European integration in the era of permissive dissensus: Neofunctionalism and agenda-setting in European health technology assessment and communicable disease control

Abstract:

This article questions the argument that we need a post-functional theory of European integration. We suggest instead that the integrative mechanisms of classical neofunctionalist theory explain advances in European integration in the twenty-first century, especially if incorporated into a broader understanding of policymaking grounded in the multiple streams approach.

Neofunctionalist mechanisms, in our understanding, work by changing the contents of the problem, politics and policy streams, systematically biasing all three toward integrative solutions to European problems.

We illuminate our argument with two cases of integration in health policy, namely communicable disease control and health technology assessment. In these areas, as with other areas of European Union health policy, substantial European integration has taken place since 2000 despite long-standing member state reluctance to integrate and Lisbon treaty language discouraging integration.