Today’s publication of the European Commission commitments to improving cardiovascular health in Europe, unveiled as “Safe Hearts Plan”, has been much anticipated and marks a significant moment for public health in Europe. It is encouraging to see many of the priorities championed by the public health community, and advocated by the European Public Health Alliance (EPHA) and its members in our Vision and Strategic Recommendations for the EU Cardiovascular Health Plan, reflected in the final Communication.
Several elements of the Plan deserve recognition. The Commission’s commitment to swiftly publish a proposal for a revised legislative framework on tobacco control and to evaluate the Audiovisual Media Service Directive aligns with EPHA’s recommendations to build on the solid foundation laid by Europe’s Beating Cancer Plan, and are important step toward further reducing exposure to tobacco and unhealthy marketing, especially among vulnerable groups.The creation of a dedicated network on the taxation of unhealthy products is also encouraging, as it could be crucial to ensuring that public health objectives remain the North Star of fiscal policymaking if representation, agenda setting, and conflict of interests within the network are handled with the public good in mind.
The Commission’s plan to put forward Council Recommendations on health checks for cardiovascular disease, is another important step. It echoes EPHA’s recommendation to develop life-course screening guidelines with evidence-based criteria on timing, target populations, and follow-up, and it could play a major role in harmonising prevention across Member States. Similarly, the proposed creation of a European network of specialised cardiovascular centres is another point we strongly advocated for, as it is a forward-looking measure that could align standards of care, foster equity across health systems, and ensure that cutting-edge research translates into clinical practice.
The Plan’s focus on data and equity is particularly noteworthy. The intention to develop an EU cardiovascular health inequalities dashboard responds directly to EPHA’s calls for robust, interoperable, and disaggregated health data under the European Health Data Space. Tracking inequalities systematically is essential for understanding where gaps persist, and for holding systems accountable for closing them. These steps, combined with multi-stakeholder and cross-sectoral approaches, including networks involving patients and medical organisations, show a clear intention to integrate evidence, expertise, and equity into EU cardiovascular policy.
Cautionary notes and remaining gaps
Despite these promising developments, several gaps remain. Health promotion and disease prevention will only go so far if EU action on primordial prevention continues to lag behind. To preserve health and wellbeing, there’s a need for coherent and robust governance that acts on the broader commercial, social, and environmental determinants of health. Cardiovascular disease is yet another reminder of this reality.
It is encouraging to see action in support of healthy diets featured prominently in the Plan. However, the level of commitment in this domain remains misaligned with the magnitude of the challenge, and with the established evidence that is available to inform this decision. EPHA has long advocated for fiscal measures on ultra-processed foods (UPFs) and products high in fat, sugar and salt (HFSS Products) as a key form of primordial prevention, addressing upstream determinants of diet-related ill health and preventing the establishment of cardiovascular and metabolic risk factors at population level. It was promising to see, in previous versions of the Plan that reached the public, a firm policy direction and a tangible commitment to leveraging these tools. The dilution of this commitment in the official communication, reduced to a conditional consideration of “possible financial actions”, significantly weakens the impact of this initiative. Moving from a clear, time-bound announcement of EU-wide levies in 2026 to more conditional language without a concrete timeline, despite the abundance of solid and consistent evidence linking UPFs and HFSS products to (cardiovascular) health impacts, risk diluting ambition and delaying action. Likewise, continued reliance on voluntary codes of conduct led by the industry to deliver a sustainable food systems transformation revives approaches that have repeatedly failed to deliver systemic change. Progress in the domain of healthy diets is achievable, but it requires binding measures developed transparently, grounded in independent, peer-reviewed evidence, and safeguarded from industry influence. To reduce diet-related cardiovascular risks, the EU must design fiscal and regulatory frameworks that make the healthy choice the default choice.
Another conspicuous gap in the Plan is the absence of concrete action on alcohol, despite its well-documented link to cardiovascular disease. This omission reflects a troubling retreat from the ambition once set by Europe’s Beating Cancer Plan, shaped once again by commercial pressure. It is a missed opportunity to embed coherent, preventive action and to demonstrate that public policy remains anchored in the pursuit of the public good rather than vested interests.
While the immense risk posed by the climate crisis and by pervasive pollution are acknowledged in the Communication, along with the need for cross-sectoral action, the lack of concrete EU-level measures in these areas weakens the Plan’s potential to reduce cardiovascular risks linked to raising temperatures and air pollution. This is a missed opportunity to deliver climate and health co-benefits, especially for vulnerable and marginalised communities. Stronger, coordinated and ambitious governance across health, climate and environmental domains is key to protect people’s health and ensure Europe’s climate and environmental efforts keep pace with cardiovascular prevention goals.
On a different note, the Commission’s commitment to tackling physical inactivity in Europe and to promoting health-enhancing physical activity as a pillar of cardiovascular disease prevention is encouraging. However, while raising awareness has played an important role in the past, it is no longer the most pressing need. Awareness of the benefits of physical activity is already high; what is missing are targeted, effective interventions that address the underlying social, cultural and structural drivers of inactivity. This is particularly critical for groups with alarmingly low activity levels, such as young girls, where tailored, supportive measures are urgently required. In this context, the commitment to update the Council Recommendation on promoting health-enhancing physical activity is a positive step, yet the current lack of clarity regarding its timeline risks undermining momentum and impact.
Finally, we value the focus on fostering multidisciplinary and person-centred mental healthcare but note that the Plan largely presents the link between cardiovascular disease and mental health as one-way, with mental health problems addressed mainly as a consequence of cardiovascular disease. However, as indicated in our Vision and Strategic Recommendations for the EU Cardiovascular Health Plan, referral pathways between cardiovascular and mental health services should be bidirectional. Poor mental health is also a key driver of cardiovascular risk factors, meaning that early action to support mental wellbeing can play a -preventive role. In this context, the positive and early-intervention approach outlined in the Toolkit for Child and Adolescent Health and Mental Wellbeing Promotion is a promising model.
There’s palpable determination across the public health field to see this Plan make a real difference for the people across Europe. What matters is maintaining political leadership, resources, and cooperation so that the ambitions set out can be matched and exceeded. Keeping health firmly on the EU agenda and ensuring that civil society remains an active, valued partner will also be crucial. Lasting attention, ambition, and support are the main ingredients to ensure that this Plan becomes a turning point for Europe’s health future.