Models of the determinants of health have gained significant traction since the publication of the 'Rainbow model' of health inequalities (Dahlgren and Whitehead (1991).Researchers have developed conceptions of the social, economic, political, commercial, environmental and behavioural determinants of health, and policy-makers have enshrined elements of these in the strategies and agendas that guide health and wider policy activity.Some of the resulting approaches have become mainstream pillars of public health and health policy.Following a 2008 World Health Organization (WHO) Commission and a wealth of research activity, the social determinants of health (SDoH) model, which encompasses economic, political and environmental factors, is now well established (World Health Organization 2008; Marmot and Wilkinson 2006; Navarro 2009).More recently, attention to the commercial determinants of health (CDoH) has increased markedly and this field has become a frontier in global health research and practice (Maani, Petticrew, and Galea 2022;De Lacy-Vawdon and Livingstone 2020;Gilmore et al. 2023;Freudenberg et al. 2021;Mialon 2020).Though conforming to a biomedical paradigm of "health determination", which presents its own set of concerns when applied to social processes and phenomena, these models have contributed to a more holistic understanding of health in both academic and policy circles.In this context, embarking upon a project to elaborate yet another health determinant, let alone one that is already implicit within existing models, might seem ill-advised.The term political determinants of health (PDoH) is not new.Moreover, the idea that it embodies -that
In response to the Covid-19 pandemic, the European Council agreed to provide major financial support to Member States. Drawing on a combination of the EU's long-term budget (2021–2027) and an additional temporary support system known as ‘NextGenerationEU' (NGEU), the EU has been providing funds to help Member States with the fall-out from the Covid-19 crisis. The so-called ‘Recovery and Resilience Facility' (RRF), at the core of the NGEU, provides financial support to Member States, notably through a combination of grants and loans (European Parliament and Council of the EU 2021). Resources made available through the RRF amount to 672.5 billion euros (360 billion euros in loans and 312.5 billion euros in grants – in 2018 prices).To access the RRF funds, Member States submitted detailed national Recovery and Resilience Plans (RRPs), in which they set out reforms and investments to be completed by 2026. In particular, RRPs are supposed to identify measures in policy areas of European relevance, structured in six pillars, deemed as key to achieving recovery from the Covid-19 crisis and to enhancing the long-term resilience of the EU and of its Member States (European Parliament and Council of the EU 2021: recital 10): (i) green transition; (ii) digital transformation; (iii) smart, sustainable and inclusive growth; (iv) social and territorial cohesion; (v) health, and economic, social and institutional resilience; and (vi) policies for the next generation, children and young people. In order to assess the adequacy of the RRPs, a set of criteria have been established, including their contribution to the green and digital transitions and to the implementation of the European Pillar of Social Rights (EPSR), as well as their consistency with the European Semester Country-specific Recommendations (CSRs) which the Member States received in previous years (European Parliament and Council of the EU 2021: recital 42).Reforms and investments linked to the RRF's ‘social and territorial cohesion' pillar are expected to help strengthen social dialogue in the Member States (European Parliament and Council of the EU 2021: recital 14); more generally, in drafting their RRPs, the Member States have been asked to report on how they conducted consultations with relevant national stakeholders, including the social partners and civil society organisations.
Policy implications:• Meaningful involvement of domestic stakeholders in the implementation of the national Recovery and Resilience Plans (RRPs) is key to ensuring the legitimacy of the Recovery and Resilience Facility (RRF). This is particularly true for social partners, also in light of the European Commission's intention to relaunch social dialogue at both the national and the European level. While the EU is going through multiple transitions and coping with several ‘crises', strong arrangements to ensure meaningful and effective social partner involvement in policymaking are needed more than ever.• Despite significant cross-country variation, national trade union involvement in the preparation of RRPs in most of the seven countries included in this analysis was far from satisfactory. Some improvement can be found at the implementation stage, although meaningful involvement is often limited to the implementation of specific measures.• Several shortcomings are still to be addressed to improve involvement in the implementation of the RRPs. These include, first, a mismatch of expectations as to the nature of the involvement process: specific EU guidance in this respect would be useful. Second, both trade union organisations and national administrations should be provided with sufficient resources to be able to engage in a meaningful dialogue under constant time pressure, during RRP implementation.
The spread of Covid-19 and the ensuing adoption of lockdown measures have had severe consequences for European labour markets. All EU governments quickly made unprecedented economic and social support available to tackle the consequences of the pandemic. However, these measures – introduced by EU Member States during the pandemic as regards unemployment benefits, sickness benefits and special leave for parents – have not fundamentally improved formal access to social protection schemes for non-standard workers and the self-employed. Especially in the domain of unemployment benefits, temporary (sometimes one-off), mostly flat-rate and means-tested benefits have been introduced for these categories, thus falling short in structurally addressing important gaps in their social protection systems, which pre-date the Covid-19 pandemic. The present report discusses the measures targeted at non-standard workers and the self-employed in eight countries: Belgium, France, Ireland, Italy, Lithuania, Portugal, Romania and Sweden. These case studies confirm the emergency and non-structural character of the measures but also provide innovative country-specific examples. The pandemic has triggered debates on the situation of specific categories of workers and on the need to address gaps in their protection (e.g. workers in the platform economy). It has also highlighted the active role that trade unions have played during the crisis. Nevertheless their involvement in the decision-making process has clearly been uneven across countries and has been dependent on political will and on the state of social dialogue.
