As the European Parliament prepares to vote on the EU Cardiovascular Health Plan and advances its work on Europe’s Beating Cancer Plan, a fundamental question hangs over Brussels: is EU public health policy aligned with the realities of disease in modern Europe, or with what is politically easiest to regulate?
The Commission’s own framing acknowledges the scale of the challenge. Cardiovascular disease, diabetes, and obesity are rising sharply, particularly among younger Europeans. Yet when one examines the Union’s policy output, a striking imbalance emerges. Regulatory intensity remains heavily concentrated on nicotine and tobacco-related measures, while the fastest-growing drivers of disease—obesity, poor diet, excessive sugar consumption, ultra-processed foods, and alcohol—are addressed only in fragmented or limited ways.
This is not an argument against tobacco control. Reducing smoking remains a legitimate and positive public health objective, and progress in this area should be recognized. But success brings with it a responsibility to adapt. Tobacco use is declining across much of Europe, driven by a combination of consumer behavior, innovation, and broader societal shifts. Meanwhile, the health burden has moved elsewhere, and policy has not kept pace.
More than half of EU adults are now overweight. Childhood obesity is accelerating, with roughly one in four children affected. Diet-related disease, 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 engines of cardiovascular disease and cancer.
Yet the EU’s policy architecture tells a different story.
Nicotine remains uniquely subject to extensive, harmonized regulation at EU level. By contrast, action on food systems, sugar consumption, and alcohol is diffuse, often voluntary, and largely left to Member States. This creates a structural asymmetry: declining risks are tightly regulated, while rising risks are governed 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, sits primarily with Member States. The Union cannot impose sweeping restrictions on food systems in the same way it can regulate products under single market rules or apply excise frameworks, as it does with tobacco.
But acknowledging these constraints does not resolve the problem—it highlights it.
If the EU cannot regulate certain risk factors directly, it must at least ensure coherence across its actions. Instead, current policy risks distorting the public health landscape: it signals urgency where progress is already being made, and hesitancy where the crisis is intensifying.
This raises a series of uncomfortable but necessary questions.
How does the Commission assess whether its policies are proportionate to the scale of Europe’s health challenges? How does it justify a continued concentration of legislative energy on declining risk factors while obesity and metabolic disease surge? And what concrete steps will it take to ensure that future initiatives reflect the full spectrum of risks identified in its own analyses?
Commissioner Olivér Várhelyi himself 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 visible prevention agenda continues to center heavily on nicotine-related measures, making it abundantly clear where regulatory focus remains concentrated, even as the broader health landscape evolves.
Because without a shift, the EU risks pursuing a public health strategy that is internally inconsistent. One that is not too strict, but selectively strict. One that applies rigorous, harmonized 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 actually occurring. That means placing metabolic health, diet, and lifestyle at the center of the conversation, and 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.
