European Union institutions increasingly acknowledge the need to include civil society in their policy processes - particularly in health - and have created a special European Public Health Forum to dialogue with non-governmental organizations and patient groups. The Commission has had frequent consultations with civil society in decision-making relating to health, for example, the extensive consultations of the European Commission that led to the development of breakthrough policies such as the green paper on mental health, on pharmacovigilance or the health effects of smokeless tobacco products. The web site of the Directorate-General for Health and Consumers (DG SANCO) provides easy access to calls for open consultation and the results of recently closed consultations. The open consultation processes, in which the Commission calls for public input into its policy formulation, is an essential stage in the policy process. In order to further the aims of ‘Health in All Policies' and ‘Together for Health', European global health actors need to participate in such consultations regularly as well as in the forums for dialogue that the Commission has established, in specialized consultation groups on specific issues such as the EU Platform on Diet, Physical Activity and Health, and in the EU Alcohol and Health Forum.

This reflects the expressed desire of EU institutions, including the Commission and the Parliament, to "bring Europe closer to its citizens". As part of a new Community programme launched in 2006, the Commission has proposed three points of action to encourage active European citizenship, including ‘Active Citizens for Europe', ‘Active Civil Society in Europe' and ‘Together for Europe'. Thus, the European Union and the World Health Organization - and, in particular, the WHO Regional Office for Europe - are developing mechanisms for engaging with civil society actors and have taken steps to improve this engagement. But it is difficult to find the right way to engage with such organizations. This is because the nature of civil society is complex and diverse, and because interstate organizations find it difficult to balance the specific interests of these organizations with the views of the governments they serve.

It is equally difficult for civil society actors to develop a consensus or agree upon joint actions at the regional or global level because they are diverse and lack adequate processes and funding for working together. To address this issue, civil society networking groups are developing across Europe and globally. One example of such networks is Active Citizens for Europe, an Italian-based network that promotes human and patient rights. Action for Global Health (AfGH) is an example of such a European network in the field of global health. AfGH is an umbrella organization, established in 2006, representing 15 Europe-based NGOs and charities. Its creation and maintenance is funded by a grant from the Bill & Melinda Gates Foundation. AfGH has offices in Spain, Italy, France, Germany, the UK and Belgium. The offices coordinate media campaigns aimed at influencing policy on global health and, in particular, on holding European governments and the Community to their commitments to achieve the health Millennium Development Goals (MDGs), including higher and better-focused financial contributions to health and health system strengthening. In addition, AfGH aims to increase the capacity, engagement and effectiveness of European NGOs' advocacy in support of the health MDGs, with improved policy analysis, media attention and networking with the NGO and development policy community.

European philanthropic actors include many that carry out and support basic and applied medical research, for example, the Institut Pasteur in France, the Wellcome Trust in the UK and the Robert Koch Institute in Germany. They also include funding and service-based organizations and advocacy groups. These are also coming together in networks. The European Foundation Centre, a Brussels-based network platform for European philanthropic foundations, for example, has a membership of over 200 active European foundations, 12 of which form the core of the member-led European Partnership for Global Health.

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