Abstract
AbstractThis article explores the relation between the meaning of what constitutes ‘evidence’ in the European Commission (EC) and the Health in All Policies (HiAP) concept. Since the 2006 Finnish EU presidency, HiAP is regularly referred to by the Commission, but has not yet been implemented as an overarching political vision. While there is a growing literature on technical implementation of HiAP, little work has delved into the political obstacles to HiAP. This article explores three ways in which the dominant meaning of ‘evidence’ in the EC reinforces neoliberal institutional characteristics in a way that undermines HiAP: The problematization of health reinforces constitutional asymmetry; the definition of ‘EU added value’ hampers positive integration; and the politicization of evidence strengthens the Better Regulation meta‐regulatory agenda. The article suggests that the meaning of evidence in the EC reinforces neoliberal rationality present at institutional level, and calls for more dialogue across public health ontologies.
Highlights
In the European Union (EU), non-communicable diseases (NCDs) are the leading cause of death, disease and disability
This article has looked at how the dominant meaning of evidence represents an obstacle to implement Health in All Policies (HiAP) in the European Commission (EC)
It explored three ways in which the meaning attributed to the notion of evidence interacts with neoliberal institutional factors and reproduces a neoliberal rationality which hinders a normatively meaningful shift towards HiAP
Summary
One way this understanding of complexity was taken up and transposed into policy recommendation, was through the Health in All Policies (HiAP) approach. Rather than a pre-defined action plan, HiAP represents a way of working, in which societal health and wellbeing is considered a priority in all areas of policy-making This approach recognizes that all public policy areas have an impact on health directly or indirectly, especially through influencing socioeconomic equity (Leppo et al, 2013). With the recognition that all policy areas impact on health, HiAP opens up a terminological ‘Pandora’s box’ of what qualifies as public health promotion, and whether ‘health’ remains an appropriate term when used in such an all-encompassing way (Synnevåg et al, 2018) Such use of language runs the risk of being perceived as ‘health imperialistic’ (Banken, 2001; Kemm, 2001). The purpose of this article is to explore how a mutually reinforcing relation between institutions and discourse undermines a HiAP uptake, neoliberal institutional characteristics of the EC, and the dominant meaning of evidence within the EC
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