Since COVID-19, the European Commission has promoted the creation of a ‘European Health Union’, signalling the desire to become a more prominent institution in matters related to (public) health. However, the trajectory and evolution of EU’s growing involvement in public health is characterised by fragmentation and contestation, which reflects the weak and vague Treaty basis in this domain. This panel examines the question of whether and how to institutionalise a European Health Union through different perspectives: Using the European Health Union as a case study, the paper by Ciceo revisits the potential of new modes of governance to reinvigorate deliberative public participation in light of the polycrisis context and the rise of Euroscepticism. The paper by Godziewski and that by Boonstra and Bekker both look at discourses and framing of the EU’s role in public health: the former maps how EU policymakers talk about health in the context of EU economic recovery tools, while the latter applies an Advocacy Coalition Framework to study the discursive construction of the ‘European Health Union’ as an agenda-setting tool. Taking a legal analytic approach, the papers by Fiorentini and by Vicenti analyse the legal and constitutional avenues towards a European Health Union, focusing on the European Health Data Space specifically (Fiorentini) and providing a comprehensive overview of the legal possibilities and challenges at stake for member state health system integration (Vinceti).

In policy domains where the European Union lacks exclusive jurisdiction, but increasingly not only in these areas, new modes of governance emerged as an alternative mode to solve policy problems. They are defined as non-hierarchical, voluntary decision-making procedures based on collaboration, communication, and learning. An important outcome is the rise of new forms of "dynamic accountability" (Sabel & Zeitlin 2010: 5) whereby each national administration is required to publicly disclose and justify their chosen approaches for addressing specific public policy issues. Consequently, official proposals can be challenged by a growing number of traditional political actors as well as non-state actors. In the new policy context, of particular significance is to explore how these emerging new modes of governance provide supplementary opportunities for community involvement.At a time when ”the conflict over European integration appears to be more politicized” (Careri 2021:3), the promotion of citizen participation has the potential to foster a perception of public ownership in political processes, so bolstering the EU's credibility in terms of legitimacy and accountability. Policy issues do not appear to have the ability to boost politicization on their own (Huter, Braun, Kerscher 2016: 149, Scott & Trubek 2002: 5-6). Most of these policy issues will never captivate the general public and will continue to attract primarily diverse groupings of epistemic communities and policy networks connecting directly and indirectly with EU actors in agenda shaping and policy development. However, citizen engagement with public policy has been demonstrated as essential in certain domains, such as public health, due to the significant influence of social determinants of health on the overall well-being of populations (Oliver 2006, Den Broeder et al 2016, Franco et al 2018).This study aims to examine the European Health Union as a case study, emphasizing the potential for strengthening the role of political and social actors within member states of the European Union. The goal is to emphasize the significance of enhancing deliberative processes within new modes of governance. In order to achieve this objective, a comprehensive analysis will be conducted, focusing on pertinent EU legislation and policy documents. The aim is to identify and examine the various instruments, processes, and mechanisms established by the European Health Union that enable citizen participation in the formulation of public health policies. The obtained results will thereafter be compared with the existing body of scientific literature.

The national COVID-19 policy responses in recent years evoked a renewed call for a ‘European Health Union’. However, the institutionalisation of the proposed Union seems unlikely. This study aimed to collect and categorize different perceptions of the concept EHU in order to analyse its meaning to EU health policy agenda setting. We used the Advocacy Coalition Framework and the concept of epistemic communities to identify groups or networks of coherent values and beliefs around the EHU concept. We then performed a scoping review of scientific literature and EC policy documents drawn from Westview, Scopus and PubMed, and conducted a narrative analysis of the discourses and conceptualisation of the EHU. Finally we validated the results in an expert interview. We identified 25 documents for study inclusion. Based on shared characteristics of belief systems expressed by authors we identified seven epistemic communities with discourses centring neo-functionalism, holism , inequity, institutionalism, nationalism, integration and legitimacy. Four of them framed the EHU as an advocational tool for health agenda setting in EU policymaking. Findings might be biased due to the dominance of conceptual articles from mostly Western-European authors with very limited attention for the crucial role and capacity of the EU’s Member States for achieving a EHU. This study contributes to our understanding of core values and motivations behind or against the EHU. Follow-up research should adopt empirical and comparative case studies on the relative success of these epistemic communities to develop into advocacy coalitions and influence EU agenda setting of health.

The integration of national health systems in Europe has rapidly shifted from a topic

of pioneering scholarly engagement to a pressing political topic, also in light of the pandemic experience. Along with political contingencies, creating an integrated European health system demands tackling a series of legal issues, among which lies the question of the most suitable “legal formant” through which the integration of health systems should be conveyed. The paper critically evaluates different “legal avenues” for the integration of Member States’ health systems: the formal amendment to European Treaties; the pathway of enhanced cooperation; the broader implementation of funding programs such as the “EU4Health”; the extensive recourse to the Flexibility Clause, or the invocation of stronger judicial engagement with the interpretation of Article 168 TFEU. Although on paper all these avenues are conducive to some level of health systems integration, it can be doubted that the kind of legal integration they bring about is equal. In this respect, the choice of the wrong “integration tool” may jeopardize the very achievement of the European Health Union. By ranking the different legal avenues to the European Health Union in terms of institutional soundness, it is here claimed that while some strike as very palatable in terms of implementation times and consensus requirements, they eventually appear amenable to yielding unstable and haphazard results as to the ensuing legal integration. By contrast, more cumbersome legal pathways will perhaps require longer completion times but will lay significantly sounder institutional foundations for the European Health Union.