The European Forum of Medical Associations and WHO

By Dr. Alan J. Rowe, former Secretary General EFMA/WHO and former Secretary General Dr. René Salzberg
A brief note on the history, development and decisions of the Forum

The European dialogue between National Medical Associations and the World Health Organisation began in December 1984 when, on the initiative of Dr. Jo Asvall, then Director of the European Regional Office of WHO a meeting took place between Western European Medical Associations and WHO EURO in Copenhagen. At this time, it was recognised that clearly the medical profession had an important role to play if the philosophy of the Health For All movement in general and the European regional targets in particular were to be achieved.

Further meetings involving national medical associations both from the west and east took place in 1986, 1987 and 1988. At a meeting in Rome (1990), the national medical associations recognised that they had created a permanent forum permitting a fruitful dialogue with WHO. This was formalised at Helsinki in 1991 when the aims of the Forum were finalised as follows:

"The aims of the Forum shall be, by establishing a dialogue and cooperation between
National Medical Associations and the World Health Organisation in the European region, to:

  1. improve the quality of health and health care in Europe;
  2. promote the exchange of information and ideas between national medical associations, and between the associations and the World Health Organisation;
  3. integrate appropriate aspects of policies of Health For All into basic, postgraduate and continuing medical education; and
  4. formulate consensus policy statements on health issues."

For the purposes of membership, a national medical association is defined as "a free independent nongovernmental association of physicians constituted in an organisation which elect its own officers, appoints its own staff and determines its own constitution, except for any statutory duties that it undertakes, and whose activities cover all the various aspects of professional practice."
With the political changes in the east of Europe, the Forum has been able to assist in the process of establishing or re-establishing such democratic medical associations in newly independent states.

In the past two meetings of the Forum, 42 of 50 member states’ national medical associations in the Region have been represented. Observers have included the Canadian Medical Association and a number of Pan-European medical associations.

In the series of meetings since 1984 a spectrum of subjects have been considered. These include future health policy in Europe, AIDS, new patterns of infectious diseases, health care in the elderly, health promotion, the rights of patients, the physician`s role in environmental health, financing
of health care, development of new health care systems, suicide in the young, quality of care development and use/misuse/abuse of drugs.

From the beginning, the subjects of Tobacco and Smoking and of Continuing Medical Education have been subjects of continuing report and action as has the subject of Quality of Care (since 1988). In more recent years, the Forum has adopted a number of statements and recommendations as follows:

  • The recommendation of the European Forum of Medical Associations and WHO on continuing medical education (Helsinki 1992)
  • The statement on help to the war devastated populations of the former Yugoslavia (Utrecht 1993).
  • Recommendations for national medical associations regarding the quality of care development (Utrecht 1993).
  • The Statement on infectious diseases in Europe (Budapest 1994).
  • The Statement of immunisation of children (Budapest 1994).
  • The Statement on tobacco and health (Budapest 1994).
  • The Statement on humanitarian assistance to the war devastated populations in the countries of the former Yugoslavia (Budapest 1994).
  • The Statement on quality of care (1994).
  • The Statement on hepatitis B & C (London 1995)
  • The Statement on health policies (London 1995)
  • The Statement on tobacco and health (legislation on advertising, tobacco tax, health warnings, smoke-free public areas (London 1995)
  • The Statement on war devastated populations (control of preventable disease amongst civilians) (London 1995)
  • The Statement on Patients’ Rights (Stockholm 1996)
  • The Statement on European Health Care Reforms (Stockholm 1996)
  • The Statement on tobacco - smoke-free flights (Stockholm 1996)
  • Statement on Anti-personnel Landmines (Copenhagen 1997)
  • Statement on the Threat of Defensive Medicine (Copenhagen 1997)
  • Statement on Tobacco (Copenhagen 1997)
  • Statement on HFA Strategy and Health Care Resources (Basel 1998)
  • Statement concerning Threats to the Health of Civilians in Kosovo (Basel 1998)
  • Statement on Tobacco (Basel 1998)
  • Statement on Physicians` Autonomy (Tel Aviv 1999)
  • Statement on Tuberculosis Control (Tel Aviv 1999)
  • Statement on Tuberculosis and Prisons (Warsaw 2000)
  • Declaration on Physicians` Autonomy (Warsaw 2000)
  • Statement on the Human Genome and International Patent Law (Ljubljana 2001)
  • Declaration on tobacco control (Vienna 2002)
  • Declaration concerning medical aid during armed conflict (Vienna 2002)
  • Statement on the “Burnout”-syndrome among physicians
  • Statement on actions to reduce tobacco smoking in Europe
  • Statement of the coopration EFMA / WHO
  • Resolution on tobacco
  • Statement on patient empowerment
  • Statement on the Bologna process and medicine
  • Statement on healthcare in prison and other forms of detention
  • EFMA Resolution on Action for Tobacco Control
  • Electronic record systems and databases in the field of health care
  • Statement on physician migration
  • Achieving a smoke-free medical profession throughout Europe

In addition the NMAs present in Basel 1998, adopted a statement on the Allocation of Resources for Curative Medicine and for Health Promotion and Preventive Medicine.
In Tel Aviv 1999 the NMAs presented, adapted a statement on torture about "The ethical obligations of physicians to refuse to participate in or condone torture or inhuman practice and violation of human rights." (Case of Dr. Cumhur Akpinar).

The Forum has followed up some of these statements by establishing action groups, notably in relation to tobacco and to the quality of care, in order to assist national medical associations in carrying forward appropriate action in their own countries.
In this connection the Forum has published a booklet entitled "Quality of Care Development (QCD), Why and How?". Through the Norwegian Medical Association the Forum publishes a Handbook every year.
Each year national medical associations report not only on their general activities but also on any action they have taken in areas which the Forum has considered. Examples in 1994 included health promotion, immunisation, HIV positive physicians, organising medical assistance in other countries.

These reports are analysed and presented as a separate volume which is a companion to a compilation
of information about the constitution, activities and officers of participating national medical associations. In 1996, a large number of national medical associations successfully joined in a
concerted action to carry out the actions called for in the Forums’ statement on “smoke-free flights”.

With the changes in the eastern part of the region there has been a need for special dialogue between the countries of the east of the region and those in the west. In Budapest (1994), London (1995) and Stockholm (1996) post-Forum meetings were held for the benefit of the newly emerging and re-establishing national medical associations from this part of the region. In 1997 this was merged with the main meeting and devoted to a discussion on health care reform, based on the WHO Ljubljana Charter.

The Liaison Committee (executive) of the Forum meets three times a year, at least once in the country hosting the plenary meeting. In November 1998 for the first time the Liaison Committee met in a newly independent state, Kazakhstan, when members also attended the first meeting of the "Eurasian Miniforum".

The following is a summary of the decisions and formal statements adopted by the Forum since its foundation.

Vienna   1986
Paris 1987
Sofia 1988
Rome 1990
Helsinki 1991
Basel 1992
Utrecht 1993
Budapest 1994
London 1995
Stockholm 1996
Copenhagen 1997
Basel 1998
Tel Aviv 1999
Warsaw 2000
Ljubljana 2001
Vienna 2002
Berlin 2003
Dubrovnik 2004
Oslo 2005
Budapest 2006
Lisbon 2007
Tel Aviv 2008