Governance approaches in the forming of European health strategies: European Commission (EC) ‘Together for Health’ and World Health Organisation (WHO) Regional Office for Europe ‘Health 2020’

Dr Paula FranklinCentre for Public Policy and HealthWolfson Research Institute for Health and WellbeingSchool of Medicine, Pharmacy and Health, Durham UniversityEmail: paula.franklin@durham.ac.uk

Forming EU Health Strategy: An Ethnographical Study of Stakeholder Positions and Governance in European Policy Making

Political Ethnography1. Documents are data2. Developing policy is

the research field3. Researcher is in

direct contact with political process, analysing the events as they unfold, through participant observations.

EC Charlemagne Building

Place Luxembourg (Plux)

ParticipationWho participates in the forming of the EC health strategy and how?1. Health Policy Forum (HPF)2. Open Health Forum3. Stakeholder Dialogue Group4. Policy platforms (alcohol; diet &

physical activity)5. Open consultations

How to strengthen the process? • Work across Commission silos –

“cross-fertilisation” • Pro-active stakeholder identification

EC Berlaymont

Openness• Transparency of proceedings:

how are interests prioritised? Decision making from broad

consultation to policy requires further transparency• Informal networks and

contacts are crucial: “You need to get in before there is a draft”• Availability of information: the

case of post-2013 health Strategy & Investing in Health

Accountability• Who is responsible for the contents of the EC

Strategy?DG SANCOMember States

• Who is represented?Stakeholders struggle to maintain accountability

to their members due to short consultation periods/timing of consultations

Governance of the WHO Health 2020 and the EAP• Two-year consultation process

with a wide range of stakeholders, including: Member States, NGOs, European Health Policy Forum, international organisations (including the EC), Healthy Cities Network, the Regions for Health Network, professional associations

• Events and written consultation process

Engaging stakeholders in the policy-making process from the beginning

EC & WHO Strategies: Similarities

1) Emphasis in intersectoral governance

2) Dialogue with diverse stakeholder groups

3) Health is an invaluable component of a well-functioning economic system

EC & WHO Strategies: Differences

• The strategies occupy different positions in Europe, and have different ways of operating

Together for Health: a political tool to defend health amongst other policy areas

Health 2020 & EAP: a tool for Member States to use, evidence informed

Franklin, P. (2013) European Public Health Strategies: State of Play. Eurohealth 19(4): 31-34.

HAVE YOU MET MR. SANCO?“When you are here [in Brussels] there’s some things you don’t realise, and one thing is the use of acronyms that we do. One of my members had been asking: “Do you know who Sanco is? Have you met Sanco?, and gotten replies: “No I’ve never met Mr. Sanco, but Mr. Sanco is very important.” She had been asking from many people, and nobody had met Mr. Sanco. It took her a long time before she finally understood it is the Directorate General [for Health and Consumers, DG SANCO].” Interview with a Director of a Brussels based public health NGO