Solidarity is serious business

Europe is measuring itself against its rivals but it should also measure itself by how its citizens are cared for.

Last week at the European Health Forum in Gastein, which centered around the discussion on the EU Multiannual Financial Framework, I asked a question that drew significant reaction. As Europe debates its priorities for the years ahead, where is the European health community?

I meant it as a challenge to doctors, nurses, patient groups and researchers, whose voices have been far quieter than those speaking for defence and industry. But the silence is only part of the story. Something more fundamental is shifting in how Europe sees itself, and I think it should be said plainly.

Europe is right to respond to the world as it is today and as we perceive it will be tomorrow. There is a war on our continent, the transatlantic relationship is less certain than it once was, the Middle East remains a powder keg and, the economic race with China is not going to slow down. Nobody in Malta is arguing that the union should ignore any of this. The question is what kind of union comes out on the other side.

For most of its history, the European Union project looked inward as much as outward. Its first measure of success was how its own people lived. Did a family in one region have the same chances as a family in another? Did a hospital, a school or a road reach the places that needed them most? That is what cohesion meant, and a great deal of it was about health. Today, Europe is increasingly preoccupied with how it compares to others, whether it’s the productivity of the United States, the industrial scale of China, or the threat from Russia. That outward gaze is very necessary. But there is a risk that this happens at the expense of the very foundations of the union—European peace and stability as well as the promise of improving the lives of its people.

For years, cohesion helped Europe bridge the gaps within. Today, the focus is turning to the gaps between Europe and the rest of the world. Both matter but closing one should not mean quietly allowing the other to widen.

Health sits awkwardly in this shift. When Europe speaks about competitiveness, health is increasingly described as a sector—pharmaceuticals, biotechnology, medical devices. The European Commission has said public health counts as part of competitiveness, and I take that in good faith. These industries matter, and Europe must support them. But they are not the same as a patient having access to the care they need. One is an economy. The other is care. A Europe that strengthens the first and loses sight of the second might look stronger on paper but would be weaker where it counts.

So where does Malta stand? We are in sync with other EU member states in looking for Europe to become more secure and more competitive. What we also support though is the idea that solidarity among Europeans does not only belong to calmer times and which we must set aside while we deal with the “serious business”. In our view, cohesion is the serious business. A union whose citizens feel it in the healthcare they receive, is a union they will be willing to defend.

We say this from experience. Malta chose, a long time ago, to treat health as a public good rather than a cost to be managed. Healthcare is free to everyone who needs it. During the pandemic, our vaccination rates were among the highest in Europe, largely because people trusted the system. European solidarity helped us build our national oncology centre, so patients who once had to travel abroad for treatment can now be cared for at home. And in 2017, during our presidency of the European Council, we brought several member states together under the Valletta Declaration to negotiate medicine prices jointly. Cooperation gave all of us a stronger hand than any of us had alone.

That is the example I would offer Europe. Put the citizens at the centre of the decision. Treat cooperation not as charity but as the way partners strengthen one another. Neither idea conflicts with a Europe that wants to be stronger in the world. Both are what make that strength worth having.