This  Roadmap  is  supported  by:    

The  Riga  Roadmap  Investing  in  Health  and  Wellbeing  for  All  

 An  action  plan  to  create  sustainable,  equitable  and  participatory  European  health  systems  that  improve  patient  outcomes    The  Vilnius  Declaration,  agreed  at  a  high-­‐level  health  event  of  the  Lithuanian  Presidency  in  2013,  aimed   to  ensure   that   European  health   systems  are  people-­‐centred,   sustainable   and   inclusive  –  and  deliver  good  health  for  all.  To  maintain  the  Declaration’s  momentum,  the  Universal  Health  Conference,   held   under   the   auspices   of   the   Latvian   Presidency   in   Riga,   aimed   to   identify  strategies   to   harness   citizen   participation   to   create   sustainable,   equitable   and   participatory  European  health  systems.      The  European  Commissioner  for  Health  Vytenis  Andriukaitis  has  outlined  four  core  principles  for  European  health  –  prevention,  promotion,  protection  and  participation  –  emphasising  the  need  to  promote  health  across  all  stages  of  life.  Patients,  and  people,  should  be  placed  at  the  centre  of  European   healthcare   systems,   including   health   promotion,   prevention,   service   delivery   and  research.  A  holistic  approach  to  healthcare  and  public  health  is  needed.      In   order   to   achieve   sustainable,   equitable   and   participatory   health   systems,   the   role   of  governments  should  be  not  only  to  control  healthcare  costs,  but  also  to  regard  health  as  a  vital  investment   in  order   to  ensure  a  healthy  population  and  promote   social   cohesion  and   inclusion  across  Europe.  The  European  Union  institutions  and  national  governments  of  the  Member  States  must  address  the  social,  economic  and  environmental  determinants  of  health  in  order  to  reduce  poverty,  social  exclusion  and  resulting  health  inequalities  and  improve  patient  outcomes.      We  call  on  the  EU  institutions  and  national  governments  to  apply  the  following  measures  in  order  to   maximise   health   and   wellbeing   and   ensure   the   long-­‐term   sustainability   of   Europe’s   health  systems.        

 

This  Roadmap  is  supported  by:    

1 Prevent  health  inequalities  by  developing  universally  accessible  health  systems      • Implement   the   principles   prevention,   promotion,   protection   and   participation   as   core  

principles  for  health  in  all  policies  and  governance  for  health  at  European  level,  particularly  in  relation  to  national  Ministries  of  Finance  and  Economics  and  the  EU  Semester  Process;  

• Identify   appropriate   and   smarter   ways   of   preventing   unnecessary   costs   to   the   system   in  health  and  economic  terms  by  promoting  health  throughout  the  life  course.    This  could  be  done,  for  instance:  by  implementing  cost-­‐effective  preventative  measures  such  as  smoking  bans;  effective   information   to   consumers;  promotion  of  physical   activity;   vaccination;   and  fiscal  measures  on  unhealthy  foods,  alcohol  and  tobacco  whilst  making  healthier  foods  more  accessible  and  affordable.  

• Continue   to   raise   awareness   and   take  policy   action   to  dramatically   reduce     anti-­‐microbial  resistance,  including  through  prevention  of  infectious  diseases,  incentivising  development  of  new  antibiotics  and  the  use  of  effective  alternatives;  

• Ensure  universal  access  for  all  in  Europe  to  effective  and  affordable  medicines,  health  and  care  services  creating  conditions  to  better  manage  disease  and  to  prevent  avoidable  health  deterioration;  

• Increase  investment  in  disease  prevention  and  health  promotion,  including  all  main  primary  prevention   services   and   supporting   programmes   for   both   communicable   and   non-­‐communicable  diseases;  

• Include   prison   health   services   to   reduce   inequalities   between   prison   health   and   public  health  and  make  sure  all  Ministries  involved  (Health,  Justice)  cooperate  effectively;  

• Develop  an  effective  health  promotion  and  disease  prevention  agenda,  which  strengthens  the   role   of   healthcare   professionals,   recognising   that   healthcare   workers   play   an  indispensable   role   in   educating   patients   and   promoting   health   literacy,   particularly   in  education  and  workplace  settings;  

• Strengthen   community   led   initiatives   in   their   capacity   to   offer   prevention   services   and  linkage  to  care  to  most  at  risk  populations    

• Adopt   an   approach   to   public   health   that   utilises   the   latest   evidence-­‐based   knowledge,  respects  personal  data  protection,  and  identifies  appropriate  and  ethical  ways  of  preventing  unnecessary  costs  to  the  system  in  health  and  economic  terms;  

• Work   towards   the   removal   of   legal   barriers   to   secure   access   to   universal   coverage   to  prevention  and  treatment  to  everyone,  independent  from  residence  status.  

• Support   a   shift   from   cost-­‐focus   to   health   outcome-­‐focus   in   the   European   Semester,   to  prevent  disease  and  avoidable  health  deterioration  whilst  tackling  healthcare  inefficiencies  and  addressing  health  inequalities.    

 

This  Roadmap  is  supported  by:    

2 Make  healthcare  systems  sustainable  by  investing  in  innovation      • Develop   a   common   definition   of   “valuable   innovation”,   starting   from   patient   needs   and  

societal   needs.   Based   on   this,   develop   common   principles   for   how   valuable   innovation  should  be  encouraged;  

• Stimulate   enhanced   collaboration   at   EU   level   between   stakeholders   to   address  sustainability,   improved  access   for  patients  and   improved  health  outcomes;  develop  a   fair  access   framework,   including   sustainable   pricing   models   which   ensure   access   and  affordability  for  healthcare  systems  and  patients;  

• Create   frameworks   for   meaningful   patient   involvement   across   the   innovation   chain   in  collaboration  with  the  relevant  parts  of  the  EU  Commission  and  stakeholders,  from  priority-­‐setting  and  research  design   to   regulatory  processes,  cost-­‐benefit  assessments,  pricing  and  reimbursement,  and  the  re-­‐use/collection  of  patient  data,  and  respecting  data  protection;  

• Ensure   sustainable   competition   and   transparency  in   post-­‐exclusivity   period   from   generics  and   biosimilar   medicines   to   improve   patient   access   to   medicines   and   the   efficiency   of  healthcare  systems;  

• Increase   efficiency   and   effectiveness   by   implementing   performance-­‐based  measurements  and  evaluations  of  patient  health,  ideally  in  real  time,  to  show  which  interventions  work  and  why,   i.e.   via   data   generated   through   electronic   patient   records,   clinical   research   and   by  patients  themselves,  whilst  respecting  personal  data  protection;  

• Develop   common   standards   across   the   EU  member   states   in   the   reuse   of   existing   health  data   registries   to   address   areas   of   unmet   medical   need   and   the   prevention   of   chronic  diseases;  

• Support   the   use   of   real   world   evidence,   to   better   understand   opportunities   to   advance  patient  care,  while  promoting  efficient  policies  that  balance  support  for  innovation  and  the  needed  uptake  for  generic  and  biosimilar  medicines  to  ensure  access  to  medicines  for  all;  

• Develop   quality   standards   and   guidelines   for   the   development   and   use   of  Mobile   Health  Applications   to   promote   direct   patient   engagement   with   health   protection   and  improvement  while  ensuring  the  quality,  security  and  safety  of  applications;  

• Harness   European   Structural   and   Investment   Funds   to   develop   IT   infrastructures   that  promote  prevention,  promotion,  patient  self-­‐management,  and  service  delivery  reforms;  

• Encourage   the   pharmaceutical   sector   to   develop   sustainable   value-­‐added   innovation   that  can  improve  health  outcomes  and  efficiency  for  health  care  providers  and  for  patients.    

   

 

This  Roadmap  is  supported  by:    

3 Ensure  universal  access  to  high  quality  people-­‐centred  health  services    • Adopt   a   clear   European   Union   position   that   all   people   in   Europe,   including   people   in   a  

vulnerable   situation,   such   as  migrant   populations,   people   using   drugs,  MSM,   sex  workers  and  prisoners,  should  have  continual  access  to  healthcare  services  and  develop  a  concrete  strategy  to  ensure  equitable  access  to  healthcare  for  all  according  to  the  principle  of  non-­‐discrimination;    

• While  they  are  under  exploration  and  study,  Member  States  and  the  European  Union  should  establish  the  process  of  early  dialogue  and  joint  advice  under  the  new  approaches  to  early  access   to   medicines   such   as   MAPPs   (Medicines   Adapted   Patient   Pathways)   in   order   to  guarantee  that  available  treatments  are  accessible  in  all  Member  States;  

• In  partnership  with  governments,   industry,  patients  and  healthcare  professionals,   improve  the   education   and   understanding   of   medicines,   including   biosimilars,   to   ensure   universal  access  to  safe,  high  quality  treatment;  

• Develop   common   tools   to  measure   access,  monitor   outcomes   and   assess   performance   in  the  health  sector  as  part  of  the  European  Semester  evaluation,  including  a  tool  to  measure  patients’  experience  in  a  way  that  reflects  their  needs  and  priorities;  

• Ensure  that  health  services  are  responsible  employers;  Address  health  workforce  shortages  and  “brain  drain”  in  planning  and  development  at  European  level,  including  via  appropriate  investment   in   a   highly   skilled   workforce   and   implementing   the   principles   of   ethical  recruitment  enshrined  in  the  WHO  Global  Code  of  Practice  on  the  International  Recruitment  of  Health  Personnel.  

 4 Develop  participatory,  people-­‐centred  health  systems    

 • Ensure  meaningful  involvement  of  patients,  public  health,  consumers  and  civil  society  in  the  

development   of   policies   and   programmes   at   EU   and   national   level   in   a   whole-­‐of-­‐society  approach;  establish  a  partnership  between  all  stakeholders  in  the  health  sector  at  regional,  national  and  European  levels  to  identify  effective  solutions  that  improve  equity  of  access;  

• Include  specific  calls   in  the  future  Horizon  2020  programme  on   innovation  of  systems  and  organisations   in  order  for  healthcare  to  better  meet  patients’  needs  (e.g.  addressing  areas  like  integration  of  care,  participatory  medicine,  patient  involvement,  organisational  culture  change)  based  on  a  gap  analysis  from  a  patient  perspective;  

• Develop  tools  and  a  common  approach  to  measurement  of  patient/person-­‐centredness  as  a  key  aspect  of  quality  of  healthcare  under  the  EU  HSPA  framework;    

• Implement   a   regular   EU   Health   literacy   survey   across   all   EU   Member   States   to   collect  comparative   data,   based   on   the   validated   EU   Health   Literacy   Survey   (HLS),   and   invest   in  

 

This  Roadmap  is  supported  by:    

health   literacy   interventions  under  various   financial   instruments   (e.g.  Health  Programmes,  Structural   Funds);Ensure   that   principles   of   transparency,   good   governance   and  accountability   are   applied   throughout   health-­‐relevant   policies,   health   systems   and   public  health.  

• Develop   a   European   strategy   to   empower   and   support   patients   (including   vulnerable   and  minority   groups)   in   the   management   of   their   health,   and   promote   access   to   accurate,  objective,   unbiased,   user-­‐friendly   and   scientifically   up-­‐to-­‐date   information   relevant   to  patients’   needs,   on   all   aspects   of   health   from   promotion   and   prevention   to   disease  management  and  therapeutic  options;  

• Implement  the  European  Commission  Guiding  Principles  Promoting  Good  Governance  in  the  Pharmaceutical  Sector  agreed  by  key  stakeholders  to  promote  transparency  of  information  and  action.  

   We   call   on   Member   States,   associated   Member   States,   European   Union   institutions   and   the  World   Health   Organization   to   work   together   to   ensure   that   European   healthcare   systems   are  people-­‐centred,  sustainable  and  deliver  inclusive  healthcare  for  all.    We   call   on   the   next   Presidency   of   the   European   Council   to   further   pursue   these  recommendations  and  carry  these  four  principles  for  European  health  –  prevention,  promotion,  protection  and  participation  –  forward  in  the  future.    Riga,  June  29th,  2015