As the European Parliament prepares to vote on the EU Cardiovascular Health Plan and progresses with Europe’s Beating Cancer Plan, a key question arises in Brussels: is EU public health policy aligned with modern Europe’s disease realities, or is it focused on what is politically easier to regulate?
The Commission acknowledges the scope of the challenge. Cardiovascular disease, diabetes, and obesity are rising sharply, notably among younger Europeans. However, when examining the Union’s policy output, a notable imbalance appears. Regulations are heavily concentrated on nicotine and tobacco-related measures, while the rapidly growing causes of disease—obesity, poor diet, excessive sugar intake, ultra-processed foods, and alcohol—receive only fragmented or limited attention.
This is not to argue against tobacco control. Reducing smoking is a legitimate and positive public health goal, and progress in this area should be acknowledged. But success brings an obligation to adapt. Tobacco use is declining across much of Europe, driven by consumer behavior, innovation, and societal shifts. Meanwhile, the health burden has shifted, and policy has not kept pace.
Over half of EU adults are now overweight. Childhood obesity is accelerating, with about one in four children affected. Diet-related diseases, metabolic disorders, and alcohol consumption are increasingly central to Europe’s long-term health trajectory. These are not marginal risks; they are now the primary drivers of cardiovascular disease and cancer.
Yet the EU’s policy framework tells a different story.
Nicotine remains uniquely subject to extensive, harmonized regulation at the EU level. In contrast, actions on food systems, sugar consumption, and alcohol are diffuse, often voluntary, and largely left to Member States. This creates a structural asymmetry: declining risks are tightly regulated, while rising risks are managed by soft measures and fragmented initiatives.
The result is a growing misalignment between policy intensity and actual health impact.
This imbalance is not accidental. It reflects the limits of EU competence. Health policy, particularly in areas such as diet and lifestyle, primarily falls to Member States. The Union cannot impose sweeping restrictions on food systems as it can with products under single market rules or apply excise frameworks, as with tobacco.
Acknowledging these constraints does not solve the problem—it highlights it.
If the EU cannot directly regulate certain risk factors, it must at least ensure coherence across its actions. Instead, current policy risks distorting the public health landscape: signaling urgency where progress is already being made, and hesitancy where the crisis is intensifying.
This raises several uncomfortable but necessary questions.
How does the Commission assess whether its policies are proportionate to Europe’s health challenges? How does it justify continued focus on declining risk factors while obesity and metabolic disease surge? And what concrete steps will it take to ensure future initiatives reflect the full spectrum of risks identified in its analyses?
Commissioner Olivér Várhelyi recently underscored the problem. In a video marking European Youth Week, he acknowledged the growing burden of cardiovascular disease, diabetes, and obesity among young Europeans. Yet, despite this, the Commission’s prevention agenda continues to focus heavily on nicotine-related measures, clearly showing where regulatory focus remains, even as the broader health landscape evolves.
Without a shift, the EU risks pursuing a public health strategy that is internally inconsistent. Not overly strict, but selectively strict. One that applies rigorous tools to politically manageable targets, while leaving more complex, systemic risks insufficiently addressed.
Public health policy should be guided by outcomes, not convenience.
If Europe is serious about reducing its disease burden, it must align its strategy with where harm is occurring. That means placing metabolic health, diet, and lifestyle at the center of the conversation, ensuring that policy tools reflect the scale of those challenges.
Otherwise, the EU will continue to invest political capital in areas where returns are diminishing, while the real drivers of disease remain largely unchecked.
That is not just a policy gap. It is a credibility problem.
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