EHMA Editorial Influencing EU health policy: supreme discipline or waste of time?

It is important not to underestimate the importance of the EU for its Member States: it has been estimated that the EU accounts for between 70 per cent and 90 per cent of Member States’ legislation.1 Policies in the field of trade and the single market as well as employment, agriculture and environmental protection all fall under the EU’s competence, and have a strong influence on health. This is in addition to the EU’s remit in health policy itself, where recent developments such as the new draft Directive on Patients Rights in Cross-Border healthcare and the Communication and Council Recommendation on Patient Safety have at least the potential to significantly shape health policy-making at national and local level.2 If the case can be made that the EU is intervening in important policy areas for health managers, it raises the question of how managers, researchers and policy makers can effectively influence its policies. The Brussels landscape is complex, with many different actors and interests, including a specialised cadre of EU lobbyists.3 Recent sources indicate that around 15,000–20,000 lobbyists are currently based in Brussels.4 A similarly large number of training courses are currently offered all around Brussels on lobbying the EU. Although professional lobbyists are an important feature of Brussels politics, this editorial is not focused on them. Rather, the editorial focuses on how those who do not spend their lives immersed in Brussels and its politics — managers, researchers and others — can best engage with the EU and shape health policy at European level. It is often argued that the biggest barrier to influencing the EU is that the EU institutions and Brussels actors are not actually very interested in external views. If one is not part of the Brussels club, there is nothing much that he or she can add. While the argument of democratic deficit is easy to make in relation to the EU, conscious efforts have been made in the last few decades to make the EU more open and transparent.5 It is now generally been accepted that effective EU policy-making needs some form of civil society input.6 In the field of health, stakeholder involvement particularly became a buzz word under Robert Madelin’s leadership of DG SANCO (2003–2010), who created with what he termed ‘co-operative voluntarism’ an alternative to hard legislation, i.e. multi-stakeholder platforms bringing together different interests to encourage them to voluntary agree on and commit to joint guidelines or policies.7 Information on EU health policy initiatives is made available online, and further disseminated by different newsletters and info channels.8 A number of advisory and discussion platforms such as the Health Policy Forum have been set up — often supported by EU funding to cover travel — in an effort to bring stakeholders around the table and promote compromise and legitimacy of EU policies.9 But if the EU is open to hearing and being influenced by stakeholder views, how can managers, researchers and policy makers get involved without having to immediately relocate to Brussels?