EHN 2012 Annual report

Annual Report

2012

Table of contents Director’s Message................................................................................................................................................................... 2 Annual Meeting......................................................................................................................................................................... 3 European Heart Health Strategy II ............................................................................................................................................. 4 Building action on Heart Disease and Stroke................................................................................................................ 4 Highlights from 2012.................................................................................................................................................... 4 European Cardiovascular Disease Statistics – 2012 edition....................................................................................................... 6 Figures at a glance....................................................................................................................................................... 7 MEP Heart Group....................................................................................................................................................................... 8 Chronic diseases...................................................................................................................................................................... 9 Targets and indicators relevant for cardiovascular diseases.......................................................................................... 9 Food and Nutrition................................................................................................................................................................... 10 Food labelling............................................................................................................................................................. 10 Health and Nutrition Claims....................................................................................................................................... 10 EU Framework for National Initiatives on Selected Nutrients...................................................................................... 11 Tobacco................................................................................................................................................................................. 11 Patients.................................................................................................................................................................................. 12 EHN Patients’ Seminars............................................................................................................................................. 12 European Commission’s Regulation Proposal on Clinical Trials................................................................................... 12 European Medicines Agency...................................................................................................................................... 12 EU Forums.............................................................................................................................................................................. 13 EU Health Forum....................................................................................................................................................... 13 Diet, Physical Activity and Health - a European Platform for Action............................................................................ 13 Cooperation............................................................................................................................................................................ 14 Smoke Free Partnership............................................................................................................................................. 14 European Public Health and Agriculture Consortium.................................................................................................. 14 European Chronic Disease Alliance............................................................................................................................ 15 European Society of Cardiology................................................................................................................................... 15 European Association for Cardiovascular Prevention and Rehabilitation..................................................................... 15 World Heart Federation.............................................................................................................................................. 15 Public Health Organisations....................................................................................................................................... 15 Statements and Publications................................................................................................................................................... 16 Responses.............................................................................................................................................................................. 16 Conferences and Meetings...................................................................................................................................................... 17 Governance............................................................................................................................................................................. 18 Membership............................................................................................................................................................... 18 General Assembly....................................................................................................................................................... 18 Board......................................................................................................................................................................... 18 Staff............................................................................................................................................................................ 18 EHN Board Members................................................................................................................................................. 18 EHN Member Organisations....................................................................................................................................... 19 Finances................................................................................................................................................................................. 20

Annual Report 2012

European Heart Network The European Heart Network (EHN) is a Brussels-based alliance of heart foundations and like-minded nongovernmental organisations throughout Europe.

Our mission To play a leading role in the prevention and reduction of cardiovascular diseases, in particular heart disease and stroke, through advocacy, networking, capacity-building and patient support, so that they are no longer a major cause of premature death and disability throughout Europe.

Our vision Every European has a right to a life free from avoidable cardiovascular diseases.

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Annual Report 2012

Director’s Message The European Heart Network (EHN) turned 20 in 2012. These past 20 years have been active and successful, as the network has grown in numbers, knowledge and influence in support of healthy hearts in Europe.

When EHN was set up as a formal association at the meeting of its General Assembly in 1992, it had 12 member organisations from nine countries. Today, EHN has 31 member organisations from 24 countries.

EHN has worked with its members and with partners in EU co-funded projects since 1998, starting with the European Heart Health Initiative (EHHI), through Children and Obesity and Associated Avoidable Chronic Diseases (CHOB) to the current European Heart Health Strategy II (EuroHeart II). These projects have produced a number of concrete Susanne Løgstrup, Director outputs, in terms of conferences which have brought experts, policy makers and civil society together, and reports summarising and disseminating the information gathered.

They have allowed our members and partners to become influential in shaping the policies regarding cardiovascular diseases and their risk factors in their countries.

In 2007, the European Heart Health Charter was launched, marking the start of the European Heart Health Strategy project. The Charter was developed jointly with the European Society of Cardiology, the European Commission, and the World Health Organization European Regional Office, and it has been signed by 15 European and international organisations. It has guided much of the work of the EHN in that we develop strategies for addressing specific articles of the Charter. We implement our strategies by providing research and information, participating in forums and platforms, and actively engaging with policy makers.

A round birthday is a time to reflect on health and its place in the policies of the European Union (EU).

The Maastricht Treaty (1992) was the first Treaty to introduce a competence in public health for the then European Community. Its Article 129 stipulated

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that “Health protection requirements shall form a constituent part of the Community’s other policies.”

This provision has been kept in place through succeeding Treaties and is now expressed in Article 168 of the Lisbon Treaty: “A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities.”

“A high level of human health protection shall be ensured in the definition and implementation of all Union policies and activities.” (Article 168, Lisbon Treaty) Even before the Maastricht Treaty, certain health programmes had been implemented. The firstever European policy statement on cardiovascular diseases dates back to a 1990 Council Conclusion Concerning Cardiovascular Disease in the Community. This statement was followed by a Council Resolution in 1994 and by a new Council Conclusion in 2004, On Promoting Heart Health. In 2007, the European Parliament adopted a Resolution on Action to Tackle Cardiovascular Disease.

In our 20 years, we have seen directives on tobacco advertising come and go and, most importantly, stay!

We have welcomed the Framework Convention on Tobacco Control. We have worked with our partners to make sure that tobacco control policies are proposed and adopted so as to combat tobacco use vigorously.

We have worked intensively on health and nutrition claims and on nutrition labelling. Regulations have been adopted – but more needs to be done, including the adoption of nutrient profiles in the context of the claims regulation. We also encourage all EU Member States to use their competences to develop their national nutrition labelling schemes. EHN supports the traffic light scheme, which has proved to be a consumer favourite in several countries.

We pride ourselves on the fact that the European Union is healthier due to the EHN and the work we are doing with our member organisations. But we would also like to thank individuals in the European Commission who work hard to fulfil the Treaty’s provision on public health, and MEPs who stand up for health in the European Parliament.

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Annual Meeting In 2012, the European Heart Network’s Annual Workshop was hosted by the European Heart Network. It took place in Leuven, Belgium, from 23 to 25 May. The workshop was attended by 46 delegates from 23 EHN member organisations and one delegate from the World Heart Federation.

The delegates were pleased to welcome Mrs Paola Testori Coggi, Director General of the European Commission’s Directorate General for Health and Consumers (DG SANCO), who delivered the keynote speech. Mrs Testori Coggi spoke about the EU’s work on chronic diseases, obesity, nutrition and physical activity, the tobacco products directive, and the reflection process on health care systems.

reduce mortality from stroke by 50% and to increase the rate of patient independence after stroke by 50%; and Dr Alexander Lyon, Senior Lecturer and Consultant Cardiologist, Imperial College, London and Royal Brompton Hospital, UK, who spoke about heart failure, its diagnosis, and its current and future treatment.

The Finnish Heart Association presented its One Life project, which is carried out in cooperation with the Finnish Diabetes Association and which embraces all target groups: healthy individuals, patients and policy makers. The Danish Heart Foundation presented its campaign on increasing awareness of cardiac arrest and raising funds for research.

A session was dedicated to advocacy for tobacco control policy with talks by the Dutch and Irish Heart Foundations and the Finnish Heart Association.

Another session was dedicated to patient support with presentations from the Danish Heart Foundation and the Swedish Heart and Lung Association.

The German and Irish Heart Foundations shared their experiences gleaned from their work in EU co-funded projects. The British Heart Foundation showed how it uses new media in its communication campaigns.

At the General Assembly, members of the EHN were delighted to accept and welcome the Faroese Heart Foundation as a new member organisation.

In addition to our colleagues from EHN member organisations, EHN welcomed as speakers Mr Steve Bridger, who spoke about how heart foundations can find their social voice in new media; Professor Gerard Hastings, Director, Institute for Social Marketing, University of Stirling, Scotland, UK, who spoke about some of the dramatic impacts of ubiquitous commercial marketing; Professor Simon Capewell, Division of Public Health, University of Liverpool, UK, who presented preliminary results of work package 5 of EuroHeart II; Professor Ulf Hedin, Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden, who spoke about a stroke fighting project which aims to

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European Heart Health Strategy II Building action on Heart Disease and Stroke

Highlights from 2012

EuroHeart II is a three-year pan-European project co-funded by the Health Programme of the European Union. It runs from March 2011 to February 2014. This ambitious project has 30 partners across Europe and a budget of over 1.9 million euros. EHN is the main partner overseeing the coordination and implementation of the project.

As planned, the latest available data on cardiovascular mortality and morbidity as well as treatment and risk factors were published on World Heart Day, 29 September 2012, in the report European Cardiovascular Disease Statistics – 2012 edition. The report also has a chapter on the economic cost of these diseases to the European Union Member States (for more detail, see pages 6 and 7).

To share knowledge on nutrition and physical activity and cardiovascular diseases and to encourage health organisations and professionals to play a larger role in shaping policies, three regional workshops and one national meeting took place in 2012: • 14 March in Berlin, Germany, regional workshop organised by the German Heart Foundation and the EHN • 25 June in Milan, Italy, regional workshop organised by the Italian Heart Foundation, the Italian Association Against Thrombosis and Cardiovascular Diseases, and the EHN • 29 June in London, UK, national meeting organised by the National Heart Forum

The main outcomes of EuroHeart II are: - Providing up-to-date statistical data and analysis to shape CVD prevention policies - Predicting future trends in coronary heart disease and identifying the most relevant and cost-effective prevention policies - Encouraging health organisations to play a larger role in shaping policies in support of healthenhancing nutrition and physical activities - Reinforcing the importance of CVD patient communities in decision making - Establishing a process for matching CVD prevention guidelines with health outcomes, including for diabetes patients

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• 18 October in Smolenice, Slovakia, regional workshop organised by the Slovak Heart to Heart League and the EHN

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The three workshops and the national meeting brought together around 120 participants from the countries of the organisers and from other European countries.

Participants included representatives from government departments, non-governmental organisations, and industry, as well as health professionals. The meetings reviewed the cardiovascular disease burden and the benefits of a healthy diet and at least 30 minutes a day of physical activity. Participants discussed policies

required to promote healthy diets, such as food-related taxes, and everyday physical activity by making big cities bicycle-friendly. Parts of the meetings were dedicated to building capacity to advocate for policies, considering the economies of health and the United Nations (UN) General Assembly resolution on a political declaration on the prevention and control of noncommunicable diseases.

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European Cardiovascular Disease Statistics – 2012 edition The fourth edition of the European Cardiovascular Disease Statistics was published on World Heart Day, 29 September 2012. The report is a joint effort between the University of Oxford, the European Society of Cardiology, and the EHN. It is co-funded by the Health Programme of the European Union within the framework of the EuroHeart II project.

fall in the majority of Central and Eastern European countries as well.

The most recent data show a significant improvement in Europe’s cardiovascular health and are a testimony to the fact that efforts to reduce deaths from heart disease and stroke have been successful.

At the same time, the report shows that cardiovascular diseases (CVD) remain the main cause of death in Europe and in the European Union and represent a huge economic burden.

Over the past 30 years death rates from coronary heart disease have been consistently falling in most Northern and Western European countries. Trends in Central and Eastern European countries have been more mixed, including relative stability in some countries (e.g. Bulgaria) and rapid increases in others (e.g. Ukraine and Belarus). However, since around 2000 to 2005, death rates have begun to

European lar scu Cardiova tatistics Disease nS 2012 editio

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Regarding stroke, death rates are also falling in most European countries. Almost all European countries recorded very substantial decreases in stroke according to the last ten years of available data.

Overall, CVD is estimated to cost the EU economy almost 196 billion euros a year. Of the total cost of CVD in the EU, around 54% is due to direct health care cost, 24% to productivity losses, and 22% to the informal care of people with CVD. Overall, CVD is estimated to cost the EU economy almost 196 billion euros a year.

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Figures at a glance: • Each year cardiovascular disease (CVD) causes over 4 million deaths in Europe and over 1.9 million deaths in the European Union (EU)

• Few adults in European countries participate in adequate levels of physical activity, with inactivity more common among women than men

• CVD causes 47% of all deaths in Europe as a whole and 40% in the EU

• Levels of obesity are high across Europe in both adults and children, although rates vary substantially between countries

• CVD is the main cause of death in women in all countries of Europe and is the main cause of death in men in all but six countries

• The prevalence of diabetes in Europe is high and has increased rapidly over the last ten years, increasing by more than 50% in many countries

• Death rates from coronary heart disease (CHD) are generally higher in Central and Eastern Europe than in Northern, Southern and Western Europe

• Overall CVD is estimated to cost the EU economy almost €196 billion a year – in health and nonhealth costs

• Death rates from stroke are many times higher in Central and Eastern Europe than in Northern, Southern and Western Europe

• Of the total cost of CVD in the EU, around 54% is due to health care costs, 24% due to productivity losses, and 22% due to the informal care of people with CVD

• CVD mortality is now falling in most European countries, including in the Central and Eastern European countries, which experienced large increases until the beginning of the 21st century

The report is available from http://www.ehnheart.org/cvd-statistics.html

• Smoking remains a major public health issue in Europe. Although smoking has declined in many European countries the rate of decline is now slow, and rates remain stable or are increasing in some countries, particularly among women • Women are now smoking nearly as much as men in many European countries, and girls often smoke more than boys • Fruit and vegetable consumption has increased overall across Europe in recent decades, while overall fat consumption has remained stable

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MEP Heart Group The MEP Heart Group was established in July 2007 in the European Parliament. It brings together almost 70 members of the European Parliament. In 2012, it was jointly chaired by Linda McAvan, MEP, S&D – UK, and Cristian Silviu Buşoi, MEP, ALDE – Romania.

It provides MEPs who have an interest in cardiovascular health with an opportunity to generate dialogue and outreach and to link activities at EU and Member State level. This objective was implemented particularly successfully around Saint Valentine’s Day in 2012. MEP Heart Group supporters tweeted and were re-tweeted by over 150 people including members of the European Parliament and the World Health Organization European Regional Office. Thanks to these tweets, it is estimated that more than 125 000 people were reached by heart healthy messages on Valentine’s Day! The MEP Heart Group is supported by the European Heart Network and the European Society of Cardiology, which provide the secretarial services for the Group.

More information about the MEP Heart Group is available on its website: http://www.mepheartgroup.eu/

Cristian Silviu Buşoi, MEP, Co-chair MEP Heart Group

Linda McAvan, MEP, Co-chair MEP Heart Group

The main objective of the MEP Heart group is to promote measures that will help reduce the burden of heart disease and stroke in the European Union and raise awareness of the disease amongst target audiences through a series of activities. It is a unique meeting point for MEPs, national heart foundations and cardiac societies, and the wider Heart Health Charter community.

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Chronic diseases With the adoption of the UN political declaration on the prevention and control of non-communicable diseases (NCDs) in September 2011, these diseases were firmly put on the agenda of the member states of the United Nations.

by 2025. In November 2012, the WHO member states agreed by consensus a comprehensive global monitoring framework, including indicators, and a set of voluntary global targets for the prevention and control of NCDs.

The political declaration fell short of agreeing targets, but the development of targets was delegated to the World Health Organization (WHO). At the World Health Assembly in May 2012, WHO member states agreed an overarching target of a 25% reduction of premature deaths due to NCDs, including CVD,

EHN, which had expressed its support for clear targets and indicators in several oral and written statements, welcomed the agreement, noting that of the nine targets, eight are directly related to CVD, and of the 25 indicators, 18 are directly related to CVD.

Targets and indicators relevant for cardiovascular diseases Targets: 1. 25% relative reduction in overall mortality from CVD 2. At least 10% relative reduction in the harmful use of alcohol 3. 10% relative reduction in prevalence of insufficient physical activity 4. Halt the rise in diabetes and obesity 5. 25% relative reduction in the prevalence of raised blood pressure or contain the prevalence of raised blood pressure according to national circumstances 6. 30% relative reduction in mean population intake of salt 7. 30% relative reduction of current tobacco use in persons aged 15+ years 8. At least 50% of eligible people receive drug therapy and counselling to prevent heart attacks and strokes

Indicators: 1. Unconditional probability of dying between ages 30 and 70 years from cardiovascular diseases 2. Age-standardized mean proportion of total intake of salt per day in grams in persons aged 18+ years 3. Age-standardized mean proportion of total energy intake from saturated fatty acids in persons aged 18+ years 4. Age-standardized prevalence of persons (aged 18+ years) consuming less than five total servings (400 grams) of fruit and vegetables per day

5. Age-standardized prevalence of overweight and obesity in persons aged 18+ years 6. Age-standardized prevalence of overweight and obesity in adolescents 7. Age-standardized prevalence of insufficiently active persons aged 18+ years 8. Prevalence of insufficiently active adolescents 9. Age-standardized prevalence of raised blood glucose/diabetes among persons aged 18+ years 10. Age-standardized prevalence of raised blood pressure among persons aged 18+ years 11. Age-standardized prevalence of raised total cholesterol among persons aged 18+ years 12. Age-standardized prevalence of heavy episodic drinking among adolescents and adults 13. Age-standardized prevalence of current tobacco use among persons aged 18+ years 14. Prevalence of current tobacco use among adolescents 15. Adoption of national policies that limit saturated fatty acids and virtually eliminate partially hydrogenated vegetable oils in the food supply 16. Availability and affordability of quality, safe and efficacious essential NCD medicines, including generics, and basic technologies in both public and private facilities 17. Policies to reduce the impact on children of marketing of foods and non-alcoholic beverages high in saturated fats, trans-fatty acids, free sugars or salt 18. Proportion of eligible persons (defined as aged 40 years and over with a 10-year CVD risk greater than or equal to 30%, including those with existing CVD) receiving drug therapy and counselling to prevent heart attacks and strokes

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Annual Report 2012

Together with the World Heart Federation, the American Heart Association, the American College of Cardiology Foundation, and the European Society of Cardiology, EHN co-published “Our Time: A Call to Save Preventable Death From Cardiovascular Disease (Heart Disease and Stroke)”. The paper

was published simultaneously in the journals of the organisations and coincided with the first anniversary of the UN political declaration on the prevention and control of non-communicable diseases (NCDs).

Food and Nutrition Food labelling Although it officially entered into force in December 2011, the Regulation on the provision of food information to consumers will apply only from December 2014, and nutrition labelling will be mandatory only from December 2016.

Article 35 of the regulation allows for additional forms of expression. This means that EU Member States may recommend to food business operators the use of one or more additional forms of expression or presentation of the mandatory nutrition declaration.

In 2012, the United Kingdom (UK) held stakeholder consultations on the traffic light scheme. The British government is expected to launch the voluntary front-of-pack label combining traffic lights with reference intakes in June 2013. In the meantime, several large retailers in the UK announced that they would introduce traffic light labelling to respond to consumer demand.

EHN welcomed the move by several retailers in the UK to use traffic lights, and in a meeting of the EU Platform for action on diet, physical activity and health it called on those retailers to convey the same benefit to all their consumers across Europe

Health and Nutrition Claims Health and nutrition claims continue to be scrutinised by the European Food Safety Authority (EFSA). Only a few claims submitted under Article 13 have been declared substantiated by the EFSA. Amongst those that have been substantiated, EHN considers that there are some that are nonetheless not compatible with public health. For example, is it

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prudent to have a positive claim on chocolate – even if it is scientifically substantiated? EHN thinks it is not.

Once again, EHN calls on the European Commission to introduce nutrient profiles as it is obliged to do according to Article 4 of the Claims Regulation. It is high time for the European Commission to get down to business - four years after these should have been established, we still do not have a Commission proposal!

In February 2012, the European Parliament adopted a Resolution which opposed a draft Commission regulation which would have allowed a claim “now contains 15% less” [energy, fat, saturated fat, salt/sodium and/or sugars]. EHN supported the Parliament resolution. Why was it the right decision?

Because the claim would likely lead to confusion and not help people to choose the product with the lowest quantity of energy, fat, saturated fat, salt/ sodium and/or sugars. Firstly, the claim compared the reduction to the amount previously contained in the product itself - so the product could still contain more sugar, for example, than other similar products on the market. Secondly, a product carrying the very similar “reduced” claim requires a 30% reduction compared to the market average.

EHN believes that in order for claims to play a positive role in addressing cardiovascular diseases and other major chronic diseases, they should not be misleading, they should not go against public health recommendations, and they should be relevant to public health. And there should be only a limited number of them.

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EU Framework for National Initiatives on Selected Nutrients In December, DG SANCO published a report of a survey on the implementation of the EU Salt Reduction Framework by the EU Member States.

The report is a summary of the responses which the Commission received from the 27 EU Member States and Norway and Switzerland on their national salt reduction initiatives. The report reveals that 13 of the countries surveyed have legislation on salt ranging from upper limits allowed in food products (e.g. bread) to upper limits allowed in food made available in schools, whether in school canteens or vending machines.

The Commission concludes that work on salt reduction should be further enhanced by the political momentum created by the UN political declaration on the prevention and control of NCDs. EHN agrees and suggests that the target regarding salt in the global monitoring framework – 30% relative reduction in mean population intake of salt – will further support European countries in their efforts.

EHN welcomes the High Level Group on Nutrition and Physical Activity (HLG) agreement to establish detailed benchmarks for saturated fats in major food groups as part of the EU Framework for National Initiatives on Selected Nutrients. With the support of experts on saturated fat and cardiovascular diseases, EHN has worked to ensure a concerted effort to reduce saturated fat, and is pleased that saturated fat is a focus for the HLG work and included in the WHO global monitoring framework as an indicator.

Tobacco Just before Christmas, the European Commission released its proposal for a Directive on the manufacture, presentation and sale of tobacco and related products (TPD). It was a piece of regulation that had been a long time in coming.

The Commission’s proposal replaces the 2001 Directive in its entirety although it maintains some of the 2001 Directive’s measures, such as maximum yields for tar, nicotine and carbon monoxide and the ban on tobacco for oral use.

The new TPD proposes a number of new requirements which have become necessary further to market, scientific and international developments.

The proposal also takes into consideration a high level of health protection, recognising that tobacco is the most significant cause of premature death in the EU, responsible for almost 700,000 deaths every year. In that context, the proposal focuses on hindering the initiation of tobacco consumption, in particular by young people, taking into account the facts that the vast majority of smokers start before they are 25 years old, and that 70% of smokers have already taken up the deadly habit before the age of 18.

The European Commission has adopted a proposal which in many ways responds to EHN’s recommendations and expectations. EHN welcomes the Commission’s proposal for large combined health warnings (text and colour photograph) covering 75% of both front and back of the package.

EHN had called for 80% coverage which, based on research, we still believe would reach the objective of deterring new smokers and increasing cessation among current smokers. EHN also called for the pictorial warnings to be introduced in combination with standardised plain packaging. The European Commission has not proposed making plain packaging mandatory at EU level, leaving it up to Member States to do so in compliance with the EU Treaty.

It is our hope that the new TPD will be adopted before the elections to the European Parliament in May 2014.

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Patients Many members of the EHN dedicate themselves to supporting cardiovascular patients. They work to ensure that patients can have a good quality of life, free of avoidable disabilities, which in turn helps the patients to continue their professional lives wherever this is an option.

In 2012, we worked together and shared experience on specific aspects of the Charter for European Cardiovascular Disease Patients, adopted in 2011, such as emergency skills, including calling swiftly for an ambulance when somebody suffers a heart attack or stroke, and rehabilitation.

EHN Patients’ Seminars In the context of the EU co-funded project EuroHeart II, EHN organised a meeting of patients in October 2012 in Brussels. This meeting, the third one of the project, gave the opportunity for EHN patients’ organisations to be updated on the different patientrelated EU dossiers. The main item discussed was the European Commission proposal for a Regulation on Data Protection. A Policy Officer from DG SANCO presented the proposal, highlighting the changes from the former Directive. The British Heart Foundation introduced the participants to the potential consequences of the proposed regulation for heart foundations and patients’ associations.

The participants debated the need for balancing the right to protection of personal data and the need for research that can help improve treatments and outcomes for patients. The participants also debated and adopted the EHN position paper on eHealth, recommending that critical eHealth interventions be well-documented and evaluated in terms of patient satisfaction, effectiveness and cost-effectiveness.

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European Commission’s Regulation proposal on Clinical Trials On 17 July 2012, the European Commission published its proposal for a Regulation on Clinical Trials of medicinal products for human use.

The proposed Regulation introduces a simpler submission process for clinical trials, easing the administrative tasks for sponsors while maintaining strong standards for the protection of patients.

Following consultation with its members, the EHN adopted its position on the proposed Regulation, underlining the need for gender balance in clinical trials and the importance of stratified analysis of the results. EHN also met with MEP Glenis Willmott (S&D, UK), who is the rapporteur for the European Parliament, to present our position.

European Medicines Agency EHN is an active member of the Patients’ and Consumers’ Working Party (PCWP) of the European Medicines Agency (EMA), the official EU agency responsible for the scientific evaluation for use in the European Union of medicines developed by pharmaceutical companies. The objective of the PCWP is to give feedback from patients’ organisations to EMA mainly on the patient information leaflet and on the European Public Assessment Reports (EPAR). The PCWP meetings enable patients’ views on different issues relating to medicines and medication to be considered by the EMA. In 2012, EHN participated in several PCWP meetings together with its member organisation, the Heart and Vessel Group, in The Netherlands.

EHN also attended stakeholders’ forums on the implementation of the new EU legislation on pharmacovigilance.

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EU Forums EU Health Forum The EU Health Forum serves as an information and consultation mechanism to ensure that the aims of the Community’s health strategy are made clear to the public and respond to their concerns. EHN has been a member of the Forum since its inception in 2001.

The EU Health Policy Forum met twice in 2012, in May and October. The Forum officially responded to DG SANCO’s Consultation on Chronic Diseases at the beginning of the year. It also adopted a position paper on the EU Research Programme – Horizon 2020.

Diet, Physical Activity and Health – a European Platform for Action The Platform, of which EHN is a founding member, was launched in 2005.

In the first quarter of 2012, EHN submitted a new commitment to the Platform. The objective of the commitment was to carry out an investigation to assess the potential for cross-sector agreement on nutritional criteria for foods and drinks marketed and advertised to children that can be applied across Europe. The methods for the investigation involve a review of existing nutritional criteria that companies use for the marketing of food to children and of current and proposed government standards for nutritional criteria for the marketing of food to children.

Perhaps spurred on by this commitment, the food industry members of the EU Pledge – 19 companies which estimate that they account for about 80% of food and beverage advertising expenditure in the EU – presented a white paper on nutrition criteria at the Platform’s last meeting in 2012. The EU Pledge White Paper establishes a common set of nutrition criteria which the signatories commit to apply as from the end of 2014.

During the summer, a number of large retailers in the UK had committed publicly to introducing traffic lights on their front-of-pack nutrition labelling schemes, in combination with their GDA labelling.

The Director of the EHN called upon these retailers to roll out their schemes across Europe so that all their customers may benefit from it. She also called on other retailers in Europe to follow the example set by retailers in the UK.

EHN submitted a new commitment to the Platform on the potential for cross-sector agreement on nutritional criteria for foods and drinks marketed and advertised to children that can be applied across Europe. EHN reviewed existing nutritional criteria that companies use for the marketing of food to children and current and proposed government standards for nutritional criteria for the marketing of food to children.

EHN published its findings in March 2013. The report is available from http://www.ehnheart.org/ publications/publications/publication/705-ehnresearch-on-nutrient-profile-model.html

EU Platform on Diet, Physical Activity and Health

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Cooperation Smoke Free Partnership EHN has been a supporter of the Smoke Free Partnership (SFP) since 2008. SFP is a strategic, independent and flexible partnership between EHN, Cancer Research UK, the European Respiratory Society, and Action on Smoking and Health UK. It aims to promote tobacco-control advocacy and policy research at EU and national levels in collaboration with other EU health organisations and EU tobacco-control networks. Its vision is the implementation of the Framework Convention on Tobacco Control (FCTC) on a global level. In 2012 the Director of EHN, Susanne Løgstrup, was Treasurer of the SFP. In conjunction with the EHN, SFP is working to ensure that a decision will be reached in the European Parliament before the 2014 elections.

As part of these efforts, SFP hosted a high level conference in the European Parliament in February 2012 that promoted large pictorial warnings and plain packaging for tobacco products. With its partners and a group of MEPs, SFP welcomed 130 participants from NGOs, research universities, national bodies, and European institutions.

SFP published a report entitled “Block, amend, delay: Tobacco industry efforts to influence the European Union’s Tobacco Products Directive (2001/37/EC).” The report highlighted the undermining and interfering strategy that the tobacco industry employed to harm the progress of the 2001 directive through the EU decision-making process.

The report is available from: http://www.smokefreepartnership.eu/news/blockamend-delay-tobacco-industry-efforts-influenceeuropean-union%E2%80%99s-tobacco-products and http://www.ehnheart.org/policy-issues/healthdeterminants.html

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European Public Health and Agriculture Consortium Created in 2008, the European Public Health and Agriculture Consortium (EPHAC) brings together health organisations to advocate for a healthier, more sustainable Common Agricultural Policy (CAP).

In 2012, EPHAC worked with the European Commission on the EU School Fruit Scheme and was instrumental in getting the School Fruit Scheme’s expert group up and running. Legislative proposals and reports from the European Parliament suggest strengthening the programme, increasing the budget from 90 to 150 million euros during the next financial framework, and increasing the EC financing from 50% to 75% in general and from 75% to 90% in convergence regions. Under the new legislative proposals, accompanying measures are eligible for EC financing.

To promote a focus on public health, EPHAC worked with members of the Parliament’s Committees on Agriculture and Rural Development Committee (COMAGRI) and Environment, Public Health and Food Safety (ENVI). However, regrettably the public health dimension was not as prominent as anticipated in the communication or in the reports from the European Parliament. In particular the COMAGRI Committee does not seem to accept the idea that the EU’s Common Agriculture Policy needs to move toward delivering multiple public good objectives, such as public health. EPHAC worked with a number of other NGOs to point out the lack of transparency in negotiations regarding the future of the CAP, arguing that the process needs to be more democratic and based more on providing public goods instead of merely mirroring vested interests.

The CAP celebrated its 50th anniversary in 2012.

EPHAC was invited to speak at the European Economic and Social Committee event celebrating the anniversary, and took the opportunity to focus on the next 50 years, emphasising that public health and food and nutrition security should be a central element.

EPHAC participated in the third meeting of the OECD Food Chain Analysis Network on “Mobilising the food chain for health” where EPHAC’s senior advisor, Robert Pederson, spoke on a panel addressing

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questions on how to align agro-food policies and initiatives with health and nutrition goals and how agriculture can contribute to achieving society’s nutrition and health goals.

After four years in charge of building up and directing EPHAC, Robert Pederson left to pursue an academic career.

European Chronic Disease Alliance The European Chronic Disease Alliance (ECDA), established as an informal group in 2010, continued as a unifying force in 2012.

Early in the year, ECDA published its input to the European reflection process on chronic diseases.

The Alliance also responded to the consultation that was carried out by the European Commission in the context of the reflection process. ECDA’s papers are available on its website, which was launched in 2012: http://www.alliancechronicdiseases.org/ Health Commissioner Borg met with the ECDA early in his mandate and announced that he would like to hold a Summit on chronic diseases and foresees an EU action plan on tackling them, complementing the joint action planned for 2013.

European Society of Cardiology EHN cooperates closely with the European Society of Cardiology (ESC). The two organisations are partners in EU co-funded projects such as EuroHeart II, and jointly support the MEP Heart Group.

EHN and ESC join forces to ensure that cardiovascular diseases remain a priority in EU policies and programmes.

European Association for Cardiovascular Prevention and Rehabilitation The European Association for Cardiovascular Prevention and Rehabilitation (EACPR) aims to be a coordinating stronghold within the ESC for all activities in the field of preventive cardiology and rehabilitation.

The Director and the Policy Officer of the EHN are members of the EACPR. The EHN Director is also a member of its Cardiovascular Prevention Implementation Committee and is a consultant to the Prevention, Epidemiology & Population Science Section.

World Heart Federation Through its membership of the World Heart Federation (WHF), EHN participates in international work to advance the cause of cardiovascular health promotion worldwide. In 2012 EHN was represented on the Executive Board of the WHF

by Hans Stam, Executive Director of the Dutch Heart Foundation, and Dan Gaita, President of the Romanian Heart Foundation.

Public Health Organisations

Commissioner Borg meeting with ECDA representatives

More information about the ECDA can be found at: http://www.alliancechronicdiseases.org/

EHN is an active member of the European Public Health Alliance (EPHA), which unites a variety of organisations throughout Europe that cover a broad spectrum of health issues.

On tobacco issues, in addition to its membership of the Smoke Free Partnership, EHN acts in close liaison with the Association of European Cancer Leagues (ECL) and the European Network for Smoking Prevention (ENSP), as well as with a number of national tobacco control organisations and experts.

15

Annual Report 2012

Statements and Publications

Responses

Salt

In 2012, EHN submitted its positions to the European Commission and the World Health Organization on three occasions:

story is solid

Statement by the European Heart Network (EHN).

Health 2020: a European policy framework supporting action across government and society for health and well-being

Statement by the EHN made at the sixty-second session of the WHO Regional Committee for Europe, Malta, 10-13 September 2012.

European Commission Proposal Regulation on Clinical Trials

• Responding to “A review of the EU regime for the fruit and vegetables sector – a European Commission public consultation on policy options and their impact assessment” • Responding to “Towards a post-2015 development framework – a European Commission public consultation”

for a

• Responding to the World Health Organization’s “Discussion paper on a Global Monitoring Framework and Voluntary Global Targets for the Prevention and Control of Non-Communicable Diseases”

EHN’s position on the European Commission’s proposal for a Regulation on Clinical Trials.

European Cardiovascular Disease Statistics 2012 A joint publication by the EHN, the European Society of Cardiology and the University of Oxford.

The report arises from the European Heart Health Strategy II project, which has received co-funding from the European Union within the framework of the Health Programme.

Cardiovascular patients and eHealth An EHN position paper.

All papers are available on EHN’s website http://www.ehnheart.org/ and http://www.ehnheart.org/euroheart-ii/euroheart-iipublications.html

16

Responses are available on our website http://www.ehnheart.org/publications/responses-toconsultations.html

Annual Report 2012

Conferences and meetings During 2012, EHN organised and participated in a number of conferences and meetings on topics relevant to promoting cardiovascular health and preventing cardiovascular diseases. They included:

February

TobTaxy capacity-building workshop - Dublin,

Ireland, 20-22 February 2012 High level conference on pictorial health warnings and standardised packaging for tobacco products - European Parliament, Brussels, Belgium, 29 February 2012; conference organised by the Smoke Free Partnership (SFP)

March

Regional workshop in the context of EuroHeart II

June

Restructuring health systems: How to promote

health in times of austerity - Brussels, 6 June 2012; conference organised by the European Public Health Alliance (EPHA) EU Food Law Conference: Health Claims & Food Labelling - Brussels, 19-20 June 2012 British Chamber of Commerce in Belgium, Health, Consumer & Social Affairs task force meeting Brussels, Belgium, 22 June 2012

project - Berlin, Germany, 14 March 2012 6th Annual European Nutrition & Lifestyle Conference: Towards a healthier future for European Citizens - Brussels, Belgium, 27-28 March 2012

April

World Congress of Cardiology - Dubai, United

Arab Emirates, 18-21 April 2012

May

EuroPRevent 2012: from research to

implementation - Dublin, Ireland, 3-5 May 2012 Living longer, better - Brussels, Belgium, 11 May 2012; conference organised by the European COPD Coalition (ECC) with the support of the EHN, the European CanCer Organisation (ECCO), the European Respiratory Society (ERS), and the International Diabetes Federation - Europe (IDF) EHN Annual Workshop and General Assembly Leuven, Belgium, 23-25 May 2012

Regional workshop in the context of EuroHeart II project - Milan, Italy, 25 June 2012

September

Sixty-second session of the WHO Regional

Committee for Europe - Malta, 10-13 September 2012

October

Slovak Heart to Heart League and EHN meeting of heart foundations in Central and Eastern European countries - Bratislava, Slovakia, 17 October 2012 Regional workshop in the context of EuroHeart II project - Smolenice, Slovakia, 18 October 2012

November

Diabetes, Women’s Health and Food: Can we do

more to meet the challenges in time of crisis? seminar in the European Parliament, Brussels, Belgium, 7 November 2012; organised by Anna Maria Corazza Bildt, MEP

December

Workshop on CV registries and data standards -

Brussels, Belgium, 12 December 2012; organised by the European Society of Cardiology

17

Annual Report 2012

EHN Governance Information about EHN and its structure, governance and finances is publicly available on its website http://www.ehnheart.org/about-us/governance.html

Membership In 2012, EHN had member organisations from 26 countries in Europe.

Costs involved in attending the Board meetings are covered by the member organisations of the Board members. Exceptions are made for those who come from member organisations with limited resources, where EHN covers the cost.

Staff EHN has maintained an office in Brussels since 1992. The Network has functioned as a legally registered, non-profit-making association in Belgium since 1993.

General Assembly The General Assembly is comprised of all the member organisations of the EHN. The principal role of the General Assembly is to set broad policy guidelines. Its other responsibilities include: • electing the Board and its President; • approving the admission of new member organisations; • approving budgets and annual accounts.

The EHN Brussels office has a team of five people who coordinate EHN’s work. The Brussels office acts as the central point for communication between the member organisations, facilitates its advocacy work with the institutions of the European Union, steers the research and publications work, and organises the Annual Workshop, seminars and meetings for members as well as special European conferences.

EHN also organises and coordinates pan-European projects with its members and other partners.

EHN Board Members

Board EHN is governed by a Board that can comprise no fewer than three and no more than eight members.

The Board met four times in 2012. Its role is to provide policy, political and procedural direction on behalf of the members of the EHN and to supervise the finances. The Board has three special positions: President, Vice President and Treasurer.

Matija Cevc Slovenian Heart Foundation Emanuela Folco (until June 2013) Italian Heart Foundation Simon Gillespie (from March 2013) British Heart Foundation Peter Hollins (until March 2013) British Heart Foundation Floris Italianer (from July 2013) Dutch Heart Foundation Staffan Josephson (President) (from July 2013) Swedish Heart Lung Foundation Therese Junker (Treasurer) Swiss Heart Foundation András Nagy (Vice President) Hungarian Heart Foundation Hans Stam (President) (until June 2013) Dutch Heart Foundation Inge Vestbo Danish Heart Foundation Martin Vestweber (from June 2013) German Heart Foundation

18

Annual Report 2012

EHN Member Organisations

in

2012

Austria

Austrian Heart Foundation

Belgium

Belgian Heart League

Bosnia and Herzegovina

Foundation of Health and Heart

Cyprus

Cyprus Heart Foundation

Denmark

Danish Heart Foundation*

Faroe Islands

Faroese Heart Foundation

Finland

Finnish Heart Association*

France

French Federation of Cardiology

Germany

German Heart Foundation*

Greece

Hellenic Heart Foundation

Hungary

Hungarian Heart Foundation

Iceland

Icelandic Heart Association

Ireland

Irish Heart Foundation

Italy

Italian Association against Thrombosis and Cardiovascular Diseases (ALT) Italian Heart Foundation Italian Heart and Circulation Foundation Italian Society for Cardiovascular Prevention (SIPREC)

Lithuania

Lithuanian Heart Association

Netherlands

Dutch Heart Foundation Heart and Vessel Group*

Portugal

Portuguese Heart Foundation

Romania

Romanian Heart Foundation

Serbia

Serbian Heart Foundation

Slovakia

Heart to Heart League

Slovenia

Slovenian Heart Foundation

Spain

Spanish Heart Foundation

Sweden

Swedish Heart and Lung Association* Swedish Heart Lung Foundation

Switzerland

Swiss Heart Foundation*

Turkey

Turkish Heart Foundation

United Kingdom

British Heart Foundation National Heart Forum Northern Ireland Chest, Heart and Stroke*

*  these members are also heart patients’ organisations

19

Annual Report 2011 2012

Finances European Heart Network – Audited Accounts for the year ended December 31, 2012 and approved by the General Assembly on 13 June 2013 INCOME (€) 1. Member subscriptions 2012

2011

Austrian Heart Foundation

1.097,00

1.075,00

Belgian Heart League

4.368,00

4.282,00

Bosnia Herzegovina, Foundation of Health and Heart

1.097,00

1.075,00

177.362,00

173.884,00

Cyprus Heart Foundation

1.097,00

1.075,00

Danish Heart Foundation

36.750,00

31.252,00

Dutch Heart Foundation

106.494,00

115.709,00

0,00

1.075,00

Finnish Heart Association

14.551,00

13.232,00

French Federation of Cardiology

20.834,00

22.863,00

German Heart Foundation

24.032,00

19.684,00

Hellenic Heart Foundation

4.368,00

1.075,00

Hungarian National Heart Foundation

1.097,00

1.075,00

Icelandic Heart Association

4.368,00

4.282,00

13.605,00

14.480,00

Italian Association against Thrombosis and Cardiovascular Diseases (ALT)

2.187,00

2.144,00

Italian Heart Foundation

1.097,00

2.144,00

Italian Heart and Circulation Foundation

1.097,00

1.075,00

Italian Society for Cardiovascular Prevention

1.097,00

2.144,00

Lithuanian Heart Association

2.187,00

1.075,00

National Heart Forum (UK)

2.187,00

4.454,00

Netherlands, Heart and Vessel Group

5.815,00

4.811,00

Northern Ireland Chest, Heart & Stroke

8.544,00

6.765,00

Portuguese Heart Foundation

4.368,00

4.282,00

Romanian Heart Foundation

1.097,00

1.075,00

Serbian Heart Foundation

1.097,00

1.075,00

Slovakia, Heart to Heart League

1.097,00

1.075,00

Slovenian Heart Foundation

4.368,00

4.282,00

10.464,00

8.711,00

5.531,00

7.109,00

Swedish Heart Lung Foundation

62.148,00

54.554,00

Swiss Heart Foundation

12.820,00

12.491,00

4.368,00

4.282,00

542.689,00

529.666,00

British Heart Foundation

Estonian Heart Association

Irish Heart Foundation

Spanish Heart Foundation Swedish Heart and Lung Association

Turkish Heart Foundation

Sub Total

20

Annual Report 2012

2. Special contributions 2012

2011

British Heart Foundation

37.335,00

36.603,00

Dutch Heart Foundation

27.152,00

26.620,00

World Heart Federation

20.162,30

19.982,42

Other Income

3.763,10

4.224,93

TobTaxy - EU Support

5.702,88

6.954,49

72.186,58

75.150,37

EU pre-financing EuroHeart Project

0,00

320.973,32

Contribution Fondation Roi Baudoin

0,00

86.831,90

Distribution EuroHeart - EHN

0,00

-407.805,22

4.130,39

28.279,82

EU pre-financing Euro Heart II

344.809,20

344.809,20

Partner payments Euro Heart II

-250.903,80

-191.193,30

EU support Euro Heart II

-147.336,95

-75.150,37

Remaining distribution Euro Heart II

53.431,55

-78.465,53

EU pre-financing Tob Taxy

18.560,44

9.280,22

EU support 2012 Tob Taxy

-12.919,39

-7.216,51

Remaining support Tob Taxy

-5.641,05

-2.063,71

170.432,25

197.815,03

Investment Income

27.316,78

10.908,72

Total Income

740.438,03

738.389,75

EuroHeart II - EU Support

Additional contributions for EuroHeart Project

Sub Total

3. Investment income

21

Annual Report 2012

EXPENDITURE (â‚Ź) 2012

2011

304.484,18

294.760,33

Office expenses

27.106,22

16.769,76

Property expenses/insurance

40.381,08

38.321,33

Travel, subsistence and conferences

6.168,03

7.961,00

Office equipment and computer hardware

9.883,62

8.580,83

Communication

10.727,87

7.603,80

Professional fees

6.587,30

4.059,55

Audit fees

1.996,50

1.936,00

Membership fees

2.588,22

2.397,22

337,89

404,17

20.808,20

20.322,00

Grant

1.000,00

0,00

Taxes

1.719,66

1.362,80

433.788,77

404.478,79

Salaries, etc.

Bank charges Annual Workshop

Total regular expenditure Seminars, research and publications

6.242,86

10.988,01

112.440,16

117.055,99

CEEC Support

844,00

890,42

MEP Heart Group

654,45

4.272,83

25.000,00

25.000,00

5.000,00

20.000,00

Diet and Physical Activity Paper

0,00

32.062,25

5th Task Force Prevention Guidelines

0,00

496,37

European Chronic Disease Alliance

7.801,68

4.224,93

TobTaxy

8.882,97

9.925,04

166.866,12

224.915,84

600.654,89

629.394,63

Total Income

740.438,03

738.389,75

Total Expenditure

600.654,89

629.394,63

40.000,00

40.000,00

99.783,14

68.995,12

273.380,86

204.385,74

373.164,00

273.380,86

EuroHeart II Project

Smokefree Partnership European Public Health and Agriculture Consortium

Total project expenditure

Total Expenditure

Reserve

Total Surplus/Deficit Balance beginning of period

Total Accumulated Surplus

22

Annual Report 2012

BALANCE SHEET AS AT DECEMBER 31, 2012 (€) 2012

2011

4.438,73

7.155,10

18.522,93

46.407,71

921.179,65

895.567,36

944.141,31

949.130,17

479.200,00

439.200,00

8.765,31

148.570,31

83.012,00

87.979,00

570.977,31

675.749,31

373.164,00

273.380,86

2012

2011

112.440,16

117.055,99

90.530,42

80.294,23

0,00

6.707,80

4.326,00

0,00

540,06

0,00

Patient Seminar (subsistence & meeting room)

3.877,80

4.220,20

EU conference

1.237,45

22.185,31

Printing costs

6.943,00

0,00

Accounting fees

1.119,25

580,80

516,82

0,00

2.916,09

3.067,65

433,27

0,00

72.186,58

75.150,37

-40.253,58

-41.905,62

Fixed Assets Current Assets Debtors and prepayments Cash at bank

Creditors Reserve Accrued costs and expenses Prepaid income

Net current assets (liabilities) EUROHEART II PROJECT (€)

Project expenses Personnel cost Meetings Staff travel and subsistence Subcontracting costs Steering committee (subsistence)

Other costs Steering committee (travel) Patient Seminar (travel) Speaker

Project income

EuroHeart II Project

23

Annual Report 2012

TOBTAXY (€)

2012

2011

8.882,97

9.925,04

8.362,77

7.639,25

Travel

231,30

366,09

Subsistence

288,90

1.261,90

0,00

657,80

5.702,88

6.954,49

-3.180,09

-2.970,55

Project expenses Personnel costs

Subcontracting Project income

TobTaxy

NOTES ON THE ACCOUNTS FOR THE YEAR ENDED DECEMBER 31, 2012

1. Principal accounting policies The following accounting policies have been applied consistently in dealing with items which are considered material in relation to the organisation’s accounts:

Accounting basis The accounts have been prepared under the historical cost convention.

2. Staff costs (€) 2012

2011

280.731,52

265.274,42

Group insurance

31.612,61

30.890,82

Social security employers

70.890,72

67.317,49

Accrued vacation pay

-2.214,15

4.891,73

Insurance personnel

3.053,87

2.565,45

Meal vouchers

6.064,13

5.709,83

353,39

341,13

Social office

4.926,87

5.702,94

Recruitment fee

7.958,41

0,00

-98.893,19

-87.933,48

304.484,18

294.760,33

Salaries

Other personnel charges

Personnel costs to recover

24

AUDITORS’ REPORT TO THE BOARD OF THE EUROPEAN HEART NETWORK FOR THE YEAR ENDED DECEMBER 31, 2012

We have agreed the financial statements on pages 20 to 24, which have been prepared on the basis of the accounting policies set out on page 24, to the records maintained by the European Heart Network.

Respective responsibilities of the Board and auditors The Board is responsible for the preparation of the financial statements. It is our responsibility to consider whether the European Heart Network’s balance sheet and income and expenditure account are in accordance with the detailed accounting records and, to consider whether we have received all of the information and explanations which we consider necessary.

Opinion We certify that we have obtained all the information and explanations required by us as auditors and that the income and expenditure account for the year ended December 31, 2012 and the balance sheet at that date are in agreement with the records maintained by the European Heart Network.

Kuurne, 31/03/2013

www.ehnheart.org European Heart Network Rue Montoyer 31 B – 1000 Brussels Belgium Telephone: +32 2 512 91 74 Fax : +32 2 503 35 25 Email: info@ehnheart.org