EU Health Governance II: Political perspectives on evidence, innovation, legitimacy and risk
Article 6 TFEU restricts the EU’s role in public health to one of support, coordination and complementarity, whilst Article 168(7) TFEU acts as a dedicated subsidiarity clause, reiterating national governments’ sole responsibility for health system organisation and financing. Yet, because health goods, services, personnel and threats cross borders, health expenditure constitutes a significant part of national fiscal policy and the health sector is a crucial site of economic growth, the EU’s influence now extends into all areas of health policy. This panel, the second of two joined panels on EU Health Governance, focuses on the politics and practice of health governance. Papers explore a mix of traditional and novel health policy issues – obesity, communicable disease and pandemics, mental health and regenerative medicine – and analyse their implications for the role of evidence in EU policy-making, for models of regulating risk and innovation, and for the legitimacy of the EU as a health actor. In doing so, they identify a variety of governing patterns and highlight the value of health as an original case study in EU governance.
Presentations of the Symposium
Everybody’s responsibility? Exploring the relationship between EU new modes of governance and the ‘lifestyle drift’
The lifestyle drift, in relation to health promotion, has been defined as a phenomenon whereby health policymakers begin with a recognition of the social, political and economic determinants of health (‘distal’ determinants of health), only to drift back into designing policies targeted largely at modifying individual behaviour (‘proximal’ determinants of health). Using the European Commission’s (EC) ‘Health in All Policy’ (HiAP) agenda as a case study, this paper investigates the discursive construction of the lifestyle drift. More specifically, it critically analyses the assumption that HiAP inevitably requires a multistakeholder approach. This assumption, the paper argues, reflects the same rationale which led to the establishment of the EU Platform for action on Diet, Physical Activity and Health, arguably one of the most high-profile EC multistakeholder tool in the area of health promotion, but which is associated with policies merely targeting proximal, behavioural determinants of health. The paper draws on Smith’s concept of ‘chameleonic qualities of ideas’ to argue that the multistakeholder assumption is an add-on to HiAP which may represent an avenue for lifestyle drift.
Legitimacy Broker: The European Commission’s Role in EU Mental Health Policy
Recent scholarship has argued that the Commission of the European Union has played the role of ‘purposeful opportunist’ in EU health policy. To what extent does this view reflect other conceptualisations of the Commission’s role in EU processes, and to what extent do these views capture adequately Commission activities in health policy? This paper explores these questions by examining the role of the Commission in the development of EU mental health policy. It finds that most theorising of the Commission focuses primarily on inter-institutional dynamics between the Commission and its EU counterparts, and that this approach fails to apprehend adequately the Commission’s role in the development of EU mental health policy. While the case of mental health does show the Commission’s purposeful opportunism role, as well some loss of political power relative to the EU Council and the European Parliament, inter-institutional analysis alone fails to highlight the complex political relations the Commission builds or attempts to build with civil society—as partner, consultant, and even co-advocate. Any understanding of the Commission must attend to its relations to civil society, including non-governmental organisations, academic experts, donors, and advocacy groups. For it is through these relations that the Commission attempts to build its legitimacy and indeed the legitimacy of European integration, as well as the legitimacy of all the actors it reaches out to, in mental health policy. The Commission is the broker of legitimacy for EU policy and even European integration, in the case of mental health.
Regenerating Europe? The Lisbon Strategy, the Knowledge-based Bioeconomy and the Politics of Innovation Governance in the European Union
Nearly twenty years ago, the Lisbon Strategy set out a project of economic, political and social renewal designed to make the European Union (EU) “the most competitive and dynamic knowledge-based economy in the world”. To do that, the Strategy introduced a new mode of governance – the Open Method of Coordination (OMC), based on the assumption that an innovative, knowledge-based economy required a more flexible approach to governance. This paper examines the governance mechanisms employed by the EU and the member states in pursuit of Lisbon Strategy goal of comparative advantage in the knowledge-based economy. The role of the OMC is assessed alongside more traditional policy instruments. It focuses on the field of regenerative medicine – the use of tissue engineering and stem-cell therapies to restore damaged or diseased organs. Regenerative medicine has been seen as one of the most promising areas of not only medical treatment, but also the new bioeconomy, and has become a priority for research funders at EU and member state level. As a highly novel form of health biotechnology whose promotion requires the strategic mobilisation of actors across a range of policy domains and the use of the full range of innovation governance mechanisms, regenerative medicine is one of the key “moon shot” missions of the European innovative knowledge-based economy. We study the governance of regenerative medicine in six EU countries: the Czech Republic, France, Germany, Spain, Sweden and the United Kingdom. Our findings are based on a set of 58 interviews with scientists, policymakers, and industry executives. Interviews were carried out in 2009-10 and 2019. We highlight the importance of benchmarking (a key OMC policy instrument) as a mechanism for convergence in innovation policies across member states, and its particular salience in biotechnology. However, we also note the continued importance of traditional policy instruments, such as distribution and regulation, which have played a central role in state strategies for supporting the biotechnology industry. We conclude that we should avoid conflating the goals of the Lisbon strategy – in this case, leadership in the global knowledge-based economy – with its innovative policy mechanism, i.e. the OMC. The failures (and successes) of the Lisbon Strategy cannot be understood simply as a weakness (or strength) of the OMC, but rather a broader failure (or success) to fully exploit the range of relevant policy modes at the disposal of EU institutions.
Learning to Regulate Epidemiological Risks in the EU’s: Taking Stock of Past Mistakes?
The development of an EU health policy has been punctuated by health scares since the late 90s. While bacteria are without borders, the authority of the EU regarding preparedness remains limited by coordinating competences and the regulation of epidemiological risks in the EU is a matter of soft networked governance comprising national agencies and a European one, the European Centre for Disease Prevention and Control (ECDC). This paper belongs to the field of public policy and pursue the ongoing scholarship on policy spaces. This literature is prolix on the mutual transformative effects of influence running simultaneously from ‘Brussels’ to the lower levels, from the lower levels to the EU authorities, thus producing coherent policy spaces. However, the regulation of epidemiological risks complicates this causal relationship: preparedness opens the black box of operational activities and costly vaccines, which remain in the hands of member states. The 2009 swine flu crisis was a trial by fire for the EU’s risk regulating network, triggering criticisms for a lack of coordination as national governments adopted vastly different strategies. The intent of this paper is to evaluate if nowadays, national governments are more receptive to the networked regulation of epidemiological risks. The claim formulated here is that an important learning process has occurred since the 2009 swine flu. Through in-depth interviews with actors of this policy space, two mechanisms of learning are identified here: reflexive learning (one learns from their mistakes) and learning in the shadow of hierarchy (which shows a change in the behaviour of national governments vis-à-vis the merits of a coordinated response). The findings of this paper will contribute to a better understanding of mechanisms that participate to the formation of policy spaces and will benefit those interested in risk regulation and epidemiological preparedness in the EU.