Interest groups in EU health policy: Revisiting insider-outside models in the context of commitments to civic space

The number of interest groups active in European Union (EU) policy-making has increased significantly, as has the EU’s commitment to broad stakeholder consultation and transparency in the policy process. Yet, civil society actors, in particular, point to deficiencies in the current system for participation in policymaking, citing lack of meaningful engagement and imbalance in representation of different types of stakeholder (EPHA, forthcoming). This paper attempts to explain why a proliferation of interest groups and mechanisms for engagement in EU level policymaking has not resulted in the vibrant, productive civic space that this would seem to support. It focuses on policymakers’ responses – specifically those of the Health and Food Safety directorate general of the European Commission (DG SANTE) – to a rapid and significant increase in stakeholder constituency. Health was reported to have 149 interest groups in 2009, the second highest across all Commission DGs (Coen, 2009: Table 8.1). Greer et al. (2022, p. 63) report that, as of January 2022, the EU Health Policy Forum had more than 11,000 registered members. Across a similar time period, mechanisms for systematic stakeholder participation have been enshrined in the Better Regulation agenda, which commits to ‘involving citizens, businesses and stakeholders in the decisionmaking process’ (Lauber & Brooks, 2023). Theories of interest group politics suggest that, to manage the ‘babble’ of multiple groups, policy-makers create ‘insiders’, smaller groups of stakeholders from which crucial policy information can be solicited (Broscheid & Coen, 2003; Dür & Mateo, 2016). How such insiders should be identified and what determines their insider status is contested but, owing to its emphasis on transparency and the resulting availability of new data, the EU offers a valuable site for exploring the question of insider interests. Using a newly constructed dataset, we identify and describe the interest group ecology in EU health policy. We analyse engagement, utilising data on participation, memberships, and dimensions of activity (across levels of governance and policy topics).The paper aims not only to refine the insider-outsider distinction, but also to explore whether a governance approach focused on accountability and transparency, rather than addressing the imbalance in power between different stakeholder groups, is able to produce meaningful civic engagement. Broscheid, A., & Coen, D. (2003). Insider and Outsider Lobbying of the European Commission: An Informational Model of Forum Politics. European Union Politics, 4(2). Coen, D. (2009). Business Lobbying in the European Union. In D. Coen & J. Richardson (Eds.), Lobbying the European Union : Institutions, Actors, and Issues. Oxford University Press. Dür, A., & Mateo, G. (2016). Insiders versus Outsiders: Interest Group Politics in Multilevel Europe. Oxford University Press. Greer, S. L., Rozenblum, S., Fahy, N., Brooks, E., Jarman, H., Ruijter, A. d., Palm, W., & Wismar, M. (2022). Everything You Always Wanted to Know About European Union Health Policies But Were Afraid to Ask (Third ed.). WHO Regional Office for Europe. Lauber, K., & Brooks, E. (2023). Why meta-regulation matters for public health: the case of the EU better regulation agenda. Globalization and Health, 19(1).