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 Franklin Centre for Public Policy and Health Wolfson Research Institute for Health and Wellbeing School of Medicine, Pharmacy and Health, Durham University

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

Political Ethnography 1.Documents are data 2.Developing policy is the research field 3.Researcher is in direct contact with political process, analysing the events as they unfold, through participant observations. EC Charlemagne Building Place Luxembourg (Plux)

Participation Who participates in the forming of the EC health strategy and how? 1.Health Policy Forum (HPF) 2.Open Health Forum 3.Stakeholder Dialogue Group 4.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 SANCO  Member 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):

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