Assessing the potential impact on health of the UK's future relationship agreement with the EU : analysis of the negotiating positions.

While policy attention is understandably diverted to COVID-19, the end of the UK's post-Brexit ‘transition period’ remains 31 December 2020. All forms of future EU−UK relationship are worse for health than EU membership, but analysis of the negotiating texts shows some forms are better than others. The likely outcomes involve major negative effects for NHS staffing, funding for health and social care, and capital financing for the NHS; and for UK global leadership and influence. We expect minor negative effects for cross border healthcare (except in Northern Ireland); research collaboration; and data sharing, such as the Early Warning and Response System for health threats. Despite political narratives, the legal texts show that the UK seeks de facto continuity in selected key areas for pharmaceuticals, medical devices, and equipment [including personal protective equipment (PPE)], especially clinical trials, pharmacovigilance, and batch-testing. The UK will be excluded from economies of scale of EU membership, e.g. joint procurement programmes as used recently for PPE. Above all, there is a major risk of reaching an agreement with significant adverse effects for health, without meaningful oversight by or input from the UK Parliament, or other health policy stakeholders

More Competences than You Knew? The Web of Health Competence for European Union Action in Response to the COVID-19 Outbreak

To combat COVID-19, unlike its Member States, the Union may act“only within thelimits of the competences conferred upon it by the Member States in the Treaties to attainthe objectives set out therein”.4As legal scholars, we understand why one may think thatthe Union has no power to act in ways that public health experts and others, such aseconomists and behavioural psychologists, suggest would be helpful. The Union’spowers in the health domain are traditionallyunderstood to be severely constrained:health law and policy are seen as matters for Member States.We propose an alternative to this standard legal analysis. The Union has more possiblelegal powers to create health law and policy in response to the COVID-19 outbreak than istraditionally understood, particularly if the different iterations of the protection andpromotion of public and human health throughout the Treaty on the Functioning of theEuropean Union (TFEU) are readin relation toone another. This alternativeinterpretation of the Union’s competence norms, the“legal bases”on which the Unioninstitutions act to adopt either binding legal rules or persuasive measures, suggests thatthere are legal options that permit the Union a wider range of actions than it has takento date, and that support–and go further than–the approaches that the EuropeanCommission (Commission) and European Centre for Disease Prevention and Controlhave suggested in various policy documents, guidance and communications in Marchand April 2020.5In short, we are arguing thatlegalimpediments to Union action areless restrictive than is commonly understood

Health ‘Brexternalities’: The Brexit effect on health and health care outside the UK

The principal effects of Brexit on health and health care will fall within the United Kingdom, and all forms of Brexit have overwhelmingly negative implications for health care and health within the UK. This article focuses on the external effects of Brexit (‘Brexternalities’) for health and health care. The EU is a particularly powerful institutional and legal arrangement for managing economic and political externalities, in health policy as in any other policy. Equally, when a state leaves the EU, the manner of leaving will result in better or worse management of relevant externalities. ‘Brexternalities’ thus involve questions about policy legitimacy and accountability. Health ‘Brexternalities’ do not fall equally in all EU countries. They are felt more distinctly in the context of those elements of health policy that are most closely entwined with the UK’s health policy: for instance, on the island of Ireland; certain areas of Spain and other parts of southern Europe. Some health ‘Brexternalities’, such as in medicines safety, will be imposed on the whole population of the EU. And some health ‘Brexternalities’, such as communicable disease control, will be felt globally

Evidence and Power in EU Governance of Health Promotion: Discursive Obstacles to a “Health in All Policies” Approach

This 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

Telling stories about European Union Health Law: The emergence of a new field of law

The ideational narrative power of law has now solidified, and continues to solidify, ‘European Union health law’, into an entity with a distinctive legal identity. EU health law was previously seen as either non-existent, or so broad as to be meaningless, or as existing only in relations between EU law and health (the ‘and’ approach), or as consisting of a body of barely or loosely connected policy domains (the ‘patchwork’ approach). The process of bringing EU health law into being is a process of narration. The ways in which EU health law is narrated (and continues to be narrated) involve three main groups of actors: the legislature, courts and the academy

State of the art. Overview of concepts, indicators and methodologies used for analyzing the social OMC.

This paper is a detailed analysis about the literature on the Social OMC from 2006-2010, focusing on how OMC research has been carried out. It specifically points to which theoretical framework/concepts are used, and how change is conceptualised and measured. It is organised in five sections. The first concerns visibility and awareness about the OMC; the second analyses research on the EU level coordination process; the third scrutinizes how features of the OMC have been analysed. The fourth and fifth sections, addressing how national integration of the OMC has been researched, respectively address substantive policy change as well as national policy-making. Strikingly, virtually all OMC research adopts theoretical frameworks derived from literature on Europeanisation and/or institutionalisation. Also, as the OMC is voluntary and sanction-free, it depends heavily on how and the the extent to which actors use it (agenda-setting, conflict resolution, maintaining focus on a policy issue, developing a policy dialogue, etc). OMC research has become nuanced and does highlight how, for which purpose and with which outcome actors engage with the OMC. Another finding is that there is data on policy issues addressed through the OMC, learning does take place and there is knowledge about domestic policy problems. However, the linkage between knowledge of an issue and direct use of the OMC for policy change in social policy is weak, but that may change with EU2020, where social policy has received a higher profile. Most research covers the EU-15, much more research needs to be undertaken in newer EU member states