ACADEMIC

PREPARATION KIT

MARSEILLE ’15

SUMMER HEALTH FORUM EYP FRANCE

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CONTENTS

A WORD FROM THE PRESIDENT (p.3) SHORT OVERVIEW OF THE EUROPEAN UNION (p.4) COMMITTEE ON DEVELOPMENT (DEVE) (p.5) COMMITTEE ON ECONOMIC AND MONETARY AFFAIRS (ECON) (p.10) COMMITTEE ON ENVIRONMENT, PUBLIC HEALTH AND FOOD SAFETY (ENVI) (p.14) COMMITTEE ON WOMEN’S RIGHTS AND GENDER EQUALITY (FEMM) (p.18) COMMITTEE ON INDUSTRY, RESEARCH AND ENERGY I (ITRE I) (p.24) COMMITTEE ON INDUSTRY, RESEARCH AND ENERGY II (ITRE II) (p.30) COMMITTEE ON LEGAL AFFAIRS (JURI) (p.35) COMMITTEE ON TRANSPORT AND TOURISM (TRAN) (p.40)

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Dear delegates,

First of all I would like to welcome you on behalf of the Chairs’ Team in the Summer Health Forum of the European Youth Parliament France, taking place in Marseille. For some of you this will be your first step into what we like to call an EYP session and we will make sure to be there for you to make this experience as enjoyable as possible. This session will last around one week, and chances are it might affect your whole life. It is important for you to enjoy it to the fullest and to take the chance to raise your voice and share your opinions. Do not let the fact that this is your first session to prevent you from expressing yourself; keep in mind that almost everyone is in the same position. During the session we will discuss health-related topics which are currently at the centre of the attention. They cover different kinds of issues, varying from health accessibility to legislation regarding euthanasia. Solving them is no easy task; this is why sufficient preparation is crucial in order to succeed. This preparation kit will try to make this process easier. In this preparation kit you will find topic overviews for every committee. They aim to explain the relevance of each topic and cover the most basic terms and facts you will be using in Marseille. The information in the overviews is easy to access, as they cover the following areas: key terms, relevance and explanation of the topic, key questions, key actors, key conflicts and measures already in place. Furthermore, each sector contains a nonexhaustive list of links which will help your research. However, do not limit yourself to the overviews! We live in the age of technology, and information is easy to access by everyone. This is why I encourage you to conduct your own research on the topic, as it will be very helpful throughout the session. The overviews are written in a neutral way. It is your task to form your own stance on the issues you will be discussing. This is very important, since you will be asked to have specific solutions in the resolutions. The Summer Health Forum in Marseille will give you a chance to express your stance and voice your opinions on these topics. The session will start in less than one week, so why not use this time efficiently by reading interesting things about relevant topics? This small effort will make sure that the time spent in Marseille during the session will be a good experience for you. I would like to close this introduction with a quote from the roman philosopher Seneca: “Luck is where preparation meets opportunity”. You have been given the opportunity; make sure to be prepared in order to control your own luck! See you soon! Yours, Anamaria, Anastasia, Can, Cliona, Darya, Lars, Margot, Marouchka, Milana, Patrick, Patris, Triin, Eoin, Felicia and Ilir.

A WORD FROM THE PRESIDENT

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In this section of the preparation kit we want to hand you some interactive materials that can help you in brushing up your knowledge of the European Union in general. Some of the videos are spoken in French, but no fear, all of them have subtitles available. - Topics of the European Union: http://europa.eu/pol/index_en.htm Portal on the official website of the European Union giving you an overview of the different areas in which the EU is active. Each topic page gives you a summary of the policy area, the relevant EU bodies and the applicable Union legislation. - The EU Institutions Explained by their Presidents (April 2013): http://goo.gl/xEKbHD A view from the inside: the Presidents of the main European Union institutions share their views on how the EU actually works. Who does what? What's specific to each institution? What is the role of President? How do they see Europe's future? - How it works: European Laws (October 2011): http://tinyurl.com/6bqf885 This animated video guides the viewer through the Ordinary Legislative Procedure and highlights the procedures that lead to the adoption of a new piece of legislation. It also clearly distinguishes the areas of jurisdiction of all the institutions included in the EU legislative procedure. - How it works: Codecision Procedure (January 2014): http://tinyurl.com/paeonyb A video shedding light on the most common legislative procedure in the EU since the introduction of the Lisbon Treaty. This procedure is used to establish around 80% of all European legislation. - How it works: European Parliament (July 2011: http://tinyurl.com/o3sqf7v) and (October 2014: http://tinyurl.com/p6son88) European Parliament explained: who its Members are, how their work is organised, what powers they yield and the impact of all this on the daily life of Europeans. - How it works: Press START to legislate (January 2012): http://tinyurl.com/ok7akd8 After being approved in Brussels or Strasbourg, that is not the end of the road for a piece of European legislation. This interactive video shows you the impact of European legislation on the Member States and how order is ensured. - How It Works: What will the Lisbon Treaty change for the Parliament? (October 2009): http://tinyurl.com/no8hxeg The EP stands to gain the most from the Lisbon Treaty. Not only will the number of MEPs increase, but also their powers to decide together with the Council on matters such as agriculture, justice and home affairs, and the budget. The EP's political control of the Commission will also be strengthened.

OVERVIEW OF THE EUROPEAN UNION

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In 2014-2015, the Ebola virus outbreak that touched Western Africa questioned the efficiency of the European Union’s (EU) humanitarian aid in terms of managing health crises. Indeed, this action was criticized as insufficient, late and lacking coordination. These criticisms draw attention to the distribution of competences in the field of external policy between the EU and its Member States that maintain an important position in this field, and more generally to the shape and modalities of the EU development aid to third countries.

To what extent and how should the European Union adopt a coordinated response to supporting developing countries in tackling infectious

diseases? 1. Key Terms

• Developing countries: refers to those countries where citizens have either low or medium incomes or where there is little industrial or economic activity.

• Ebola virus: also known as Ebola haemorrhagic fever, is a type of virus that is highly contagious

and is often fatal in humans. Ebola is transmitted through direct contact with body fluids of someone who is infected.

• Humanitarian aid: represents a commitment to support a population who has suffered a

tragedy or experienced a sudden emergency, to improve their quality of life and facilitate a recovery process.

• Infectious diseases: are caused by pathogenic microorganisms, such as bacteria, viruses,

parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another1.

• Outbreak: represents the occurrence of cases of disease in excess of what would normally be

expected in a defined community, geographical area or season.2 Links: • The Journal of Humanitarian Assistance: https://sites.tufts.edu/jha/archives/1935

• A chart of the West Africa ebola outbreak :

http://ec.europa.eu/echo/files/infographics/infographic_ebola_en.pdf#view=fit

• Map of all the current outbreaks around the world : http://outbreaks.globalincidentmap.com/

1 http://www.who.int/topics/infectious_diseases/en/ 2 http://www.who.int/topics/disease_outbreaks/en/ 2 http://www.who.int/topics/disease_outbreaks/en/

COMMITTEE ON DEVELOPMENT (DEVE)

By Anamaria Olaru (RO)

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2. Relevance and Explanation of the Problem West Africa is experiencing the biggest outbreak of the Ebola virus on record, causing thousands of deaths, devastating fragile healthcare systems and damaging the economies of the countries affected3. Since September 2014, the EU has been alarmed by the continuously increasing number of affected people and by the possibility of the disease reaching Europe. However, the possibility of the virus spreading to and throughout the EU has been low due to the readiness of European countries in fighting haemorrhagic fever (which includes Ebola). The main course of action taken to prevent Ebola infections in Europe was to help control and monitor the outbreak in West Africa.4 Given that the EU has not been directly affected to this point, there have been controversial discussions regarding the amount of financial and humanitarian aid that the EU should offer. The problem is not isolated to the particular case of Ebola, but to the general stance and methodology that the EU should have in dealing with such matters. The Ebola outbreak has indeed highlighted how vulnerable our globalized world is to the spread and containment of infectious diseases. Links: • How does Ebola spread? How can the risk of transmission be reduced? :

http://ecdc.europa.eu/en/healthtopics/ebola_marburg_fevers/Pages/Infographics.aspx

• Is there a risk of Ebola spreading in Europe?: http://ec.europa.eu/health/preparedness_response/videos/videos/ebola_2015_long_en.mp4

3. Key Questions

• How should the EU behave with regards to dangerous outbreaks of infectious diseases in non-EU28 countries?

• Taking into consideration EU’s actions in regard to the Ebola outbreak, how should the EU react

if such a disease would threaten its borders?

• Considering both short-term and long-term solutions, should the EU prioritise the provision of humanitarian and financial aid or the medical research conducted for finding a cure?

Links: • Is the EU doing enough?: http://www.debatingeurope.eu/2014/08/29/eu-enough-help-

fight-ebola-outbreak/#.VWr2NPnF-PY

3 Number of deaths as at 16th May 2015: Liberia – 4,806; Sierra Leone – 3,906; Guinea – 2,405; Nigeria – 8; 4 http://www.euro.who.int/en/health-topics/emergencies/ebola-outbreak-2014

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• Action taken in the Ebola case: EU vs. US: http://www.ibtimes.com/ebola-spreads-europe-eu-doing-better-job-containing-ebola-us-1707148

4. Key Actors

Since the outbreak, the European Commission and the EU Member States have worked together with the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) in order to assure that the virus is kept under control. The ECDC is an independent EU agency, which aims to identify, assess and communicate current and emerging threats to human health posed by infectious diseases.5 The primary role of the WHO is to direct and coordinate international health within the United Nations’ system.6 The European Commission's Emergency Response Coordination Centre (ERCC) has also been monitoring developments since the outbreak was notified in March 2014. An EU Ebola Task Force has been established, bringing together all Commission services and the European External Action Service (EEAS), including EU Delegations in the affected countries. More specifically relating to the Ebola outbreak, the WHO organised a Ministerial meeting in order to assure effective action in July 2014 where 11 African countries were represented. Together, the representatives came up with an operational plan outlined under the Strategy for Accelerated Response to Ebola Outbreak in West Africa7. Not only did individual African States have outbreak control plans, but also coordinated regionally and with external international organisations. Another major contributor to the Ebola outbreak was Médecins Sans Frontière (MSF), a humanitarian organisation which was actively involved in fighting the disease since March 2014. It currently employs 185 international and around 1,150 national locally hired staff in the region.8 Links: • Short explanation of what the ERCC does: http://ec.europa.eu/echo/what/civil-

protection/emergency-response-coordination-centre-ercc_en

• Control of the Ebola disease chart: http://www.cdc.gov/mmwr/preview/mmwrhtml/figures/m6342a6f2.gif

5. Key Conflicts Given the fact that all EU-28 countries have developed health-care systems and that an outbreak similar to the Ebola one in West-Africa is highly unlikely, people question whether the EU should allocate funds to countries who are experiencing such cases. Some believe that there is only need for the EU to focus on matters that directly affect the Member States. In the case of Ebola, the EU acted outside its territory and tried to prevent the disease from spreading. Some fear that if another outbreak would occur, the EU would waste important manpower and

5 http://ecdc.europa.eu/en/aboutus/Pages/aboutus.aspx 6 http://www.who.int/about/en/ 7 The goals of the strategy can be found at pages 4 and 5 of this document: http://www.who.int/csr/disease/ebola/evd-outbreak-response-plan-west-africa-2014.pdf?ua=1 8 http://www.msf.org/diseases/ebola

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supplies that could be better directed to different sectors. On the other hand, the moral issue also needs to be taken into consideration, as people believe that if the EU has the ability to help in any way, it should prevent as many deaths as possible. Furthermore it has been argued that without the initial containment of the disease in West Africa, there could have been extensive and widespread health consequences for Europe and the rest of the world. There are heated discussions on exactly how the EU should intervene and support countries in combating infectious diseases. Some argue for increased humanitarian aid others for more preventative measures such as medical research. The MSF and others have also suggested the increased use of the military being sent to affected countries in order to keep the situation under control. This is also a point of contention. During the Ebola outbreak, military support in West Africa played a central role in the managing the situation through not only trained medical personnel but primarily though concrete manpower such as moving bodies and controlling the movement of people. It is clear that the EU has a major part in dealing with the outbreak but does it have a hidden reason for its efforts? Some believe that the ultimate aim is the protection of its citizens rather than the protection of those living in the affected areas. Others are contesting that the way it intervenes is not beneficial for the citizens of the Member States.

Links: • Why do people care about Ebola?: http://www.nouse.co.uk/2014/11/01/why-dont-we-care-

about-ebola/

• A discussion on different types of interventions: http://www.idpjournal.com/content/pdf/2049-9957-3-42.pdf

• Ebola and Military intervention: http://www.thechronicle.com.au/news/oxfam-calls-military-intervention-against-ebola/2424055/

6. Measures Already in Place The EU has been active in the case of the Ebola outbreak. It has supported the cause by offering medical equipment, aid supplies and manpower. 13 EU Member States, Norway and the UK have set assistance to the cause through the EU Civil Protection Mechanism, which facilitates the rapid deployment of emergency supplies and experts.9 The EU has financially assisted the fight against the epidemic with over €1.2 billion (as of 02/03/2015). The European Commission has allocated more than €65 million in humanitarian funding to address the most urgent needs. The Commission has also looked beyond the actual disease threat and provided development aid of €210 million to stabilise the countries and assist them in recovering from the crisis. The development fund is also used in order to strengthen areas such as education or healthcare. From Horizon 2020 (EU's research and innovation funding programme), €140 million were allocated to medical research.10

9 http://europa.eu/rapid/press-release_IP-14-2629_en.htm 10 http://europa.eu/rapid/press-release_MEMO-15-4507_en.htm

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Links: • Division of EU aid : http://citizen.co.za/wp-

content/uploads/afp/2014/10/23/8c86c108a374d1ece82e3373fdf531244b9498fe.jpg?d6ee5c

• Ebola: from emergency to recovery: http://ec.europa.eu/echo/files/aid/countries/factsheets/thematic/wa_ebola_emergency_recovery_en.pdf

• EU research on Ebola (refer to the ‘Actions taken’ table): http://ec.europa.eu/research/health/infectious-diseases/emerging-epidemics/ebola_en.htm

7. Summary Ebola was one of the most rapidly spreading and dangerous diseases of our generation and the EU was able to tackle this problem in an efficient manner. However, the probability of another similar outbreak hitting the world cannot be determined and thus, the EU needs to consider its preparedness for action. The amount of financial, humanitarian or development aid that it is allocated to such matters is of high importance, as well as how such resources should be distributed and decided upon. The EU might benefit from a clearer strategy in regard to such matters. The need for a transparent intervention plan might clarify the reasons behind EU’s Ebola intervention to its citizens. It is a controversial matter whether the EU is entitled to be that involved in the situation. While some believe that its help is demanded, others feel that the West African states would be able to cope with the situation on their own.

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By Cliona Cowhig (IE) & Patris Pustina (AL))

In response to the economic crisis, several Member States of the European Union (EU) have taken measures to reduce spending, many of which affected public services. Access to healthcare and social security are very developed on the continent, but account for a high budgetary burden. Several factors may increase this burden further, such as the aging of the population, while political events, such as the conservatives’ victory in the recent United Kingdom’s elections, can question the existence of public health services.

In light of austerity measures across Europe, how can the EU support Member States in ensuring access to quality health services?

1. Key Terms

• Beveridge Model: Healthcare system in which health care is provided and financed by the government through tax payments. Examples of countries which use this model include the UK, Spain and most of Scandanavia.

• Bismark Model: Healthcare financed by an insurance system usually financed jointly by

employers and employees through payroll deduction. Insurance companies involved must cover all citizens and do not operate for profit. Examples of countries with the Bismark Model include Germany, France and the Netherlands.

• Quality Adjusted Life Years(QALYs): takes into account both the quantity and quality of life

generated by healthcare interventions. It is the arithmetic product of life expectancy and a measure of the quality of the remaining life-years.

• Non-communicable diseases (NCDs): also known as chronic diseases, are not passed from

person to person. They are of long duration and generally slow progression.11 The burden of chronic diseases is rapidly increasing worldwide. In 2001, chronic diseases were approximately 46% of the global burden of disease. The proportion of the burden of NCDs is expected to increase to 57% by 2020.

Links:

• Lecture by Joseph Kutzin Coordinator, Health Financing Policy, WHO explaining the difference between health financing models and their current convergence into a mix of healthcare funding models: http://www.oecd.org/gov/budgeting/49095378.pdf

• Further explanation of QALYs and their use: http://www.medicine.ox.ac.uk/bandolier/painres/download/whatis/qaly.pdf

• Further information on NCDs: http://www.who.int/nutrition/topics/2_background/en/

1 World Health Organization website on non-communicable diseases

COMMITTEE ON ECONOMIC AND MONETARY AFFAIRS (ECON)

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2. Relevance and Explanation of the Problem Healthcare expenditure is the second highest form government spending across Member States with on average 15% of public spending going towards healthcare12. As a result of the recent economic crisis there has been increased austerity measures across EU Member States, and healthcare cannot escape these cutbacks in government spending. The recent economic crisis has also caused an increase in right-wing political parties who in general oppose public spending on health-care. In this climate, ensuring effective and accessible healthcare is becoming increasingly difficult. This political and economic shift is accompanied by a social and medical shift. The average life expectancy is increasing, thus the dependent age bracket is doing the same. As well as the economic side of providing healthcare for an aging population, the causes of death and types of illnesses suffered by citizens of aging populations in developed countries are largely NCDs (insert graph http://www.nejm.org/doi/full/10.1056/NEJMp1113569). The shift towards NCDs has been a challenge for modern healthcare, as these illnesses are generally long lasting and managed rather than cured, so this change has forced us to re-evaluate how healthcare services should work. Another change in medicine is the high expectations and greater health literacy of the general population. This has led to increased use of expensive testing and examination techniques driven by both patient expectation and health professionals’ fear of litigation which is also on the increase. Against the backdrop of these challenges faced by healthcare, good population health is a pre-requisite for the Europe 2020 goals to be met. Health investment is a central goal for the EU. This may not necessarily mean an increase in health spending, but rather that we need spend the money in a more efficient way, as well as ensure health-promotion and easily accessible healthcare.13 Links:

• Article exploring the link between the economy and health: http://www.oecdobserver.org/news/archivestory.php/aid/1241/Health_and_the_economy:_A_vital_relationship_.html

• Article exploring the increasing number of unnecessary medical care in the US:

http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande • EU Commission staff working document on investing in health:

http://ec.europa.eu/health/strategy/docs/swd_investing_in_health.pdf

3. Key Questions

• How do we ensure patient’s needs are met with limited resources?

• Does increased health spending correlate with better health outcomes?

• What indicators of success should we use as barometers of healthcare?

12 European Commission infograph on health investment 13 The EU Health Strategy "Together for Health"

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• Should the economic burden of illness be shared between governments and individuals, if so to what degree?

• How should health spending be balanced between preventative measures and treating those suffering from illness?

Links:

• Article on how the US healthcare system, which spends the largest percentage of GDP on healthcare worldwide, compares with other health systems : http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror

• WHO document on preformance measurement in Health Systems: http://www.who.int/management/district/performance/PerformanceMeasurementHealthSystemImprovement2.pdf

4. Key Actors National Governments and Health Authorities are key actors in coming to solutions in relation to healthcare systems. Health is an area in which the EU has supporting competence. The EU is an actor not only through its competence in healthcare, but also through initiatives such as the European Structural and Investment Fund14 and Regional Development Funds, which ensure that healthcare facilities can be developed in Member States. Insurance companies, in countries that facilitate or require health insurance, are key actors. Insurance and pharmaceutical companies are key actors in setting costs for healthcare that must be agreed upon by these actors as well as national governments. Links:

• Article exploring the way in which key actors of pharmaceutical companies, insurance companies and governments can interact to control drug prices in the US: http://www.ft.com/intl/cms/s/0/7e3571da-b08c-11e4-92b6-00144feab7de.html#axzz3bkC2GQpN

• Publication showing how the EU commission and regional development fund financed healthcare infrastructure in Hungary: http://ec.europa.eu/commission/2014-2019/cretu/announcements/over-203-million-euro-health-care-infrastructure-hungary_en

5. Key Conflicts One of the key conflicts in ensuring effective healthcare systems is dealing with limited resources. Improvements in medicine often come at high costs so finding finances for medical examinations and interventions can be a challenge. Another key conflict is an ideological one, to what extent the government should finance healthcare is largely dependent on political ideology and this varies greatly at both national and European level. Further conflicts can be found in what areas to spend in healthcare. Is prevention better than cure? Conflict can also be found in what the goal of healthcare is. When there are limited resources, trade-offs have to be made, how do we choose between quality of life and longevity?

14 The European Structural & Investment Funds on the European Commission website

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Links:

• Ted Talk on financing the changing healthcare system: https://www.youtube.com/watch?v=L3QkaS249Bc

6. Measures Already in Place As the EU simply has supporting competence in this field measures in place vary between Member States. The majority of EU interventions in healthcare systems surround the areas of public health and health infrastructure. Links:

• European Commission webpage on public health: http://ec.europa.eu/health/index_en.htm

• Engine allowing comparison between different European countries health policies: http://www.hspm.org/searchandcompare.aspx

• EU competences: http://ec.europa.eu/citizens-initiative/public/competences/faq#q1

• Previous EU legislation on public health: http://eur-lex.europa.eu/summary/chapter/public_health.html?root_default=SUM_1_CODED=29

7. Summary Today’s European economic environment, combined with a change in health requirements of ageing populations in developing our world, culminates in underfunded healthcare systems and a political climate unwilling and unable to support these spiralling costs. The challenge the EU faces is to support better access to healthcare for all citizens as well as continuing to improve health outcomes with limited resources and, in certain Member States, lack of political will. In spite of what one would think, increased spending does not correlate with better health outcomes, so perhaps it is simply a question of how to ensure efficient spending and sustainable healthcare models.

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COMMITTEE ON ENVIRONMENT, PUBLIC HEALTH AND FOOD SAFETY

By Triin Kaup (EE)

Alcoholism is recognised as an important cause of avoidable mortality and therefore a crucial health issue in the European Union (EU). This challenge is addressed through multiple public policies in each Member State, regulating, for instance, the advertising of alcoholic beverages, their taxation and sale, but these remain different throughout the EU. These different legislations result in different levels of protection while alarming consumption behaviours, especially among the young, continue to be developed.

What measures should the European Union and its Member States adopt in order to fight alcoholism and its negative consequences, especially on

health?

1. Key Terms

• Alcohol use disorder (AUD) – medical diagnosis, which indicates alcohol disorder and abuse, and can be categorised as mild, moderate and severe sub-classifications.

• Blood alcohol concentration level (BAC) - the level of alcohol present in person’s

bloodstream.

• BAC limit for drivers – the legal limit how many grams of alcohol can be in drivers blood per litre.

• Heavy episodic drinking (HED)/ Binge drinking - drinking at least 60 grams or more of pure

alcohol in a short period of time. Links: • “Alcohol and Your Brain”:

http://ec.europa.eu/transport/road_safety/specialist/knowledge/alcohol/prevalence_amp_rate_of_alcohol_consumption/the_legal_limit_en.htm

• Heavy episodic drinking among drinkers

2. Relevance and Explanation of the Problem 12,5 litres of pure alcohol in a year or nearly three drinks a day are consumed by an average EU adult15 and therefore Europe has the highest alcohol consumption rate in the world. Alcohol is also the third leading risk factor for disease and mortality in Europe. Alcohol can cause dependency, criminal behaviour, alcohol-related diseases and even cancer16. People can severely or mortally harm themselves or others while being under the influence of alcohol. Drink driving contributes

15 Alcohol in the European Union - Consumption, harm and policy approaches. 16 European Status Report on Alcohol and Health 2010.

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annually to at least 10,000 deaths in the EU roads17. Alcohol abuse further has many social and economic costs for European society as a whole.18 It is up to the Member States to regulate alcohol consumption. In most countries the legal purchase age is 18, however many Member States do not have any regulation when it comes to alcohol possession19. The same divergence among Member States goes for legal alcohol limits for drivers.20 Links:

• Alcohol consumption profiles per country • Amount of alcohol consumed per capita by country in Europe (map)

3. Key Questions • How is alcohol consumption being regulated in the Member States at the moment?

• Is there a need for a clear directive within the EU or should the Member States tackle this

problem themselves with EU guidelines? • Are EU guidelines even necessary when taking into consideration the fact that a consumer is

responsible for their own decisions?

• Are there any areas where government regulation is lacking?

• What specific measures would be most effective in decreasing alcohol abuse? Links:

• European Status Report on Alcohol and Health 2010 • EU Alcohol Policy

4. Key Actors The trends and developments in alcohol consumption and alcohol-related harm are monitored by the European Union Information System on Alcohol and Health (EUSAH).21 Whilst the alcohol policy is coordinated by the particular authorities within each Member State, the Committee on National Alcohol Policy and Action is responsible for the implementation of EU Alcohol Strategy22. Another committee, which is set up by the EU is Committee on Alcohol Data, Indicators and Definitions, which essentially generates key indicators to monitor alcohol consumption and the implementation of the EU Alcohol Strategy23.

17 European Transport Safety Council Fact Sheet 18 European Status Report on Alcohol and Health 19 Eyes on ages. A research on alcohol age limit policies in European Member States. 20 The Legal Limit. 21 EUSAH is maintained through cooperation between the European Commission and the World Health Organisation (WHO) within the framework of the EU Public Health Programmes: EU Alcohol Policy 22 EU Alcohol Strategy 23 Committee on Alcohol Data, Indicators and Definitions

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Stakeholders, who are interested in decreasing alcohol consumption are also gathered in the European Alcohol and Health Forum (EAHF) 24 . It is a voluntary based organisation, which comprises companies, associations, NGOs, research organisations and other professional bodies25. However, the news about the European Commission not adopting new alcohol strategy has led to the resignation of twenty health organisations from EAHF in the first days of this month26. The European Region of WHO is also very active on the subject and has created several scientific reports. Whilst new direction for the alcohol problem is being formulated by the EU, activists in MS are also stepping up to create ways to reduce alcohol consumption27. An important part of getting a policy through is also lobbying, which is not that transparent in the EU. Transparency International highlights that alcohol industry is one of the most problematic lobbying areas and calls for urgently for new lobbying reform28. Finally, perhaps the most important actor who must be taken into account, is the consumer who in the end decides what and how much to drink. Links:

• Alcohol in the European Union – Consumption, harm and policy approaches • European action plan to reduce the harmful use of alcohol 2012–2020

5. Key Conflicts High alcohol consumption is a problem in Europe and each Member State tries to tackle it in their own way. The EU put together an Alcohol Policy in 2006, which was almost 10 years ago. While the EU keeps funding different projects related to monitoring alcohol consumption, a new action plan has still not been formulated and it seems that it will not be in the future29. Labels on the bottles give information to the consumer30, but yet it seems that most young people do not pay attention31. Advertisement is also regulated, however, regulations vary in Member State and therefore some reports32 call for stronger limitations. It is important to underline that the economic cost caused by alcohol to the EU is 125 billion Euros per year. Additionally, the pain, lost life, and harm created by alcohol is estimated to be 270 billion Euros each year.33 Whilst many policies are trying to tackle the problem of overconsumption, it is vital to pay attention to prevention and rehabilitation as well. Links:

• Alcohol advertising in the European Union

24 European Alcohol and Health Forum 25 Forum members 26 Health NGOs walk out of EU alcohol forum 27 Pharma wins first round in booze battle 28 Europe: Unregulated Lobbying Opens Door to Corruption 29 Commission set to dump EU alcohol strategy 30 Beverage Alcohol Labelling Requirements by Country 31 How do young consumers respond to alcohol labelling and prevention 32 The Impact of Alcohol Advertising 33 Alcohol in Europe A public health perspective

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• Action Plan on Youth Drinking and on Heavy Episodic Drinking (Binge Drinking) (2014-2016)

• Eyes on Ages A research on alcohol age limit policies in European Member States.

Legislation, enforcement and research.

6. Measures Already in Place In 2001 the European Council adopted a Recommendation on the drinking of alcohol by young people, in particular children and adolescents34. It lays down basic criteria how to decrease alcohol consumption and calls for common approach within the union. In 2006, the EU adopted its first EU Alcohol Policy. Since the adoption of the Strategy, there has been considerable activity on the part of the Commission, the MS and the wider stakeholders (mainly the European Alcohol and Health Forum). Whilst coordination at the EU level continues, no new strategy has been made since 2006, despite calls for new plans in recent years from many NGOs35 and from the European Alcohol Policy Alliance36. Within Member States, the policies which regulate alcohol prices can be taken to manage consumption, with indications that increased prices delay the age when a young person starts to drink and that as alcohol taxes have been lowered, sales and consumption have usually increased37. Regarding audio visual advertisement, the current EU Directive 2010/13/EU sets out a criteria, which includes that the advertising must not be aimed at minors; it must not link alcohol with enhanced physical, sexual or social performance; and it must not encourage immoderate consumption38. Links:

• First Progress Report on the Implementation of the EU Alcohol Policy • Eurocare Response to Structure for EU Alcohol Action Plan

7. Summary Despite the common existing EU policy, regulations and restrictions seem to be not effective enough given the ongoing high alcohol consumption and death rate. The EU has a long road to go in order to stabilise the consumption behaviours of its citizens, but the main question is - where to start?

34 Council Recommendation 35 NGOs call for a comprehensive Alcohol Policy Strategy in the European Union 2013-2020 36 Eurocare Response to Structure for EU Alcohol Policy 37 European Status Report on Alcohol and Health 2010 38 Alcohol advertising in the European Union

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COMMITTEE ON WOMEN’S RIGHTS AND GENDER EQUALITY

By Anastasia Lvova (EE) & Marouchka Descamps (FR)

According to the 2014 Report by the EU’s Agency for Fundamental Rights, 1 in 3 women in the European Union (EU) on average, has been victim to physical or sexual violence, making it a major public health issue. The perception of- and approach to gender-based violence differs across the EU particularly in terms of legislation. Furthermore, violence against men and against gender minorities is largely excluded from investigations, discussions and action plans, despite initial evidence of its prevalence. The 2014 report encourages Member States to ratify the Istanbul Convention of the Council of Europe, on preventing and combating violence against women and domestic violence. This convention has still not been signed or ratified by all Member States, nor is it an inclusive approach to gender-based violence.

Which measures should the European Union and its Member States adopt to eradicate gender-based violence?

1. Key Terms • Gender-based violence (GBV): Violence that is directed against a person on the basis

of gender. It constitutes a breach of the fundamental right to life, liberty, security, dignity, equality between women and men, non-discrimination and physical and mental integrity.

• Domestic violence: Regroups all acts of physical, sexual, psychological or economic

violence that occur within the family or domestic unit or between former or current spouses or partners, whether or not the perpetrator shares or has shared the same residence with the victim.

• Physical violence: refers to bodily harm suffered as a result of the application of

immediate and unlawful physical force. It encompasses also violence resulting in the death of the victim.

• Sexual violence: Is defined as a sexual act committed against someone without that

person’s freely given consent.

• Psychological/emotional violence: Involves trauma to the victim caused by acts, threats of acts, or coercive tactics.

• Victim blaming: victim blaming is a devaluing act that occurs when the victim(s) of a

crime or an accident is held responsible — in whole or in part — for the crimes that have been committed against them.

• LGBT people: acronym refers to Lesbian, Gay, Bisexual, Transgender, Queer or

Questioning, and Asexual or Ally

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• Gender minority: An umbrella term used to describe members from the Trans community.

Links:

• Definitions of different type of violence against women: http://eige.europa.eu/content/activities/gender-based-violence

• Definition of sexual violence:: http://www.cdc.gov/violenceprevention/sexualviolence/definitions.html

• Definition of psychological/emotional violence: https://workfamily.sas.upenn.edu/glossary/p/psychologicalemotional-violence-definitions

• Gender and sexual minorities- some useful definitions: https://www.pcc.edu/resources/illumination/documents/fill-in-the-blank-glbtq-defintions- answers-and-handout.pdf

2. Relevance and Explanation of the Problem The 2014 Report on violence against women by the European Agency for Fundamental Rights showed the extensive abuse that affects many women’s lives. One in 10 women has experienced some form of sexual violence since the age of 15, one in 20 has been raped. Furthermore, one in 5 women has experienced physical and/or sexual violence from either a current or previous partner and one in 10 women indicates that they have experienced some form of sexual violence by an adult before they were 15 years old39. Violence against an individual has been proven to have sometimes life-long health implications such as chronic pain, gastrointestinal disorders or even anxiety and depression40. Violence against women is a problem that has complex societal and cultural roots. It is often perceived to be a women’s issue rather than a challenge that concerns both genders. The co-founder of Mentors in Violence Prevention Jackson Katz argues that victim-blaming and men’s reluctance to acknowledge the importance of their contribution to combating violence against women are some of the reasons this problem is not being effectively solved41. Another obstacle is the disparity in legislation of different Member States42. Moreover, the 2011 British Crime Survey has found that 26% of men had experienced at least one incident of interpersonal violence in their lifetimes. That includes bisexuals, homosexuals and transgender people. The scope and challenges of eradicating violence

39 http://fra.europa.eu/en/publication/2014/violence-against-women-eu-wide-survey-main-results-report 40 http://www.stopvaw.org/health_effects_of_domestic_violence 41 http://www.ted.com/talks/jackson_katz_violence_against_women_it_s_a_men_s_issue/transcript?language=en 42 Only five countries have taken measures to establish a national action plan to combat all forms of violence against women, they are Denmark, France, Germany, Spain and Sweden. On the other hand Austria, Czech Republic and Greece are among the Member States that have no national action plan to combat violence against women at all. http://lastradainternational.org/lsidocs/360%20EWL_Reality%20Check.pdf

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against men and gender minorities is very challenging, not only is there a lack of empathy for these men, but also a lack of knowledge, legal frameworks and acknowledgement for their situation.

Links:

• Violence against women: an EU-wide survey: http://fra.europa.eu/sites/default/files/fra-2014-vaw-survey-main-results-apr14_en.pdf

• Reality Check: When Women’s NGOs Map Policies and Legislation on Violence against Women in Europe: http://lastradainternational.org/lsidocs/360%20EWL_Reality%20Check.pdf

• Violence against women - it’s a man’s issue:

http://www.ted.com/talks/jackson_katz_violence_against_women_it_s_a_men_s_issue

• Domestic violence against men and women in Europe:

http://www.doveproject.eu • ILGA-Europe Reports and Other Materials: http://www.ilga-

europe.org/resources/ilga-europe-reports-and-other-materials

3. Key Questions • What steps should be taken in order to integrate all Member States into the process

of battling gender-based violence?

• How can it be ensured that both genders are equally involved in combating gender-based violence?

• How can the priority to tackle violence against women, men and gender minorities be

increased? Links:

• Violence against women is an issue for men too: http://www.theguardian.com/commentisfree/2012/mar/26/domestic-violence-against- women

• Acceptability of domestic violence against women in the European Union: a

multilevel analysis: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2588066/ • Preventing and addressing intimate partner violence against migrant and ethnic

minority women: the role of the health sector: http://www.euro.who.int/__data/assets/pdf_file/0018/270180/21256-WHO-Intimate-Partner-Violence_low_V7.pdf?ua=1

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4. Key Actors The European Commission - Directorates-General on Justice and Consumers (JUST) works together with EU countries and other EU bodies to get more and better information, which will strengthen policy responses to gender-based violence. EU’s Agency for Fundamental Rights (FRA) helps to ensure that the fundamental rights of people living in the EU are protected. It is one of the agencies are set up to provide expert advice to the institutions of the EU and the Member States on a range of issues. The European Institute for Gender Equality (EIGE) is an autonomous body of the European Union, established to contribute to and strengthen the promotion of gender equality. Member States are responsible of adopting legislation meant to eradicate violence against women and adjust their health care systems in order to provide for the best support possible. The European Women’s Lobby (EWL) is the largest umbrella organisation of women’s associations in the European Union, working to promote women’s rights and equality between women and men. Links:

• Directorates-General on Justice and Consumers (JUST) - Zero tolerance of violence against women: http://ec.europa.eu/justice/gender-equality/gender-violence/index_en.htm

• Council of the European Union - Preventing and combating all forms of violence

against women and girls, including female genital mutilation: http://ec.europa.eu/justice/gender-equality/files/jha_violence_girls_council_conclusions_2014_en.pdf

• European Parliament Committee on Women's Rights and Gender Equality:

http://www.europarl.europa.eu/committees/en/femm/home.html • Different definitions and legislations about violence against women in European

countries : http://fra.europa.eu/en • The European Institute for Gender Equality: http://eige.europa.eu/gender-

based-violence/administrative-data-sources/about • The European Women’s Lobby:

http://www.womenlobby.org/spip.php?rubrique43&lang=en

5. Key Conflicts Today, some measures to reduce gender-based violence exist, but it is still widespread and not all countries adhere to them. It has been observed that there is a significant difference among Member States regarding definitions and legislations on gender-based violence. These differences in representation are linked to differences in culture, traditions and religion among other things. Different Member States’ economic and social situations may also interfere on how and to what extent they tackle violence. Gender-

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based violence is closely related to gender inequalities, and can reinforce them. On the other hand gender inequalities could also be the causes of the violence. Despite the measures to end violence against women there is a lack of specific measures about violence against men. This type of violence is not well known and not considered in discussed measures. There is a lack of data about gender-based violence because victims don't always report acts of violence. This applies especially to violence against men. To end gender-based violence we have to take into account these issues and be inclusive to women, men and all gender minorities. It is important that everyone acts to end this violence. Links:

• Different definitions and legislations about violence against women in European countries : http://eige.europa.eu/content/activities/gender-based-violence

• Unknown and underreporting domestic violence against men :

http://family.findlaw.com/domestic-violence/domestic-violence-against-men.html

6. Measures Already in Place In 2011, the Istanbul convention was written by the Council of Europe, to combat violence against women. This convention is focused on prevention, protection and prosecution of the perpetrator. In 2012 directive 2012/29/EU was put in place by the European Parliament and the Council. It establishes minimum standards on the rights, support and protection of victims of crime that are, among others, aimed at victims of violence against women. Over the last 7 years, the European Commission supported Women Against Violence Europe (WAVE), a network of European women’s NGOs working to combat violence against women and children, in particular focused on improving victim support. WAVE provides you information regarding services supporting women survivors of violence. The Daphne programme is part of the Rights, Equality and Citizenship Programme of the European Commission. It distributes funding to NGO projects that support victims of violence and combat the violence against women, children and young people. In 2010, the Committee of Ministers of the Council of Europe adopted the recommendation to Member States on measures to combat discrimination on grounds of sexual orientation or gender identity. It is a policy instrument for member states and especially to combat gender-based violence. Links:

• EU guidelines on violence against women and girls and combating all forms of discrimination against them: http://www.consilium.europa.eu/uedocs/cmsUpload/16173cor.en08.pdf

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• Convention on preventing and combating violence against women and domestic violence (Istanbul Convention): http://www.coe.int/t/dghl/standardsetting/convention-violence/brief_en.asp

• European Commission actions to combat Violence Against Women

http://ec.europa.eu/justice/gender-equality/files/documents/140303_factsheet_vaw_en.pdf

• The Daphne Toolkit – An active resource from the Daphne Programme

http://ec.europa.eu/justice/grants/results/daphne-toolkit/en/daphne-toolkit-–-active-resource-daphne-programme

• A basic information booklet for the members of the FEMM committee of the

European Parliament: http://www.europarl.europa.eu/document/activities/cont/200907/20090728ATT59207/20090728ATT59207 EN.pdf

• Recommendation to member states on measures to combat gender-based discrimination (paragraph I,A about gender-based violence): https://wcd.coe.int/ViewDoc.jsp?Ref=CM/Rec%282010%295&Language=lanEnglish&Ver=original&Site=COE&BackColorInternet=DBDCF2&BackColorIntranet=FDC864&BackColorLogged=FDC864

7. Summary Some Member States have acknowledged the scope of the problem when it comes to gender-based violence by domestic legislation; however, the efforts on the EU level remain scarce. The statistics demonstrate how far-reaching the issue of violence against women is and the scarcity of information on the situation of gender-based violence against men and LGBT people is daunting. Keeping in mind the underlying causes in European societies, tackling the problem in hand remains a great and urgent challenge.

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COMMITTEE ON INDUSTRY, RESEARCH AND ENERGY I (ITRE I)

By Patrick Lavelle (IE)

Remarkable progress has been made this past century in the pharmaceutical sector, offering cures to what were once fatal diseases, and even eradicating certain diseases from Europe. However, the evolution of bacteria resistant to even the most powerful antibiotics and emerging diseases both point to a constant need for further pharmaceutical research. Furthermore, most new medicines are patented, which makes them often too expensive for many of those who need them, particularly in developing countries.

How can the European Union ensure both further pharmaceutical innovation and that medicines are accessible to those who need them?

1. Key Terms • Pharmaceutical (Pharma) Industry – the industry responsible for the development,

production and marketing of medications. It is one of the world’s largest industries in terms of wealth.

• Research & Development (R&D) – activities in corporate or governmental innovation tasked with developing new products or tasked with applied research, which may facilitate future product development43.

• Patent – the exclusive right granted by a government to an inventor to manufacture, use, or sell an invention for a certain number of years, typically 20 years for drugs.

Links:

• Patents, branded drugs and generic drugs: http://www.news-medical.net/health/Drug-Patents-and-Generics.aspx

• Research & Development (R&D) explained: http://www.ifpma.org/innovation/rd/about-

research-development.html

2. Relevance and Explanation of the Problem Pharmaceutical research has greatly improved both the life expectancy and the quality of life of people around the world. Today’s European citizens can expect to live up to 30 years longer than they did a century ago44, and many formerly deadly diseases and illnesses have been controlled with the help of new treatments. Nowadays, developing medicinal products is increasingly complex, expensive and risky, with R&D costs having grown dramatically. However pharmaceutical innovation remains critically important for citizens with major hurdles remaining

43 What is Research and Development (R&D) 44 The Pharmaceutical Industry in Figures

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including Alzheimer’s, Multiple Sclerosis, cancers, emerging diseases 45 and so-called ‘superbugs’46. Governments thus feel it important to take measures to incentivise R&D in the industry, including publicly funding research. However some policy measures to support innovation in the industry, such as patents, are seen to negatively affect accessibility to new pharmaceutical discoveries for patients, especially at a time when disparities in access to pharmaceutical treatments within and across Member States (MS) are increasingly evident. Links:

• European Commission Document on the Pharmaceutical Industry – Pages 1-12 http://ec.europa.eu/DocsRoom/documents/7649/attachments/1/translations/en/renditions/native

• The Pharmaceutical Industry in Figures – be aware this is published by the main federation of pharmaceutical companies in Europe: http://www.efpia.eu/uploads/Figures_Key_Data_2013.pdf

3. Key Questions • How do the EU and Member States’ governments currently promote and support innovations in

the pharmaceutical sector?

• What effect do such measures have on accessibility to newly discovered treatments?

• What should the role of public (EU and Member States) actors be in supporting R&D?

• Where should public funds for R&D focus, and what should the relationship with private actors be?

• What measures would most effectively increase pharmaceutical innovation in the EU?

• How can patient accessibility to the products of this innovation be ensured for patients? 4. Key Actors The actors involved in this problem are rather complex. Pharmaceutical policy making is highly politicised and involves a multiplicity of actors with competing interests47. R&D policies are primarily set at national level and vary among MS, however research is a shared competence of the EU48.

45 An emerging disease is one that has appeared in a population for the first time or that may have existed previously but is rapidly increasing in incidence or geographic range. Examples include Ebola virus (first outbreaks in 1976), HIV/AIDS (first isolated in 1983) and E. coli (first detected in 1982). 46 Superbugs – a term coined by the media for bacteria that have become resistant to antibiotics, such as Methicillin-resistant Staphylococcus aureus (MRSA). 47 p5-8: Actors in pharmaceutical regulation, legislation and market authorisation 48 European competence in research

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The EU only has a supporting competence49 in public health policy, a policy area that greatly affects accessibility to treatment for citizens. The market for medicines is highly regulated within each country, with pricing and reimbursement rules for medicines varying.50 The European Commission51 is a major actor. It scrutinises the implementation of EU law by Member States, drafts legislation in areas of EU competence, coordinates the EU’s programmes (e.g. R&D programmes), proposes rules and regulation – for example in competition policy – and represents the EU in international trade negotiations. The pharmaceutical (‘Pharma’) industry lobby is one of the world’s most influential industry and trade lobbying groups52. Due to high costs in the industry, such as R&D costs, the market is dominated by a small number of large multinational corporations - such as Novartis, Pfizer and GlaxoSmithKline - with the so-called ‘patent cliff’ increasing this trend in recent years53. Links:

• Legal framework governing medicinal products in the EU: http://ec.europa.eu/health/human-use/legal-framework/index_en.htm

• Competition policy and the pharmaceutical sector:

http://ec.europa.eu/competition/sectors/pharmaceuticals/overview_en.html

5. Key Conflicts Central here is the debate of who should fund science, in this case R&D in the pharmaceutical sector. Some take issue with the state supporting pharmaceutical R&D, whose offspring will be patented for private profit. Others argue it is necessary to ensure companies have incentives to invest in R&D, particularly for orphan drugs54, by enabling them to enjoy sufficient profits from any discoveries. And given the US pharmaceutical industry continues to outperform the EU industry, can the EU afford to be having such an argument55? However measures to support R&D, especially patent protection, are the source of much criticism, with many feeling they directly affect accessibility to treatment for patients by increasing the cost of medication. This issue has provoked much debate with regard to providing medicines in less developed countries for pandemics like HIV/Aids. As several countries in Europe have seen their public health service and goods reduced, and out-of-pocket

49 Supporting Competence – the EU can only intervene to support, coordinate or complement the action of MS. 50 As a result, unlike most sectors, there is little competition on price in the pharmaceutical sector within the EU internal market. 51 European Commission 52 Example of Pharma Power - Big Pharma spend over €40 million per year lobbying in the EU 53 The patent cliff describes the scenario whereby the world’s biggest pharmaceutical firms stand to lose billions of dollars in revenues from the patent expiration on blockbuster drugs developed during the 1990s, a golden era for the industry for discoveries of new drugs. 54 Orphan drugs are drugs for rare diseases or disorders which the pharmaceutical industry has little interest in developing under normal market conditions given it would only be intended for a small number of patients 55 US & EU Industries compared: Global Competitiveness in Pharmaceuticals

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payment by patients have risen56, there is now increased debate in Europe too, particularly with regard to issues such as incremental drugs57. Links:

• Article – Drug patents: innovation vs. accessibility: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680575/

• European Commission on Access to medicines: http://ec.europa.eu/trade/policy/accessing-

markets/intellectual-property/access-to-medicines/

6. Measures Already in Place A new proposal, the European patent with unitary effect (EPUE)58, or unitary patent, plans to reduce the high costs and legal uncertainty of issuing patents in the EU. 25 Member States have signed up for the proposal which would give its holder uniform patent protection in these Member States59. However the proposed cost for the patent is causing dissent in the industry from those who consider it excessively high60. The European Commission is administering Horizon 2020, the biggest EU Research and Innovation programme ever, for the period 2014-202061. At the same time, it is co-funding the 2nd phase (2014-2024) of the Innovative Medicines Initiative (IMI), the world’s largest public-private partnership, seeking to improve health by speeding up the development of, and patient access to, innovative medicines, particularly in areas where there is an unmet medical or social need62. At present, when the patent on a drug expires, competitors can produce generic drugs63 and seek approval to produce biosimilars64. This is particularly significant with the ‘Patent Cliff’ nearing. However the registration system for such goods has been criticised as costly and as a barrier to cheaper generics and biosimilars65. The Transatlantic Trade and Investment Partnership (TTIP)66 will have several implications for the pharmaceutical industry in Europe and for patients. The proposed investor-to-state-

56 OECD on inequalities in access to quality care in Europe: Between 2009 and 2012 expenditure on health in real terms fell in half of the EU countries and significantly slowed in the rest. 57 Where a pharmaceutical company makes only small improvements on an existing drug, and is able to extend the life of its patent, keeping generic drugs out of the market for longer. Incremental innovation is also referred to as ‘evergreening’. 58 Unitary patent aims to make the European system simpler and less expensive and consequently is expected to stimulate R&D and investment in innovation. 59 EU on intellectual property rights 60 The Secretary General of the European Chambers of Commerce and Industry has criticised unitary patent plans as developing into a tax on innovation. 61 Horizon 2020 aims to produce world-class science, remove barriers to innovation and make it easier for the public and private sectors to work together delivering innovation 62 What is the Innovative Medicines Initative (IMI). 63 Generic drugs are chemically identical drugs to a branded equivalent (bioequivalent) and are typically sold at substantial discounts from the branded price. 64 Biosimilars are highly similar versions - but not bioequivalent - of an original biological medicine with allowable differences which have no clinically meaningful differences. 65 Report: Regulatory and cost barriers are likely to limit biosimilar development and expected savings in the near future. 66 TTIP is a trade & investment deal the European Commission is currently negotiating with USA.

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dispute-settlement (ISDS) procedure has caused much controversy, with many NGOs warning it will jeopardise access to affordable medicines and public health protection in Europe67 or in developing countries68. The World Trade Organization’s Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement69 provides for compulsory licensing70 of pharmaceuticals. Whilst the EU and others have adopted regulation to allow compulsory licensing of pharmaceutical patents for export to ‘countries in need’71, in practise the industrialised world has been accused of failing to supply essential medicines72. The European Commission has identified a lack of information sharing between Member States as a major barrier to greater patient accessibility to orphan medicinal products. Multi-country managed entry point (MEAs)73, differentiated pricing74 and joint medicines purchasing75 are among the suggestions it proposes. Links:

• European Commission Document on the Pharmaceutical Industry – Pages 13-25 http://ec.europa.eu/DocsRoom/documents/7649/attachments/1/translations/en/renditions/native

• NGO criticism of TTIP’s implications for patient accessibility to medicines and healthcare: http://www.prescrire.org/Docu/DOCSEUROPE/20140324CivilSocietyResponseBigPharmaWishList_final.pdf

• EU defence of pharmaceuticals in TTIP: http://trade.ec.europa.eu/doclib/docs/2015/january/tradoc_153010.4.7%20Pharmaceuticals.pdf

7. Summary Are patents a barrier to access? Or would these drugs have existed at all otherwise? Does patent-type protection need to be strengthened to boost R&D? Or does the opposite need to be achieved to improve accessibility to new medicines for patients? How will proposals such as

67 An NGO coalition says ISDS will enable pharmaceutical companies to sue MS that take measures to improve access to medicines, or excludes less effective treatment from reimbursement. 68 Oxfam has said the EU is trading away access to medicines with TTIP and warns that TTIP is not compatible with the EU’s development and public health objectives. 69 International agreement on intellectual property of which the EU is a signatory. 70 A compulsory license is granted by a government and allows an individual or company to produce a patented product without seeking the patent holder’s consent. 71 Regulation (EC) No 816/2006 on Compulsory licensing system for the production and export of generic medicinal products to developing countries. 72 Médicins Sans Frontieres accused the USA in 1999 of ensuring that Thailand would not produce or import low cost AIDS drugs or any other life-saving patented drugs through pressure tactics 73 MEAs are formal agreements between payers and manufacturers with the aim of sharing the financial risk due to uncertainty surrounding the introduction of new technologies, in order to enable access to new medicines. 74 When a customer is charged different prices for a product based on the type of customer, quantity ordered, delivery time, payment terms etc. 75 Joint medicines purchasing is when Member States procure pandemic vaccines and other medicinal countermeasures as a group, rather than individually, improving Member States’ purchasing power and equitable access to these products

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TTIP and the unitary patent impact on these issues? Are there alternative routes to boost innovation? At the same time, how can accessibility not only be protected but improved? In essence the question facing the committee is how to accommodate these different objectives with constrained resource, i.e. “striking a balance between guaranteeing patients’ access to state-of-the-art medical treatment and ensuring that incentives are provided for the industry to continue to invest in pharmaceutical R&D”76.

76 p9 http://ec.europa.eu/DocsRoom/documents/7649/attachments/1/translations/en/renditions/native

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COMMITTEE ON INDUSTRY, RESEARCH AND ENERGY II (ITRE II)

By Milana Yandieva (CZ)

Agricultural innovation has enabled centuries of productivity gains and thus supported the needs of an ever greater population. However, some innovative methods, such as the intensive use of pesticides and fertilisers, are accused of being harmful towards human health, biodiversity and the environment. In addition, several recent innovations are particularly controversial, such as genetically modified organisms (GMOs) and hormonal growth promotants.

How can the European Union foster agricultural innovation while

ensuring the good health of its citizens?

1. Key Terms • Genetically modified organisms (GMOs) - an organism in which the genetic material has

been altered in a way that does not occur naturally. GMOs may include plants, animals or micro-organisms, such as bacteria, parasites and fungi.

• Hormonal growth promotants (HGPs) - naturally occurring hormones, such as oestrogen,

progesterone and testosterone, which are used to accelerate weight gain in cattle. It is prohibited to import meat containing HGPs in the European Union.

• Pesticides - any material of natural or synthetic origin that prevents, destroys, or controls a

harmful organism (‘pest’) or disease, or protects plants or plant products during production, storage and transport.

• Maximum residue levels (MRLs) - the highest level of a pesticide residue that is legally

tolerated in or on food when pesticides are applied correctly.

• Fertilisers - any material of natural or synthetic origin that is applied to soil and plants to supply plant nutrients essential to the plant’s growth.

Links:

• Genetically Modified Organisms: http://www.efsa.europa.eu/en/topics/topic/gmo.htm + https://www.youtube.com/watch?v=ZvciTwAQ9rM (VIDEO)

• Hormonal Growth Promotants: www.eea.europa.eu/.../issue-22-part-14.pdf • Pesticides: http://ec.europa.eu/food/plant/pesticides/index_en.htm +

https://www.youtube.com/watch?v=aTm7i84mcMI (VIDEO) • Maximum Residue Levels:

http://ec.europa.eu/food/plant/pesticides/max_residue_levels/index_en.htm

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2. Relevance and Explanation of the Problem Research and development of new agricultural methods are crucial for fulfilling the needs of growing a population in Member States. However, despite the significance of agricultural innovation, national governments prioritise their citizens’ health and are inclined to give access to the market only to the food that is grown ‘traditionally’ rather than induced with controversial Genetically Modified Organisms (GMOs) and/or Hormonal Growth Promotants (HGPs). While the priorities of the governments are justified, this approach might lead to a long-term stagnation in agricultural progress and inability to sustain the needs of the next generations. On the other hand, food safety is a pressing issue that needs to be addressed in the light of a more active use of GMOs, pesticides and fertilisers. Since it is essential that agricultural innovation goes hand-in-hand with EU Health Strategy, European Food Safety Authority (EFSA) carries out the risk assessment of GMOs, pesticides and fertilisers, with the process including the evaluation of the effects on human and animal health. European Commission and Member States go through the process of authorising risk-free substances. While certain GMOs are permitted due to their safety, the EU prohibited the use of HGPs in Member States in 1981, as well as imports of meat with HGPs from other countries.

Links:

• Agricultural research and innovation: http://ec.europa.eu/agriculture/research-innovation/index_en.htm

• Decision-making process on GMOs (pesticides, fertilisers, etc.) safety:

http://ec.europa.eu/food/plant/gmo/new/authorisation/decision_making_process/index_en.htm

3. Key Questions • How can the European Union ensure the safety of agricultural innovative methods and

techniques?

• Is there a sound argument in favour of using the GMOs and HGPs?

• Does the European Union need to prioritise the population’s health standards or sufficiency of food supply?

• What are the platforms through which the European Union can promote agricultural

innovation? Links:

• Assesing the safety of chemical mixtures (VIDEO): https://www.youtube.com/watch?v=0BgpGPzXYy4

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4. Key Actors The European Commission acts as the main decision-maker in terms of fund allocation to research and innovation projects, as well as GMO authorisation and Maximum Residue Levels (MRLs). Motivated by the Europe 2020 and Horizon 2020 goals, the European Commission might overlook the general public’s concern with long-term health effects. The European Commission also went forward to form the Research, Innovation and Science Policy Experts (RISE) High Level Group (HLG). Set under the Innovation Union initiative, the RISE advisory groups focus on how to best use EU research, innovation, and science policy to create conditions for a sustainable economic growth. The European Food Safety Authority (EFSA), in collaboration with national authorities, provides additional expertise in order to elevate the rate of food production, food quality and degree of innovation. EFSA carries out risk assessment regarding food and feed safety, i.e. evaluates the safety of GMOs, pesticides, etc. It also holds an advisory forum for the aforementioned national authorities - the heads of the respective national agencies, as well as Iceland and Norway, come together to exchange scientific data and tackle the divergence of opinions on food safety. Finally, Member States’ governments’ top priority is to ensure the highest standards of living for its citizens, while, agricultural innovation might be considered less important. Links:

• EFSA: http://www.efsa.europa.eu/ + https://www.youtube.com/watch?v=KSluc9igxkA (VIDEO)

• EFSA Advisory Forum: http://www.efsa.europa.eu/en/networks/af.htm • RISE HLG: http://ec.europa.eu/research/innovation-union/index_en.cfm?pg=expert-

groups • Scientific cooperation between actors: https://www.youtube.com/watch?v=p9Ze78R4BtI

(VIDEO)

5. Key Conflicts The GMOs and HGPs are undeniably a breakthrough for agricultural workers and researchers. However, the most important concern behind the use of GMOs is its long-term effects on human health. Even though EFSA carries out risk assessment in order to assure the consumers of safety of permitted substances, the prominence of negative connotations deters the potential consumers. The long-term effects of GMOs are still unclear due to the fact that they have emerged only recently, therefore resulting at the conflict of long-term agricultural progress vs. long-term health risks. According to the 18th century’s Malthusian thesis, food production increases at an arithmetic rate, whereas populations grow at a geometric rate, which is more than relevant in the 21st century, as well. If we were to equalise the rates of growth of food production and of population, the only way to achieve that would be the use of relatively unsafe (or yet untested) GMOs and EU-prohibited HGPs, which would allow a more protected and richer produce. Therefore, the conflict of satisfying the nutrition needs vs. satisfying the health needs arises. Looking specifically at HGPs, it is not banned anywhere but in the EU, while Australia, New Zealand, USA, Canada, South Africa and Japan freely produce and trade the hormone-treated

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meat. The World Trade Organisation (WTO) found that the EU’s ban is not supported with science and is inconsistent with WTO obligations. Therefore, the EU needs to decide if it wants to follow the global trends vs. to retain ‘European values’, which will directly impact the EU imports’ competitiveness.

6. Measures Already in Place Innovation Union focuses on achieving the goals of Europe 2020 with its plan aiming to tackle three main tasks: make Europe into a world-class science performer; utilise the Innovation Partnerships in order to achieve greater cooperation between private and public sectors and remove ‘bottlenecks’- like expensive patenting, market fragmentation, slow standard setting and skill shortages - that currently prevents idea from quickly reaching the market. Additionally, under Europe 2020, the EU stresses the importance of harmonising the Member States’ agriculture with the framework of Horizon 2020, the EU Research and Innovation programme. With the budget of EUR 80 billion, nearly EUR 4 billion have been specifically allocated to Horizon 2020’s Societal Challenge 2, tackling, among other issues, the challenge of sustainable agriculture and forestry. Moreover, Rural Development Policy 2014-2020’s main goal is ‘fostering knowledge transfer and innovation in agriculture, forestry and rural areas’, which, in order to be reached, will also be funded. For the funds to be allocated efficiently, The European Innovation Partnership for Agricultural Productivity and Sustainability (EIP-AGRI), acts as a platform for integrating and streamlining the processes of agricultural output, research and innovation. What is more, run by the European Commission, this Innovation Partnership aims to foster competitive and sustainable farming and forestry. The funding is received from Horizon 2020 and Rural Development Policy 2014-2020. The EIP-AGRI brings together farmers, advisors, researchers, agribusinesses, NGOs and other actors as partners in agricultural innovation. In order to satisfy the health goals, the aims of agricultural innovation could be aligned with the aims of Together for Health (EU Health Strategy), which is the programme aimed at investments in sustainable health systems, health promotion and health coverage. Links:

• Europe 2020 in a nutshell: http://ec.europa.eu/europe2020/europe-2020-in-a-nutshell/index_en.htm

• Innovation Union: http://ec.europa.eu/research/innovation-union/index_en.cfm • EIP-AGRI: http://ec.europa.eu/agriculture/research-innovation/eip-

agriculture/index_en.htm • Horizon 2020 and Societal Challenge 2: http://ec.europa.eu/programmes/horizon2020/

http://ec.europa.eu/programmes/horizon2020/en/h2020-section/food-security-sustainable-agriculture-and-forestry-marine-maritime-and-inland-water

• Horizon 2020, Work Programme of Societal Challenge 2:

http://ec.europa.eu/research/participants/data/ref/h2020/wp/2014_2015/main/h2020-wp1415-food_en.pdf (pages 6-33)

• Rural Development Policy 2014-2020: http://ec.europa.eu/agriculture/rural-

development-2014-2020/index_en.htm

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• EU Health Strategy: http://ec.europa.eu/health/strategy/policy/index_en.htm

7. Summary It is crucial to realise that our topic, despite what has been mentioned in the ‘Key Conflicts’, craves a solution that would combine both agricultural innovation and good health of EU citizens. There is plenty of funding available from Horizon 2020 and from the Rural Development Policy, as well as many of the measures and programmes, including EIP-AGRI and Together for Health, are already working towards reaching the needed levels of innovation and health provision. That is why, the main aim of our discussion is to realise whether the controversial innovative methods are indeed unsafe, how to exclude the unsafe techniques to accelerate the agricultural progress and how to maintain and maximise health benefits during the process of innovation.

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COMMITTEE ON LEGAL AFFAIRS (JURI)

By Lars Kieni (CH) & Margot Sulvic (FR)

Dying with dignity: euthanasia and/or assisted suicide are legal in three Member States of the European Union (EU) and Switzerland, authorised in certain forms (such as refusing treatment, also called passive euthanasia) in many Member States, and prohibited in five Member States. This topic is not only a question of health and treatments, but also of ethics, religion, and politics, on which the EU has not yet taken a stance. What stance, if any, should the European Union adopt in the definition of

the legislation on euthanasia and assisted suicide?

1. Key Terms

• Euthanasia: deliberately ending a person's life to relieve suffering77. Euthanasia can be: - Voluntary: a person, in a position to give consent, requests euthanasia; - Non-voluntary: the decision is taken by someone such as a relative because the person is

not capable of taking the decision. - Active: acting for the person’s death (e.g: triggering a medical overdose); - Passive: withholding treatment necessary for life to continue.

• Assisted Suicide: An entitled person provides the means, but allows the person end their life

themselves (e.g: providing pills).

• Palliative Care: Easing a patient’s suffering by treating their pains to make their situation more endurable.

• Human dignity: An individual’s or group's sense of self-respect and self-worth, physical and

psychological integrity and empowerment78. Considered inviolable79, it is the base of Human Rights law.

• Individual autonomy: Principle stating that a person should have the right to take decisions

regarding his treatment.

• Right to life: Implies a right to be alive, to protection in case of risk to one’s life and to not have one’s life ended unjustly.

• Bioethics: Moral principles that influence research in medicine and biology80.

77 Definition given by the British National Health Service: http://www.nhs.uk/Conditions/euthanasiaandassistedsuicide/Pages/introduction.aspx. 78 Definition given by the Duhaime legal dictionnary; http://www.duhaime.org/LegalDictionary/H/HumanDignity.aspx. 79See articles 1, 2, and 3§1 of the Charter of Fundamental Rights of the European Union: http://www.europarl.europa.eu/charter/pdf/text_en.pdf. 80 http://www.oxforddictionaries.com/fr/definition/learner/bioethics.

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Links:

• Straightforward explanations of euthanasia, assisted suicide and palliative care can be found on the (British) National Health Service’s website: http://www.nhs.uk/Conditions/euthanasiaandassistedsuicide/Pages/introduction.aspx.

• An overview on the relationship between Human Rights, human dignity and bioethics:

http://www.unesco.org.uy/ci/fileadmin/shs/redbioetica/dignidad_Andorno.pdf.

2. Relevance and Explanation of the Problem Assisted suicide was first legalised in Switzerland in 1942, while euthanasia was only legalised for the first time in 2002 in the Netherlands, although it had been tolerated there for many years before, and both have been a source of controversial debates for a long time. Indeed, bioethics and human rights, both central here, are always delicate topics. Within the EU, the situation is made more complex by the differing national legislations: while assisted suicide is punished up to 14 years of prison in the UK, it is legal in the Benelux countries81. Due to cultural differences and this juxtaposition of diverging national legislation, it is difficult to come up with a common perception of “morally right”. The unity of the Member States is therefore threatened, and while the EU can take a stance on euthanasia to try encouraging a consensus, its action is limited by the Member States’ sovereignty in public health matters82 and the principle of conferral83. These differences also produce so-called “suicide tourism”: suffering people travel to countries authorising euthanasia/assisted suicide to end their lives. This is facilitated by the fundamental freedoms of movement in Europe, and is sometimes a source of conflict among Member States.84

Links:

• An article by News Week summing up the legal situation in the Benelux countries as well as the debate about euthanasia in other European countries: http://www.newsweek.com/2015/02/20/choosing-die-netherlands-euthanasia-debate-306223.html.

• An article by CNN about “suicide tourism” to Switzerland, where assisted suicide is

permitted: http://edition.cnn.com/2014/08/20/health/suicide-tourism-switzerland/.

3. Key Questions • Should the EU intervene on this matter, and if yes, to what degree and on what aspects?

• What weight should be given to non-institutional groups in this debate?

• What role do ethics and morals play in this discussion?

81 http://www.nhs.uk/conditions/euthanasiaandassistedsuicide/pages/introduction.aspx. 82 Explanation of EU competencies: http://ec.europa.eu/citizens-initiative/public/competences/faq?lg=en. 83 The principle of conferral states that the EU may only act where competence to act has been conferred by the Member States. 84 http://euhealth.wikispaces.com/Fundamental+rights+and+Euthanasia.

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4. Key Actors The EU has no exclusive competences on euthanasia85, and the jurisdictional power normally lies on the Member States: their Parliaments can legislate on the matter86. Courts of justice87 have a say on the interpretation and the legality of the laws passed by these institutions. Various groups try to make their voice heard: the Catholic Church strictly condemns suicide and treats it as blasphemy88, whereas organisations like Dignity in Dying89 argue in favour of individual autonomy. Physicians and clinics detain the knowledge necessary to judge the patient’s state and needs, and have a scientific input in the debate. Lastly, individuals seeking to end their life are the most directly involved and revive the debate by bringing their case in front of the courts. Links:

• Relationship between the EU and the European Court of Human Rights (ECHR), religious groups and MS: http://www.hanselawreview.org/pdf3/Vol2No1Art04.pdf, pp. 55-6090.

• How the Lisbon Treaty has changed the EU, Chapter 2 about Human Rights:

http://www.eepa.be/wcm/dmdocuments/OSI_Lisbon_Treaty_Implications_2010-06.pdf, pp. 10-13.

• Implication and influence of lobby groups in Greece, Great Britain and the Netherlands:

http://www.hanselawreview.org/pdf3/Vol2No1Art04.pdf.

5. Key Conflicts Euthanasia touches the core of many moral matters: many different groups protest against it, arguing that the “right to suicide” disrespects the right to life. Some argue that medical advances have reduced the need for euthanasia or assisted suicide91, or that liberalisation of access might lead to involuntary euthanasia 92 and abuse of the treatment 93 . Others claim a need for legalisation based on respect of human dignity and individual autonomy94. As the EU tries to

85 It does have certain competences in the area of respect for Human Rights and has competence to compliment and support MS in public health policy. 86 With the enforcement of the Lisbon Treaty in 2009, the MS however have to respect the Charter of Fundamental Rights when passing a law. 87 The European Court of Human Rights, the European Court of Justice and national judiciaries. 88 See, for example, the Vatican's Declaration on Euthanasia. 89 Official website of the organisation. 90 Keep in mind this was published in 2006; the relationship with the European Convention on Human Rights has since then changed with the Lisbon Treaty (2009): the EU might, under strict conditions, accede to the European Convention on Human Rights, and therefore commit to applying the decisions of the European Court of Human Rights. 91 http://news.bbc.co.uk/2/hi/health/background_briefings/euthanasia/331273.stm. 92 Involuntary euthanasia is euthanasia performed against the will of the patient; it is almost always considered murder or manslaughter. 93 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070710/. 94 https://www.youtube.com/watch?v=A8iCelUNXTU&NR=1.

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conciliate and respect most opinions, finding a solution suiting both sides’ view of what is moral is difficult. Furthermore, while the diverging legislations can be a source of conflict between Member States, an explicit supranational stance from the EU might bring it into conflict with the Member States. Links: • Arguments against the legalisation of euthanasia:

http://www.bbc.co.uk/ethics/euthanasia/against/against_1.shtml.

• Arguments for the legalisation of euthanasia: http://www.bbc.co.uk/ethics/euthanasia/infavour/infavour_1.shtml.

• On whether the EU should intervene in the euthanasia debate or not:

http://www.debatingeurope.eu/2015/03/16/euthanasia-legalised-across-europe/#.VXGhH8_tmkp.

6. Measures Already in Place The specifics of legislation vary from state to state, but within the EU and neighbouring European states, three broad categories can be identified in this map95:

The EU has not taken any stance. The Council of Europe96 passed a resolution against euthanasia in 201297. However, the ECHR recognised a right to determine the end of one’s own life as part of the Human Rights Convention98.

95 Translated from http://www.touteleurope.eu/actualite/l-euthanasie-dans-les-etats-membres.html.

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Links:

• BBC summing up the debates and the legal framework in 11 European countries: http://news.bbc.co.uk/2/hi/europe/7322520.stm.

• 6 cases where the ECHR has taken a stance on Euthanasia:

http://www.echr.coe.int/Documents/FS_Euthanasia_ENG.pdf. • The recent case of Vincent Lambert, where the ECHR ruled in favour of passive

euthanasia: http://www.telegraph.co.uk/news/worldnews/europe/france/11653596/Man-in-vegetative-state-can-be-taken-off-life-support-against-parents-wishes-rules-European-court.html.

7. Summary Despite not being fully competent on the matter of Human Rights, the EU, due to its growing scope and the conflicts that might emerge from greatly diverging legislations between Member States, has an interest in taking a stance on euthanasia, although this is a sensitive topic in terms of the sovereignty of MS. The matter is to know on what aspect(s) of the issue, if any, the EU should assert an opinion or act with regulation or legislation. The way the EU should act should also be carefully thought through, between balancing the interests of Member States and other actors and striving for the wellbeing of the Union and its citizens.

96 The Council of Europe gathers 47 countries and protects Human Rights since 1949. It works closely with the European Court of Human Rights, which ensures that the Councils implements properly the European Convention on Human Rights. A committee on bioethics covers the topic of euthanasia within the Council. See the website of the Council of Europe. 97 Resolution 1859 (2012) of the Parliamentary Assembly of the Council of Europe. See the paragraph 5. 98 http://www.dw.de/europe-split-on-right-to-die-regulations/a-17383707.

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COMMITTEE ON TRANSPORT AND TOURISM (TRAN)

By Can Ali Sehirlioglu (TR) & Darya Savishcheva (BY)

The use of fossil fuels for transportation means was criticized over the recent years for damaging the environment and also health. Indeed, it releases particulate matter (PM) that can cause illnesses in the short, mid and long term (lung and heart diseases, cancers). The peak pollution incidents, which take place regularly in the main European capitals, illustrate the importance of this health issue and of tackling it. In the meantime, electric cars, for instance, must still be developed before they are an efficient and durable alternative to traditional vehicles. What policy should the European Union and its Member States implement

in order to fight transport-led air pollution taking into consideration current trends towards sustainable development?

1. Key Terms • Alternative energy sources - energy sources that have no undesired consequences such for

example fossil fuels or nuclear energy. Alternative energy sources are renewable, have comparable or better performance, however do not emit carbon99

• Fossil fuels – hydrocarbons, primarily coal, fuel oil or natural gas, formed from the remains of dead plants and animals100.

• Biofuels - energy sources made from living organisms or from metabolic by-products (organic or food waste products) 101

• Greenhouse gases – gases that trap heat in the atmosphere. Increase in the atmospheric concentration of such gases, e.g. carbon dioxide (CO2), leads to global warming102

• Shared economy - takes a variety of forms, often leveraging information technology to empower individuals, corporations, non-profits and government with information that enables distribution, sharing and reuse of excess capacity in goods and services103

Links:

• An explanatory article about alternative energy sources: http://www.universetoday.com/74599/what-is-alternative-energy/

• An encyclopaedia entry about fossil fuels:

http://instituteforenergyresearch.org/topics/encyclopedia/fossil-fuels/

99 http://www.altenergy.org/ 100 http://www.sciencedaily.com/terms/fossil_fuel.htm 101 www.alternative-energy-news.info/ 102 http://www.epa.gov/climatechange/ghgemissions/gases.html 103 http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2271971

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• What are greenhouse gases: http://whatsyourimpact.org/greenhouse-gases • Transport-led air pollution: http://www.eea.europa.eu/themes/transport/intro

2. Relevance and Explanation of the Problem Clean air is essential to our health and to the environment. But since the industrial revolution, the quality of the air we breathe has deteriorated considerably - mainly as a result of human activities. Rising industrial and energy production, the burning of fossil fuels and the dramatic rise in traffic on our roads all contribute to air pollution in our towns and cities which, in turn, can lead to serious problems for both health and the environment. As a result the direct costs to society from air pollution, including damage to crops and buildings, amount to about €23 billion per year, and the external costs from health impacts alone are estimated at € 330-940 billion (3-9% of EU GDP) 104. Road transport in particular makes a significant contribution to emissions of all the main air pollutants. Transportation is responsible for 31% of EU energy consumption and is 94% dependent on fossil fuels105. The main effect of such energy on health is related to ambient air pollution resulting from combustion that increases the level of carbon monoxide in the air and leads to exaggeration of direct health problems including nervous system. Indirect health effects may be related to climatic changes caused by emissions106. Current decrease in transport demand and its energy consumption as well as technology improvements due to market saturation, policy restrictions and oil prices have not had a significant influence on the issue. According to assumptions, transportation will be dominated by oil (approx. 87% in 2035) still being one of the largest consumers of non-renewable energy sources and emitters of carbon dioxide pollution107. Nowadays a number of promising opportunities and technologies are candidates for lowering vehicle emissions. On one hand, the digitalisation of the world economy made it possible to reduce transport usage significantly through invention of car sharing108, start-ups as Uber, Blablacar etc. On the other hand, new technological advancements opened the opportunity to use such alternative innovations as electronic vehicle controls, electric and hybrid vehicles, and, of course, biofuels that serve as the main renewable substitute to fossil fuels in the EU's transport sector109. However, despite the overall positive potential of alternative technologies, their unsustainable production and usage can lead to serious environmental consequences having, as a result, even worse effect on health.

104 http://ec.europa.eu/environment/air/index_en.htm 105http://www.eubia.org/107.0.html 106http://www.eolss.net/sample-chapters/c09/e4-23-05-02.pdf 107 http://www.bp.com/content/dam/bp/pdf/Energy-economics/Energy-Outlook/Energy_Outlook_2035_booklet.pdf

108 Car sharing is a model of car rental where people rent cars for short periods of time, often promoted as an alternative to owning a car. In comparison to traditional car rental, car sharing is not limited by office hours, based on self-service, imposes fewer ownership responsibilities, and provides easy access to vehicle locations. (http://tsrc.berkeley.edu/sites/tsrc.berkeley.edu/files/Carsharing%20in%20Europe%20and%20North%20America.pdf) 109http://ec.europa.eu/energy/en/topics/renewable-energy/biofuels

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Despite the progress in tackling the transport issue achieved through legislative frameworks on international, regional and national levels, air quality continues to worsen. Therefore further actions and improvements taking into consideration the main conflicts are required.

Links:

• Fossil Fuel Energy Impacts on Health: http://www.eolss.net/sample-chapters/c09/e4-23-05-02.pdf

British Petroleum Energy Outlook 2035: http://www.bp.com/content/dam/bp/pdf/Energy-

economics/Energy-Outlook/Energy_Outlook_2035_booklet.pdf • European Commission Overview on Bio fuels:

https://ec.europa.eu/energy/en/topics/renewable-energy/biofuels • European Commission Environmental policies, Air:

http://ec.europa.eu/environment/air/index_en.htm

3. Key Questions • How to reduce transportation usage and therefore negative consequences it has?

• Which steps should be taken to further promote development of alternative technologies in

order to reduce reliance on fossil fuels?

• How can the potential negative effect from production and consumption of alternative technologies be mitigated?

• How to find a balance between restricting regulations and potential benefits for all the actors

in society in order to produce and to consume green technologies?

• How to motivate people to switch to a sustainable way of life? Links:

• Renewable Energy in Public Transport (REPUTE Project): https://www.youtube.com/watch?v=3VohQJlqnSQ

• White Paper on the Future of Transportation Policy:

http://ec.europa.eu/avservices/video/player.cfm?ref=I069182

• Shared Economy in Transport Sector: http://smartycents.com/articles/the-sharing-economy-transportation/

• Sustainable Urban Mobility – The Right Mix:

https://www.youtube.com/watch?v=kFeSrG7gjvU

• Air Pollution from Ground Transportation. An Assessment of Causes, Strategies and Tactics, and Proposed Actions for the International Community: http://www.un.org/esa/gite/csd/gorham.pdf

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4. Key Actors In the transportation sector the EU shares competences with the Member States. That means the Union and the Member States may legislate and adopt legally binding acts in that area. The Member States shall exercise their competence to the extent that the Union has not exercised its competence110. In this situation the European Commission develops, promotes and enforces transport policies as well as set of goals that are efficient, safe, secure and sustainable providing an orientation for the Member States legislation. Agencies of the EU, such as the European Environment Agency (EEA) are responsible for providing sound, independent information on the environment being a major information source for those involved in developing, adopting, implementing and evaluating environmental policy, and also the general public. As result the Member States are in charge of implementation of transport policy, based on provided framework and information, as well as of improving the issue through regulation and control an investing in possible solutions and transportation infrastructure on the local level. They develop fiscal, regulatory, legislative and other strategic instruments in the area of transportation that have a direct effect on all the actors in the country. E.g. such instruments can have positive or negative influence on private sector, which is a driver of creative, cost-saving solutions to complex transportation problems as well as source of possible essential investments in sustainable transport infrastructure in partnership with public sector. In its turn, society can also influence private sector by changing consumer expectations that leads either to development of new technologies and services or blocking such potential, or drive changes through NGOs, innovative initiatives etc. Links:

• European Environment Agency: http://www.eea.europa.eu/about-us • European Commission: http://ec.europa.eu/about/index_en.htm • Working with Private Sector to meet Transportation Goals:

http://www.fhwa.dot.gov/publications/publicroads/05nov/06.cfm

5. Key Conflicts One of the main questions that arises in this topic is who is responsible for the nowadays air pollution, transportation demand and therefore increased health risks? Is it governments that implement ineffective actions providing unbalanced restrictions and motivational policy? Is it private sector that makes not enough effort in commercialising alternative technologies? Or is it society that is still not ready to change its behaviour towards sustainability? First of all, national and European regulatory environments are not always appropriate and in place. There are still no common European standards for transport safety and security. Technological advances in the automotive industry, for example, have considerable potential to reduce air pollution, greenhouse gas emissions, congestion and a variety of other negative externalities of the transportation. However, such technologies require high investments and

110 http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=celex:12012E/TXT

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time for research and development. In addition, price, availability, performance characteristics and governmental incentives are all uncertain, but important considerations in comparing technology options. Consumer preferences are a key driver for transportation and urban development trends. However, people are still not ready to alter their travel behaviour or commercial purchases because of congestion, air pollution, global warming and health risks. In most cases even if people may tell they favour “sustainable” projects, they don’t buy and don’t use them. In this case rationalized measures to change people’s behavior are needed111. Another conflict is the negative effects of alternative energy sources. Despite their advantages they impose high costs on Member States as well as society. Furthermore, development and usage can negatively influence water use, food security as well as changes in land use that lead to destroying of ecosystems and increase in CO2 emissions112. Links:

• Debate on fuel quality directive and renewable energy directive: http://www.greens-efa.eu/debate-on-fuel-quality-directive-and-renewable-energy-directive-13936.html

• What is biofuels, advantages and disadvantages:

https://www.youtube.com/watch?v=xAms3Q_3pXg / https://www.youtube.com/watch?v=IT91cSfli4M

6. Measures Already in Place Since the early 1970s, the EU has been working to improve air quality by controlling emissions of harmful substances into the atmosphere, improving fuel quality, and by integrating environmental protection requirements into the transport sector113. Directorates-General (1973) is one of the more than 40 Directorates-General and services that make up the European Commission. Commonly referred to as DG Environment, the objective is to protect, preserve and improve the environment for present and future generations. This is the core of everything, the first step to the legislation, like a company’s vision, mission and goals. Recently, there have been other actions taken in order to be more environmentally friendly and more specifically cure air pollution. The Clean Air for Europe (CAFÉ) programme launched by the European Commission in 2001 underpins the development of longer-term policy position on air pollution for EU Member States. However, despite significant improvements in Europe's air quality driven by legislation and other factors, air pollution continues to have serious human health and environmental effects. Following this programme, 6th Environment Action Programme was proposed in 2005 and the Thematic Strategy on Air Pollution was subsequently adopted as one of the seven thematic strategies promised with the action programme. The objectives of the Thematic Strategy fell short of the long-term targets of the 6th Environmental Action Programme.

111 http://uctc.net/papers/519.pdf 112 http://biofuel.org.uk/disadvantages-of-biofuels.html

113http://ec.europa.eu/eurostat/statistics-explained/index.php?title=Air_pollution_statistics&oldid=212274

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After this failure the European Commission initiated a comprehensive review of EU air policy, building on the attempts with the Thematic Strategy and the CAFÉ programme. The review consisted of a stakeholder expert group, Committee of the Regions, and a public consultation. Drawing on the conclusions from the review, the Commission has adopted a Clean Air Policy Package in December 2013, consisting of a new Clean Air Programme for Europe with new air quality objectives for the period up to 2030, a revised National Emission Ceilings Directive with stricter national emission ceilings for the six main pollutants, and a proposal for a new Directive to reduce pollution from medium-sized combustion installations. In addition there are other measures that indirectly effect air pollution. The Paints Directive is a limitation of emissions of volatile organic compounds due to the use of organic solvents in decorative paints and varnishes and vehicle refinishing products. It aims to prevent the negative environmental effects of emissions of volatile organic compounds (VOC) from decorative paints and vehicle refinishing products. With the development of alternative technologies Renewable Energy Directive was established as an overall policy for the production and promotion of energy from renewable sources in the EU. Furthermore, the Fuel Quality Directive amends a number of elements of the petrol and diesel specifications and establishes sustainability criteria that must be met by bio fuels if they are to count towards the greenhouse gas intensity reduction obligation. Links:

• Directorate-General Environment: http://ec.europa.eu/dgs/environment/index_en.htm • Thematic Strategy on Air Pollution:

http://europa.eu/legislation_summaries/environment/air_pollution/l28159_en.htm • Clean Air Policy Package: http://ec.europa.eu/environment/air/clean_air_policy.htm • National Emission Ceilings:

http://ec.europa.eu/environment/air/pollutants/ceilings.htm • The Paints Directive:

http://ec.europa.eu/environment/air/pollutants/stationary/paints/paints_legis.htm • Renewable Energy Directive: http://eur-lex.europa.eu/legal-

content/EN/ALL/?uri=CELEX:32009L0028Directorate • General Environment: http://ec.europa.eu/environment/air/transport/fuel.htm

7. Summary The necessity for our living is to breathe clean air into our lungs. Unfortunately with the rise of the industrial revolution, more specifically by burning more fossil fuels, there has been a dramatic escalation in the levels of polluted air, which leads to both health problems as well as environmental contamination. From numerous contributors, transport-led air pollution, in particular, makes a significant impact to worldwide emission levels. Thanks to the fast developing technology, many promising innovative opportunities came to reality towards stopping this development, however these innovations do not eliminate serious environmental consequences when unsustainably

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produced and used. Despite the overall progress in tackling the issue, it is still unclear who from the interconnected actors is responsible for transport issue improvements. The European Union has been working to improve air quality by legislative frameworks, directives, initiatives, but is it really working well? Why not all Member States adopt and follow strict transportation regulations? The governmental legislative balance between incentives and regulations for businesses as well as actions of private sector itself can also be criticized. In its turn, society, who as consumer shape the transportation and urban development trends, still is not ready for changes. Then how could the EU possibly change people’s behavior and make the society become sustainable? Having all said, unquestionably there is a lack of attention together with actions that are being taken towards this matter.

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