What the next EU budget could mean for prevention and health equity

From national investment plans to EU-wide funding programmes, a policy dialogue at the European Parliament on 15 October explored how health promotion and disease prevention could be supported under the EU's proposed 2028–2034 budget, and what will determine whether that support materialises.

How can Europe maintain investment in health promotion and disease prevention without a dedicated EU health programme? And who will influence which activities receive funding?

These questions were central to Investing in Health, a policy dialogue organised by JA PreventNCD and EuroHealthNet and hosted by European Parliament Vice-President Victor Negrescu.

Under the European Commission's proposal for the next Multiannual Financial Framework (MFF), EU4Health would no longer exist as a standalone programme. Instead, health-related activities would be supported through broader funding instruments, including the European Competitiveness Fund, National and Regional Partnership Plans, and Horizon Europe.

Opening the event, Negrescu reflected on the lessons of the COVID-19 pandemic and the importance of maintaining European cooperation on health. He emphasised that investing today can help avoid greater costs in the future. Referring to the European Health Union, he stressed: "This is not simply a buzzword," calling for greater substance behind the concept.

Presenting JA PreventNCD’s position paper, Dr. Mojca Gabrijelčič Blenkuš, who leads the joint action’s sustainability work, highlighted the need to ensure that prevention is not only adequately funded, but also reflected in how European investments are assessed and measured.

Two panel discussions brought together national, regional and European Commission perspectives on the proposed arrangements. Five key themes emerged.

1. Funding opportunities remain, but dedicated safeguards are missing

The proposed MFF offers several possible routes for supporting health promotion and disease prevention. However, the absence of a dedicated health programme and guaranteed funding allocations raises questions about how these priorities will compete with other investment needs.

At least 20% of the current EU4Health programme's budget is reserved for health promotion and disease prevention. No equivalent protection is currently proposed for the next funding period.

This distinction matters. The inclusion of health among the objectives of a funding programme does not necessarily mean that resources will be allocated to it.

The proposed framework would place greater emphasis on decisions taken through national investment plans and EU-level work programmes. How priorities are defined, which stakeholders are involved and how results are measured will therefore become increasingly important.

2. National investment plans will need strong health priorities and regional involvement

The first panel examined National and Regional Partnership Plans (NRPPs), under which Member States would develop investment plans responding to their national and regional needs. These would bring together several existing EU funding streams under one coherent strategy, including the European Social Fund Plus and cohesion policy funds.

Introducing the discussion, Vania Putatti, Policy Expert at EuroHealthNet, outlined how the proposed plans would operate, including their potential links to agreed targets and to the European Semester.

While the proposed arrangements include spending objectives for climate and environment (43%) and social objectives (14%), there is no equivalent target for health. This places greater importance on how health, and prevention in particular, will be positioned within national priorities during negotiations on the NRPPs.

Hanna Tolonen, Director of Research, Development and Innovation at the Finnish Institute for Health and Welfare, explained that Finland has begun early discussions on the NRPPs and intends to involve public institutions and other stakeholders.

She emphasised that many challenges affecting population health, including obesity, mental health and health inequalities, cannot be addressed by healthcare services alone. Effective prevention also requires action in areas such as education, agriculture, taxation and the environments in which people live.

Drawing on Finland's experience, Tolonen also stressed the value of learning between countries. While national plans can respond to specific needs, European cooperation allows Member States to share evidence, adapt effective approaches and avoid developing solutions independently.

The importance of regional involvement was reinforced by Dorota Tomalak, Deputy Head of Unit at the European Committee of the Regions. She raised concerns about the role of local and regional authorities in shaping future plans, particularly given their important role in addressing health inequalities across European regions.

Tomalak argued that health needs to be more clearly reflected in the objectives of the proposed plans, alongside meaningful opportunities for cities and regions to influence investment decisions.

Together, these perspectives illustrated both the opportunities offered by nationally tailored investment and the importance of ensuring that regional needs, health inequalities and cross-sectoral prevention priorities are not overlooked.

3. Connecting health priorities, national reforms and investment

Ruth Paserman, Director for Funds, Programming and Implementation at the European Commission's DG Employment, Social Affairs and Inclusion, outlined how the proposed arrangements could provide Member States with greater flexibility to address their national and regional priorities.

She explained how investment could be linked to reforms, including through the European Semester and its country-specific recommendations. These already address health-related challenges in several Member States, including access to healthcare, prevention and health system reform.

Paserman gave examples of how investment could support practical changes, such as strengthening networks of prevention centres and addressing regional differences in access to healthcare. She also emphasised the importance of national and regional engagement in developing investment plans.

The Commission’s proposed connection between the European Semester and investment planning could create opportunities to translate identified public health needs into funded measures. However, the precise role of the European Semester within the new arrangements remains subject to negotiation, with Member States expressing different views on the approach.

Another important question is which health promotion and prevention measures could qualify under the proposed 14% social spending target, and how these investments would be classified and monitored.

The discussion illustrated both the potential of linking investment to identified policy needs and the importance of ensuring that prevention is adequately reflected in the priorities guiding national funding decisions.

4. Funding flexibility raises important questions about safeguards and governance

The second panel focused on the European Competitiveness Fund (ECF) and Horizon Europe, examining how health promotion and disease prevention could be supported within broader EU funding programmes.

Setting the scene, Rebecca-Evelyn Papp, Policy Officer at EuroHealthNet, outlined how prevention would need to compete for resources alongside other priorities, including biotechnology and agriculture, without dedicated spending guarantees.

Anna Kubina, Strategic Advisor to Belgium’s Federal Public Service Health, Food Chain Safety and Environment, emphasised the importance of clear objectives, financial safeguards and governance arrangements that give health an appropriate voice in future funding decisions.

She questioned how funding priorities would be determined, who would participate in the relevant decision-making bodies and how public health experts and civil society could remain involved. Without sufficient safeguards, health-related activities could face repeated competition with other priorities as funding decisions are made.

Cristina Modoran, Head of Unit for Policy Strategy at the European Commission’s DG Health and Food Safety, emphasised that demonstrating the importance of health is no longer sufficient on its own. Public health stakeholders need to engage across policy areas and develop convincing, evidence-based arguments showing how health investment contributes to wider European objectives.

This includes connecting prevention to economic resilience, competitiveness and social wellbeing, and identifying opportunities for cooperation across sectors such as agriculture and food systems.

Modoran also explained that established public health consultation mechanisms would continue, even as funding arrangements evolve. However, questions remain about how public health expertise and stakeholder perspectives will influence decisions within the new funding instruments.

Franck Conrad, Head of Unit for the Multiannual Financial Framework at the European Commission's DG Budget, explained the Commission’s rationale for proposing greater funding flexibility. Fixed allocations over seven years, he argued, can make it difficult to respond to changing circumstances and emerging challenges.

He encouraged participants to examine the objectives of the different funding instruments and how health-related activities could be supported across them.

He also argued that flexibility need not come at the expense of predictability, highlighting the role of expert input and stakeholder engagement in shaping future funding priorities.

The exchanges highlighted a central tension: greater flexibility may create opportunities to respond to emerging needs, but without clear objectives, safeguards and appropriate governance, long-term priorities such as prevention risk losing visibility and financial support.

5. Measuring prevention outcomes will be essential

Alongside funding and governance, the discussion highlighted the importance of measuring what EU investment actually delivers.

The proposed MFF Performance Framework aims to introduce a more consistent approach to tracking expenditure and measuring results across funding programmes.

For prevention, this means going beyond counting activities, such as campaigns delivered or services provided, to examining whether investments address major health risks, reach disadvantaged communities, support healthier environments and contribute to improved population health.

JA PreventNCD has made detailed recommendations to strengthen the recognition and measurement of health promotion, disease prevention and health equity within the framework.

Several of these recommendations have already been reflected in the Council’s partial negotiating position on the MFF Performance Regulation. This represents encouraging progress, although the final framework and how its indicators will be implemented remain to be determined.

The discussions reinforced the importance of ensuring that prevention is not only eligible for funding, but also visible in funding decisions and assessed against meaningful, longer-term outcomes.

The policy dialogue demonstrated that opportunities to support health promotion and disease prevention remain within the proposed MFF. However, turning these opportunities into sustained investment will depend on the final funding arrangements, the safeguards they provide for prevention and the decisions made during implementation.

The discussions also raised questions about how cooperation between Member States, particularly the implementation-focused collaboration supported through Joint Actions, could be maintained under the future funding arrangements.

Drawing on the discussions and JA PreventNCD’s published position paper, four priorities deserve continued attention:

As negotiations continue, an important challenge will be finding the right balance between flexibility and the sustained investment needed to deliver lasting improvements in health. Europe simply cannot be strong and competitive without healthy citizens.

The dialogue highlighted the value of bringing different perspectives together, not only to identify the risks and opportunities within the proposed framework, but also to consider how Europe can ensure that prevention remains a priority in its future investment decisions.

For more on JA PreventNCD's recommendations and its engagement in the policy dialogue, read our accompanying article, JA PreventNCD and EuroHealthNet bring the case for prevention to the European Parliament.