‘Health in All Policies’ at EU Level: A Critical Analysis

The politics of non-communicable diseases (NCDs) has been the focus of a growing body of research. Political, social and macroeconomic determinants of NCDs are increasingly well understood. Consequently, ‘Health in All Policies’ (HiAP) was introduced to the EU in 2006. HiAP is an approach to policymaking which seeks to prioritise and mainstream health across policy areas. This thesis offers a critical analysis of HiAP at EU level, in relation to broadly defined health promotion. While HiAP has been looked at from a technical angle, this thesis uses discursive institutionalism to engage with the ideational dimensions of HiAP in the EU. This normatively-oriented research agenda builds on the work highlighting links between neoliberalism and ill-health. It explores the tensions between neoliberalism as a determinant of ill-health, and HiAP. The empirical analysis of HiAP in the EU is divided into three sections: first, the institutional context offers insights into how the EU institutional architecture, with its ingrained neoliberal bias, limits the space for HiAP. Secondly, the thesis goes beyond institutional power and zooms into the EU background ideational structures. This section sheds light on how neoliberalism underpins paradigms and frames around health and knowledge, and how that affects the scope for HiAP. The third empirical section looks at foreground discursive abilities, the agential space to define HiAP. It draws on the concept of ‘chameleonic ideas’ to argue that, on one hand, this space for agency is used to co-opt and water down HiAP. On the other hand however, this space for agency can also be used to reshape and adapt HiAP. This is seen in the shift from HiAP towards the ‘economy of wellbeing’. Finally, the thesis offers reflections on the potential synergies between chameleonic HiAP, and radical degrowth discourses to push for endogenous institutional change.