The Riga Roadmap Investing in Health and Wellbeing for All

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

2 1 Prevent health inequalities by developing universally accessible health systems Implement the principles prevention, promotion, protection and participation as core principles for health in all policies and governance for health at European level, particularly in relation to national Ministries of Finance and Economics and the EU Semester Process; Identify appropriate and smarter ways of preventing unnecessary costs to the system in health and economic terms by promoting health throughout the life course. This could be done, for instance: by implementing cost- effective preventative measures such as smoking bans; effective information to consumers; promotion of physical activity; vaccination; and fiscal measures on unhealthy foods, alcohol and tobacco whilst making healthier foods more accessible and affordable. Continue to raise awareness and take policy action to dramatically reduce anti- microbial resistance, including through prevention of infectious diseases, incentivising development of new antibiotics and the use of effective alternatives; Ensure universal access for all in Europe to effective and affordable medicines, health and care services creating conditions to better manage disease and to prevent avoidable health deterioration; Increase investment in disease prevention and health promotion, including all main primary prevention services and supporting programmes for both communicable and non- communicable diseases; Include prison health services to reduce inequalities between prison health and public health and make sure all Ministries involved (Health, Justice) cooperate effectively; Develop an effective health promotion and disease prevention agenda, which strengthens the role of healthcare professionals, recognising that healthcare workers play an indispensable role in educating patients and promoting health literacy, particularly in education and workplace settings; Strengthen community led initiatives in their capacity to offer prevention services and linkage to care to most at risk populations Adopt an approach to public health that utilises the latest evidence- based knowledge, respects personal data protection, and identifies appropriate and ethical ways of preventing unnecessary costs to the system in health and economic terms; Work towards the removal of legal barriers to secure access to universal coverage to prevention and treatment to everyone, independent from residence status. Support a shift from cost- focus to health outcome- focus in the European Semester, to prevent disease and avoidable health deterioration whilst tackling healthcare inefficiencies and addressing health inequalities. This Roadmap is supported by:

3 2 Make healthcare systems sustainable by investing in innovation Develop a common definition of valuable innovation, starting from patient needs and societal needs. Based on this, develop common principles for how valuable innovation should be encouraged; Stimulate enhanced collaboration at EU level between stakeholders to address sustainability, improved access for patients and improved health outcomes; develop a fair access framework, including sustainable pricing models which ensure access and affordability for healthcare systems and patients; Create frameworks for meaningful patient involvement across the innovation chain in collaboration with the relevant parts of the EU Commission and stakeholders, from priority- setting and research design to regulatory processes, cost- benefit assessments, pricing and reimbursement, and the re- use/collection of patient data, and respecting data protection; Ensure sustainable competition and transparency in post- exclusivity period from generics and biosimilar medicines to improve patient access to medicines and the efficiency of healthcare systems; Increase efficiency and effectiveness by implementing performance- based measurements and evaluations of patient health, ideally in real time, to show which interventions work and why, i.e. via data generated through electronic patient records, clinical research and by patients themselves, whilst respecting personal data protection; Develop common standards across the EU member states in the reuse of existing health data registries to address areas of unmet medical need and the prevention of chronic diseases; Support the use of real world evidence, to better understand opportunities to advance patient care, while promoting efficient policies that balance support for innovation and the needed uptake for generic and biosimilar medicines to ensure access to medicines for all; Develop quality standards and guidelines for the development and use of Mobile Health Applications to promote direct patient engagement with health protection and improvement while ensuring the quality, security and safety of applications; Harness European Structural and Investment Funds to develop IT infrastructures that promote prevention, promotion, patient self- management, and service delivery reforms; Encourage the pharmaceutical sector to develop sustainable value- added innovation that can improve health outcomes and efficiency for health care providers and for patients. This Roadmap is supported by:

4 3 Ensure universal access to high quality people- centred health services Adopt a clear European Union position that all people in Europe, including people in a vulnerable situation, such as migrant populations, people using drugs, MSM, sex workers and prisoners, should have continual access to healthcare services and develop a concrete strategy to ensure equitable access to healthcare for all according to the principle of non- discrimination; While they are under exploration and study, Member States and the European Union should establish the process of early dialogue and joint advice under the new approaches to early access to medicines such as MAPPs (Medicines Adapted Patient Pathways) in order to guarantee that available treatments are accessible in all Member States; In partnership with governments, industry, patients and healthcare professionals, improve the education and understanding of medicines, including biosimilars, to ensure universal access to safe, high quality treatment; Develop common tools to measure access, monitor outcomes and assess performance in the health sector as part of the European Semester evaluation, including a tool to measure patients experience in a way that reflects their needs and priorities; Ensure that health services are responsible employers; Address health workforce shortages and brain drain in planning and development at European level, including via appropriate investment in a highly skilled workforce and implementing the principles of ethical recruitment enshrined in the WHO Global Code of Practice on the International Recruitment of Health Personnel. 4 Develop participatory, people- centred health systems Ensure meaningful involvement of patients, public health, consumers and civil society in the development of policies and programmes at EU and national level in a whole- of- society approach; establish a partnership between all stakeholders in the health sector at regional, national and European levels to identify effective solutions that improve equity of access; Include specific calls in the future Horizon 2020 programme on innovation of systems and organisations in order for healthcare to better meet patients needs (e.g. addressing areas like integration of care, participatory medicine, patient involvement, organisational culture change) based on a gap analysis from a patient perspective; Develop tools and a common approach to measurement of patient/person- centredness as a key aspect of quality of healthcare under the EU HSPA framework; Implement a regular EU Health literacy survey across all EU Member States to collect comparative data, based on the validated EU Health Literacy Survey (HLS), and invest in This Roadmap is supported by:

5 health literacy interventions under various financial instruments (e.g. Health Programmes, Structural Funds);Ensure that principles of transparency, good governance and accountability are applied throughout health- relevant policies, health systems and public health. Develop a European strategy to empower and support patients (including vulnerable and minority groups) in the management of their health, and promote access to accurate, objective, unbiased, user- friendly and scientifically up- to- date information relevant to patients needs, on all aspects of health from promotion and prevention to disease management and therapeutic options; Implement the European Commission Guiding Principles Promoting Good Governance in the Pharmaceutical Sector agreed by key stakeholders to promote transparency of information and action. We call on Member States, associated Member States, European Union institutions and the World Health Organization to work together to ensure that European healthcare systems are people- centred, sustainable and deliver inclusive healthcare for all. We call on the next Presidency of the European Council to further pursue these recommendations and carry these four principles for European health prevention, promotion, protection and participation forward in the future. Riga, June 29th, 2015 This Roadmap is supported by: