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      The path to a European Health Union

      review-article
      a , , b
      The Lancet Regional Health - Europe
      Elsevier
      European Union, Health, Policy

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Summary

          The European Union has historically left health policy decisions to individual member states, cooperating only on issues like cross-border healthcare and medicine safety. However, the COVID-19 pandemic underscored the need for collective action across borders. In response, in October 2020, European Commission President Ursula von der Leyen called for the creation of a “European Health Union”. This initiative aims to enhance the protection of European citizens' health, bolster pandemic preparedness, and strengthen healthcare systems. So far, the initiative has not led to major contestation. This might be because the proposals under this heading have been rather piecemeal and are not generally seen as being part of a comprehensive vision for identifying areas where EU intervention benefit national health policy. In this contribution we propose a path forward in terms of content and process for developing a more comprehensive vision on the policy content and the process. In so doing, we are not debating the need for a European Health Union. We take for granted that the existing European Health Union presents an opportunity to deliver, now and in the future, the added benefit of harmonizing, centralizing, or coordinating health-related laws, institutions, policies and actions at EU level.

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          Most cited references11

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          The revision of the 2014 European tobacco products directive: an analysis of the tobacco industry's attempts to ‘break the health silo’

          Background The 2014 European Union (EU) Tobacco Products Directive (TPD) was negotiated in a changed policy context, following adoption of the EU's ‘Smart Regulation’ agenda, which transnational tobacco companies (TTCs) anticipated would increase their influence on health policy, and the WHO Framework Convention on Tobacco Control (FCTC), which sought to reduce it. This study aims to explore the scale and nature of the TTCs' lobby against the EU TPD and evaluate how these developments have affected their ability to exert influence. Methods Analysis of 581 documents obtained through freedom of information requests, 28 leaked Philip Morris International (PMI) documents, 17 TTC documents from the Legacy Library, web content via Google alerts and searches of the EU institutions' websites, plus four stakeholder interviews. Results The lobby was massive. PMI alone employed over 160 lobbyists. Strategies mainly used third parties. Efforts to 'Push' (amend) or 'Delay' the proposal and block 'extreme policy options' were partially successful, with plain packaging and point of sales display ban removed during the 3-year delay in the Commission. The Smart Regulation mechanism contributed to changes and delays, facilitating meetings between TTC representatives (including ex-Commission employees) and senior Commission staff. Contrary to Article 5.3, these meetings were not disclosed. Conclusions During the legislative process, Article 5.3 was not consistently applied by non-health Directorates of the European Commission, while the tools of the Smart Regulation appear to have facilitated TTC access to, and influence on, the 2014 TPD. The use of third parties undermines Article 5.3.
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            From Health in All Policies to Health for All Policies

            Worldwide responses to the COVID-19 pandemic have shown that it is possible for politicians to come together across departmental boundaries. To this end, in many countries, heads of government and their health ministers work closely with all other ministries, departments, and sectors, including social affairs, internal affairs, foreign affairs, research and education, transport, agriculture, business, and state aid. In this Viewpoint, we build on the Health in All Policies approach by which the Sustainable Development Goals (SDGs) support intersectoral collaboration to promote health but argue that this relationship should be bidirectional and that health enables the attainment of other SDGs—Health for All Policies. We contend that strengthening health policies and improving health outcomes have major and tangible co-benefits for other sectors.
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              Health law and policy in the European Union.

              From its origins as six western European countries coming together to reduce trade barriers, the European Union (EU) has expanded, both geographically and in the scope of its actions, to become an important supranational body whose policies affect almost all aspects of the lives of its citizens. This influence extends to health and health services. The EU's formal responsibilities in health and health services are limited in scope, but, it has substantial indirect influence on them. In this paper, we describe the institutions of the EU, its legislative process, and the nature of European law as it affects free movement of the goods, people, and services that affect health or are necessary to deliver health care. We show how the influence of the EU goes far beyond the activities that are most visible to health professionals, such as research funding and public health programmes, and involves an extensive body of legislation that affects almost every aspect of health and health care.
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                Author and article information

                Contributors
                Journal
                Lancet Reg Health Eur
                Lancet Reg Health Eur
                The Lancet Regional Health - Europe
                Elsevier
                2666-7762
                22 November 2023
                January 2024
                22 November 2023
                : 36
                : 100794
                Affiliations
                [a ]London School of Hygiene & Tropical Medicine, United Kingdom
                [b ]University of Amsterdam, the Netherlands
                Author notes
                []Corresponding author. martin.mckee@ 123456lshtm.ac.uk
                Article
                S2666-7762(23)00213-2 100794
                10.1016/j.lanepe.2023.100794
                10709035
                38074445
                a82f9873-1702-4f3d-921e-11c9412b0354
                © 2023 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 20 October 2023
                : 5 November 2023
                : 7 November 2023
                Categories
                Viewpoint

                european union,health,policy
                european union, health, policy

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