Europe's health research: getting the right balance; preoccupation with technology mustn't erode public health research

British Medical Journal, March 14, 1998 by Rodolfo Saracci, Jorn Olsen, Anthony McMichael

Negotiations on the European Union's fifth framework programme of research are at a critical juncture. Within the next few weeks discussions between the council of ministers and the European parliament will determine the direction of collaborative multinational research in Europe over the next five years. Funds for the life sciences programme, which includes health, are likely to amount to 2-2.5 billion ecu. The programme will be based on "key actions" proposed by the European Commission. These currently include food and health, vaccines, health and the environment, biotechnology, and aging.[1] How funds will be apportioned is yet to be decided, but it is very important that research on disease prevention is given a high priority.

Implementing a policy orientated towards prevention will require a commitment to fund transnational collaborative epidemiological, environmental, and public health research and this must be made explicit in the framework programme. Such research not only reflects the mandate of the Maastricht Treaty but also holds considerable potential for improving the health of Europe's populations. The wide dietary variations across Europe, for example, present an ideal opportunity to investigate the link between diet and the development of cancers and other chronic disorders such as ischaemic heart disease. One such study, the European prospective investigation into cancer (EPIC) study, has already been set up and includes over 400 000 adults in nine countries.[2] Subjects will be followed for 10 years to assess the relation of cancer and other diseases to nutritional intake, biochemical variables, and genetic markers. In addition, longitudinal studies of newborn infants have been established for a life course investigation of health in different European settings. Currently the international study on asthma and allergy in childhood (ISACC) is investigating patterns of disease across Europe and the extent to which they relate to exogenous allergens, other environmental agents, and susceptibility factors such as previous infections and immunisations.

Cross national research is essential to determine the health effects of meteorological and climatic change. It also has a key part to play in determining the health impact of social and economic change and of the new healthcare policies that are being introduced throughout Europe. This is now widely accepted, even by those who are critical of EU research policy.[3] There is, however, a view, currently propounded by pressure groups within the European Parliament, that the fifth framework programme should adopt technological research as its main area for support. It is argued that Europe lags behind America in such research and that funds for such research should be increased.

But the health of populations depends less on technical fixes--clinical or environmental--than on broader changes in social relations, living conditions, consumer choices, and personal behaviour. Epidemiologists and experts in public and environmental health must therefore be called in to draw up convincing, detailed research proposals which can be built into the programme, in which the population research components are clearly delineated. It would be regrettable if this opportunity to mobilise European funds and skills for such research were missed.

[1] European Commission.COM (97) 553 Final. 5 May Brussels: European Commission, 1997.

[2] EPIC: European prospective investigation into Cancer and Nutrition. Int J Epidemiol 1997; suppl:1-189.

[3] The European Community spends a lot of money on scientific research. Is this worthwhile? Economist 1998:14 February;93-4.