European Health Policy Group: Speaking Truth to Populism?

By Jan-Kees Helderman and Zeynep Or

Established over 20 years ago, the European Health Policy Group (EHPG) is a collegial network which aims to stimulate international collaboration and cross-country learning for improving evidence-based health policy. The network brings together a multidisciplinary group of researchers - from political science, economics, health services research, medicine, organization and management studies - and  policy advisers from across Europe, and North America because we  believe that Europe represents an idea rather than a strict entity defined purely by geographical boundaries. The EHPG holds two meeting a year, providing members with a forum for exchange and debate on a broad spectrum of subjects, always structured by the presentation of academic research and discussion papers. 

One of the most attractive aspects of EHPG meetings is the amount of time taken in discussing   individual papers. On average one hour is given to each paper so that the authors are assured of a thorough discussion and peer review feedback, something that is in stark contrast to many academic conferences where you are lucky to get a 15-minute slot to present and debate your work. The role of the EHPG discussant (who presents your paper on your behalf) is one of a critical friend as opposed to a hard-nosed peer reviewer.  Discussants often add their own perspective on the paper, informed by their particular academic or policy discipline and country background.  EHPG aims to bridge national and disciplinary boundaries, as well as those between academic research and health policy.

On 11 and 12 May 2017, the EHPG Spring meeting was hosted by Judith Smith and Laura Griffith at the Health Services and Management Centre of the University of Birmingham.  

At the EHPG Spring meeting, there is often a specific focus on a critical issue or reform facing the host country.  This year’s topic was the implications of Brexit for the NHS. Professor Mark Exworthy (University of Birmingham) presented his analysis of the immediate issues that will likely be faced by more than a million British citizens living in other European countries if they lose their European health insurance card and reviewed how the matter of cross-border care is used in the wider Brexit debate. A paper by Gilles de Wildt, comparing different scenarios for Brexit and the NHS, gave a taste of the impact a ‘hard Brexit’ might have on the NHS, its workforce supply, public health policy, and health research in the UK.

A paper submitted by Ewen Speed (University of Essex) and Russell Mannion (University of Birmingham)  helped us to broaden the focus of our discussions from Brexit to political populism in general and to explore its dynamics and consequences for health (care) policy, building on a previous publication by the authors. Nationalist and populist movements are gaining momentum in Europe (e.g. in the Netherlands, France, Denmark) and in the United States, appearing to echo some of the sentiments expressed as part of  the British Brexit vote, with the claim of re-establishing the boundaries of nation states, limiting migration from outside, and restoring a sense of apparently lost national identity.

Whereas Brexit can be conceived of as about identifying an ‘enemy out there,’ across the sea and external to ‘the common people’, responsible for  domestic problems, some populist policies in other European countries also identify ‘enemies within’, people who, by virtue of some background factor should be limited in their access to care.

Populism is something that health policy researchers can no longer ignore. Populist policies are fundamentally incompatible with a universal healthcare system because they are likely to legitimize, at the very least, inequalities in access to care, dividing the population to those who deserve health care (or specific services) and “others” who are defined as outsiders and/or undeserving (in France gay couples were also targeted), somehow responsible for many national policy problems such as limited funding and waiting times within a health system.

The ambiguity and inexactness of populism as a concept, makes it analytically slippery, powerful and potentially dangerous. Therefore, the paper for EHPG by Ewen Speed and Russell Mannion was particularly helpful for its understanding of populism as a political phenomenon, exploring its strategies and narratives in health policy by using examples from the UK, US and mainland Europe. Speed & Mannion show that objective facts and evidence are increasingly found to be less influential in shaping public opinion than appeals to emotion or “alternative facts”.  In the context of the UK NHS, the populism that has arguably been legitimised via Brexit will potentially promote further inequalities in health status and provision, along with  a likely deterioration in the diversity and availability of the health and social care workforce.  

In these turbulent and perplexing times, the prospect of ‘hard Brexit’ along with populism gaining further traction in different European nations is depressing and holds significant risks for the solidarity and equity that has underpinned much of Europe’s health policy and healthcare systems. Our EHPG meeting in Birmingham challenged us to think about how we as a group can contribute to ‘deconstructing’ and understanding populism in respect of health policy and systems; develop our own means to tackle ‘fake news’ about health funding and systems, and have an impact on the wider public debate about the future of Europe and its health policy as a matter of urgency.

We do not have all the answers yet, but will continue our exploration of the ‘causes and consequences of populism’ at the next Autumn meeting of the EHPG which will take place at the London School of Hygiene and Tropical Medicine on 21-22nd of September 2017. If you wish to be kept informed about EHPG and our upcoming meetings, sign up to the EHPG mailing list (ehpg@jiscmail.ac.uk) or go to our website (www.ehpg.org).

The views and opinions expressed in this article are those of the author and do not necessarily reflect the official policy or position of the University of Birmingham.