Beyond funding: why Europe must protect its prevention infrastructure

The European Union’s next long-term budget will help determine Europe’s capacity to promote health and prevent cardiovascular diseases, cancer and other non-communicable diseases for years to come. But the debate is not only about how much funding will be available. It is also about whether Europe will retain the structures needed to turn investment into coordinated and sustained action.

JA PreventNCD has previously called for health promotion, non-communicable disease prevention and health equity to be made visible, adequately funded and measurable across the 2028–2034 Multiannual Financial Framework, or MFF. Our position paper, published in June, highlighted the need for clear health allocations, stronger prevention objectives and indicators covering health and equity.

Building on this discussion, an editorial published in July in the European Journal of Public Health, “Protecting Europe’s prevention infrastructure in the next EU budget,” reinforces this narrative while adding an important dimension. Written by Dr. Benedetta Armocida, Coordinator of JACARDI; Prof. Knut-Inge Klepp, Scientific Coordinator of JA PreventNCD; and Dr. Hanna Tolonen of the Finnish Institute for Health and Welfare, who plays an important role in both Joint Actions, the editorial focuses on the governance and implementation infrastructure behind European public health action.

Its central message is clear: continued funding for health activities is important, but funding alone is not enough.

As outlined in our earlier analysis of the next EU budget, under the current EU budget, EU4Health provides a dedicated framework for European cooperation on public health. It includes clearly defined programme objectives and eligible actions, national focal points, performance indicators and a requirement that at least 20% of programme expenditure support health promotion and disease prevention.

The European Commission’s proposal for the next MFF would bring EU4Health into the much broader European Competitiveness Fund. Health would sit within a policy window covering health, biotechnology, agriculture and the bioeconomy, without an explicitly ring-fenced allocation for health promotion and disease prevention.

Health activities are expected to continue within the proposed architecture. However, the editorial argues that the important question is not simply whether health remains somewhere in the EU budget. It is whether prevention will retain the visibility, predictability, accountability and implementation capacity it currently receives through a dedicated health programme.

“Prevention must be treated as a strategic investment in Europe’s resilience, economic sustainability and social cohesion. But investment requires more than funding individual activities. It also depends on strong institutions, reliable evidence and mechanisms that allow countries to implement and sustain effective action,” says Prof. Knut-Inge Klepp.

A broader and more flexible funding structure may create opportunities for cooperation across policy areas. At the same time, without clear safeguards, health promotion and disease prevention could become less visible and may have to compete with larger industrial, technological and economic priorities.

Prevention infrastructure is not a single institution or programme. It encompasses the public health institutions, professional expertise, governance arrangements, monitoring systems and cooperation mechanisms that enable evidence to be translated into policy and practice.

Dedicated objectives and funding create visibility. Indicators make it possible to track investment, implementation and outcomes. National focal points and established professional networks connect European priorities with national systems. Common frameworks allow countries to compare experiences and learn from one another.

Together, these elements create the conditions for prevention to be implemented consistently, evaluated transparently and sustained beyond individual activities.

“Europe already has ambitious health strategies. The question is whether it will retain the governance and implementation structures needed to turn those ambitions into coordinated and measurable action across Member States,” says Dr. Benedetta Armocida.

This distinction matters because policy commitments do not implement themselves. The EU Safe Hearts Plan and Europe’s Beating Cancer Plan set important ambitions, but achieving them requires institutions with the capacity to coordinate action, develop common approaches and support implementation across countries.

Joint Actions are a central part of Europe’s public health infrastructure. By bringing national authorities, public health institutes, researchers and other partners together, they provide a practical mechanism for translating shared European priorities into coordinated action across Member States.

JACARDI and JA PreventNCD demonstrate how this works at considerable scale across different but connected parts of the response to non-communicable diseases. JACARDI involves 21 European countries and addresses cardiovascular diseases and type 2 diabetes through areas including health literacy, data, screening of high-risk populations, integrated care and self-management. JA PreventNCD brings together 25 European countries and supports the prevention of cardiovascular diseases, cancer and other non-communicable diseases by addressing structural drivers at societal level alongside strategies for individuals at higher risk.

Their work directly supports the implementation of major EU flagship initiatives. JA PreventNCD contributes to the prevention ambitions of both Europe’s Beating Cancer Plan and the EU Safe Hearts Plan, while JACARDI provides implementation experience across prevention, early detection and care that is particularly relevant to the Safe Hearts Plan.

In both initiatives, pilot activities are designed to be scalable and transferable, allowing effective approaches to be adapted and integrated into national health systems. As the editorial highlights, Joint Actions therefore serve as operational platforms that connect European strategies with implementation, while strengthening institutional capacity, cross-country collaboration and policy learning.

The concern is not that European public health cooperation would disappear immediately under a new funding structure. The risk is that it could become less predictable, less visible and more fragmented.

Without Joint Actions or an equivalent cross-border implementation mechanism, countries may have fewer opportunities to harmonise methods and learn systematically from implementation in different settings. Professional networks and institutional relationships developed over many years could become harder to sustain.

Fragmentation could also make it more difficult to compare progress and determine whether European investments are producing meaningful and equitable health outcomes.

“Long-term progress depends on continuity: continuity of cooperation, expertise, data and implementation capacity. These are strategic European assets that take years to build and cannot simply be recreated whenever a new priority emerges,” says Dr. Hanna Tolonen.

The editorial identifies three conditions needed to protect Europe’s prevention infrastructure.

1. Health promotion and disease prevention require a dedicated and adequately protected financial envelope. This would help prevent them from being diluted within a much broader competitiveness framework.
2. The next MFF should maintain a clear basis for Joint Actions or provide a functionally equivalent cross-border implementation mechanism. Europe needs a practical way to translate shared health priorities into coordinated action across Member States.
3. Health-specific objectives, indicators and monitoring arrangements must continue. These provide transparency and accountability, while allowing countries to learn from implementation and improve future policy.

These safeguards are mutually reinforcing. Funding without implementation capacity may not produce sustainable change. Implementation without predictable funding becomes uncertain. Without monitoring and accountability, it becomes difficult to understand what was achieved, who benefited and where further action is needed.

Europe has already invested substantially in building its public health capacity and cooperation. The next EU budget provides an opportunity not only to protect that infrastructure, but to strengthen it as a foundation for healthier populations, more resilient societies and a more sustainable European future.