The European Society of Cardiology (ESC) welcomes the European Commission's presentation on 16 July of the proposal for the Multiannual Financial Framework (MFF) for the period 2028 -2034, also known as the long-term EU budget. We fully support the ambition of an "investment-focused Commission" for a thriving society and economy, and we underline the importance of focusing on key strategic priorities, including health. On this timely occasion, we reiterate our call on policymakers and all actors involved in the process to ensure that the next EU budget reflects the profound health, social, and economic burden posed by cardiovascular disease (CVD) - the leading cause of death in the EU and globally.
With an estimated 62 million people in the EU currently living with CVD, and 1.7 million lives lost each year, CVD remains Europe's biggest health challenge1. It accounts for 34% of all deaths in the EU and imposes an annual economic burden of €282 billion, representing almost 20% of all healthcare expenditures, equivalent to 2% of Europe's GDP, and exceeding the entire EU budget2. This underscores the scale of the problem and the value of prioritising preventive measures. Notably, investments in CVD prevention and control - as seen with tobacco control and hypertension management - have consistently delivered strong economic and public health gains3456. For example, effective hypertension management can yield a 3:1 return on investment7, reducing healthcare costs and boosting workforce productivity. These figures showcase the need for a strategic, measurable, and proportionate allocation of resources in the next MFF to prevent, treat, and manage CVD. In this context, the European Commission's proposal to introduce an EU-level tax on tobacco products represents a concrete step. This measure, part of a broader effort to finance the EU budget through new own resources, reinforces the vital role of fiscal levers in driving better health outcomes. "Stronger taxation for all tobacco products, including vapes, is not only a proven tool for reducing cardiovascular risk, but also a smart and sustainable way to channel resources towards prevention" Professor Thomas F. Lüscher, ESC President, says.
As the Commission has rightly noted, the current EU funding landscape is fragmented, with overlapping programmes and inconsistent requirements that hinder access and limit impact. The ESC supports the announcement of the European Competitiveness Fund as one of the core pillars of the new EU budget and positively acknowledges that investments in strategic technologies and acceleration of EU funding will be channelled and not limited to health, but also digital transition, clean transition and decarbonisation. In particular, health innovation - including technologies and advanced solutions for CVD prevention, diagnostics, and care – should be considered an integral part of this investment stream. Specific innovation priorities should include artificial intelligence for cardiovascular risk stratification, remote diagnostics, and digitally enabled care pathways that can improve early detection and patient outcomes. Targeted health investment is not only aligned with strategic EU priorities, but also a prerequisite for sustainable economic growth, resilience, and competitiveness across the bloc.
In view of the forthcoming negotiations between the Member States in the Council and European Parliament lawmakers on the future long-term budget, the ESC recalls its key asks for the next MFF, which were also emphasised in its consultation response submitted to the Commission last May:
Ensure robust funding for cardiovascular health across the MFF
CVD must be prioritised within the strategic focus of the MFF, with dedicated investments aligned with the forthcoming EU Cardiovascular Health Plan. The plan should be backed by a budget that reflects the full scope of the disease burden and drives action across primary and secondary prevention, early detection, treatment, quality of care and rehabilitation. This should also consider geographic inequities across Member States - notably between Western and Eastern Europe - where disparities in access to care, outcomes, and research capacity require tailored support. Mortality rates from heart disease and stroke vary dramatically between countries; for example, age-standardised death rates for heart disease are up to 13 times higher in women in Lithuania compared to France8, highlighting the urgent need for targeted investment.
Expand and strengthen Horizon Europe
It is essential to preserve and significantly expand funding for Horizon Europe, a pillar supporting innovation in public health and research, and to maximise potential of the next Framework Programme for Research and Innovation (FP10). In this regard, we applaud the doubling of the research programme's size, from €95.5 billion under the previous MFF to €175 billion in the new proposal. It is now of outmost importance for Horizon Europe to prioritise areas with the greatest unmet need and impact potential - CVD among them. However, the ESC regrets that the EU4Health programme, the first earmarked EU budget for health and a cornerstone of the current programming cycle, is not mentioned and has been disregarded as a stand-alone fund in the Commission's latest proposal.
Establish a robust flexibility reserve for public health and climate-linked health challenges
ESC commends the establishment of a dedicated crisis mechanism valued at €400 billion, to be triggered when severe crises occur in the Union. It is for this reason that we once again stress the imperative need to include a flexibility reserve to allow for the rapid mobilisation of funds in response to emerging crises, including those stemming from climate change, such as air pollution and noise exposure - known risk factors for cardiovascular conditions. Such a reserve will enhance the EU's capacity to respond to public health emergencies and bolster long-term health resilience.
Align funding priorities with disease burden and impact
Investment decisions should be informed by evidence, including disease burden data and economic cost. The scale of the CVD burden calls for budgetary allocations that are commensurate with their impact on patients, families, healthcare systems, and the European economy.
In line with the goals of the Competitiveness Compass and the Political Guidelines of President von der Leyen's Commission, a strategically aligned and health-smart MFF can deliver more than the sum of its parts - especially in areas, like cardiovascular health, where coordinated EU-level action adds clear value beyond what Member States can solely achieve individually.
The ESC stands ready to contribute its expertise and further collaborate with Members of the European Parliament and national capitals in the next phase of negotiations requiring the unanimity majority, to shape a future-proof MFF that delivers measurable results for citizens' health and wellbeing, including those affected by CVDs.