An interview with Anniek de Ruijter, Professor of Health Law and Policy at the University of Amsterdam, about the European welfare state model and its relevance for EU and global health issues.
HEALTHY EUROPE
We are living in a time marked by acute crisis – the COVID-19 pandemic and the war in Ukraine, as well as ongoing challenges like demographic shifts and climate change. Does this endanger the model of people-centric welfare states in Europe?
Anniek de Ruijter: On the contrary, you could even go as far as to say we’re currently experiencing a revenge of the European welfare state, after its accomplishments were disputed and also dismantled to varying degrees in many countries since the 1980s. The COVID-19 pandemic has prompted the majority of policymakers to reaffirm their commitment to this model. Of course what will come of this remains a question.
HEALTHY EUROPE
Was the COVID-19 pandemic a kind of catalyst for this development?
Anniek de Ruijter: The COVID-19 pandemic did indeed play a significant role here. It not only showed us as individuals how much we rely on each another, but also highlighted the central importance of an inclusive and fair welfare state, and ultimately also the importance of a strengthened solidarity among Member States at European Union level. Prior to the COVID-19 pandemic, facilitating the joint purchase of vaccines and medicines so quickly or taking on debt jointly to cope with the consequences, and thus make the EU’s Recovery and Resilience Facility a reality, was all but unimaginable. And the EU also set up the Health Emergency Preparedness and Response Authority (HERA) as a new body in the field of healthcare with an annual budget of one billion euros.
The European Union is in the first stages of performing a role in health governance at a global level.
ANNIEK DE RUIJTER, PROFESSOR OF HEALTH LAW AND POLICY AT THE UNIVERSITY OF AMSTERDAM
HEALTHY EUROPE
The COVID-19 pandemic has also led to the realisation that, like environmental issues, health issues must be considered on a global scale. To what extent is this already being taken into consideration in the European Union?
Anniek de Ruijter: The European Union is in the first stages of performing a role in health governance at a global level. The EU is playing a leading role in the adoption of the international pandemic treaty, which the World Health Organization intends to present in 2024. This treaty is expected to include a variety of measures to reduce inequalities in pandemic preparedness between the Global North and Global South. The EU Global Health Strategy was introduced back in November 2022 with the same goal of improving global health security and delivering better health for all. Also, the work of the European Medicines Agency (EMA) establishes standards that are recognised worldwide. This has been called the “Brussels” effect, and it means that EU regulation that might be intended to have an impact only for Europeans, can have a direct and indirect impact on the health of people beyond.
HEALTHY EUROPE
Can you give some examples?
Anniek de Ruijter: The 27 countries of the European Union are collectively the second-largest exporters and importers of goods in the world. Only China and the United States export and import more goods respectively. In global health the trade aspect is very important. Legal instruments such as the EU Supply Chain Law, which is currently under negotiation, can really set a new standard outside of Europe and contribute to better health and living conditions for people around the world. It establishes standards that companies within the EU must adhere to throughout their supply chains and thus has a knock-on effect on supplier companies based outside the EU. Amongst other things, the law contains regulations intended to prevent child labour, ensure fair wages and protect the environment. There are definite issues here that can be raised regarding a new type of colonialism, but on the other hand these supply chains are there, and it remains unfair if in Europe we are not paying for the unhealthy situations we create elsewhere in the world. In any case, there is more than health legislation alone that can make an important contribution to ensuring better health.
HEALTHY EUROPE
What is needed in order to safeguard the European welfare state model for the future?
Anniek de Ruijter: The European welfare state model is a success story. One reason for this is because investments in social security and the health of the population ultimately benefit other important aspects of our communities as well. In order to ensure its future, it needs to adapt to the changes brought about by new ways of working, digitalisation, demographic shifts, and the challenges of climate change. This may also mean changing how the welfare states are funded and adjusting the taxes levied on income from work, capital, wealth, inheritance, consumption and carbon emissions accordingly. The fundamental principle of the European welfare state model remains unchanged: to ensure social security and healthcare for all, while providing targeted support for the socially disadvantaged. The European Pillar of Social Rights has established an important foundation for consolidating and expanding the European welfare state model at EU level. I would like to see this pillar being supported by appropriate legislative measures and consideration being given to the topic of health specifically in accordance with its importance. The European Pillar of Social Rights will certainly be a particular focus of Belgium’s EU Council Presidency from January to June 2024.
Anniek de Ruijter was born in 1982 and is Professor of Health Law and Policy at the University of Amsterdam as well as a member of the Board of the European Health Forum Gastein.
What constitutes a welfare state?
Welfare state is the term used to describe a state that seeks to provide high levels of social security and welfare services for its citizens through comprehensive programmes such as compulsory health insurance, pension schemes and unemployment insurance, as well as appropriate social policies such as state support for education and retraining, and housing subsidies. In addition, a welfare state includes state support for wealth accumulation, social tax benefits and comprehensive public infrastructure such as educational and recreational facilities.
Source: Abridged from a glossary entry (in German) on the “welfare state” on the website of the German Federal Agency for Civic Education: https://www.bpb.de/kurz-knapp/lexika/lexikon-der-wirtschaft/21166/wohlfahrtsstaat/, accessed 25 August 2023
THE FUTURE OF THE WELFARE STATE IN THE EU
A group of eleven experts examined the future of social protection and the welfare state in the EU between November 2021 and December 2022. Anna Diamantopoulou, former European Commissioner for Employment, Social Affairs and Equal Opportunities chaired this high-level group. The final report on their work contains nine recommendations on the measures that are predominantly important for safeguarding the welfare states in Europe. Specifically, these are:
1 Starting strong: nurturing child development for all
2 Creating a springboard for the young generation
3 Ensuring inclusive social protection and lifelong learning
4 Supporting longer careers in good health to safeguard adequate retirement incomes
5 Ensuring equitable and high-quality long-term care provision
6 Promoting inclusive and environment-friendly housing and transport
7 Ensuring sustainable financing for a resilient welfare state
8 Ensuring inclusive service provision that enhances well-being and capabilities
9 Stepping up EU capacity to secure social protection in the future.
Source: “The future of social protection and of the welfare state in the EU”, Luxembourg: Publications Office of the European Union, 2023