Beyond the funding crisis: what the next European budget means for public health

We have said this before. So have others. Over the past 2 years, the consequences of removing operating grant funding from European health programmes have been documented, debated, and deplored. Organizations reduced staff. Networks contracted. Institutional memory was lost. The pattern was not unique to health: a broader dismantling of civil society infrastructure has been observed across sectors and governance levels, combining delegitimization, defunding, and, in some national contexts, active legal obstruction (Alemanno A. How NGOs die–Europe’s playbook for dismantling democracy. EUobserver, 28 October 2025. Available at: https://euobserver.com/eu-political/ar1c67c9a3). EUPHA has contributed to that public record, and we will not repeat the full account here. What we want to address now is what comes next and why it matters for every European citizen, not only for the organizations caught in the crossfire. It is important to be clear about the nature of what has happened. The removal of civil society operating grants from European health funding was a political choice, not a technical necessity. Budgets are never simply constraints; they are statements of priority. The decision to cut structural support for independent health organizations—representing 1% of the health budgets—while maintaining larger programme lines elsewhere reflected a particular reading of what European public health governance needs, and what it does not. For the health sector specifically, the consequences were immediate and concrete, with staff cuts and an NGO simply closing its doors. Across the broader civil society ecosystem, organizations were left in limbo for months, unable to plan, partner, or act. Whether intended or not, the message was clear: the structural work of public health organizations is not being treated with the urgency it demands. We also recognize something that is easily lost in advocacy debates: the civil servants and technical health experts within the European institutions did not make these choices in a vacuum. Many of them have worked for decades to build the architecture of European public health cooperation. They are themselves navigating significant institutional turbulence—reorganizations, political pressures, and shifting mandates. The problem is systemic, not personal. Acknowledging that matters if we want to build something better together, rather than simply assign blame. What concerns us most, looking ahead, is not the operating grant question alone, though it remains unresolved. It is the direction of travel signalled by the Commission’s July 2025 proposal for the next Multiannual Financial Framework, which incorporates EU4Health into a new European Competitiveness Fund alongside biotechnology, agriculture, and defence (Health in EU’s next Multiannual Financial Framework—EU4health). The proposed absorption of health funding into a broader competitiveness framework carries a specific risk that deserves to be named plainly: health equity and competitiveness are not natural partners. Competitiveness logic favours returns, scale, and speed. Equity logic requires attention to those who are furthest behind, to structural determinants that do not yield measurable short-term gains, and to the populations whose health needs are most complex and least profitable to address. Placing health within a competitiveness envelope does not merely create administrative inconvenience. It creates a gravitational pull towards the parts of health that are legible in economic terms, health technology, digital infrastructure, pharmaceutical innovation, and away from the parts that are harder to monetize: prevention, community health, health literacy, the social determinants of health, and the civil society organizations that work at those intersections. The risk is not that competitiveness is the wrong goal. It is that making it the dominant frame distorts what counts as a legitimate health investment. This is not an inside debate about institutional architecture. It has direct consequences for people across Europe. For decades, public-interest organizations have been essential to shaping, implementing, and enforcing the protections Europeans rely on. Their work is often technical and unseen, yet indispensable (Bas-Defossez F, Heidegger P, Skrivervik C, Silk R, ten Brink P. What happens after Europe’s NGOs are dismantled? Euobserver. Available at: https://euobserver.com/53345/what-happens-after-europes-ngos-are-dismantled/). When the organizations that translate epidemiological evidence into policy recommendations, coordinate national responses to health threats, monitor equity gaps, and carry the voice of communities into European institutions are weakened, those functions do not disappear. They migrate to actors with different mandates, different incentives, and different accountability structures. The imbalance is already visible. Data on Commission high-level meetings show that approximately two-thirds involve corporate representatives, while around 16% involve civil society organizations (Integrity Watch EU. Data on Commission high-level meetings with interest representatives. Available at: https://www.integritywatch.eu/ecmeetings.php). When independent public health voices lose structural capacity, that imbalance deepens, precisely at the moment when Europe’s health challenges demand the opposite. Europe’s health challenges over the coming decade, such as ageing populations, antimicrobial resistance, the mental health crisis, growing health inequalities, and climate-related health burdens will require exactly the kind of sustained, cross-sectoral, equity-oriented response that project-based funding is poorly designed to support. They require organizations with memory, independence, and long-term relationships with both institutions and communities. The negotiations over the next Multiannual Financial Framework are, in the end, a conversation about what kind of Europe we want, and what kind of health we are prepared to invest in. The decisions made in the coming months will shape the conditions under which public health science, advocacy, and community action operate for the next decade. We are not asking for the protection of organizations for their own sake. We are asking for a deliberate political choice: to treat independent public health infrastructure as a public good worth funding structurally, rather than as an optional add-on that competes in project grant rounds with better-resourced actors. And we are asking that health equity be maintained as a co-equal objective in the next MFF, not a subcategory of competitiveness, but a distinct political commitment in its own right. The EU’s forthcoming Civil Society Strategy represents an opportunity. It could recognize civic space as a strategic asset and establish a framework for stable, independent funding that allows organizations to function as genuine partners in governance (Civil Society Europe. Shaping an EU Strategy for Civil Society. Available at: https://civilsocietyeurope.eu/shaping-an-eu-strategy-for-civil-society/). For public health, that means ring-fenced operating support, designed for organizational sustainability, within a funding framework that keeps equity at its centre. The technical experts, the civil servants, the researchers, the practitioners, and the communities who depend on European public health infrastructure are all navigating the same turbulence. The next MFF is an opportunity to give that navigation a clearer, fairer direction. That choice belongs to political leaders. But its consequences belong to all of us. The world is facing a public health crisis, with one in eight individuals living with obesity [1]. This burden is mirrored across Europe; subsequently, cardiovascular diseases (CVD) remain the leading cause of death and disability [2]. Without decisive action, CVD prevalence is projected to increase by 90% and mortality by 73.4% by 2050 [2]. Yet, up to 80% of these conditions are preventable through lifestyle modifications [3]. Among the many determinants of health, the food environment plays a central role. Within this, front-of-pack nutrition labelling (FOPL) has emerged as a key policy tool. Recommended by the World Health Organization as part of its ‘Quick Buys’ for non-communicable disease prevention, FOPL aims to simplify nutritional information and support healthier choices [4]. Evidence suggests that interpretative, colour-coded labels can improve consumer understanding and guide purchasing behaviour [5]. However, a critical question remains: ‘Are populations equipped to use these tools?’ Food literacy is uneven across populations. Understanding and use of FOPL are strongly influenced by education, socioeconomic status, and prior knowledge, with more vulnerable groups facing the greatest challenges [5]. Importantly, food choices are rarely driven by information alone; they are shaped by cost, marketing, convenience, and habit [6]. Insights from the NEXT-FOOD-MT project highlight this reality. NEXT-FOOD-MT is a national study being carried out in Malta focusing on adolescents (13–15 years) and their parents; it explores how FOPL is interpreted and used in real-world settings. Emerging findings reveal low engagement, partial understanding, and limited trust in back-of-pack labels, while, for front-of-pack labelling, most participants reported either not paying attention to it or not knowing how to interpret it. Adolescents frequently reported superficial recognition without comprehension: ‘I’ve seen the colours, but I don’t know what they actually mean’. Others described labels as irrelevant to decision-making: ‘I choose what I like, not based on the label’. Parents echoed similar sentiments, often citing time constraints and complexity: ‘You don’t have time to read everything, so you just ignore it’. A recurring theme across groups was the dominance of price over health: ‘Healthy usually means more expensive, so we don’t go for it’. Marketing and packaging also emerged as powerful influences, particularly among adolescents: ‘If it looks nice or is advertised, that matters more than the label’. Teachers provided critical insight into the structural context shaping these behaviours. While food labelling is nominally included in the curriculum, its delivery is inconsistent and often dependent on individual teachers rather than being systematically enforced: ‘It can or cannot happen depending on the teacher… FOPL specifically is not guaranteed to be covered’. Teachers emphasized that food literacy is primarily shaped by the home environment, with strong disparities linked to parental knowledge and socioeconomic status: ‘You see a distinction between knowledgeable parents and non-knowledgeable… and low-income families’. At the same time, teachers highlighted that education can still drive behavioural change, with students reporting applying skills at home, such as preparing their own meals or modifying food choices based on classroom learning. However, a major systemic contradiction was identified: schools often deliver nutrition education while simultaneously exposing students to unhealthy food environments, including vending machines, tuck shops, and external food outlets. As one teacher noted, ‘We teach them…but then there is the vending machine… there are conflicting messages’. These findings reflect broader European challenges. FOPL remains voluntary and fragmented across Member States, leading to inconsistency and confusion [7]. In contrast, countries such as Chile have implemented mandatory front-of-pack labelling legislation, while Australia currently operates a voluntary system and, as of February 2026, has initiated the process towards potential mandatory implementation, reflecting a shift towards more standardized approaches with demonstrated population-level impact [8, 9]. The evidence is clear: FOPL is not a standalone solution. Its effectiveness is constrained by low food literacy, inconsistent implementation, and structural barriers such as affordability. Political and economic considerations continue to delay harmonization, yet the cost of inaction is substantial. A shift is needed from individual responsibility to system-level accountability. This requires: Mandatory, harmonized EU-wide FOPL legislation Integration with education systems to build food literacy early Policies addressing affordability and misleading food marketing A multi-sectoral, upstream approach across government FOPL has the potential to empower consumers but only if the system empowers them first. Project NEXT-FOOD-MT is financed by Xjenza Malta, through the ‘R&I Thematic Programmes: Obesity Research Programme’ in collaboration with the Ministry for Health and Active Ageing.