EU Health Policy Research Articles

The Network of Expertise on Long COVID as a means to synthesise intelligence and improve our response to long COVID at EU level

Abstract To promote international collaboration and strengthen EU and national-level responses to Long COVID, the Commission set up the Network of Expertise on Long COVID (NELC) in 2023. It brings together national institutions involved in Long COVID work, nominated by the Public Health Expert Group (PHEG) representatives of each Member State. The network provides a platform for exchanges of national experiences on diagnosis, treatment, and management of long COVID. The Commission and the NELC agreed on eight specific actions to be implemented to manage Long COVID. The development of a Long COVID definition is complex due to the diverse range of symptoms experienced by patients, and so working towards a unified EU case definition is the first action proposal. This will allow the development and implementation of a surveillance system on national and EU level to foster the knowledge on the actual scale and the symptomatology of Long COVID across the EU leading to a better comparability of health data at Union level. The proposal to develop and implement a training programme for healthcare professionals at EU level will allow for the exchange of expertise/training on Long COVID across Member States. The provision of clinical guidelines based on evidence to Member States will help manage Long COVID, and international collaboration will allow for the sharing of valuable information and data with third countries that have experience with Long COVID. The Commission will use the EU Health Policy Platform to create an open stakeholder group. This group will allow stakeholders and patient groups to express their point of view, and to share experiences. Assessing the far-reaching social and economic consequences of Long COVID across the EU will allow for more targeted social and economic policy responses from Member States. It is important that priority is given to research responding to the most urgent needs of health care systems, which is why the Commission aims to identify research needs.

Administering a Chill Pill? Better Regulation and the Potential for Regulatory Chill in European Union Health Policy

The European Union's “good governance” program, known as Better Regulation, seeks to improve the quality of EU legislation by controlling the policy-making process. Despite its importance, it is rarely accounted for in the EU health policy literature. Seeking to address this gap, this article introduces Better Regulation in the context of health policy making. It conceptualizes a model of regulatory chill, drawn from the literature on international trade, to interrogate the impact of Better Regulation on EU policy-making processes. Using examples from the literature and data from a series of interviews with EU officials, it explores potential pathways of response and anticipatory chill, identifying direct enforcement of Better Regulation, its utilization by corporate actors, interpretation of its provision by officials, and feedback loops as possible routes of influence. The article argues that such an approach not only presents methodological challenges but also offers a valuable way of conceptualizing the relevance of political institutions in general, and Better Regulation specifically, for health. As part of broader calls for attention to the political determinants of health, the article's findings highlight the particular, and often overlooked, importance of metaregulatory policy frameworks.

Can EU Law Be Used to Challenge Better Regulation Practices That Do Not Lead to Better Health?

Legislation produced under the EU Commission's Better Regulation Agenda sometimes fails to achieve the Treaty obligation to ensure a high level of health protection in all EU policies and activities. Public health advocates have raised the question of whether EU law can be employed to challenge this apparent breach of Treaty obligations at the proposal preparation stage, compelling the Commission to amend prospective EU legislation so that it better protects health. This article will demonstrate that unfortunately this is not possible due to the justiciability of both Article 168 TFEU and the Better Regulation Agenda. However, this awareness can help public health advocates to re-focus their efforts on strategies that will likely have a greater impact in swaying the direction of EU health policy.

EU Health Policy and the Healthcare Labour Market in Latvia: The Out-Migration of Healthcare Practitioners

Healthcare systems in Europe are facing increasingly complex challenges that demand innovative solutions. Furthermore, public health is increasingly recognised as a productive factor which impacts the healthcare sector’s contribution to national economies. The out-migration of healthcare practitioners from Latvia is one of the most pressing problems in the health sector, which, in turn, negatively impacts the country’s economy. The outflow of healthcare practitioners to other EU countries has increased since 2004, the year which saw Latvia’s accession to the EU. This trend is a consequence of labour accumulation efficiency in the single market, and this article aims at conducting analyses of the main push factors governing healthcare practitioners’ emigration from Latvia and the impact of these factors on the healthcare sector. The complexity of this migration determines the use of an interdisciplinary as a methodological approach in the analysis of the main trends in the healthcare labour market. This approach can assist one in carrying out an assessment of the healthcare system’s losses as a result of the out-migration which has occurred thus far. Particular attention is paid to the training of resident doctors as a perspective trend in keeping healthcare professionals in the country. The legal mechanism for recovering public funding dedicated to residency programs has also been assessed. In conclusion, the article states that the mass emigration of healthcare practitioners from Latvia may jeopardise the efficient functioning of the country’s healthcare system.

Health policy in the European Union

The purpose of this article is to present the problem of medical law in European terms. This article discusses the topic of European Union health policy. The history of EU integration in terms of the law governing medical standards will be traced. Specific provisions of the treaties and the most important directives will be discussed as well as landmark cases decided by the CJEU. Another element of the article is a summary of the community’s activities in terms of EU funding for health programmes through the European Health Plans. The change in funding and the emphasis on different is gradually transforming the way EU health policy is viewed. The article explains how the EU’s solutions work and the phenomena occurring within it, and this translates into understanding and being able to create future solutions that are better for Europeans.

The role of task shifting in mitigating health workforce shortages - the ambitions and results of the TaSHI project

Abstract The shortage in the health workforce is a long-standing phenomenon while the importance of the human factor in health is constantly increasing. The COVID-19 pandemic has further increased the burden of the health sector, the workload, the stress and the risk of burnout. At the same time, the pandemic acted as a catalyst as professionals had to take on new roles, join new teams and increase collaboration with other health professionals. Task shifting can reduce the workload and skill-mix imbalances by sharing and redistributing tasks between health professionals, involving patients and the digital ecosystem. Task shifting can be an effective way to improve cultural sensitivity and openness thereby increasing a positive working environment. Moreover, task shifting can enlarge resilience while addressing HWF shortages and geographical imbalances, particularly in remote rural areas. TaSHI “Empowering EU health policies on Task SHIfting” aims to provide a novel understanding and up-to-date knowledge on task shifting, transferability and uptake of good practices in implementation. The project performs (regional) pilots in five European countries (Estonia, Italy, Lithuania, the Netherlands and Norway). It gathers evidence and data on the different types of task shifting in primary care, mental health care, wound care and eye care including the role of telemedicine and digital health. Through the involvement of health professionals TaSHI delivers a collection of good practices, useful tools and methods through case studies of the pilot experiences, producing a guidebook on task shifting supporting implementation, with practical training materials and curricula, and a set of recommendations. The deliverables on tangible solutions aim to support EU Member States at national, regional and organisational level to implement their own actions and promote sustainability of practices adapted to local settings. TaSHI project is co-funded by the Health Programme of the EU.

The Maastricht Treaty 1992: Taking stock of the past and looking at future perspectives

Aim: The article contains a personal view of the history as well as the future of the European Union‟s (EU) health policy. Describing and evaluating the developments on the road from the Treaty of Maastricht to a new Europe it asks and tries to answer the question if weespecially the EU Member States – really know where we want to go to and how to get there. Method: Based on personal experiences, countless EU documents, as well as scientific publications the paper shows the impact EU Health policy has had in the Member States in the past. Historical development: Considering that the legal basis for health has been and remains to be very weak limiting EU action to support, coordinate, and supplement actions of Member States – which, as a rule, still consider health to be first and foremost a national responsibility and therefore do not want interference from international institutions – the amount and content of EU health activities in the past years has been quite remarkable. Health policy may not be an EU priority and as a crosscutting policy sector it is dominated by many other EUpolicies. However, especially the “hard law” regulations and directives of the Internal Market give EU the power and competence to achieve health objectives. The size of this growing influence is shown by direct interventions, made possible by the legal acts to improve economic policy coordination. Health and health care in this context are considered as a key policy area for economic growth and EU macroeconomic policy. On the other hand, there isrisk that such regulations affecting health policy and population health may be dominated too much by economic institutions and their interests, whereas health authorities play onlyminor role to date. Conclusion: For the future of EU health policy it is essential that its position is considerably strengthened, in order to assure that health interests of the EU population are sufficiently safeguarded.

Komunikacija u cilju uticaja - razvoj strategije diseminacije informacija i komunikacije u periodu nakon pandemije - studija slučaja SHARP JA

Increased pressure on government spending has led to raised urgency for bodies receiving public support to demonstrate their impact - the 'return' that they deliver on public 'investment'. Dissemination is of great importance for impact or take-up, and take-up is crucial for the success of a project or programme, and for the sustainability of project's results in the long term. Communication and dissemination of deliverables is a one of the key elements of EU funded projects. Grant beneficiaries must promote the project and its results by providing targeted information to multiple audiences, in a strategic and effective manner which clearly links the project messaging to the EU strategic priorities. Communication activities feature as part of the proposal, usually with a specific work package responsible, and communication activities are typically considered in the project evaluation. This study is informed from the perspective of Joint Action on Strengthening International Health Regulations and Preparedness in the EU (SHARP JA) implemented from 2019 to 2023 - a collaborative action of 26 countries and 61 partners. In addition to achieving communications and dissemination goals for the project, its deliverables, and tasks; the SHARP JA aimed to generate long-term, sustainable benefits by increasing communications and dissemination capability and capacity across the work packages. SHARP JA Work Package 2 Communications and Dissemination has used its experience of communications and dissemination (C&D) - the strengths; weaknesses; opportunities and threats - when supporting the joint action to create a Blueprint for Effective Programme Communications for Future EU Health Policy Joint Actions. It does not set out how to do communications, but provides practised communicators with fresh ideas, tools, and inspiration; plus, the pitfalls to watch out for when developing a C&D strategy. It also suggests recommendations, including some for the funding organisations to consider when specifying the communications requirements of future proposals. This essay summarises some of the insights and best practices from the blueprint. Further, it serves those responsible for developing dissemination and communication strategy to improve research, policies, practice, and education in the broad field of public health, both in Serbia and internationally.

European Regional and Local Health Authorities (EUREGHA)

Abstract EUREGHA's vision is to ensure that the local and regional perspective is represented in EU health policy because local and regional authorities are the natural interface between citizens and European institutions, being the bridging bodies between policies and practices and the closest organizations to the concept of communities. We are the only European network prioritizing the representation of local and regional health authorities at EU level, as they fulfil a key role in improving efficiency, quality, and accessibility of healthcare systems and services. EUREGHA understands their specific needs and works tirelessly to represent regional and local health authorities in EU health policy, to amplify their voices as a means to improve European public health and healthcare. Through advocacy, policy monitoring, profile promotion, partnerships, and project development, EUREGHA facilitates and promotes collaboration between its members, EU institutions, pan-European health networks and other healthcare stakeholders. Network activities and projects are implemented upon a strategic background of “ways to make things happen” such as value based healthcare, smart specialization strategies and skills for innovation and digital transformation - on one side - and along thematic and field objectives such as cross-border healthcare, cancer, obesity, mental health and ageing - on the other side. Lower Austria is a long-standing member and Vice-Chair of EUREGHA.

How does better regulation shape EU health policy? A case study of unhealthy advertising regulation

Abstract Introduction Better Regulation is a meta-regulatory tool designed to improve regulatory quality and reduce regulatory burden in the development of EU policy. Despite concerns by civil society that its operation may have a chilling effect on regulatory protections, its impact on health policy has not been researched systematically. Using provisions on high fat, sugar and salt (HFSS) food and alcohol advertising to children within the revision of the audiovisual media services directive (AVMSD) as a case study, we explore how the operation of Better Regulation affects EU health policy processes. Methods We employ a qualitative process tracing approach based on policy documents, Freedom of Information requests, media reporting, and expert interview data. Results After an evaluation in 2016, the revised AVMSD maintained a reliance on self- and co-regulation of alcohol and HFSS food advertising to children, despite significant evidence supportive of statutory measures and pressure from the public health community to strengthen provisions. This result aligns with calls from commercial actors to retain the status quo. Preliminary results indicate that pathways via which Better Regulation guidelines may have contributed to this outcome include, for instance, the structure and approach used in the impact assessment and the related scrutiny process, the design of the consultation strategy, and the evaluation criteria of the AVMSD proposal. Conclusions Considering how policymaking infrastructure - as a key political determinant of health - may shape the processes and dynamics underlying decision-making can support those working towards a policy environment which protects human and environmental health. In examining EU alcohol and HFSS food advertising provisions within the AVMSD revision through a focus on Better Regulation processes, we contribute a novel perspective towards explaining how measures to improve regulatory quality interact with actors’ agency to shape policy outputs. Key messages • The Better Regulation agenda should be understood as a key political determinant of health at the EU level. • Understanding the ways in which governance tools such as Better Regulation can shape health policy is important for those engaged in promoting effective and evidence-informed public health action.

10.E. Round table: Climate emergency, health and equity education: policy and practice recommendations for Europe

Abstract Climate change continues to be the biggest challenge of the 21st century, with profound and growing negative consequences on public health. While the public health and wider healthcare sector faces the health risks and consequences of climate change, it is also an important actor as producer of carbon footprint. There is therefore a need for public health and healthcare professionals to be prepared to address the climate emergency and its inequitable impacts across vulnerable populations. Climate resilience and climate-health-equity and political literacy should be built to enable public health and healthcare professionals to gain a deeper understanding of the needed changes and communicate the direct and indirect environmental impact of our health system, institutions and daily lives. This round table discussion will be framed by the joint statement “Moving towards the right to ‘health for all’ by training the public health workforce on climate change and health” issued by a network of public health stakeholders under the EU Health Policy Platform. Endorsed by more than 75 organisations from the global, European and national level, the statement calls actors in public health to bring climate change and health concerns to the forefront of the debates. During the round table, 4 panellists will touch on evidence, solutions and guidance to address the climate emergency from the different perspectives of ASPHER, EuroHealthNet, Ecorys and EHESP French School of Public Health. The added value of the round table is conveying the different views of the panellists, bringing together European CSOs and partnerships of public health authorities, academia and a research-based consultancy company, and laying out possible ways of how working together could steer the EU and national multidisciplinary policy and decision-making on the intersection of climate, health, social justice, and education. After setting the need for action, the round table will seek to produce recommendations from public health actors to address the climate emergency, bringing the dialogue parallel to COP27. This workshop will explore how different actors from inside and outside the public health domain can contribute to climate mitigation and adaptation actions. The discussion will cover: investing in climate-health training for public health and healthcare professionals; investing in public health research; designing and monitoring mitigation programmes (e.g., sustainable and resilience-enhancing healthcare policies); building climate-health-equity literacy; and providing space for dialogue for those communities who will be most harmed by an inadequate public health response. From a policy perspective, the workshop will help prepare recommendations for actions related to COP27 and will reflect on strategic processes taking place at the European level (including the Conference on the Future of Europe, the European Health Union, the Strategic Foresight, and the Recovery and Resilience Plans). Key messages • Climate change poses an immediate threat to planetary health, and the co-benefits of climate change mitigation and adaptation actions to health and social justice should be highlighted in policies. • The workshop provides public health actors the opportunity to produce recommended actions from public health actors to address the climate emergency at the European and national level. Speakers/Panellists Tara Chen ASPHER, Brussels, Belgium Dorota Sienkiewicz EuroHealthNet, Brussels, Belgium Daniek Korver Ecorys NL, Rotterdam, Netherlands Laurent Chambaud École des Hautes Études en Santé Publique, Rennes, France

European Union health policy after the pandemic: an opportunity to tackle health inequalities?

COVID-19 has exposed and exacerbated the health inequalities across and between European Union member states. It has also raised the profile of EU health policy and the highlighted the value of European cooperation in health. Early failures to respond adequately, coupled with this increased salience, have given rise to a series of initiatives designed to strengthen and expand the EU’s role in health. This presents an opportunity to address the imbalances in the EU’s institutional and legal structure which prevent it from addressing health inequalities more effectively. Drawing on changes underway in the public health, internal market and fiscal governance elements of EU health policy, this paper explores the potential for the post-pandemic EU health policy framework to better support the reduction of health inequalities.

Quality Soil as a Pathway to Healthy Food in the EU – Project Information

Abstract Globalization and the pressure to increased industrial agriculture result in deterioration of the environment, climate change and a serious threat to human and animal health. Soil contamination affected by the environmental pollution is one of the most pressing issues in the political and expert debate on food safety within the related EU policies as Common Agricultural Policy, EU agri-environmental, EU food policy and EU health policy.

The role of the European Union in health policies of member states – an example of the rare diseases policy in Croatia

AimTo assess the European Union's (EU) impact on the Croatian health policy, and identify which mechanisms and processes were used to shape a particular health policy on the EU and national levels. The study focused on the rare diseases policy to obtain a better insight into the process of policy shaping, starting at the EU level and moving down to the Croatian national level.MethodsWe conducted actor analysis, policy networks, and semi-structured qualitative interviews with key policy actors at the EU and domestic level. The analysis of actors included actor mapping, the analysis of their relationships, and of their interdependence. Policy networks involved identifying key actors and analyzing them separately to create both policy networks to explain their hierarchy and relationships. Semi-structured interviews included ten key experts at the EU and national health policy levels.ResultsThe implementation of the EU health policy is complex. Hard and soft law were complementary in the way they affected the translation of EU rare diseases policy into Croatian law. Strong and interconnected EU and domestic actors were significant in this process, which resulted in the creation of Croatia’s rare diseases policy.ConclusionGiven that the rare diseases policy area is a developing policy area, this study contributes to a better understanding of the implementation of the EU health policy, clarifying a mechanism that can enable national governments to adopt specific health policies.

2.K. Round table: Everything you always wanted to know about (COVID-19 and) EU-health policy

ObjectiveThere is no European Union (EU) health system but there is an EU health policy and this health policy is rapidly changing due to the COVID-19 responses of the EU and Member States. The aim of this panel discussion is to analyze and put into context the rapid evolvement of EU health policy during the pandemic. This panel discussion will therefore focus on 1) EU public health policy 2) EU action for health 3) the EU Market shaping health 4) the fiscal governance 5) the institutions, processes and powers.BackgroundEU health policy has often been overlooked and was never on the political agenda. COVID-19 and the pandemic response, however, changed this dramatically. EU-health policy has become centre stage followed by bold investments and new regulatory initiatives. Obvious examples are the EU4Heatlth programme, the Recovery and Resilience fund, the new agency HERA, the new remit for the European Medicines Agency and the European Center for Disease Control. There are also new European Commission mechanisms with regards to the purchase of personal protective equipment, supplies, medicines including vaccines and medical technologies. But will the new EU health policy strengthen health systems of Member States or just focus on stronger emergency responses? Will the constitutional asymmetry between health and internal market be addressed? Will EU-health policy remain after the crisis a centre-piece of European Integration? This panel is based on the COVID-19 update of the EU-health policy handbook ‘Everything you always wanted to know about European Union health policies but were afraid to ask'InteractivityThere will be a high level of interactivity. After an introductory presentation, attendees can use the chat-box to choose specific topics from the aforementioned five themes. These topics will be presented in a table. The chair will then pass the questions and topics to the panelists.Speakers/Panelists Sarah Rozenblum University of Michigan, Ann Arbor, USA Holly Jarman University of Michigan, Ann Arbor, USA Nick Fahy University of Oxford, Oxford, UK Anniek de Ruijter University of Amsterdam, Amsterdam, Netherlands Eleanore Brooks University of Edinburgh, Edinburgh, UK Key messages The European Health Union will be one of the most important constitutional and policy outcomes of the pandemic.It is essential that the European Health Union is not only strengthening emergency planning and response but also accessibility, equity and resilience of health systems.

‘Preventing Pandemics by Building Bridges in EU Policy and Law’

A successful strategy aimed at preventing the emergence and spread of Emerging Infectious Diseases – and therefore a strategy to avoid future pandemic scenarios – should take into account the human dependency on – and profound connection with nature and include not just health considerations but also animal welfare and health, agriculture and food production, environmental protection and climate action in all their facets, including spending and finances, and trade. In this light, policy and legislative acts not only need to be sufficiently ambitious to tackle the drivers behind the emergence of infectious diseases, but they also need to work in symbiosis, in synergy, to avoid that progress made in a certain field is eroded by a lack of ambition and foresight in another field. This research article aims to shed some light on the issue by considering key areas and key recent developments in EU law and policy. It shows how approaches and stances taken by the EU and by Member States frequently lack grit and ambition and are only limitedly synergetic and coherent with each other, often representing veritable missed opportunities both in terms of ambition and in building bridges across different fields. Covid-19, zoonoses, One Health, EU health policy, animal welfare law, animal health law, CAP, EU Climate Law, climate change, environmental protection

Quality Soil and Healthy Food in the Jean Monnet Project

Abstract Soil quality issues, together with issues related to healthy food, are becoming key areas of interest at the European level. Both spheres play an important role in the formulation of EU policies such as the EU Common Agricultural Policy, EU Agri–environmental Policy, EU Food Policy but also EU Health Policy. For this reason, deepening knowledge and exchanging experiences in these areas seem to be necessary preconditions for finding ways to respond to current challenges and problems. The project “Quality Soil as a Pathway to Healthy Food in the EU”, acronym FOODIE, also reacts on the mentioned issues. The main aim of the project is to foster an expertise dialogue between the crucial experts (academics, public authorities, professionals from practice) in the field of food/feed management in the EU affecting the achieving the objectives of correlated EU policies and recently adopted European Green Deal. The presented paper is of a disseminating nature and aims to acquaint the reader with the mentioned project.

EU health solidarity in times of crisis: explaining public preferences towards EU risk pooling for medicines

ABSTRACT The COVID-19 outbreak in Europe has brought attention to EU health policy as a focal point for solidarity, particularly as it concerns access to medicines. Against the backdrop of policy proposals for EU joint procurement of medicines, this article expands our understanding of public opinion towards this particular aspect of European integration. Drawing on data from a conjoint experiment in five EU countries, the study investigates the extent to which citizens’ preferences concerning alternative policy designs for EU joint procurement of medicines are either structured along a pro-EU versus anti-EU or ideological divide, or are crisis driven by the perceived COVID-19 threat. The analysis reveals that individual preferences over the design of EU risk pooling for medicines are most strongly explained by Euroscepticism, while egalitarian ideology plays only a modest role. How citizens’ perceived threat of COVID-19 affects their preferences for this form of EU risk pooling is dependent on the national context.

EU on the way toward Health Union

The article deals with numerous initiatives of the EU Commission, both legislative and political, aimed at strengthening the MS coordination in the field of health. Based on the Commission’s recommendations on restrictions of freedom of movement, the author analyzes the «colour coding» of the EU regions to discover travelers arriving from «risk zones», and identifies conflicting approaches of Member States and other critics to this practice. The author shows interest in Commission’s activities for joint procurement of coronavirus vaccines and other medicines and medical instruments, which it carries out using the power received from the Member States. However, the author notes that only a few MS take advantage of these contracts, preferring their national procurement channels. The author considers Commission’s desire to take the next steps in the direction of the Health Union a significant event in the EU health policy. In conclusion, the author foresees upcoming discussions about who will make decisions in the field of health policy in the EU.

The development of EU health policy and the Covid-19 pandemic: trends and implications

ABSTRACT EU health policy is a policy forged in crisis. Whilst maintaining the strict limitations on the EU’s role that are described in the treaties, crises have historically been followed by incremental but integrative policy change. Given this trend, should we be expecting a radical expansion of EU health policy in the aftermath of Covid-19? And, if so, what parameters and characteristics might this new agenda have? As we enter the period in which the EU will try to elaborate its new health policy, this paper uses a Complexity perspective to assess how the emerging agenda compares to existing and historical EU action on health, the kind of decision-making that we are likely to see in the different areas of action, and the limitations of EU health policy development as it pushes into more political and complex areas of policy.