Better Regulation for Better Health

This project is about how policy-makers balance the protection of health with the need to encourage economic growth by reducing burden on businesses. Governments address this balance through a set of mechanisms known as Better Regulation (BR). The project asks whether BR is undermining health regulation in the EU and the UK and what can be done about this.

Most European governments have BR programmes which try to reduce the volume and burden of their legislation, and many face opposition for civil society organisations (CSOs), concerned that this might threaten health protection. The first part of the project focuses on the EU, where there is evidence that corporate interests, such as big tobacco companies, had a role in the design of the Better Regulation Agenda (BRA) and anticipated that it would help them to weaken anti-smoking rules. The BRA applies to all EU policies so the potential damage of an unbalanced process is significant. However, a number of things are not known for certain:
- The extent of the problem - exactly what impact (positive or negative) on health is being seen as a result of the BRA?
- Why it is happening - what part of the BRA is causing the problem? Is there an issue with the kind of scientific evidence used, or the actors involved, perhaps?
- How is this related to broader pressures to deregulate and oblige big business?

The first stage of the project seeks to answer these questions and, in doing so, to change the way in which the BRA works. It focuses on a particular element - a process known as REFIT (Regulatory Fitness), in which existing laws are reviewed to make sure that they do not present an undue burden for business. It will use four case studies; pieces of law which the EU has chosen to improve using REFIT. CSOs will help to choose three of these but the fourth will be the REFIT review of the Air Quality Directives. Taking these as an example, the project will:
1. Develop the analytical framework. How will we know if the air quality rules have been weakened? How can we measure this?
2. Build the dataset. We will gather all documents from the review of air quality law, interview key people involved and construct a map of how the process worked.
3. Analyse the data. Using our analytical framework, we will assess whether the review has strengthened or undermined health objectives, how this has happened, and how this relates to broader policy patterns.
4. Build capacity and share knowledge. Throughout the project, we will train CSOs interested in air quality and health, share what we have learned, and promote change in the BRA.

In the second phase of the project, these steps are replicated at the UK level, looking at the UK's BR programme. This will involve engaging in debates about the UK's rapidly changing regulatory framework as its links with the EU continue to evolve. By the end of the project we will (a) know how BR has affected health, (b) have built CSO capacity for involvement in future reviews, and (c) have established a network of actors working for the improvement of health regulation in the EU, UK and beyond.

To be sure that the project reaches the right audiences, two organisations with experience in BR in the EU (the European Public Health Alliance) and the UK (New Economics Foundation) will be closely involved. Their extensive network of CSOs and policy-makers will help the project to reach a wide audience of actors who can shape the way in which BR works and what it achieves. This change is urgently needed; improving laws and policies is not a new idea but, in the aftermath of the economic crisis, governments have renewed their efforts to simplify regulation and cut red tape. Moreover, as the UK adapts its changing relationship with the EU, the form of BR that it adopts will impact upon the 'health' of UK public policies. This project provides the tools to ensure that such reforms are designed to strengthen health policy, not undermine it.

Mapping stakeholders and 'change agents'

The BRA is set and implemented by the European Commission's Secretariat General (SG), which also holds the power to reform its mechanisms and priorities. Inputs into the process come from four main groups: representations of member states (MS; supported in this case by national health attachés), the European Parliament (EP; specifically, in this case, the health committee, ENVI), civil society organisations (CSOs, directly and via lobbying of MS and ENVI) and industry. The influence, interests and potential engagement of these stakeholders was discussed with a key research user (European Public Health Alliance, EPHA). Industry is deemed an inappropriate partner, since its participation in BR is governed by commercial interest and is often in conflict with health objectives, whilst MS and the EP are unlikely to engage until their action can be framed in a positive, proactive manner (see pathways to impact statement). Health attachés and ENVI members may be interested in findings which can help them achieve their health-promotion goals, but only where these align with their strategic political interests. Thus the main beneficiaries of the research, also acting as intermediaries, will be those directly seeking change in the BR process - CSOs from health and other sectors - since it will equip them with the tools and knowledge needed to achieve their objectives in this area. As such, the project is designed around a programme of engagement with key change agent, EPHA, and its networks.

Who will benefit from this research?

- [directly] CSOs concerned with EU health policy
- [directly] CSOs in other sectors (e.g. climate) and settings (e.g. national)
- [via intermediaries] National health attachés
- [via intermediaries] European Parliamentarians
- [long term] Representations of MS
- [long term] European Commission SG
- [indirectly] European citizens and society more broadly

Since the overarching objective is to better protect and promote health via European public policies, there is a clear, if indirect, benefit to European citizens. However, the nature of EU policy-making, being remote from the level of the individual, and of the BRA, as a horizontal framework rather than a specific policy issue, make direct, grassroots engagement unsuitable in this case. Rather, for the purposes of the project, social interests are represented by CSO stakeholders.

How will they benefit from this research?

The research will provide three key insights for CSOs:
(1) a comprehensive evidence base, presenting and explaining the precise impact of BR upon health, including the specific features which undermine / strengthen health
(2) a better understanding of their own role in the BRA and how best to maximise this, including examples of best practice from other sectors
(3) strategic knowledge of how other actors, particularly those working to conflicting ends, are using the BR agenda to further their own interests.

CSOs will use these insights, respectively, to:
- support advocacy efforts and persuade stakeholders with greater influence (e.g. MS and EP) to lobby for long-term change
- raise the quality, relevance, value and overall efficacy of their engagement with the existing BRA
- frame their arguments and evidence in a way which effectively counter-balances opposing interests.

This action builds on and will feed into existing civil society campaigns, such as the Reprotection campaign, launched by the New Economics Foundation (NEF) and others to defend EU rules against a 'deregulation drive', and the EU4Health campaign, launched by EPHA and others to save health as a policy priority under the next European Commission. These debates and the advocacy that surrounds them are ongoing and will intensify as the next European Commission takes office at the end of 2019 and embarks upon its new work programme in 2020 and beyond.