covered in the “Economic Instability” section.

Terrorism

Health systems and emergency response systems must be prepared to respond to the ever-growing threat of terrorism in European nations, and must do so with great care and caution. When responding to threats resulting from the growth of Islamic State and the Syrian Civil War and refugee crisis, the Council of Health Ministers must continue to prioritize taking every necessary measure to ensure the health of its citizens. The Council may also be asked to respond to or prepare for events of bioterrorism, should this threat grow in the future. Addressing issues of terrorism will require a multi-faceted approach taking advantage of the combined expertise of various bodies in European government and politics.

No matter what the situation or crisis, the maintenance of public health will always be of paramount importance. However, in order for the Council of Health to fulfill this responsibility, it is necessary for the Health Ministers to be able to work with other Councils and outside organizations (such as the Red Cross or World Health Organization).

As stated previously, the Council of Health is a subsidiary body of the Council of Europe. As a result, its main function is to provide policy suggestions that work to improve the health of European citizens.

As far as working with outside organizations, the Council of Health currently maintains good relations with the World Health Organization and the EU. In case of emergency, a cooperative response with organizations such as the Red Cross and Red Crescent would be of clear benefit.

i. Economic and Financial Affairs: What is the immediate and long-term economic impact of an unhealthy population? What happens when certain health policies--such as increased traveller screening, or more stringent alcohol labelling--have the potential to impact economic growth?

ii. Culture and Social Affairs: How does culture drive health awareness, practices and attitudes towards mortality and morbidity?

iii. Education and Youth: What sort of population-wide health education should be taught? How does that affect crisis response?

iv. Environment: How do environmental factors--such as pollution--affect health?

v. Food and Agriculture: Is there a change that we cannot see in the genetic composition of the food and agriculture Europe consumes internally and exports?

vi. Foreign Affairs: What type of health care structure might be a good template for other countries with undeveloped health care systems?

vii. Home Affairs: What regulatory policies should the health council implement?

viii. Immigration and Refugees: How can we ensure immigrants and refugees are protected under the health care system

ix. Justice: What measures are justified in order to protect the health of citizens? For instance, when can quarantine and mandatory screening measures be implemented?

x. Employment, Labor Policy and Consumer Affairs: What are the impacts of the crisis on health council workers? How do we minimize these impacts?

xi. Transport, Telecommunications and Energy: How can transport infrastructure be improved to best achieve health outcomes? What is necessary in times of crisis?

Keep in mind that these are only guidelines, and as the crisis is released, the links with other councils are likely to keep changing.