A brief note on the history and development of EFMA

by Dr Alan J. Rowe, OBE, FRCGP, Secretary EFMA

The dialogue between National Medical Associations and the World Health Organisation began in December 1984 with a meeting of Western European national medical associations and WHO in Copenhagen. At this time, it was recognised that clearly the medical profession had an important role to play if the philosophy of the Health For All movement in general and the European regional targets in particular were to be achieved.

Further meetings involving national medical associations, both from the West and East, took place in 1986, 1987 and 1988. At a meeting in Rome in 1990, the national medical associations recognised that they had created a permanent forum permitting a fruitful dialogue with WHO. This was formalise at Helsinki in 1991 when the aims of the Forum were finalise as follows:

"The aims of the Forum shall be, by establishing a dialogue and co-operation between National Medical Associations and the World Health Organisation in the European region, to:

• a) improve the quality of health and health care in Europe;
• b) promote the exchange of information and ideas between national medical associations, and between the associations and the World Health Organisation;
• c) integrate appropriate aspects of policies of Health For All into basic, postgraduate and continuing medical education; and
• d) formulate consensus policy statements on health issues

For the purposes of membership, a national medical association is defined as a free independent non-governmental association of physicians constituted in an organisation which elect its own officers, appoints its own staff and determines its own constitution, except for any statutory duties that it undertakes, and whose activities cover all the various aspects of professional practice.

With the changes in the eastern part of the region there has been a need for special dialogue between the countries of the east of the region and those in the west. In Budapest (1994), London (1995) and Stockholm (1996) post-Forum meetings were held for the benefit of the newly emerging and re-establishing national medical associations from this part of the region. In 1997, this was merged with the main meeting and devoted to a discussion on health care reform, based on the WHO Ljubljana Charter on Reforming Health Care.

In the past two meetings of the Forum, 42 of 50 Member States' national medical associations in the Region have been represented. Observers have included the Canadian Medical Association, which has attended regularly, and a number of Pan-European medical associations.

Each year, national medical associations report not only on their general activities but also on any action they have taken in areas which the Forum has considered. These reports are analysed and presented as a separate volume which is a companion to a compilation of information about the constitution, activities and officers of participating national medical associations.

From the beginning, the problems of tobacco and smoking and the subject of continuing medical education have been subjects of continuing report and action and, starting in Sofia in 1988, the quality of care. 1998 was the thirteenth in the series of meetings which have considered a spectrum of subjects including AIDS, new patterns of infectious diseases, health care in the elderly, health promotion, the rights of patients, the physician's role in environmental health, financing of health care, development of new health care systems, suicide in the young, quality of care development and use/misuse/abuse of drugs.

Over the years, the Forum has adopted a number of declarations, statements and recommendations. Some of these statements have been followed up by establishing action groups, notably in relation to tobacco and to the quality of care, in order to assist national medical associations in carrying forward appropriate action in their own countries.

February 1999