Using Q-Methodology to Study Concurrent Policy Change: The Emergence of the European Health Union

How can we study concurrent instances of structural policy change? How can we identify policy preferences across simultaneous agendas amid conditions of ambiguity? Combining an innovative application of Q-methodology with a modified iteration of the Multiple Streams Framework (MSF), adapted to the EU level, this paper addresses these questions through the case study of the emergence of the European Health Union. The European Health Union is a loosely defined framework constituting the EU’s consolidated response to future public health threats, which emerged in the aftermath of the COVID-19 pandemic. It encompasses a series of concurrent structural reforms initiated shortly before, during, and after the outbreak of the COVID-19 crisis. The findings demonstrate how the COVID-19 crisis was strategically leveraged by EU policymakers to complete the pharmaceutical sector’s transformation from a single-market-oriented field into a health-policy-oriented one through a mechanism of “concentric circles coupling.” The paper offers theoretical and methodological contributions to policy process and MSF research in the EU and beyond, including the development of novel metrics for assessing relative policy network integration and issue prioritisation. Finally, it advances understanding of how narratives can be deployed to sustain and expand short-term momentum in the pursuit of long-term policy transformation.