5 - Public health policies  pp. 231-281


By Martin McKee, Tamara Hervey and Anna Gilmore

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Introduction

This chapter considers how the European Union (EU) has discharged its obligations to develop and implement public health policy, obligations that arise primarily from its competences granted by Article 152 EC and Article 95 EC on the creation of the EU's internal market.

In doing so, the EU confronts four important tensions. The first concerns the relationship between those matters that are national and those that are international. Throughout history, threats to public health have transcended national borders, initially in the form of infectious diseases and more recently in the form of trade in dangerous goods, such as tobacco. Yet, reflecting the absence of an appropriate international architecture, responses have largely been developed and implemented at a national level. This only began to change in the latter part of the nineteenth century, when a series of international sanitary conferences began a process that would, in time, lead to the creation of the World Health Organization. However, even now, international public health remains a state-based model, involving interactions among state-defined actors, albeit through institutions established in international law.

The nub of this tension is that the EU is neither an international public health organization nor a state. The EU lacks the public health expertise, resources and experience of international bodies such as the World Health Organization, the World Bank or UNICEF. It also lacks the capacity – in particular, the financial and human resources – of a state, which would enable it to deliver public health policies.