Beyond the Window of Opportunity: Policy Stream Dynamics and the European Health Union

The establishment of the European Health Union represents a substantial shift in European health policy. For decades, this policy field was characterized by limited formal responsibilities, fragmented governance structures, and structural subordination to single market logics (Greer & Jarman, 2021). Existing literature predominantly interprets this development as a reactive response to the COVID-19 pandemic, which, as an exogenous shock, exposed shortcomings in national crisis management and increased political pressure for action (McKee & de Ruijter, 2024; Ferrera et al., 2024). However, this perspective primarily explains the timing of the reforms, not their specific content or institutional compatibility. This paper develops an alternative explanation by analyzing the emergence of the European Health Union using the Multiple Streams Framework (Kingdon, 1984; Herweg & Zohlnhöfer, 2023). The analytical focus is on the long-term development of the policy stream and how public health has emerged as an independent, programmatically coherent framework at the EU level. Empirically, the study is based on a systematic, document-based process-tracing analysis of EU legal and policy documents from 1992 to 2026, identified exclusively via EUR-Lex. The results show that key elements of the European Health Union were not developed in the wake of the pandemic, but rather built upon programmatic structures, coordination instruments, and knowledge infrastructures in the field of public health that had been developed over decades. The COVID-19 pandemic thus acted as a focusing event, enabling the integration of existing solutions with a politically open window.