IN HIS SECOND ARTICLE concerning health care in the European Union (EU), Dr. Graham explores issues connected with developing a unified EU health policy. In this article, "European Health Policy: Working Within a Paradox," Dr. Graham makes the case that although the EU clearly values health and access to a high standard of care for all citizens of EU countries, individual countries are extremely reluctant to relinquish their control of health care systems within their own borders. One of the major concerns about an overarching EU health policy cited by countries is the belief that although EU countries have common concerns, they also have unique cultures and needs that would not be served well by one standard health policy or system.
The situation within the EU is similar to that within the United States, where health policy, systems, and programs exist at national and state levels. States closely control health efforts within their borders, but also are affected by national policies and programs (e.g., Medicare). The EU and the United States can learn from each other's efforts to resolve the seeming paradox of delivering health care in such situations. Articles such as Dr. Graham's can facilitate this understanding.
LAURIE SHERWEN, PhD, RN, FAAN
ScKool of Health Professions
New York, New York
This article gives an overview of the position of European health policy within the European Union. A general introduction as to what the European Union is, its structure, and its purposes is followed by an explanation of the status of an overriding European health policy. What is revealed through the debate is the situation in which potential conflict between member states and the European Commission has suppressed the establishment of an integrated health policy. The debate also reveals a paradox, however, because other drivers and policy decisions are creating health policy in a partly unofficial and nonintegrated way. J Allied Health. 2004; 33:139-143.
Context of European Health Policy
The European Union (EU) (see map) is a family of democratic European countries committed to working together for peace and prosperity. It is not a State intended to replace existing states; it is an international organization, which is unique. Its member states have set up common institutions to which they delegate some of their sovereignty so that decisions on specific matters of joint interest can be made democratically at the European level (Table 1).
Europe is a continent with many different traditions and languages, but also shared values. The EU defends these values. It fosters cooperation among the populations of Europe, promoting unity while preserving diversity and ensuring that decisions are taken as closely as possible to the citizens.
Many Europhiles advocate across the EU that this cooperation should be based on the exporting of liberal and democratic ideas. The EU believes in the notion of a social contract between government and people, with reduction in inequality, the provision of public services, the principle that workers must be treated as assets rather than commodities, regulation of enterprise, rehabilitation of criminals, and tolerance and respect for minorities all featured in this contract. The commitment to a social contract between government and people is one of the core values of European democracy.
It is against these values that the creation of European health policy can be witnessed. According to the European Health Executive (www.dur.ac.uk/european.healthexec), European health policy is now an emerging discipline. The Executive argues that the health care systems in the member states continue to be exposed to radical policy changes and improvement programs. The isolated manner in which they function as member states and not a collective often dilutes the impact of the agencies engaged in health care improvement, however. …