Glass half empty: the Eurozone and internal market overshadow the health effects of Maastricht

Abstract

In the past 20 years, the European Union (EU) has become part of health policymaking to an extent that few commentators would have predicted. But the EU’s positive contributions as an advocate for public health have been overshadowed by the effects of its internal market regulation and centralized fiscal governance on the health of Europeans. Three things happened in Maastricht 20 years ago. European heads of state met to celebrate the completion of the internal market as prefigured in the Single Europe Act, agreed to create a common currency and added the first clear and positive words about health to the Treaties. This first mention of health was the harbinger of more effective promotion of health issues within EU policymaking.1 In time, however, the internal market and the single currency have had the biggest health consequences of the three.2 Putting aside some specific areas of EU competency created under the public health power, such as blood safety, the public health language in the treaties as they stand authorizes EU action, obliges the EU to take health into account and clarifies that it does not have a role in the organization and finance of health care services. Within this framework, most of EU public health policy is expenditure. This means it is limited. EU expenditures as a percentage of gross domestic product (GDP) are nowhere near as much as a member state health system spends, and health is a tiny share of EU expenditures (the EU member states’ average expenditure on health in 2012 was 9% of GDP, according to …