The EU as a Global Health Actor: Policy Coherence, Health Diplomacy and WHO Reform

This article explores the European Union's (EU) role and position on global health, including its role in the World Health Organization (WHO), and the impact of the Lisbon Treaty. Struggles over the implementation of the Lisbon Treaty potentially undermine the EU's ability to speak with one voice and its effectiveness. EU influence is determined by the remit of the EU (defined by competences outlined in the Treaty on the Functioning of the EU, TFEU), as well as the specific rules and procedures of international institutions. Based on empirical research, we considered the role of the EU in global health, via policy and policy coherence across the EU when it came to health matters (including the WHO reform) and through EU representation within multilateral fora. We conclude that the EU is a significant player in global health. It has established global health policy and played a leadership role in negotiating international health agreements. It has had a coordinated voice at the WHO, whilst being less cohesive in other multilateral health fora. Effectiveness of EU representation at the WHO was affected by a number of factors, including Member State's (MS) trust in EU representation and reluctance to cede competence on health matters, lack of EU flexibility in negotiations, lengthy EU coordination processes, MS vying for influence within the EU, and MS rather than EU engagement in behind the scenes and 'soft power' diplomacy. Vertical and horizontal integration within and across the EU also determined EU influence within international organizations. The Lisbon Treaty also had limited impact due to MS and others' concerns about the EU acting on institutional matters. The results are considered in light of the role that global health plays within foreign policy, the multitude of global health actors and prior theory and research on the EU's role in multilateral governance.