The European Commission has included separate references to „sex“ and „gender“ in a draft recommendation on the early detection of cardiovascular diseases. Document COM(2026) 481 was presented on 28 September and is due to be discussed and potentially adopted by the Council of the European Union.
The draft provides a practical framework for identifying people at increased risk by measuring blood pressure, cholesterol, blood sugar, kidney function and body mass index. The aim is for at-risk patients to be referred in time for further assessment and medical care.
What the Draft Says
Recital 21 states that differences in risk related to sex and gender should be taken into account when cardiovascular check-ups are designed and implemented. The European Commission justifies this by noting that cardiovascular diseases generally develop earlier in men, while the risk in women increases after menopause and may be affected by pregnancy and other life events.
The text does not describe in detail how the concept of „gender“ should be applied during a specific cardiological examination. This is precisely one of the disputed issues raised in a publication by Glasove, which links the inclusion of the term to Bulgaria’s constitutional debate over the concept of „social sex“.
The Recommendation Is Not Binding
The European Commission explicitly states that the draft does not impose binding obligations on the Member States. The document says that each country will determine itself to what extent and in what way it will apply the recommendation, depending on its national health system and available resources.
The organisation and financing of healthcare also remain within national competence. This means that the draft does not automatically change the rules for preventive check-ups in Bulgaria and does not require general practitioners to introduce a new model.
Check-ups Outside the Doctor’s Office
The draft encourages countries to expand access to preventive care through check-ups in primary care settings, pharmacies and local community centres. It also identifies the possibility of mobile health services at markets and in shopping centres, particularly in remote and underserved areas.
The European Commission describes primary care as the main setting for conducting the check-ups, while presenting mobile and community services as an additional way of reaching people who would otherwise have difficulty accessing preventive care. The draft requires an identified increased risk to be followed by an accessible system for further assessment and medical care.
What Happens Next
The Working Party on Public Health of the Council of the EU is examining a second compromise text on 9 November. Once the discussions are completed, the document may be amended before it is potentially adopted.
For Bulgaria, the issue also has a constitutional context. In Decision No. 13 of 2018, the Constitutional Court declared the Istanbul Convention incompatible with the Constitution, while in Decision No. 15 of 2021 it ruled that the constitutional concept of „sex“ has a biological meaning. These decisions, however, do not change the fact that the European document is still a draft non-binding recommendation and that its final text has not been adopted.
Sources: glasove.com