chapter  7
The EU’s Performance in the World Health Organization: Internal Cramps after the ‘Lisbon cure’
WithLouise van Schaik
Pages 16

This article analyses the European Union’s emerging role in international health issues and, in this respect, focuses on its activities within the World Health Organization (WHO). The European Union (EU) has gradually become a more unified actor in a range of policy areas that are subject to international cooperation. This is the result of expanded internal competence to make common European laws, the European Commission’s ambition for EU leadership on a range of international issues, and increased pressure to operate with a single voice. The latter is reinforced by a declining role of individual EU member states in the international system. In line with this development, the designers of the

Lisbon Treaty aimed at strengthening EU coordination on international affairs and ensuring a single external representation by a permanent EU representative. However, in the field of health, just as in other areas, a strengthening

of EU coordination and a joint external representation are not uncontested. EU member states consider health policy primarily a national prerogative, which Brussels should not interfere with (Greer 2006). This has repercussions for their willingness to cooperate internationally. At the same time, the political dimension of international health issues and reasons to cooperate on them are increasingly being recognised. WHO is no longer considered just another implementing UN agency, but instead a serious international organisation where issues with significant security and foreign policy impact are discussed (McInnes and Lee 2006). This combination of circumstances provides an interesting setting for analysing the evolution of the EU’s role and performance in WHO discussions. This article will consider if and why EU member states are willing

and/or legally obliged to operate with a single voice on issues discussed within WHO. It will analyse the EU’s performance in policy debates taking place within the organisation. It will look at two elements of performance. The first element is the effectiveness of the EU in terms of achieving its goals in WHO negotiations. The second element is the relevance of the EU’s involvement in WHO processes for the EU member states. It focuses on the extent of EU unity throughout policy-making processes by looking at EU coordination and external representation practices. In this respect it also discusses the efficiency of these processes in terms of time and resources invested. In addition, the financial viability of the commitments the EU engages in within the WHO will be briefly discussed, in order to see if they match the objectives agreed upon. The empirical information presented here is based on a study of docu-

ments, literature and other written materials, and on about 20 (telephone) interviews the author conducted in 2008 with representatives of EU member states and other experts involved in WHO negotiations. These interviews focused on WHO negotiations around two strategies: one on diet, physical activity and health (2004), and the other on public health, innovation and intellectual property (2008).1 The interviews also included more general questions on the evolution of the process of EU coordination in the WHO. This also allows them to be used for this paper. About five additional (telephone) interviews were conducted in 2009 and 2010 to check and update information. This article proceeds as follows: first, the overall relationship between the

EU and WHO will be discussed; second, the EU’s performance is considered. The concluding section will discuss whether an increased involvement of the EU’s foreign policy track, represented by the High Representative of the Union for Foreign Affairs and Security Policy and the European External Action Service, could offer opportunities for strengthening EU health diplomacy.