Brooks, Eleanor and Geyer, Robert (2016) Public health, free movement and macroeconomic coordination : mapping the evolving governance of European Union health policy. PhD thesis, Lancaster University.
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Abstract
Health is a unique and intriguing sphere of European Union (EU) policy, not least of all because it has only been recognised as such for the last 15 years. From piecemeal origins in public health and occupational safety it underwent dramatic expansion as a result of exposure to free movement and internal market law in the 1990s. Now, in the aftermath of the economic crisis, it is entering another unprecedented era. As the focus of the European project has turned to fiscal sustainability and the strengthening of collective economic governance, health policy has been swept into frameworks designed for the oversight of macroeconomic policy and national expenditure. Crucially, these frameworks extend EU health influence into areas reserved in the founding treaties for exclusive national control. This thesis seeks to map the changing nature, scope and governance of EU health policy, contributing to the existing patchwork of literature and reviewing the prevailing narrative in light of the critical juncture now being faced. It draws on the theories of European integration, the Europeanisation framework and the more recent governance approaches to assess the continuing relevance of core themes – crisis politics, regulatory policy, the internal market, new modes of governance, and the role of the Court – in health policy development. Using six case studies and data from 41 interviews with experts, policy-makers and officials, it examines the catalysts, drivers and dynamics of health policy integration. It finds that as the actors and interests involved in health policy have proliferated, health issues have become increasingly politicised. Addressing the consequences of this trend, the thesis explores the growing dependence on, and progressive strengthening of, voluntarist governance, as well as the declining scope and influence of EU health policy. Finally, it reflects upon the future of health within a politicised European integration project.