EU Cohesion Policy

• The evolution of EU health policy reflects a gradual and dynamic trajectory.
• It has shifted from a marginal, supplementary role to an increasingly integrated framework influenced by crises, institutional advocacy, and the growing necessity of transnational cooperation.
• Historically, health policy within the EU remained largely under the purview of Member States, grounded in their sovereign rights to organize, finance, and deliver healthcare services.
• Article 6 of the Treaty on the Functioning of the European Union (TFEU) outlines the EU's role as limited to a supporting competence, reflecting the principle of subsidiarity.
• The interplay of functional needs, political pressures, and unforeseen crises, such as the COVID-19 pandemic, has expanded the scope of EU involvement in health policy over time.
• disparities in health systems also play a role

Early EU Health Policy

• Explicit recognition within the treaties was lacking in the early days of EU health policy.
• The Treaties of Rome (1957) omitted any direct reference to healthcare.
• The EU's role in health emerged indirectly as a byproduct of other policy areas such as labor mobility, environmental protection, and internal market integration.
• A more defined role for health began after the Single European Act of 1987 introducing the principle of maintaining a high level of health protection in EU policies.
• The Maastricht Treaty of 1993 marked a pivotal moment by establishing a formal legislative basis for the EU's supplementary role in public health.
• This role was confined to issues with cross-border implications, such as communicable diseases and health emergencies. Directive 2011/24/EU on patients' rights in cross-border healthcare enabled EU citizens to seek medical treatment in other Member States when adequate care was unavailable domestically.
• Practical challenges of implementation were underscored despite the step toward integration, such as language barriers, administrative hurdles, and varying national healthcare.
• European Reference Networks (ERNs) for rare diseases establishing networks for cooperation among Member States.
• Challenges of harmonizing healthcare systems became revealed revealing governance, financing, and quality differing widely.
• Through targeted initiatives and programs, the EU also expanded its health policy.
• The Health Programme, first established in 2003, provided funding for projects addressing public health issues such as cancer prevention, smoking cessation, and childhood obesity.
• The program evolved to include more ambitious objectives, such as improving health system resilience and fostering innovation, over time.
• The European Centre for Disease Prevention and Control (ECDC), established in 2005, reflected the growing focus on transboundary health threats, providing expertise and coordination in areas such as disease surveillance and outbreak response. Political sensitivities surrounding healthcare shaped the cautious pace of integration.
• Member States were reluctant to cede significant authority to the EU, particularly in areas such as healthcare financing and service delivery, which are closely tied to national identities and welfare systems.
• The EU's role remained focused on public health and regulatory harmonization rather than direct involvement in healthcare provision.
• The steady but incremental nature of integration became more pronounced during the COVID-19 pandemic, which acted as a powerful accelerator.
• The collective action in managing transboundary health threats because of the crisis underscored the importance.
• The creation of the European Health Emergency Preparedness and Response Authority (HERA) and the expansion of the ECDC's mandate initiatives reflected a significant deepening of integration.
• Gradual progress in health policy integration created the foundation for more robust responses in times of crisis.

Drivers of Integration

• The emergence of transboundary health challenges has been a major catalyst in the integration of health policy in the EU.
• Issues such as the spread of infectious diseases, the impact of climate change on public health, and reliance on international supply chains for pharmaceuticals.
• Highlighted is the need for coordinated EU-level responses as an European pillar on social rights: rights to access affordable health care of good quality
• Economic integration has played a significant role, as functional spillovers from policies related to the internal market have necessitated the harmonization of regulations governing pharmaceuticals, medical devices, and professional qualifications.
• The COVID-19 pandemic served as a critical inflection point, revealing significant gaps in national healthcare systems and the limitations of fragmented responses to global crises.

Post-COVID-19 Surge and the European Health Union

• The post-COVID-19 period has been marked by a surge in health policy initiatives, collectively referred to as the European Health Union (EHU).
• This framework represents a significant step forward, encompassing legislative measures aimed at enhancing the EU's governance in public health.
• The expansion of the ECDC's role enables better risk assessment, epidemiological surveillance, and coordination of national responses to health threats.
• The EMA's broadened mandate includes addressing shortages of medicines and medical devices during emergencies, a function that proved critical during the pandemic.
• HERA was modeled after the U.S. Biomedical Advanced Research and Development Authority (BARDA) to focus on rapid countermeasure development and preparedness for future crises.
• The EU4Health program, with a budget of €5.1 billion for 2021-2027, exemplifies the EU's enhanced commitment to health security, resilience, and equality.
• This program supports initiatives such as cancer prevention, digital health, and cross-border health cooperation.
• Health policy in the EU operates within a shared but limited competence, with Member States retaining control over healthcare delivery and financing.
• Principles of subsidiarity and proportionality guide EU interventions, ensuring that action is taken only where cross-border challenges demand collective solutions. Programs like REACT-EU, designed to address the socio-economic impacts of the COVID-19 pandemic, demonstrate the EU's capacity for rapid response without encroaching on national sovereignty.
• The Union Civil Protection Mechanism has provided critical support during emergencies, showcasing the benefits of pooled resources and coordination.
• The EGTC enables public authorities to team up and deliver joint services, without requiring a prior international agreement to be signed and ratified by national parliaments.
• Member States must agree to the participation of potential members in their countries.
• The law applicable for the interpretation and application of the convention is of the Member State where the official EGTC headquarters are located.
• A crossborder hospital is located at the border for france and spain, providing both language, for both country's residents
• Strong public support for enhanced EU competence in health was revealed regarding the future of EU health policy integration.
• Sustaining recent developments will require robust coalitions among Member States, political parties, and interest groups.
• Institutionalizing changes will depend on maintaining political will and securing adequate funding in future multiannual financial frameworks.
• Selective focus on public health has proven effective, broader healthcare delivery integration may face resistance caused by diversity of national systems and political sensitivities.
• Driven by transboundary challenges, institutional entrepreneurship, and crises like COVID-19, EU health policy has evolved from a peripheral area of governance to a critical domain of integration.
• The EU continues navigating the delicate balance between supranational coordination and Member State sovereignty as it has expanded in public health.
• Undoubledtly, the pandemic has accelerated integration, laying the groundwork for a more resilient and cohesive European Health Union.
• Sustainability of these changes will depend on political commitment, effective governance, and the ability to adapt to future challenges continuing.

Health and Neo-Functionalism

• The evolution of EU health policy is deeply connected to the theoretical framework of neo-functionalism, which explains regional integration as a dynamic process driven by functional, political, and cultivated spillovers.
• Neo-functionalism, developed by Ernst Haas, posits that integration in one sector creates pressures for further integration in related areas, and this has been particularly evident in the gradual development of EU health policy.
• While health policy initially remained a marginal area of EU competence, the interplay of crises, institutional advocacy, and cross-border challenges has steadily expanded the EU's role, with the COVID-19 pandemic acting as a powerful catalyst.
• The concept of functional spillover lies at the heart of neo-functionalism explains that integration in one domain necessitates cooperation in others due to interdependencies.
• In the context of EU health policy, this has been evident since the early days of the Union.
• The creation of the internal market required the harmonization of regulations on pharmaceuticals, medical devices, and professional qualifications to facilitate the free movement of goods, services, and labor.
• Ensuring that healthcare professionals could facilitate the free movement of goods, services and labor and work across borders necessitated mutual recognition of medical diplomas.
• Common standards for safety and efficacy was required regarding the trade in pharmaceuticals.
• The unintended effect of embedding health-related considerations within EU policy frameworks, demonstrating the functional interconnectedness of health and the economy.
• Supranational institutions are entrepreneurs of integration, using crises and policy gaps to push for new initiatives.
• The European Commision leveraged the 2011/24/EU Directive on patients' rights in cross-border healthcare to establish ERNs, fostering collaboration on rare diseases.
• This directive not only addressed immediate challenges but also created a precedent for deeper health policy cooperation.
• Cultivated spillover further explains how supranational institutions actively shape the trajectory of integration by creating new frameworks and capacities.
• The European Commission has consistently advocated for enhanced cooperation, often preparing the groundwork for initiatives years before they are formally adopted.
• The ECDC designed to address transboundary health threats, is an example of this proactive approach.
• HERA in 2021 built on existing Commission efforts to centralize crisis response mechanisms, further institutionalizing the EU's role in health policy
• Neo-functionalism highlights crises as accelerators of integration, and this dynamic has been particularly evident in the development of EU health policy.
• Exposure revealed the limitations of fragmented national responses and the need for stronger EU coordination, and this acted as a critical juncture with the COVID-19 pandemic. Initially Member States adopted unilateral measures, but these actions quickly gave way to EU-led initiatives, underscoring the interconnectedness.
• The development of EU health policy exemplify the neo-functionalist logic of spillover and institution-building after COVID-19.
• Expansion of ECDC's mandate to include real-time epidemiological surveillance and risk assessment reflects functional spillover.
• The European Medicines Agency (EMA)was granted aligning its role closely with broader health security objectives with real time epideomiological survelliance
• The establisment of HERA illustrates cultivated spillover, as it represents a deliberate effort to centralize health crisis preparedness within the EU framework. Despite these advances, the integration of EU health policy remains selective, reflecting the neo-functionalit idea that integration progress where the need is most pressing.
• Healthcare delivery remains largely under Member State control while public health issues, have seen significant EU involvement.
• This division aligns with the principle of subsidiarity, which ensures that decisions are taken at the most appropriate level of governance.

EU Cohesion Policy

• enshrined in the Treaties, one of the foundations for promoting solidarity and cohesion in european integration
• aims to reduce regional development disparities
• reflects the EU's commitment to balanced growth and inclusion - the policy addresses significant socio-economic gaps
• economic disparities between regions could stifle economic intergration.

Historical Background

• began with the European Social Fund under the Treaty of Rome
• gained with the estabishment of the ERDF (European regional development fund)
• gained momentum throughout Europe

milestones

• the 1988 reform
• principles of programming concentration
• co-financing, subsidiarity
• result-orientation and partnership

what it includes

• European regional development (ERDF)
• European social funds (ESF)
• Cohesion fund and just transition funds

Operationally

• cohesion policy exemplifies multilevel governance
• involves members states, the european comission, and auditing autorities

Cohesion Policy's Resilience

• demonstrated during the 2008 financial crisis and the COVID-19 pandemic
• safeguarded public investement in debt-striken member states
• The CARE (Cohesion's Action for Refugees in Europe) initiative further demonstrates the adaptability of CP in response to emerging crises.
• The CARE reallocates CP resources to manage states with impact during the war

The RRF's Role

• complementary but distinct tools, addressing socioeconomic desparities for growth
• The RRF operates on a “payment by results" principle.
• A streamlined and centralised mechanism enables rapid implementation, addressing urgent crisis needs

Synergies

• RECOVERY assistance through EU connects the RRD with thee CD through a bridge
• it provided additional resources to ongoing RD resources for the 2014-2020 period

Challenges

• Coexistence of the CP and the GRF raises concerns of potential inefficiency, such as duplication of funding

from 2021-2027

• The CD retains its multilevel goverenance framework by adhering to broader objectives
• a renewed emphasis on macroeconomic and ex-ante conditionalities

Principles in play:

• involves progamming to ensure that funds are allocated through tailored multi-annual strategic programs
• includes the concentration and supplement of resources (additionality)
• EU funds supplement rather than replace national investemnts, requiring own resources from member states

the three main government goals

• vertical and horizontal: between govenrrnance levels
• adapative and inclusive (enable policy adaptations)
• institutionnalizing networks CoR Advocating for MLG: Emphasise the importance of Involving governments in decision making

Regions in European Unity(EU) have grown in significance in the pass seven decades

• have evolved into key factors in policy implementation

Policy Implementation

• Regions are critical to implementation
• The manage Substantial funds, aiming at addressing across regions

Aggregators of Local Interests

• regions act stakeholders and local interest
• by doing so this enriches innovation and better sharing and connections among trust

Contenders to National Governments

• the ability to have a "Greater Autonomy" is essential
• occassionallt direct Contradiction

Theories of Intergration: Neo Functionalism

• a theory rooted in hast, emphasizes spillover effect, with integration in the sectory
• political occurs such COM and entities advocate

Theories of Intergration: International Governments

• emphasizes the role of Nation States
• states are essential for integration
• highlights the fact that sovereign can be taken in supranational entities

Theories of Intergration Institutionalisms

• focuses on EU role regarding structural choice of actors of COM
• historical hightlights shape

Multi-Level Governance

• theories are to provide a Comprehensive framework into the making European Union

MLG: Decentralized PolicyMaking

• Reflects weakening governments of Exclusive Control -The MLG and decentralisation create a weaking relationship

MLG: Policy Networks

• public and private actors Collaborate, as in the eu is smart. Specialazition
• the MLG are underscores the TERRION REIDINITION of states

Pros of MLG

• Inclusivitiy the MLG can empower diverse actors for desicion making
• Flexiblity by adhearing to a nonhierichal approach
• democractic potential can adress in the EU democractic Deficit

Cons of MLG

• complexity can result in "INEFFICIENCY" for decision making Democratic Defict, strugglling with transpareny
• uneven Capacities, regions vary in their ability to participate

Permacrisis

• Eu is now is at a era of "permacrisis" with interconnected crises
• it has forced adopting a " EU coordination", which emphasizes a informal coordiation
• has increased desicion making and policy complience

coordinative Europeanization

emerging in the EU in order to challenge Unique concerns of "Permacrisis"

• colaborative policy making to swift for effective response

Legislative initiativ: The Comission holds the exclusive right to legislative properls

Policy implementation: it is is to oversee manage to implementation

Relatiosnhip In betweet Comitology Act

• to make sure COM actions are to be supervisied by the State
• ensure clear comitology is in effect

What the Comission does: Legislative, supervisory

(The comisson power can be limited, therefore the need of the European Court or Parlinment to make deciosin more legimantate)

European Parliament (EP)

• democratic representation to the millions states

European Court of Auditors(ECA)

Guardian of the European is financial interests

Agenda --setting in Public Policy;

critical component is to priortilize the the issues for action

agenda settings: The types of Intiation;

inside or outside. Inside is when they have to resolve problems for there political policies not including outisude

• Outside Intiation: is pressure for people and groups

the Challenge of agenda entering :

the method of issuing is from the getgo it is organized not to be too complex

Policy window. (when problems / recognition are to align)

Policy formulation in public policy :

Is a critical stage that is used to Assess the assessing potiental solutions to the existing issues

"Policy formulation stages include :

Appraisal,( to provide evidence) Dialog, dialog and discussions ) formulation, consolidation (which ensures it is stable) The policy Formulation helps increase stability all accross the board

Decision-Making Model: the theory can show up w/ How policymakers arrive at decisions Model

• The model can indicate the complexities and how various approaches involved
• comprehensive and bounded rationality (rational model)
• prospect theory (how various people "perceive" risks)
• incremental models

the implementation pahse involves: the transitioning to from policy and transition

• "civil servants and ADM official play a central role in the policy process."

Implementation theorie: implement a linear to more of a direct top-down structure

policy evaluation and effectivness: The steps to achieve it are:

• quantitate methods the process's will often change to Bimary and quantative variables
• qualitative research methods (the use and ability of implementing new changes if nessesary )
• mixed method : combo that offers ability

Explore the EU's Cohesion Policy, its evolution, and key principles like additionality and partnership. Understand how it addresses regional disparities, promotes economic and social cohesion, and supports a just transition. The quiz covers the policy's mechanisms and operational approaches.