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Health governance in Europe

The politics, policy and governance of health in the EU

Regulating health for a democratic, transparent and accountable European Union

In an age of complex public policy challenges and disenfranchisement with the European project, what model of regulation can best facilitate collective, democratic and transparent policy-making? The second session of Forum 2 at this year’s European Health Forum Gastein set out to explore this question. In an unusual and stimulating debate format, two experts presented polarised positions on the issue. Hanne Melin, Policy Strategy Counsel for eBay and David Stuckler, Professor of Political Economy and Sociology at Oxford University, introduced the advantages and challenges of regulating in a complex society, each being given time to refute the other’s statements, before the floor was opened to questions by moderator Peter O’Donnell, from the European Voice.

Panelists at Forum 2 Session 2

Panelists at Forum 2 Session 2

Regulation should, on the one hand, serve public policy goals as effectively as possible. Examples of inefficient regulation can be found in many areas and the better regulation agenda requires that these patterns are disrupted, making room for new models. At the centre of how new models should be designed is an emphasis on performance – creating, reviewing, assessing and revising regulation based on its performance towards the stated policy goals, rather than blind assessment of implementation. Such regulation models might involve many ‘intervention agents’ and encourage all parties to innovate in the public policy space.

Regulation must, on the other hand, not be captured by the interests of those with the greatest resources. These stakeholders are commonly those with a vested commercial interest in both the model and content of regulation – profit-making actors have a duty to their investors above all else and thus have an inherent conflict of interest. Civil society organisations do not have the capacity to counterbalance this – reform of the governance and policy-making process is needed.

How then can ‘healthy’ partnerships and stakeholder involvement be established? David Stuckler presented a series of criteria for assessing the ‘health’ of a potential partnership in health policy and regulation, including considerations of independence, conflicts of interest and transparency. Where these criteria are met, efficient, productive and valuable partnerships can be forged in health policy, bringing together multiple stakeholders and encouraging innovation.

The session concluded by reflecting upon three central points. Firstly, it acknowledged that uncertainty is an inherent part of the policy-making process – this cannot be removed, only better managed and prepared for. Secondly, the evidence base is understood to be a crucial weapon in the fight to mitigate uncertainty, but it is also used as a tool, to conflicting ends, by both the industry and the public health community. This makes its use in policy-making more complex. Finally, the panel acknowledged the need to depoliticise the policy-making process. This is a difficult task, particularly in light of the ongoing transatlantic trade and investment partnership (TTIP) negotiations – the TTIP has the potential to introduce a system where governing institutions can become the target of litigation if regulation is damaging to multinational companies.  As such, DG SANCO’s timely Forum highlighted the importance of reviewing policy-making and regulatory models in health policy to ensure that they remain effective, democratic and accountable.

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