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Context: The COVID-19 pandemic has highlighted how the European Union (EU) impacts national health systems and people's health. In November 2020, the European Commission launched the European Health Union (EHU) to better coordinate and maximize EU member states' abilities to deal with cross-border health threats. This article scrutinizes the early institutionalization of the EHU and its implications for EU health policy as a political determinant of health (PDoH). Methods: The article explores how EU health policy may be appreciated from a PDoH perspective. It draws from EU documents and existing research to analyze the early-stage institutionalization of the EHU. The study complements this policy output–focused perspective with an outcome-based exploratory assessment of EU health policy as a PDoH focusing on three examples: joint vaccine procurement, health reforms and investments under the Recovery and Resilience Facility, and the development of a European Health Data Space. Findings: The article shows that the policy change triggered by the EHU and the potential impact on citizens' health are not necessarily congruent. Modest change can have a potentially strong impact on health outcomes and vice versa. Conclusions: The article argues that the PDoH perspective provides a useful approach that is complementary to policy output–based perspectives, allowing for a more comprehensive assessment of the EU's role in health. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic served as a catalyst to build a stronger European Health Union to protect the health of Europeans and to develop a new Global Health Strategy to contribute to global health security. In positioning itself as a key player in global health governance, the EU seeks to assert its responsibility as a global health actor and deepen its leadership in global health law. [ABSTRACT FROM AUTHOR]

After the COVID-19 pandemic, the European Union (EU) put in action the plan to create a European Health Union, the structural pillar of which is the creation of the European Health Data Space (EHDS). In 2022, the European Commission presented the proposal for a regulation for its creation. Its purpose is to enable European citizens to control their health data and to strengthen health research and innovation in the EU. The EHDS is a key step in the transition to digital health in the EU. Digital health is the means to enhance the resilience of healthcare systems in the EU as it will strengthen healthcare. For this reason, the "MyHealth@EU" platform is being created, which will contribute both to the transfer of primary data and to checking the validity of digital health documents. On the research and innovation side, the "HealthData@EU" platform is being developed, which will bring together a plethora of health data. The EHDS Board will play a coordinating role in the EHDS project. The policy brief concludes with the need for an immediate adoption of the proposed EHDS Regulation, which will contribute to improving healthcare provision while completing the single internal market and achieving the free circulation of health data. [ABSTRACT FROM AUTHOR]

The paper analyses how, between 2020 and 2022, the von der Leyen European Commission employed discursive legitimization strategies to endorse the proposal for a European Health Union. There is a literature gap regarding the discursive construction of a European Health Union. Departing from discursive strategies of legitimization and the distinction between Type I and Type II systems of multi-level governance, the paper addresses the following research conundrum: How can it be argued that the von der Leyen European Commission's discourse about the need to build a European Health Union favors a particular type of multi-level governance in the health sector? The paper argues that the discursive strategies employed by the von der Leyen European Commission to legitimize the idea of a European Health Union reveal a preference for a Type I system combined with some elements of a Type II multi-level governance system. [ABSTRACT FROM AUTHOR]

The Covid 19 pandemic has cast traditional health protection issues in a new light due to their cross-border significance with far-reaching consequences for almost all areas of social life and places health protection in the European Union in a broader context that goes beyond the national consideration of necessary measures at EU Member State level. The pandemic has made it clear that the responsibility for public health remains in principle with the EU Member States and that the competences of the European Union under Article 168 TFEU are – with a few exceptions – generally limited to supporting, coordinating and assisting tasks. This article examines whether the European Union is adequately prepared for future pandemics and other cross-border health threats based on its responsibilities under the current system of competences between the EU and its Member States in the area of health policy under article 168. The article concludes with some suggestions for discussion and consideration. [ABSTRACT FROM AUTHOR]

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The response to the Covid‐19 pandemic in 2020–21 was dominated by the Westphalian primacy of national territory and sovereignty, significantly worsening and prolonging this crisis. Global platforms for cross‐border coordination and cooperation were constrained by national self‐interest. Arguably, the lack of a worldwide supranational (or post‐Westphalian) authority in health governance is one important structural reason for the fragmented, chaotic, and ineffective response to Covid‐19. The failure of Westphalian governance responses to the pandemic provides a unique opportunity for post‐Westphalian governance structures to be established and contribute to reforming international pandemic preparedness. While this is unlikely to happen soon at the global level, a comprehensive framework is emerging at the European Union level in the form of a European Health Union. Through a combined conceptualisation of supranational governance and the securitisation process of international health crises, Covid‐19 has opened the door to post‐Westphalian health governance coordinated by the European Commission. [ABSTRACT FROM AUTHOR]

In this article we argue that the Member States of the European Union (EU) have consistently, since its inception, developed a shared framework to measure, monitor and intervene to improve the health status of its population, while invoking the subsidiarity principle for the health sector. As a result, a European Health Union (EHU) has been emerging insidiously and consistently, following the concept of a system for health. Using the World Health Organisation Building Blocks Framework, we analyse the normative and institutional developments related to EU citizens' health that have created a de facto EHU. Developments towards an EHU remain unequally distributed among the different building blocks analysed. The existing EHU is the result of a fragmented and incremental process, mostly grounded in governance, health intelligence and services' development. Health crisis, the Commission's agenda-setting activities and market pressures have been the most important push factors for these step-by-step processes., (© 2023 John Wiley & Sons Ltd.)

Public health concerns in Europe demonstrate the necessity of building a health policy that could contribute to the long-term sustainable development of the European Union (EU), as stated in the European Health Union (EHU) manifesto. The main desire to create an EHU is embodied in the launch of the European Health Data Space (EHDS). The EHDS seeks to foster a genuine single market for digital health services and products by, among other things, accelerating the uptake and implementation of harmonised and interoperable electronic health record (EHR) systems across the EU. In the context of primary and secondary use of EHR data, developments in Europe have thus far resulted in patchy and, in some places, non-interoperable solutions. Taking the gap between international ambitions and national realities as a starting point, this paper contends that both EU level and Member State level circumstances should be considered to make the EHDS a reality., (Copyright © 2023. Published by Elsevier GmbH.)

The COVID-19 pandemic brought visibility and intensified the discussions on the European Union's (EU) health mandate. The proposals of the European Commission (EC) to move towards a European Health Union (EHU) can be seen as a starting point towards more integration in health. However, the definition of what the EHU will look like is not clear. This paper searches to find a common definition, and/or features for this EHU through a systematic literature review performed in May 2021. "European Union's concern about health for all" is suggested as a definition. The main drivers identified to develop an EHU are: surveillance and monitoring, crisis preparedness, funding, political will, vision of public health expenditures, population's awareness and interest, and global health. Based on these findings, five scenarios were developed: making a full move towards supranational action; improving efficiency in the actual framework; more coordination but no real change; in a full intergovernmentalism direction; and fragmentation of the EU. The scenarios show that the development of a EHU is possible inside the current legal framework. However, it will rely on increased coordination and has a focus on cross-border health threats. Any development will be strongly linked to political choices from Member States. [ABSTRACT FROM AUTHOR]

Non-communicable diseases (NCDs) impose a heavy burden on the healthcare system of countries in the European Union (EU). An estimated 91.3% of all deaths and 86.6% of DALYs in the EU-28 were attributable to NCDs. It is imperative that the EU act on mitigating this challenging health issue and help create trajectories for building resilient health systems. Using qualitative analysis, this study examines the question of how the European Commission 2019–2024 is planning to mitigate the impact of NCDs on health systems, while taking into account the COVID-19 pandemic. A content analysis of 44 documents communicating the European Commission's position on the issue was done. In vivo coding was performed using the software package ATLAS.ti 9. Unique codes were simplified and grouped into main themes. Five main themes were identified: 'health plan', 'COVID-19', 'future direction', 'collaboration and solidarity', and 'persuasion'. This study shows that the European Commission is emphasising the impact of the pandemic and the relevance of policies tackling NCDs. By calling for more cross- and multi-sectoral collaboration, the Commission hopes to create the right climate for a European framework for cooperation, which can help develop EU-wide resilient health systems. [ABSTRACT FROM AUTHOR]