This article follows on an overview of the European Semester’s Spring Package and the European Pillar of Social Rights released by EPHA in October 2022. It provides an excellent introduction to the basic premise of the European Semester and how it can take a more socially inclusive approach. Access it here.
Resilience, crisis preparedness, and the European Semester
With the aftermath of the COVID-19 pandemic and the war in Ukraine in mind, it is no surprise that action on ‘resilience’ and ‘crisis preparedness’ are key in the European policy space. As European countries stumble from one crisis into the next, they are repeatedly reminded of the importance of the ability of their health systems to handle the peaks and troughs in demand. While navigating these crises, it is crucial to keep in mind that some people are impacted by crises more than others But how can we ensure that national health systems develop resilience as equitably as possible?
One of the most important frameworks available for national policy change is the European Semester. At first glance, an ‘economic governance framework’ might not seem like the most relevant instrument to drive socially inclusive policy development. However, the opposite is true, as the Commission wants to drive ‘fair and inclusive recovery’ by integrating the European Pillar of Social Rights (EPSR) into the Recovery and Resilience Facility. The importance of the Pillar within the Semester cannot be emphasised enough, which is exactly why we continually call for its further integration.
Civil society exchange on European Semester Priorities
On the 16th of February, the Commission organised an event on ‘priorities for the European Semester 2023 against the background of the energy crisis’. It provided an excellent chance to explore the social aspects of the European Semester. It also included an ‘exchange with civil society organisations’, which took the form of workshops on a variety of topics. We took part in workshop 3 on health, which focused on some of the challenges faced in healthcare, as well as on health in the workplace.
The results of this workshop were mixed. On the one hand, the Commission mentioned that the number of health-related country-specific recommendations is expected to remain low. On the other hand, when we asked about the integration of the EPSR, the Commission said it is developing specific indicators based on the Pillar. This might result in thematic reports on health within future Semester Packages. We strongly encourage the creation of such thematic reports, as they allow for the social determinants of health to be a key frame of reference for these indicators.
In fact, social determinants such as age, income, education or country of origin, are often of equal importance for our health outcomes as the quality of the health system. A health system may be well-designed, but may still be ineffective if certain people are not considered in its design. Though development of inclusive health systems remains important, we must keep the socioeconomic factors that fall outside of those systems in mind. The Distributional Impact Assessment (DIA), which was discussed during the event, can help facilitate this. In simplified terms, this assessment identifies the ‘winners and losers’ of policy reform and could prevent inequalities through inclusion in policy design and budgetary processes.
The ‘exchange of views with civil society organisations on priorities for the European Semester 2023 against the background of the energy crisis’ provided a better understanding of the social aspects of the European Semester. At the same time, we hope that the exchange with civil society will become more structural. Nobody is better suited to support in the integration of the European Pillar of Social Rights than local organisations who understand people’s needs on a personal level.
The event had some shortcomings. A large amount of time was spent on explanation and exposition of Commission initiatives. Though important, these policy frameworks were not explicitly relevant to the European Semester as a process. As a result, out of the full-day event, only an hour was devoted to national civil society organisations. These organisations may already have little capacity to engage with the Semester, which severely hampers their influence in the process.
Health and social determinants in the European Semester
The door to a more social European Semester is open, but there is still a fair distance to cover. During the event, we learned that the focus will remain on energy poverty and digitalisation efforts. At the same time, the number of country-specific recommendations on health is expected to remain low. Previous crises have shown that the most vulnerable are the first to bear the burden. If we aim to build resilience for future crises in Europe, we must place the most disadvantaged in the centre of our health policy design without any further delay.
A structural exchange with civil society in the context of the European Pillar of Social Rights is required, as is a shift from a narrow focus on health systems to addressing all social determinants. The Commission has now taken another step in reaching out to civil society, and it is hoped that this trend will continue so Europe’s health systems are truly resilient and prepared, especially for those who need them the most.