Europe’s role in global health governance

The European Union is a major force in the emergence of global governance. It contributes politically and economically to the processes of globalization that have demonstrated the need for, and reality of, global governance. And it offers a model and precedents for how state- and non-state actors can shape global governance processes and norms. The Commission’s white paper, European Governance (COM(2001) 428), notes the importance of developing stronger interaction with regional and local governments and civil society, primarily through member state governments and, in relation to global governance, to improving dialogue with governmental and non-governmental actors of third countries. The white paper also proposed ensuring that EU member states could speak with a single voice, where possible.

The EU has been a committed supporter of multilateral efforts to address global challenges. This is highlighted in the Commission’s communications to the European Parliament and the Council of Ministers on Building an Effective Partnership with the United Nations in the Fields of Development and Humanitarian Affairs (COM(2001)231), and The European Union and the United Nations: the Choice of Multilateralism (COM(2003)526).

Because the European Union is fundamentally a legal agreement between states, with an independent legal process for settling disputes at the European Court of Justice (ECJ), many issues that might otherwise be considered matters for agreements between states are adjudicated through a legal process. Thus, for example, the right to treatment in certain cases, to obtain health services beyond the borders of a particular member state, the application of working-hour directives to health, and action on tobacco and other products, have all been subject to legal action at the ECJ.

The European Union faces the challenge of improving compliance with the great body of pre-existing international law relevant to health. For example, while the EU has passed more than 200 laws on environmental health, including 140 directives on issues such as water quality and waste treatment, more than a third of all infringement cases, where the failure of governments to implement EU laws are investigated, relate to environmental issues. Improved compliance involves strengthening European performance under the regimes, and increasing political, financial, and technical assistance to least-developed and developing countries that lack compliance capacity. Such assistance is badly needed in order to create the surveillance and response capacities demanded by the International Health Regulations of 2005. States that either will not or cannot comply with international law render such law ineffective and threaten to undermine it. The development of the European Centre for Disease Prevention and Control (ECDC) as an agency for the coordination of EU capacity to monitor and respond to threats to public health is, therefore, vital to the effective application of the new International Health Regulations, which provide an international legal framework for monitoring and taking action on health threats .

EU member states have generally been strong supporters of legal action to protect global health; see, for example, the speech by Marc Danzon, WHO Regional Director for Europe, on the inauguration of the European Centre for Disease Prevention and Control. The European Union has supported the Framework Convention on Tobacco Control (FCTC), not only by adopting, it but also by introducing directives on tobacco advertising and initiating action against governments that have failed to comply. It has, therefore, been instrumental in the adoption and implementation of these new international legal regimes.

Similarly, EU action on diet, physical activity and health has not sought to introduce new legal instruments, but to develop instead a European Platform for Action involving European consumers, producers and legislators with the aim of supporting – but not leading – actions at other levels. The EU has also worked with producers on Codex Alimentarius committees to define standards for food safety, and Sanitary and Phytosanitary committees to define food and product safety. The EU’s experiences with international law place it at the forefront globally in its use of international law to benefit human health. The European experience could be taken as a case study.

In recent years, the institutions of the European Union have addressed, through its various treaties, health and many of its underlying determinants. These include public health threats to safety, health at work, environmental degradation, the spread of communicable diseases, and the broader impact of social and economic policies on health. For example, the Treaty of Amsterdam (1997) calls for all EU social and economic policies to be subject to a health impact assessment, while the 2004 policy reflection, Enabling Good Health for All, looks forward to the establishment of mechanisms for health impact assessments to ensure that all sectors become accountable for their policies and actions on health.

The health theme taken up by the Finnish presidency of the EU in 2006 was the Health in All Policies initiative – a concept that has been institutionalized as one of the core principles of the new European Health Strategy 2008-2013. Furthermore, the reforms proposed under the Lisbon Treaty will strengthen the EU’s role in ensuring pandemic preparedness – a task that not only requires collaboration at various levels of government, from local to international, but also across sectors. Therefore, good governance at European level and global governance for health can be seen not only as defining aspects of the EU’s organization and strategy, but also as a reflection of its essential values.