European Heart Network
EHN
The European Heart Network promotes cardiovascular health and prevents heart disease across Europe through advocacy and research.
Lobbying Activity
European Heart Network Urges Binding Bans on Harmful Marketing
19 Dec 2025
Message — The network calls for replacing voluntary industry codes with binding laws to restrict harmful marketing. They propose a standalone directive to ban junk food advertising on digital media and during daytime television. This would also cover tobacco, vapes, and alcohol to protect children's health.123
Why — Stricter regulations would lower the societal burden and economic costs of cardiovascular diseases.4
Meeting with Victor Negrescu (Member of the European Parliament)
10 Dec 2025 · Cardiovascular Health Summit
Meeting with Olivér Várhelyi (Commissioner) and
2 Sept 2025 · Cardiovascular
Response to EU cardiovascular health plan
28 Aug 2025
Cardiovascular disease is Europes leading killer and a major social and economic burden. Over 60 million people across Europe live with CVD, which causes more than 1 in 3 deaths in the EU many premature and preventable. The economic cost is estimated at 282 billion annually through healthcare, lost productivity and informal care. Yet up to 80% of premature CVD deaths can be prevented through effective prevention, earlier detection and better care. Although health systems are mainly a Member State competence, many determinants of cardiovascular health cross borders. Food and alcohol consumption, tobacco and nicotine regulation, digital trade, marketing, advertising, and environmental standards all have a cross-border impact and can be shaped at EU level, as are research, procurement and investment policies. Leveraging these tools can deliver a coherent and equitable response. The Plan should rest on three pillars, with equity as a horizontal priority: 1. Prioritise Prevention. The EU must use regulation, fiscal tools and procurement to make healthy choices affordable and accessible. Key actions include: - Harmonised, mandatory front-of-pack nutrition labelling. - Strict restrictions on marketing HFSS (High in fat, salt and sugar) foods to children. - Mandatory criteria for sustainable public food procurement. - Reformulation targets to cut salt, sugar and saturated fat while increasing plant-based foods. - Redirecting CAP (Common Agricultural Policy) and promotion funds to support healthy diets. - Revising tobacco legislation to include all nicotine products and vapes, ensuring smoke-free environments. - EU-level alcohol policies: health and energy warnings, higher prices, reduced availability, and bans on promotion and subsidies. - Stricter air pollution laws. - Promoting physical activity in schools, cities and communities. - EU guidance for systematic screening in primary care for hypertension, cholesterol, diabetes and atrial fibrillation. 2. Empower Patients. People with CVD must have access to holistic rehabilitation, digital continuity of care and psychosocial support. The EU should promote multidisciplinary and digital rehabilitation, ensure patient representation in health and research policy, strengthen legal protections against discrimination, and scale investment in health literacy, awareness and mental health. Furthermore, those living with or recovering from a CV condition require access to ongoing CV health maintenance, structured programmes, peer to peer, psychological and community-based support (nursing and care, medical adherence programmes, remote monitoring). All stakeholders should be improving patient experiences, outcomes, and value throughout the care continuum. New technology could play a major role in improving quality of life. 3. Strengthen Research & Innovation. EU research funding must increase for CVD, with a strong focus on prevention, early detection, sex- and age-specific factors, paediatric CVD, and inequalities. Investment in interoperable EU data platforms will enable high-quality research and equity analyses. Predictable regulatory frameworks should ensure timely access to diagnostics and therapies, while implementation science must help proven interventions reach scale. In parallel, the EU should ensure a system for both pharmaceuticals and medical devices that prioritises and facilitates the availability of life-saving innovationsparticularly for children and for those living with rare conditions. Address inequalities in CVD CVD disproportionately affects people with lower incomes, ethnic minorities and rural communities. Women remain underrepresented in research and care, with symptoms often misunderstood or misdiagnosed. Children with cardiovascular conditions are also overlooked. EU policy can reduce inequities by targeting determinants, ensuring sex- and age-sensitive approaches, and funding programmes in regions with the greatest burden.
Read full responseEuropean Heart Network demands protection from harmful health product marketing
10 Jul 2025
Message — The organization calls for policy makers to protect consumers from marketing tactics for unhealthy food, alcohol, and tobacco. They advocate for an integrated food systems approach and stricter oversight of digital health tools and AI algorithms.123
Meeting with Maria Walsh (Member of the European Parliament)
9 Apr 2025 · Cardiovascular Healthcare
Response to EU rules on medical devices and in vitro diagnostics - targeted evaluation
20 Mar 2025
The European Heart Network (EHN) advocates for improved access to life-saving medical devices for cardiovascular patients in Europe, particularly for paediatric and rare disease care. While medical devices play a crucial role in patient outcomes, the European Unions Medical Devices Regulation (MDR) has led to market exits and shortages, exacerbating access disparities. EHN calls for a more balanced regulatory approach that includes a priority tier system for devices addressing unmet needs, similar to support systems for pharmaceuticals. To ensure the continued availability of essential devices, regulatory flexibility should be granted, such as the "grandfather clauses" used in the U.S. market. These provisions allow established devices to remain available under updated regulations, preventing unnecessary shortages particularly for orphan and paediatric patients who rely on specialised technologies. Additionally, EHN emphasises the importance of addressing gender and paediatric CVD disparities, improving national certification processes, and fostering innovation to maintain a steady supply of critical devices.
Read full responseMeeting with Ricard Ramon I Sumoy (Acting Head of Unit Agriculture and Rural Development) and Bureau Européen des Unions de Consommateurs and
28 Jan 2025 · Exchange of views on issue considered relevant by the organisations on the Vision of agriculture and food, under preparation; in particular the food aspects.
Meeting with Catherine Amalric (Member of the European Parliament) and European Brain Council and
18 Mar 2024 · Renew Europe Workshop on Healthcare in Europe and the patient-centric approach
Meeting with Sirpa Pietikäinen (Member of the European Parliament)
13 Dec 2023 · Cardiovascular Health
Meeting with Erik Poulsen (Member of the European Parliament, Rapporteur)
22 Jun 2023 · NCD
Meeting with Antonius Manders (Member of the European Parliament)
17 Nov 2022 · Cardiovascular Health
European Heart Network calls for patient-led health data governance
15 Jul 2022
Topic — The consultation concerns proposed rules for the safe exchange and secondary use of health data.
Message — They want the EU to define 'public interest' alongside patients and ensure meaningful involvement in governance. They also urge alignment with GDPR to reduce legal fragmentation across member states.123
Why — Harmonized data access would boost underfunded cardiovascular research and improve patient outcomes.45
Impact — Citizens with low digital literacy risk facing greater health inequalities and exclusion.6
Response to Evaluation of the rates and structures of excise duty on alcohol and alcoholic beverages
4 Jul 2022
The European Heart Network (EHN) welcomes the opportunity to provide input on the evaluation of the rules governing excise duty on alcohol and alcoholic beverages.
Harmful alcohol consumption is responsible for an estimated 50 000 cardiovascular disease (CVD) deaths in the EU.
High alcohol consumption increases the risk of CVD by raising blood pressure and blood levels of triglycerides. Consumption of three or more alcoholic drinks per day (10 g of alcohol per drink) is associated with increased CVD risk.
Alcohol taxation is part of the WHO “best buys” (cost-effective interventions) as it contributes to a reduction in alcohol consumption by decreasing affordability of alcohol. Despite the potential benefits of taxation measures, many EU countries do not make use of this public health measure. For example, 15 EU countries do not impose an excise tax on wine. Imposing an excise tax on all drinks containing alcohol and raising the minimum taxation on alcohol should be considered a top priority for public health action.
Given that pricing policies remain the most untapped potential of tax measures to reduce alcohol consumption and correlated harm, it is EHN’s strong recommendation to:
• raise minimum excise duties on all alcoholic beverages to the highest possible level;
• set up a harmonized level of alcohol taxation across Europe for all types of alcoholic beverages.
Read full responseResponse to Sustainable food system – setting up an EU framework
25 Oct 2021
The European Heart Network (EHN) welcomes the opportunity to comment on the European Commission’s inception impact assessment (IIA) on the Sustainable Food System (SFS) Framework initiative. It is increasingly recognised that current food systems are flawed and fail to deliver affordable healthy diets to all. Food systems need to be transformed. In 2017 EHN commissioned expert reviews on 4 specific issues that are relevant to the challenges of creating sustainable European food systems for cardiovascular health: Agriculture and supply side issues (what are we producing in Europe); Trade (impact of trade and investment agreements on food and nutrition); Food promotion as a driver of consumption patterns; Food-environment links (matching cardiovascular health promotion with a sustainable food system). Today’s food systems are intricate – with long food chains that involve many different actors – and powerful external factors influence what is produced, how it is sold and at what price (the ‘food environment’). This complexity presents both challenges and opportunities for policymakers. While many of the external drivers are beyond the control of national or regional authorities, there are many entry points along the food chain where policymakers can take action.
The EU’s Common Agricultural Policy (CAP) has helped shape current dietary patterns, and radical rethinking of the CAP could enable positive dietary changes. There needs to be a shift away from highly inefficient food production (ultra-processed convenience foods, meat, dairy) towards generating a greater volume of more sustainable foods that can contribute to cardiovascular health and support the fast-growing global population (generally plant-based foods/crops). A cardiovascular health-promoting diet means a shift from an animal-based diet to a more plant-based diet. It includes vegetables, fruit and berries in abundance. Whole grain products, nuts and seeds, fish, pulses, low-fat dairy products are also important, as are non-tropical vegetable oils in modest amounts. This everyday dietary pattern also limits consumption of red meat, processed meat products and foods or drinks with low content of vitamins, minerals and dietary fibre and/or a high content of free sugars, saturated/trans fats or salt. Trade and investment agreements can impact on the food environment and there is a need to take nutrition into account in trade negotiations. Food system activities have considerable environmental impact, including on climate change, land use and water use. Climate change is likely to have a negative impact on diet-related health overall. There is considerable overlap between consuming healthier diets and achieving higher levels of sustainability, and an integrated health and environment approach to food systems is needed as suggested in the farm to fork strategy. Health-environment win-wins need to be promoted through dietary guidelines and broader policy approaches are also required.
EHN recommends for the EU to
• Implement policies to tackle cardiovascular health inequalities in Europe
• Ensure that robust mechanisms for nutrition governance are in place and fit-for-purpose
• Develop an integrated health and environment approach to food systems and promote health-environment win-wins in food-based dietary guidelines
• Establish a global food convention
• Reform agricultural and food policy to align with public health priorities
• Ensure trade and investment policies protect and promote public health
Considering the above, EHN supports POLICY OPTION 4 (a new comprehensive framework law on the sustainability of the EU food system) as the only credible way forward to respond to the multiple challenges and opportunities linked to reforming the European food system
EHN’s full set of recommendations are available via the paper attached. EHN is also a member of the European Public Health Alliance, and fully supports its submission to this consultation.
Read full responseResponse to Review of the EU school fruit, vegetables and milk scheme - EU aid
27 Jul 2021
The school fruit, vegetables and milk scheme is designed to help children follow a healthy diet. School fruit and vegetable programmes are effective at increasing both intake of, and positive knowledge and attitudes to fruit and vegetable consumption tracking into adulthood. Despite international recommendations to eat at least 400g/day, populations in most of the EU Member States are not reaching recommended levels of intake, and differences in consumption contribute to inequalities in health. If every person in the EU consumed 600g of fruit and vegetables per day, it is estimated that more than 135 000 deaths/year from coronary heart disease (CHD) and stroke could be prevented.
Schools are an ideal environment to focus interventions designed to increase fruit and vegetable intake and tackle Europe’s major health burdens. School systems and food cultures may vary between countries, but throughout the EU, schools can provide a platform for combining healthy nutrition education and increased intake – i.e., learning about healthy foods in classroom and eating, tasting, and experiencing healthy foods provided at schools.
Increase budget to reach more children
The potential of the EU school scheme to contribute to public health objectives by promoting the consumption of fruit, vegetables and milk among schoolchildren together with educational activities is huge. However, the current budget is too small to reach ambitious targets as it does now not enable all children and schools to fully benefit from the scheme.
Schools can reach almost all children and adolescents during their first two decades of life and are a critical part of the social environment that shapes young peoples behaviours. Interventions targeting healthy nutrition need to occur early in childhood or adolescence to prevent or reverse the adverse health effects of overweight and poor eating habits. School-based schemes are effective at increasing both intake of, and positive knowledge and attitudes to fruit and vegetable consumption.
The 2019/20 summary report on the implementation of the scheme indicated that only 19,1 million children in 142.000 schools participated in the programme, while 76,2 million pupils are enrolled in the European education system (Eurostat, 2020). This report also showed that only 4 countries distributed fruit and vegetables on a daily basis, and 6 supplied children with milk every day. Thus, most of the schools do not regularly offer the products to schoolchildren but only make them available under the educational measures, such as tasting or cooking workshops or theme days. A steep increase in the budget allocated to school schemes is therefore necessary.
Select healthy and sustainably produced products
The EU school scheme should also contribute to reduce overweight and obesity by promoting the consumption of fresh fruits and vegetables and milk and selected milk products that are in line with national dietary recommendations and food based dietary guidelines.
However, the school schemes instead allow for distribution (and thus) promotion of products that ‘may contain limited quantities of added sugar, salt and/or fat’. Even though authorisation of these products is necessary from national authorities, this is worrying as it is not in line policies promoting consumption according to healthy and sustainable dietary guidelines. School schemes distributing processed vegetables and fruit products, but also milk products should apply nutrient profiling to determine which products, according to levels of salt, saturated fat and/or sugar, may be distributed to children. The EU should develop this nutrient profile model and only products that conform to health, environmental and ethical criteria, as well as cultural products from the region and/or using short supply chains, should receive EU co-financing and therefore be part of the EU school scheme.
EHN is also a member of EPHA and fully supports EPHA's submission.
Read full responseResponse to Revision of Food Information to Consumers for what concerns labelling rules on alcoholic beverages
19 Jul 2021
The European Heart Network welcomes the opportunity to provide input and feedback on the Inception Impact Assessments of the Proposal for a revision of Regulation (EU) No 1169/2011 on the provision of food information to consumers, for what concerns labelling rules on alcoholic beverages.
Cardiovascular disease is still the number one cause of death in the EU, in Europe and at global level. Harmful alcohol consumption is estimated to be responsible for close to 50 000 CVD deaths in the EU. High alcohol consumption, particularly binge drinking, increases the risk of CVD by raising blood pressure and blood levels of triglycerides. Consumption of three or more alcoholic drinks per day is associated with increased CVD risk. Reducing harmful use of alcohol is therefore an important step in fighting the risk of CVD.
The European Heart Network is in favour of Option 2: Revising the rules for all alcoholic beverages, revoking the exemption and requiring all indications on-label.
EHN has three policy recommendations when it comes to reducing the harmful use of alcohol:
1. Introduce mandatory, front-of-pack energy labelling on alcohol: The absence of uniform and mandatory regulatory requirements results in an unacceptable fragmentation of rules and leads to different levels of understanding about the health risks associated with alcohol consumption.
2. Introduce mandatory ingredients list on alcoholic beverages: Consumers and citizens in Europe also have the right to know that alcohol is high in sugar and that it contains a considerable number of calories, with an energy content of 7.1 kilocalories per gram. Additionally, many types of alcoholic beverages have extra added sugar which contributes to an even higher total calorie content.
3. Raise minimum excise duties on alcoholic beverages to the highest possible level. Since this consultation is part of the revision of the Food information to consumers Directive, this particular aspect is not further developed.
Read full responseMeeting with Stella Kyriakides (Commissioner) and
18 Jun 2021 · Europe’s Beating Cancer Plan and cardiovascular health
Response to Evaluation and revision of the general pharmaceutical legislation
27 Apr 2021
The European Heart Network (EHN) welcomes the patient-centred approach of the Pharmaceutical Strategy for Europe, with a view to foster patient access to innovative, safe, available and affordable medicines.
EHN represents heart foundations and cardiovascular patient associations dedicated to improving cardiovascular health in Europe. Cardiovascular disease (CVD) remains by far the leading cause of death in the EU and it impacts the lives of more than 60 million EU citizens, both young and old. Around 20% of all premature deaths in the EU are caused by CVD. Many cardiovascular conditions are inherited (e.g. certain cardiomyopathies & arrhythmias) but they do not necessarily manifest themselves until adulthood. Risk and prevalence of CVD increase even further with age. Whilst Europe is still amid the management of the COVID-19 pandemic, its repercussions on CVD mortality & morbidity will continue to increase and further impact the resilience of healthcare systems.
Investment in CVD research is particularly low compared to the disease burden and innovation in CVD medicines lags behind. The role of and access to innovation in cardiovascular medical technologies and medicines should be recognised. This can help close the gap in investment in CVD research.
Several pharmaceutical companies moved out of the cardiovascular field. In the past five years, about a dozen CVD treatments have been approved by the EMA, yet the vast majority were generics or biosimilars. Challenges that have a negative impact to innovation in CVD include:
- Clinical trials (CTs) on CVD therapies are more expensive compared to other areas. They tend to be very large & lengthy to include the most robust measures of mortality, while in other areas surrogate endpoints are more accepted (e.g. progression-free survival).
- There is a strong focus on ‘unmet need’. However, the concept merits a much clearer definition considering the variety and diversity of needs across disease areas and importantly what patients need. For example, for some CVD patients, the ability to breathe unrestricted is more important than limited additional time to live. Quality-of-Life and patient-reported outcome measures in CVD CTs could be more prominent.
Shortages of cardiovascular medicines have become increasingly common. Surveys by the European Association of Hospital Pharmacists show a worrying upward trend of CVD shortages. Given few therapeutic alternatives to drugs in short supply, these shortages pose a major challenge and have heavy consequences on CVD patients’ health.
Digitalisation is steering medicine towards real world data and analysis of various sources (e.g. electronic health records, wearable devices & registries). Big Data and AI hold great potential to boost clinical & pharmacological research in CVD by improving the design, speed and efficacy of more targeted & multi-country CTs at lower cost and less time without compromising safety of patients. Real world data can provide important information, complementing CT data, on the natural course of a disease, on patient characteristics, on therapeutic gaps & quality of life. It can also serve as an external reference for determining comparative effectiveness. Interoperability, data standards, quality controls and independent scientific and regulatory validation are key to foster reliability to digital technologies and important for patients to trust them. Clear rules on data ownership including data transfer to third parties and for withdrawing consent need to be covered in legislation.
- Views of CVD patients on ‘unmet need’, ‘innovation’ and value assessment must be central to decision-making.
- The diminishing pipeline of new CVD treatments needs to be tacked by a greater emphasis on matching discovery science to unmet clinical needs and by modernising clinical trials to fit the digital era.
- A balanced regulatory approach weighing digital innovations against protection of personal data is needed.
Read full response8 Mar 2021
Cardiovascular disease (CVD) remains the main killer in Europe and in the EU and COVID-19 has aggravated the situation for people suffering from CVD.
In the EU, unhealthy diets are associated with over 800 000 deaths from CVD each year, accounting for over 40% of all CVD deaths – 417 000 in men and almost 400 000 in women. Dietary risks are responsible for almost 45% of all the years lost to CVD death or disability in the EU. In view of the evolution of European Union (EU) policies in the areas of food systems and public health, following especially the adoption of the Farm to Fork Strategy, the EU policy for the promotion of agricultural products is no longer fit for public health purposes and requires a fundamental revision.
The scientific evidence base for recommending a cardiovascular health-promoting diet has strengthened in the last six years. A cardiovascular health-promoting diet means a shift from an animal-based diet to a more plant-based diet. It includes vegetables, fruit and berries in abundance. Whole grain products, nuts and seeds, fish, pulses, low-fat dairy products are also important, as are non-tropical vegetable oils in modest amounts. This everyday dietary pattern also limits consumption of red meat, processed meat products and foods or drinks with low content of vitamins, minerals and dietary fibre and/or a high content of free sugars, saturated/trans fats or salt.
The CAP is not in line with this recommendation and a radical rethinking of the CAP is necessary to enable positive dietary changes. Trade and investment agreements can impact on the food environment and there is a need to take nutrition into account in trade negotiations.
Current approaches to restricting marketing of unhealthy foods to children are inadequate and decisive policy actions for health protection and promotion is highly desirable.
Promoting Health-environment win-wins between different sectors through for example dietary guidelines and broader policy approaches is also required. The main pillars of a healthy diet are spelled-out in food-based dietary guidelines, available in all EU Member States. Bringing food demand closer to existing guidelines will not only improve people’s health and cut healthcare costs but will also reduce environmental impacts.
Current food environments across Europe exploit individuals’ biological, psychological, social, and economic vulnerabilities, making them more likely to consume unhealthy foods and impacting on cardiovascular health. Current food marketing practices contribute heavily to the current food environment, which tends to stimulate behaviour causing obesity. Yet, the purpose of public health nutrition policies should be to create food environments where the healthy option is the easy, default and most affordable option. Such policies do not restrict or put the burden of change on individuals, but rather empower people to choose in line with common-held aspirations about their own, their children’s and the planet’s long-term health. Many different types of action will be needed to shift diets towards healthier and more sustainable outcomes.
For a cardiovascular health-promoting diet to become a reality across Europe some major forces that influence food systems need to be addressed. EHN’s overarching recommendations are:
• Implement policies to tackle health inequalities in Europe, including equal access to healthy food and environment.
• Ensure that robust mechanisms for nutrition governance are in place and fit-for-purpose.
• Develop an integrated health and environment approach to food systems and promote health-environment win-wins in food-based dietary guidelines.
These overarching recommendations need to be supported with specific recommendations, outlined in the paper transforming European food and drink policies for cardiovascular health promotion (document attached).
Read full responseResponse to Setting of nutrient profiles
2 Feb 2021
The European Heart Network is pleased with the European Commission’s decision to set Nutrient profiles. In the EU, unhealthy diets are associated with over 800 000 deaths from Cardiovascular disease (CVD) each year, accounting for over 40% of all CVD deaths – 417 000 in men and almost 400 000 in women. Dietary risks are responsible for almost 45% of all the years lost to CVD death or disability in the EU.
The European Commission was under a legal obligation to come forward with nutrient profiles by 2009 under the Claims Regulation ; more than 10 years later, this has still not happened. For years, this was a missed opportunity to enhance the health of all EU-citizens. It can now be amended.
We note that the Commission has now decided that it will develop Nutrient Profiles in the framework of the revision of the FIC regulation. EHN supports developments of Nutrient Profiles, as has been shown in several EHN statements in the past. In light of the parallel development of a front-of-pack (FOP) nutrition labelling scheme, it may indeed be worthwhile to consider streamlining the two processes in terms of nutrient profiling.
At the same time, setting nutrient profiles for claims should not be made dependent on the process of FOP labelling. After a REFIT evaluation of the Claims Regulation, the European Commission concluded that: “the setting of nutrient profiles is still pertinent and necessary to meet the objective of the Claims Regulation, which is a high level of consumer protection”.
For the development of nutrient profiles, EHN calls for:
• The European Commission to proceed immediately with establishing nutrient profiles.
• The European Commission to base its nutrient profile model on work already done in Europe; good examples are the WHO nutrient profile model for regulating the marketing of food to children, but also nutrient profiles that are at the basis of the Swedish key hole system or the Finnish heart symbol.
• A model which is based on nutrients relevant to public health. In its paper, WHO has defined nutrient profiles as "the science of classifying or ranking foods according to their nutritional composition for reasons related to preventing disease and promoting health". EHN is supporting this view.
• The nutrient profiling model should be ‘category-specific’ i.e., have different criteria for different categories of food. The number of categories used should be limited.
• The reference quantity should be 100g or 100ml.
Most existing nutrient profiles are and should be based on national dietary guidelines (or for WHO on guiding principles). Since these are not available at EU level, setting a series of guiding principles on how diets can contribute to health would be a good starting point for the EU. In the calculation of the profiles, “population dietary goals”, should be used. EHN has developed a series of population goals in its paper ‘Transforming European Food Policies for cardiovascular Health’, which could be used as a basis for the EU dietary guidelines .
Achieving a health-promoting diet, and in particular a CVD health promoting diet requires moving away from an animal-based diet to a more plant-based diet. It includes vegetables, fruit and berries in abundance. Whole grain products, nuts and seeds, fish, pulses, low-fat dairy products are also important, as are non-tropical vegetable oils in modest amounts. Consumption of products with high content of free sugars, saturated fats or salt must be limited.
Read full responseMeeting with Lukas Visek (Cabinet of Executive Vice-President Frans Timmermans) and European Environmental Bureau and
20 Jan 2021 · Discussion on minimum sustainability criteria for public procurement
Meeting with Annukka Ojala (Cabinet of Commissioner Stella Kyriakides) and European Environmental Bureau and
20 Jan 2021 · VC Meeting - Discussion on minimum sustainability criteria for public procurement.
Response to Cross-border acquisitions of excise goods by private individuals
5 Jan 2021
Smoking is the second largest cause of Cardiovascular disease (CVD) after high blood pressure. It is associated with 13% of all CVD deaths in the EU, which translates to almost 250 000 CVD deaths every year (around 165 000 male and 82 000 female deaths). The average prevalence of smoking (daily and occasional smokers; people older than 15) in the EU is 24%. However, prevalence varies hugely, from just under 17% in Sweden to almost 35% in Bulgaria.
Harmful alcohol consumption is estimated to be responsible for close to 50 000 CVD deaths in the EU. High alcohol consumption, particularly binge drinking, increases the risk of CVD by raising blood pressure and blood levels of triglycerides. Consumption of three or more alcoholic drinks per day is associated with increased CVD risk.
Alcohol and tobacco taxation are some of the most effective policy instruments for reducing consumption and thereby the prevalence of alcohol and/or tobacco related harm. Increasing excise duties and raising the real price of both products through taxes and pricing policies is identified by the World Health Organisation as one of the most effective and cost-effective ways to reduce harm from both products. The lack of rate (and price) convergence creates a strong economic incentive to shop in Member States with lower tax rates and increases the risk of fraud. The difficulties encountered by national authorities to enforce Article 32 have an impact on Member States’ abilities to set their own public health policies and taxation rates for these two products.
Therefore, EHN asks that:
• There should be an upward convergence of prices across the European Union for the products under this proposal. This would reduce cross-border purchasing and improve public health.
• Member States should have the flexibility to limit individual cross-border purchases so as not to diminish the impact of their current tax policies. For tobacco products, the guide level should be lowered to 200 cigarettes and 150g of smoking tobacco
• It is important that different combinations of the identified policy options are considered. The problems with the current rules are multi-layered and challenges differ slightly between countries. The best final policy option is most likely a combination of different policy changes.
The European Heart Network (EHN) is a founding member of the Smoke Free Partnership (SFP). EHN also refers to SFP’s comments for more information on this topic.
Read full responseResponse to Tobacco taxation – revision of EU rules
4 Jan 2021
The European Heart Network (EHN) supports the current initiative, introduced in the framework of Europe’s Beating Cancer Plan.
Smoking is the second largest cause of cardiovascular disease (CVD) after high blood pressure. It is associated with 13% of all CVD deaths in the EU, which translates to almost 250 000 CVD deaths every year (around 165 000 male and 82 000 female deaths).
EHN supports the review of tobacco taxation rules, as taxation is known to be the single most effective policy to curb tobacco consumption.
EHN would recommend in particular that this review:
- Sets an objective to meet the 30% tobacco use reduction target by 2025, committed to under the WHO Global Monitoring Framework for NCDs. Taxation is the single most effective policy to curb tobacco consumption, making tobacco products less affordable, especially for younger
consumers
- Achieves upwards convergence of prices across Member States and raises minimum tobacco excise duties to the highest possible level. This would help reduce the inequalities in the level of human health protection and reduce the incentives for cross-border tax evasion
- Brings excise duties on “roll your own” tobacco up to the same level as manufactured cigarettes. Roll your own brings similar risks to human health and should therefore be subjected to equivalent excise duties. Moreover, the current price gap undermines the health impact of excise duties on manufactured cigarettes
- Introduces a specific definition and tax category for raw tobacco. This would help avoid classification uncertainties between customs and tax codes and would reduce disparities of treatment across countries. It would also support efforts to curb illicit manufacturing of smoking products.
Recent studies increasingly highlight the risks of electronic cigarette use to the cardiovascular system. Therefore EHN would like to advocate for a special excise duty or tax on e-cigarettes. It has the dual benefit of discouraging use – especially for young people – and raising income for governments. EHN recommends taxing e-cigarettes at a rate high enough to discourage uptake.
EHN is a funding member of the Smokefree partnership. For further information, EHN refers to the position paper of the Smokefree partnership on tobacco taxation. EHN also refers to its own position paper on e-cigarettes for more information on (taxation of) e-cigarettes, and its impact on cardiovascular health.
Read full responseResponse to Delivering for children: an EU strategy on the rights of the child
28 Jul 2020
Article 24 of the Convention on the Rights of the Child (CRC) recognises the “right of the child to the enjoyment of the highest attainable standard of health” (i.e. the right to health). Childhood overweight and obesity has reached epidemic levels across the European Union (EU), entailing significant risks to child and young adult’s health and well-being.
An obese child faces a lifetime of increased risk of various diseases, including cardiovascular disease, diabetes, liver disease and certain forms of cancer. Even during childhood, obesity increases the risk of these diseases, and is a significant cause of psychological distress. There is convincing evidence that exposure of children to the marketing of foods high in fat, sugar and salt (unhealthy food) influences what and how much children eat. The EHN lead project on Children, Obesity and Associated Avoidable Chronic Diseases helped disseminating research showing that food marketing affects the preferences of children (type and brand of food) and what they buy or urge their parents to buy. The project also provided policy recommendations on this topic.
Tackling marketing as part of childhood obesity policy has featured prominently in multiple EU policy documents, including the 2017 Council Conclusions on childhood obesity and the EU Action Plan on childhood obesity 2014-2020. Despite the fact that CRC signatories need to respect, protect and fulfil human rights, legislative action to tackle child exposure to health-harming marketing practices has been deemed inadequate across the EU. (For more see: WHO (2018) Evaluating implementation of the WHO set of recommendations on the marketing of foods and non-alcoholic beverages to children. Progress, challenges and guidance for next steps in the WHO European Region).
The impact of health-harmful marketing on child rights is increasingly recognised, including in General Comment No. 16 to the CRC. It reads that “The activities and operations of business enterprises can impact on the realisation” of children’s rights and gives the marketing to children of products such as “foods and drinks high in saturated fats, trans-fatty acids, sugar, salt or additives” as an example.
Ensuring the protection of children from harmful commercial practices, such as the marketing of unhealthy foods and alcohol, should be a core component of the EU’s framework of action on promoting and protecting the rights of the child. (For more see: UNICEF (2018) A Child Rights-Based Approach to Food Marketing: A Guide for Policy Makers).
Read full responseMeeting with Stella Kyriakides (Commissioner) and European Society of Cardiology
25 Jun 2020 · The MEP Heart Group also participated. The Associations presented their work and the discussion focused on the impact of COVID19 on patients with cardiovascular diseases and F2F and its link to healthy diets and benefits for cardiovascular patients.
Response to Farm to Fork Strategy
10 Mar 2020
The European Heart Network (EHN) welcomes the European Commission’s commitment to develop a Farm to Fork (FtF) Strategy for sustainable food in the framework of the European Green Deal. An effective strategy can contribute to reducing the burden of cardiovascular disease (CVD). CVD is the leading cause of death in the EU and a major cause of illness and disability. Unhealthy diets are a major contributor to CVD responsible for around half of the CVD burden in the EU at an estimated cost of €102 .
A cardiovascular health-promoting diet means a shift towards a more plant-based diet. It includes vegetables, fruit and berries in abundance. Whole grain products, nuts and seeds, fish, pulses, low-fat dairy products are also important, as are non-tropical vegetable oils in modest amounts. It entails limiting consumption of red meat, processed meat products and foods or drinks with low content of vitamins, minerals and dietary fibre and/or a high content of free sugars, saturated/trans fats or salt.
Many economic and policy drivers determine what food is produced, what is imported and how foods are marketed. These factors are well beyond the reach of individuals.
To that end, EHN recommends that the FtF strategy tackle a) the food supply side; b) the food demand side; as well as c) food composition.
Recommendations for supply-side interventions:
Establish a global food convention
Reform agriculture and food policies to align with public health priorities
Ensure trade and investment policies protect and promote public health
Recommendations for demand-side interventions:
Use taxes and/or subsidies
Implement regulatory controls on marketing of unhealthy foods to children
Adopt a nutrient profile for regulation of claims, mandatory simplified front-of-pack nutrition labelling and menu labelling
Recommendations for food composition:
Establish nutrition standards for food in schools, hospitals and other public institutions
Implement wide-reaching ambitious food reformulation programmes
EHN further recommends that the FtF be underpinned by three overarching principles which necessitate:
Implementing policies to tackle cardiovascular health inequality
Ensuring that robust mechanisms for nutrition governance are in place and fit-for-purpose
Developing an integrated health and environment approach promoting health-environment win-wins in food-based dietary guidelines
More information can be found in EHN’s publication ‘Transforming European food and drink policies for cardiovascular health’ (document available on this web page: http://www.ehnheart.org/publications-and-papers/publications/1093:transforming-european-food-and-drinks-policies-for-cardiovascular-health.html).
Read full responseMeeting with Vytenis Andriukaitis (Commissioner) and
11 Sept 2019 · EU Platform for action on Diet, Physical Activity and Health
Meeting with Anne Bucher (Director-General Health and Food Safety)
13 Feb 2019 · introductory meeting
Response to Establishing a legal limit for the industrial trans fats content in foods
25 Oct 2018
The European Heart Network (EHN) welcomes the European Commission's draft regulation which seeks to introduce a restriction on the levels of industrial trans fatty acids in foodstuffs. We support the decision to opt for a legislative limit of 2g of industrial trans fatty acids per 100g of fat.
EHN has run a sustained campaign for an EU harmonised regulation on industrially produced trans fatty acids for years, during which we have highlighted that it is not appropriate to rely on voluntary measures to virtually eliminate industrially produced trans fatty acids (iTFA) from the food chain in the EU when iTFA are known to increase the risk of heart disease – Europe’s biggest disease burden.
In the EU, several Member States have already introduced regulatory measures; an EU regulation will ensure that the cardiovascular health of all citizens is protected, no matter where they live in the EU.
Given the importance of the measure, we regret that the draft regulation proposes a transition period that runs until 1 April 2021.
Read full responseMeeting with Alina Timofte (Cabinet of Commissioner Vytenis Andriukaitis), Inga Preikšienė (Cabinet of Commissioner Vytenis Andriukaitis)
12 Sept 2018 · Cardiovascular diseases, world heart day
Response to Multiannual Financial Framework - CAP Strategic Plans
3 Aug 2018
The European Heart Network (EHN) welcomes that the proposed regulation on the CAP Strategic Plans (2018/0216 (COD)) acknowledges that it “… is well known that consumption patterns have an influence on public health. Via its link to food and sometimes also the way food is produced, agricultural policies are linked to health policies…” EHN also welcomes that one of the proposal’s nine specific objectives is dedicated to “Improve the response of EU agriculture to societal demands on food and health, including safe, nutritious and sustainable food, as well as animal welfare.”
Our concern is about the proposal’s ability to deliver this specific objective in a meaningful way. Concerns include:
- the objective is very broadly formulated; in our view, the impact and result indicators (Annex I) do not sufficiently reflect the stated objective. For example, impact indicators on consumer demand and use of antibiotics and pesticides do not include the societal need for the CAP to align with health priorities and population guidelines on nutrition/food
- a structure, where the vast majority of financing is allocated to direct payments, does not seem to allow adequate flexibly for the Member States to achieve the CAP’s objectives, notably in terms of health
- there do not seem to be clear accountability mechanisms linking the implementation of the CAP Strategic Plans to subsidies/financial allocations
- the proposal provides no new, or expanded, instruments to achieve the aim to make “nutritious valuable products such as fruit and vegetables easily available for EU citizens”, as included in the Commission Communication The Future of Food and Farming. No indicator on fruit and vegetables has been proposed, which is inconsistent with the need to transition towards more sustainable and healthy – i.e. more plant-based – diets.
One way of addressing our concerns is to involve stakeholders, including health organisations, at national and EU levels in developing the Strategic Plans to ensure that the CAP will effectively contribute to health-promoting, sustainable food systems.
Read full responseResponse to Evaluation of the EU agricultural promotion policy
30 Jul 2018
The current EU Agriculture promotion policy finances demand-oriented information and promotion campaigns, with the ultimate aim to increase the market share and consumption of certain European food products.
This policy is implemented in a context in which non-communicable diseases (NCDs), such as cardiovascular disease, diabetes and cancer, are responsible for 86% of all deaths and 77% of all diseases in Europe, amounting to healthcare costs of around €700 billion per year. In the EU, cardiovascular disease (CVD) is the leading cause of death accounting for more than 1.8 million deaths every year. In the EU dietary risks are responsible for 49% of the CVD burden, at an estimated annual cost of €102 billion. A cardiovascular health-promoting diet means a shift from an animal based diet to a more plant-based diet. It includes vegetables, fruit and berries in abundance. Whole grain products, nuts and seeds, fish, pulses, low-fat dairy products are also important, as are non-tropical vegetable oils in modest amounts. More information on food/nutrition is available in the EHN publication Transforming European food and drink policies for cardiovascular health.
Therefore, and in light of Article 168(1) of the TFEU, which mandates that the EU pursues a high level of human health protection in the development and implementation of all its policies, it is important to envision an agricultural promotion policy that integrates healthy nutrition at its core. This will contribute to attaining several of the Global Sustainable Development Goals, including Goals 3 (good health and well-being; reduction of NCDs) and 12 (sustainable consumption and production patterns)
EHN believes that the EU agricultural promotion policy is an opportunity to encourage more diverse, sustainable and healthy diets. Financial allocations should favour a food group’s contribution to a healthy diet, and a methodology to this end should be elaborated with input from qualified experts. Such policy orientation will also support the agricultural and food sector’s competitiveness by helping it adapt to citizen’s concerns about healthy nutrition, as highlighted in the Commission Communication The Future of Food and Farming.
Read full responseMeeting with Jerzy Bogdan Plewa (Director-General Agriculture and Rural Development) and European Public Health Alliance and Freshfel Europe - the forum for the European fresh fruits and vegetables chain
27 Mar 2018 · exchange of view on the Communication on Food and Farming
Meeting with Xavier Prats Monné (Director-General Health and Food Safety)
18 Jan 2018 · Discussion on the adoption of the EC Communication of the future of food and farming
Meeting with Xavier Prats Monné (Director-General Health and Food Safety)
24 Nov 2015 · chronic diseases framework, TTIP, trans fatty acids and refit evalutation of the regulation on Nutrition and Health Claims made on foods
Meeting with Vytenis Andriukaitis (Commissioner) and
28 Sept 2015 · World Heart Day Campaign ‘Environment & the Heart’
Meeting with Cecilia Malmström (Commissioner)
2 Feb 2015 · Health service and TTIP