As part of its European Semester approach, the European Commission released the so-called Spring Package on the 23rd of May. At its core, the European Semester allows for coordination of fiscal, economic, and social policies in Europe. Deeper into the second half of the 2022 Semester, we reflect on its social components which, though included, still require much more attention. As implied, the Spring Package is one of two parts of the Semester and follows on the 2021 Autumn Package which saw the Commission holding its Annual Sustainable Growth Survey (ASGS). To support the recovery from the pandemic, one of the ASGS’s central instruments is the Recovery and Resilience Facility (RRF). With these instruments in mind, we explored how the Semester can be made more socially inclusive and how we can ensure that Europe’s most vulnerable groups have equal access to healthcare.
Fairness
Included in the Spring Package are the Commission’s so-called country-specific recommendations (CSR), which point out some of the gaps in the member states’ recovery and resilience plans. We welcome the fact that the Commission is paying increased attention to what it calls fairness. With this concept, the Commission’s goal is to bolster resilience across European member states and to encourage them to enable a fair and inclusive recovery.
This is important for healthcare too, as the pandemic has not only exacerbated existing health inequalities but has also uncovered existing gaps in health systems which prevent vulnerable groups from fully exercising their right to healthcare. For this purpose, we looked at how (health) inequalities are integrated in the Spring Package and in the country-specific recommendations.
Country-specific Recommendations
The Commission addresses inequalities through two tools: the European Pillar of Social Rights (EPSR) and the United Nation’s Sustainable Development Goals (SDGs). Within the SDGs, SDG 3 on good-health and well-being and SDG 10 on reduced inequalities are of particular relevance. In the EPSR this is principle 16, focusing on equal access to healthcare. Though the Pillar and the SDGs may not be explicitly anchored in the CSRs, they are an important frame of reference to measure inclusion and equality. In fact, The Commission explicitly states its ambition to drive recovery in line with the EPSR.
When reviewing the CSRs, a direct link between the EPSR and fairness is difficult to establish. Although there is a lot of attention to vulnerable households, there are still gaps visible. The majority of recommendations cover inequalities mainly through energy poverty. Meanwhile, health inequalities are barely addressed, which is surprising, given that the COVID-19 pandemic laid bare large gaps in health systems across Europe.
For the majority of CSRs, there are suggestions to reform the (health)care system, yet these recommendations lack detail. There are exceptions, as some member states are encouraged to improve their long-term care and primary and preventive care systems (notably Hungary and Poland), their e-health service (Poland), or to account for equal access and healthcare gatekeepers (Greece). It is encouraging to see more specific health topics included, however a more structural approach to achieving health equity is necessary. A fair health system could help ensure the most vulnerable groups in Europe are not the first to suffer from a future pandemic, and the last to benefit from the health system.
Marginalised Groups
It is also crucial to be aware of groups that may be more marginalised. The CSRs cover groups such as youth, low-skilled and temporary workers, persons with disabilities and people with a migrant background. However, despite the Commission’s dedication to fairness, these are mentioned only in a limited capacity. There are a few exceptions, such as countries getting recommendations on equality of gender (notably Austria and the Netherlands), children, (social) housing, social support, disadvantaged students and/or people from migrant backgrounds (notably Sweden). Unfortunately, the CSRs do not account for intersectionality and social determinants which are crucial in understanding the causes of inequalities.
Importantly, despite being one of Europe’s most marginalised ethnic groups, Roma are barely mentioned. The only CSR that explicitly mentions Roma is the one for Hungary, yet here the focus is mainly on employment and education. The European Semester may not be the designated policy instrument to achieve Roma inclusion, but there is a great opportunity to align it with the Commission’s own Framework for Roma equality, inclusion and participation.
The Way Forward
As Europe has set the ambition to become a ‘Union of Equality’, we believe that there should be a stronger and more explicit integration of both the EPSR and SDGs in the European Semester framework. We applaud the introduction of fairness, however, it is still insufficiently translated into the CSRs of the 2022 Spring Package. Even though the COVID-19 pandemic is a health crisis first and foremost, there is little attention to the health inequalities that inevitably come with such a crisis.
Other crucial elements for a socially inclusive and equitable union are tackling gender inequalities, setting specific targets to protect vulnerable groups (such as Roma and other ethnic groups, migrants and LGBTQ+ people) and addressing intersectionality and discrimination. If the European Semester is to pave the way to fairness in earnest, this must show more clearly in the country-specific recommendations. The groundwork has been laid, but there is still some ground to cover before we can move from words to deeds.
