Is Borg suitable for European Health Commissioner role?

Tonio Borg's political record on abortion, homosexuality and immigration has raised several questions about the compatibility of his personal beliefs and values - and the duties of the European Health Commissioner

As the debate about Malta's Dr Tonio Borg's appointment as the European Commissioner for Health and Consumer Protection rages, there are a number of issues that have emerged which are relevant for people living in Europe. As reported widely - Dr Borg's political record on abortion, homosexuality and immigration has raised several questions about the compatibility of his personal beliefs and values - and the duties of the health commissioner. Does a health commissioner need to hold different values to a commissioner for another portfolio? Do the personal beliefs of an individual commissioner prevent him or her from doing their job? Perhaps, most challenging for those who believe in the strength that Europe's diversity gives us, what qualities and values do we expect and need from our leaders?

As the top European Union official in charge of issues as fundamental as equal access to healthcare, health promotion, disease prevention and the reduction of health inequalities - I would expect Borg to act in the interest of all people living in Europe; including vulnerable groups like single mothers, gay and lesbian, minority groups and migrants. However, I would also expect the non-health commissioners to act in the same way. The challenging discussions surrounding the proposal from Viviane Reding for female quotas on company boards show how the values and beliefs of commissioners unrelated to the file have an impact on the position as a whole. The uncertainty lies in how each commissioner interprets this responsibility both within his or her own portfolio, and those files emerging from the portfolios of others. This is particularly important in the case of the health commissioner, where very little competence is derived from his or her own brief and a lot of the impact emerges from other parts of the European Commission.

As an area of work falling with the health brief, sexual reproductive health and rights has received a lot of attention. But amid all the criticism of Borg, we seem to have forgotten that under previous Maltese Commissioner John Dalli the work of DG Sanco on the issue was barely visible. Dr Borg has not answered how he would handle the work of the Civil Society Forum on HIV/AIDS, the Sexual Health Forum, and the EU Action plan on HIV - whose priority groups are homosexuals, injecting drug users and migrants. In fact, the European Parliament failed to ask questions regarding Borg's record on migration at all.

Secondly, the question of lifestyle determinants such as tobacco, alcohol and diet is a key public health concern. The EU Tobacco Products Directive has already been discussed widely, although I cannot stress enough how important it is to have a Europe-wide proposal for plain packaging. If we are supposed to be moving towards a functioning single market, how would different approaches at national level support this? The treaty allows for member states to object to integrative single market measures on the basis of public health - not the other way around. How can we argue for integration on the one hand within the single market, but on the other hand claim that plain packaging is a matter for member states? Surely this is disingenuous. Plain packaging - graphic warnings and unpleasant packets - are a public health measure and citizens should have just as much right to better health protection as they do to their economic rights.

Relating to the Tobacco Products Directive, I expect the next commissioner to pursue DG SANCO's current commitment to ensure the commission integrates health and social issues better in its 'impact assessment' processes. The current bias towards perceived - not proven, perceived - economic interest simply has not worked. It is 10 years since we adopted 'Better Regulation' - during which our economy has practically collapsed while our obesity, chronic diseases and inequalities have ballooned. Our tools are flawed and failing our people and our societies - and the health commissioner needs to stand strong to make the point.

I was concerned about Borg's insistence that it is member states that have exclusive health competences. Despite being technically correct, this is far from the legal reality. Internal market case law since the 1970s have led to a dawning political and legal realisation that health policy is also made in Brussels - by default. The EU Patient Rights Directive attempts to address this very point, on the basis that we should not be making our health policies through the undemocratic back door, led by unelected judges in Luxembourg. Clinical trials, medical devices, health professionals' education and training, cross border services, medicines policy and many others have a direct impact and EU competence - whereas austerity and economic governance have an increasing indirect impact and belong almost exclusively to the EU.

Even the European Council is in the middle of reflection processes on both chronic disease and healthcare systems - something really quite beyond imagination just a few years ago. A health commissioner needs to understand this complexity and legal dichotomy, and attempt to lead health from behind. I particularly welcomed Borg's statement that he would bring forward work on the economic crisis to ensure quality of healthcare and the most vulnerable are not hit the hardest, as this demonstrates his knowledge of one of the most pressing issues to health systems.

The public health brief is difficult, weak, unpopular and quite frankly a hard sell in an arena dominated by market thinking, a preoccupation for growth and what appears to be an ideological belief that economic progress magically improves social and health outcomes. We cannot forget in Brussels that the reason member states fight tooth and nail to keep the health competences is that these are some of the most important political issues to their populations - as repeatedly reported by Eurostat in polls. It is very easy to fall into the Brussels trap that health does not matter much as a policy, because the European competence is weak.

The Brussels competence is weak, because health policy matters very much indeed. Speaking before MEPs Borg was articulate, well prepared, confident and performed as a man both able to master his brief and with integrity. He took pains to assure his critics that he will not allow his personal beliefs to influence his decisions affecting the rights of people living in Europe. The question is whether this will be enough for Members of the European Parliament.

Monika Kosiñska is secretary general of the European Public Health Alliance non-governmental organisation