Exploring Integration Trajectories for a European Health Union

Abstract

COVID-19 emerged as a cross-cutting problem across governance sectors and levels, urging the creation of a European Health Union. There are already a number of integrated European governance strategies – such as the European Energy Union (2015) and the European Green Deal (2019) – adopted for overcoming problems of governance fragmentation and inadequacy of fragmented policy responses to cross-cutting policy challenges. Past studies focused on the interaction between crisis and policy change and investigated the activation of different mechanisms to enhance integration. This article contributes to the debate over the creation of a European Health Union by unpacking the acknowledged dimensions of policy integration – policy frame, subsystem involvement, policy goals and policy instruments – in order to assess their manifestations in the new EU4Health policy and to establish what contextual conditions triggered the activation of the integration-enabling mechanisms that led to a more integrated European Health Union. In so doing, it offers an analytical illustration and discusses implications for decision-making.

The European Health Union: European Union’s Concern about Health for All. Concepts, Definition, and Scenarios

“…Moreover, the EHU should be included in a wider public health approach. It is linked to movements or concepts such as One Health [ 44 , 46 , 53 ], Global Health [ 39 , 54 , 55 ], Sustainable development goals (SDGs) [ 39 , 54 ] or Determinants of health [ 54 , 56 ]. There is a conception of public health, and health security, as a public good and the EU is seen as the appropriate level to provide it [ 40 ].…”

“…There is a conception of public health, and health security, as a public good and the EU is seen as the appropriate level to provide it [ 40 ]. This vision is linked to the SDG3 and can relate to the promotion of well-being as a demand for a future EHU [ 39 , 53 ].…”

“…To achieve the EHU, there are two major key points. The first one is the political will as no policy can be achieved without it [ 12 , 40 , 51 , 53 , 54 , 57 , 58 ]. The second is the funding [ 40 , 41 , 43 , 44 , 45 , 50 , 51 , 55 , 59 ].…”

The emergence of post‐Westphalian health governance during the Covid‐19 pandemic: the European Health Union

“…The EHU is a form of pooled sovereignty (Kickbusch and de Ruijter, 2021 ). The Covid‐19 pandemic might lead to greater integration of national health systems/policies owing to EU crisis planning in the health sector (Bazzan, 2020 ), in the same kind of way that major European crises in the past have frequently led to intensified integration processes as a consequence. The EHU aims to coordinate health crises, accrue medicines/vaccines for them, and encourage the prevention, treatment, and aftercare of diseases multilaterally in the EU.…”

The State of the Health (Dis)-Union in the EU: the legacy of austerity under the trial of Covid-19

“…Hence, the tragedy of the pandemic, notwithstanding the far from trivial improvements in awareness for the need of greater health coordination and the (partial) policy measures to follow, provides a solid case for treaty reform. From such a perspective, Covid-19 has touched a raw nerve and political third rail of multilevel governance in the EU, which grounds a call for the establishment of a genuine Health Union, able to ensure direct action at the European level and overcome critical shortcomings in health governance within the old continent (Bartlett 2020;Bazzan 2020). The support of a coherent supranational health policy would also benefit from the developing EU fiscal powers as the novel pandemic recovery instrument of Next Generation EU could help to create effective capabilities to reinforce health preparedness in weaker Member States and managing cross-border threats -another arena, however, in which the Covid-19 crisis and its temporary emergency response mechanism is a powerful indication of the need for further integration and revision of the Treaties.…”