Dr. Vytenis Andriukaitis:

All of the questions raised are on issues which I believe are important. Yesterday I discussed with the acting director general, Ladislav Miko, how we must act together. My bible is the book Everything You Always Wanted to Know About European Union Health Policies but Were Afraid to Ask. It is written by prominent authors and makes excellent recommendations and suggestions. When I read it, I want to act on its recommendations and ideas, beginning with medical devices. Today a very important file went from my portfolio to that of the Commissioner for the Internal Market, Industry, Entrepreneurship and SMEs, Elbieta Biekowska, but we have joint responsibility.

Very sensitive questions have been raised. I am a cardiac surgeon and I cannot imagine cardiac surgery without medical devices and technology. Such devices and technology must be assessed and controlled and the relevant notified bodies must be informed. We must keep an eye on the medical devices directive. The Latvian Presidency is ready to act and we will work together. Ireland submitted huge technical files on medical devices covering many topics in detail. Such information is important to be more effective and comprehensive with regard to clinical trials data, because we must know the positive and negative aspects. We must have transparency in clinical trials. Not all 28 member states have the capacity to have a notified body for everything, so we must have a European network and mechanisms. I am ready to ask my colleagues for more detailed answers if committee members wish.

The issue of the Internet was raised. I have been asked by Finland to help stop the advertising of alcohol on the Internet because it is impossible to regulate it at member state level. At this meeting we have discussed excise issues relating to Northern Ireland and Ireland, as the price of alcohol is different in both states. It is impossible to deal with these issues in one member state, but if minimum pricing and VAT are raised at EU level various countries and stakeholders will resist it. I agree that we must keep our eye on it.

Young people buy many things, from electronic cigarettes to contraceptives and drink. The difference is that we must all act together. Let us act to together and look at the possibility of change because the situation is so dangerous. I would like to check Ireland's position.

On obesity and budgets, it is always difficult to say how much money should be allocated to public health promotion initiatives, but after one year I know enough to ask questions. I would like to present to the committee the common picture and to send this study to my government and ask that the strategic committee follow my statement to say which approach is more effective.

My final slide is on statistics for demographic, mortality, unemployment and abortion rates. In 1989 we had 3.6 million inhabitants; today we have 3 million, indicating a loss of population. Every year some 35,000 to 36,000 people die, deaths due to alcohol, tobacco and accidents, deaths which are avoidable. I view this loss of life in economic terms, noting how much money is wasted every year by not paying attention to these deaths. Now that I am speaking about the European Union, I have an idea about the investment package proposal. I propose that we call together our specialists to discuss the possibility of making additional investment of about €180 million to €200 million to introduce and co-ordinate the instruments on the table to reduce alcohol and tobacco consumption and promote public health initiatives. We must control in a co-operative manner health risks and set yearly targets. This will have implications for investment in terms of growth and employment. I would like to raise with my colleagues the possibility of calculating the proposed expenditure and agreeing on how the money should be spent. For example, we could have instruments to reduce alcohol and tobacco consumption and the level of obesity. All member states should be profiled and we should establish the instruments on which they will co-operate at European Union level. That is the route I would like to follow. I ask the committee to raise these questions in Parliament and present the outcome to the European Parliament. This message should be sent to all stakeholders because together we can improve our capacity. Today, around 1.2% of total budgets is allocated for prevention measures. Let us not discuss the need for additional moneys but discuss the possibility of using effective instruments in year one. In the second year we must be more active and encourage member states to draw attention to the need for greater investment.

I think about the budget question a lot and see a very different picture today. There are different strategies - the cancer strategy, the alcohol strategy and the tobacco strategy. My aim is to try to join all of them together. I would like to see neighbouring countries, for example, Ireland and the United Kingdom, discussing instruments. We must co-operate and adopt a coherent approach to resolving these common issues and questions and use the instruments agreed to by all member states. I have resolved to present indicators and instruments to my colleagues. Having lost three months, I have only five years and would like all of us to move forward together.

I have been asked about budgets for measures to tackle obesity and the lack of physical activity. In some countries it is mandatory to have two lessons in physical education each week. We must see the possibilities to encourage children to be more physically active. Should we encourage physical activity on the street or the corridor and give children longer breaks to allow them to be more active and change their behaviour? This is a difficult debate and one can see that this example has not been followed in all 28 member states.

I will now address the issue of implementation of the article on tobacco. Our first job is to improve our activities through delegated responsibility because it is our job to implement the tax changes and look at how all 28 member states are ready to-----