Case 4: Covid-19 & European health union

Question 1

Why have a European Health Union?

Answer 1

• Expanding Unions preparedness & resonse capacities to make health systems more resilient
• Potential to strengthen crisis preparedness & management of cross-border health threats by reinforcing & empowering the EMA and ECDC

Question 2

What is the responsibility of the European Commission?

Answer 2

responsibility to shape PH agenda & oversee implementation of EU legislation → but they don’t function in a vacuum

Question 3

What do we mean when we say the European Commission doesn’t function in a vacuum?

Answer 3

• Governmental actors, lobby groups & other stakeholders are also involved
• Not always transparent who gets a voice when it comes to shaping
  public policy → in PH, MS retain control over health policy & functioning of their health systems = more complicated
• Results in divergent perspectives & approaches that open floor to national & international interest groups → the roles that lobby/interest groups play in influencing agenda setting must be understood extensively

Question 4

What is a typical way to create a policy window?

Answer 4

Crisis response is a typical way to create a policy window that can enable a reframing of issues to influence the agenda

Question 5

Why is it difficult to have a European Health Union?

Answer 5

• Due to the high amount of actors with different interest groups
• etc

Question 6

What is agenda setting?

Answer 6

• collection of problems; understanding of causes, symbols, solutions of problems that come to attention of public & governmental officials
• agendas exist at all levels of government

Question 7

What does agenda setting focus on?

Answer 7

raising issues for discussion and looks at the competition among issues

Question 8

What is a systematic agenda?

Answer 8

all issues commonly perceived as requiring public attention

Question 9

What is an institutional agenda?

Answer 9

list of items that need active consideration from legitimate decision-makers with some level of authority

Question 10

Explain agenda setting and how they move issues

Answer 10

A process by which groups compete to move their issues from a systematic agenda to a institutional agenda

Question 11

What is the process of agenda setting?

Answer 11

Problem recognition is a socially constructed process & not very rational → policy actors tend to clash during problem recognition

Question 12

How is discourse influenced?

Answer 12

Discourse (way we think and talk about things) is influenced by context and shapes how a problem is perceived → policy tourists come and go

Question 13

What is framing?

Answer 13

Process of selecting & presenting types of information that shape how people understand & interpret an issue → often there are competing frames

Question 14

What is a venue?

Answer 14

Institutional forums in which decisions are taken on policies → legislative, executive, judicial or the news media (Ministry of Health)

Question 15

Why are some issues not put onto the agenda?

Answer 15

• Issue isn’t relevant, prioritised or a legitimate government concern
• Non-decision making (governments actively decide not to act)
• Issue is purposely kept off the agenda

Question 17

According to Kingdon’s mutliple streams framework, when do issues appear on the agenda?

Answer 17

1. Issue is recognised & a problem
2. Accumulate knowledge & different perspectives in policy area
3. Political events

Question 18

Explain “issue is recognised & is a problem” as part of Kingdons claims as to when issues appear on the agenda

Answer 18

The issue is recognised and a problem - develops the frame of understanding

Question 19

Explain ” accumulate knowledge and different perspectives in the policy area” as part of Kingdons claims as to when issues appear on the agenda

Answer 19

finding alternative solutions & generating different policy proposals

Question 20

Explain “political events” as part of Kingdons claims as to when issues appear on the agenda

Answer 20

political processes like:
* national mood
* legislative turnover
* interest group involvement
* public opinion
* election results
* state of economy
* technology

Question 21

What is a policy stream?

Answer 21

Problems, solutions & political events all together can motivate/constrain change that can enable an issue to be placed on the agenda.

Question 22

What 2 broad phenomena is agenda setting driven by according to Kingdon?

Answer 22

1. Changes in indicators of underlying problems
2. Focusing events

Question 23

Explain the phenomena by Kingdon “changes in indicators of underlying problems” as a driver of agenda setting

Answer 23

lead to debates on the extent of the problem (through data collection, monitoring, analysis)

Question 24

Explain the phenomena “focusing events”

Answer 24

• sudden shocks to policy systems that lead to attention & agenda change & eventually a policy change
• (e.g. 9/11 and war on terror)
• Focusing event by itself is often insufficient to drive change

Question 25

Who can set the agenda?

Answer 25

Individual & group actors involved:
* political administrative officials
* legislators
* academics
* development partners such a donors
* NGOs
* media
* institutions such as unions
* consumer groups
* patient groups
* companies
* the public

Question 26

How are policy outcomes infleunced?

Answer 26

• Engage in framing problems & understand how agendas are set
• Recognise political windows of opportunity
• understand how to manipulate political processes to encourage wider acceptance of problem definition
• Understand positions, interests & power of other interested parties (& media)
• Adapt solutions to make them more politically legitimate, feasible &
  supported by the public → need for flexibility

Question 27

What 3 components exists of the European healthcare union?

Answer 27

1. European refers to EU
2. Healthcare
3. Union

Question 28

Explain healthcare as a component of European healthcare union

Answer 28

Healthcare being the organisation, financing & provision of diagnosis, care & cures to ill people, including pharmaceuticals & medical devices → should be distinguished from public health which is broader & includes all policy measures to increase well-being of all people

Question 29

Explain union as a component of European healthcare union

Answer 29

Union refers to a commonality that makes a collection of units (e.g. health systems) a distinct entity → may involve common use of professionals, patients or other healthcare system actors, common financing or regulation → strength varies

Question 30

What are the drivers of EHU?

Question 31

What is a top-dwn vs bottom-up approach?

Answer 31

• top-down approach goes from the general to the specific
• bottom-up approach begins at the specific and moves to the general

Question 32

*What are the stages of implementation experienced?

p.30 of stuvia

Answer 32

1. Mobilisation (bottom-up)
2. Gaining access (exchanging experiences)
3. Use of implementation experiences

Question 33

Explain mobilisation (bottom-up) with regards to EU implementation & policy change

Answer 33

how and by whom is implementation mobilised and what are motivations to do so

Question 34

Explain gaining access (exchanging experiences) with regards to EU implementation & policy change

Answer 34

process of gaining/creating access to policymakers → important to analyse venus most receptive to this type of expertise → depends on demand for information

Question 35

Explain use of implementation experiences with regards to EU implementation & policy change

Answer 35

other factors which affect if these experiences are actually used → legitimacy, political factors, conflict, societal interests, technical knowledge, etc

Question 36

What is the importance of European dimension in health?

Answer 36

● Viruses/bugs are not confined within borders, and neither are European citizens due to the freedom of movement
● Services, including digital services, are offered across borders
● Increased globalisation of trade & interconnected supply chains
● Climate change is a European and global problem
● Principle of solidarity across the continent and moral obligations

Question 37

What are some EU health policies as a shared competence?

Answer 37

1. Principle of conferral (Art 5 (2) TEU): EU can only act within PH as stated in the treaties. Appplies to art 4,6,168 in TFEU
2. Principle of subsidiartiy (Art 5 (3) TEU): EU only permitted to act if there’s added value relative to MS action
3. Principle of proportionality (art 5 (4) TEU): union action shall not exceed what is necessary