The new economic governance (NEG) regime established by the European Union after the 2008 financial crisis has been used by the European Council and the Commission to promote the commodification of services and labour in Member State health systems (Erne et al, 2024; Copeland and Daly, 2018), threatening national social protections. The justification for these reforms comes not from law but governance by numbers and their coercive force varies (Supiot, 2017; Jordan et al, 2021). Therefore, this article examines whether and how these policy prescriptions were implemented domestically. We analyse measures implemented in the national health system of Ireland and the regional health system of Spain, which were identified authorities as having been adopted in line with NEG policy. We found that in both locations, policymakers not only curtailed budgets and wage levels but also marketised service provision and employment relations. While wages and budgets have been restored, marketising reforms of public employees’ working time and benefits remained in force. By highlighting the commodifying impacts of non-legal instruments, our study forces us to go beyond the market citizenship vs social citizenship dichotomy in our attempts to understand the interaction between integration and social protections.

A growing number of studies have examined the securitization of the EU’s role in health policy, in particular after the covid-19 pandemic. This paper explores the health security nexus from a new angle, as Europe is boosting its over-all preparedness in a time of war and military security challenges. Drawing on policy documents in the wake of the Niinistö report and the EU preparedness union strategy, it traces discursive shifts in relation to health in the EU context. Namely, the findings reflect a turn away from pandemics towards war-time resilience of health systems, mass-causalities, civil-military cooperation and whole-of-society approaches that may change the place and meaning of health policy in EU-cooperation. The paper draws on online material and stakeholder interviews.

Background:

Barriers to embedding Health Impact Assessment (HIA) in developments that impact on the wider determinants of health remain. Despite the European Union’s Treaty commitment to health in all policies and assuring high levels of health protection, trade policy often considers health in a limited way. Few analyses consider how trade policy conceptualises health; it is often subsumed in Sustainability Impact Assessments (SIAs). We explored the inclusion of health in SIAs, which are a type of assessment specific to European Union (EU) trade and are intended for a wider exploration of potential economic, sustainability and environmental impacts.

Methods:

We analysed various SIA documents with an evaluation checklist informed by the literature and by best practice in health impact assessment to explore the consideration of health in EU trade policy. We also compared our findings with the EU guidance, including from Better Regulation, for assessment of health impacts within the SIA framework for trade. Key informant interviews with stakeholders (e.g., researchers, policymakers) explored the development, use, relevance, and/or alternatives to HIAs in identifying and taking account of trade policy related health concerns.

Results:

Our findings suggest that in the SIA documents themselves, and in the existing EU guidance on their implementation, health has not gained substantial ground compared with other areas of assessment. However, consideration of public health policy priorities where trade negotiations are likely to restrict policy space remains limited. We found significant differences between EU guidance on evaluating potential health impacts in SIAs and best practice and guidance on carrying out HIAs from public health experts. We will present a checklist from a public health perspective to enable wider assessment of whether and how health impacts are being raised in future sustainability impact assessments of trade-related documents.

Conclusions:

Although public health is referenced in the guidance on carrying out SIAs, our findings suggest that this consideration is superficial, limited in scope and lacks meaningful application and practice. Our evaluation checklist provides a potential means to examine the adequacy of and caveats in the current process. However, SIA needs to be understood as part of a wider context of how power, politics, and decision-making under multilevel governance take place.