The case studies explore the ways in which ten regions address health in their Structural Funds programmes for the 2007-2013 spending cycle. The case studies are based on 21 Structural Fund Operational Programmes, strategic documents issued by regional health authorities, and over 20 interviews with regional development and health experts. In addition to providing input to this guide, the ten case studies contain examples of how things are done in practice.

The case studies reveal significant differences across regions in their approach to the integration of health in Structural Fund programmes. However, several common findings emerge: 

  • Programme managers often have not considered health authorities and stakeholders as essential to programme planning and monitoring, unless direct investment in health care systems is an investment priority. This means there has been a limited opportunity for health experts to provide input on the potentially substantial health gains (and impacts) from non-health investment sectors.
  • At the same time, in many regions health policy makers and those responsible for the health care services have not shown an interest in the programmes if there is no direct funding for health care or health infrastructure projects. The scope of the dialogue needs to be broadened beyond statutory health authorities, to areas such as social care and well-being.
  • To enable a comprehensive and dedicated approach to health and wellbeing in the programmes, EU-level encouragement is needed. A “bottom-up”, awareness-raising-based approach to the integration of public health concerns into Structural Funds programming is also useful, but can only go so far due to resource constraints and competing priorities.
  • Innovative projects that target health determinants are often complex, cross-sectoral and have long-term goals. In many regions, especially those in lower income Member States, large-scale infrastructure projects with short implementation time frames and immediately recognisable outputs are often prioritised for funding. It is therefore a greater challenge in these regions – where the need is often greatest – to fund projects that actively integrate public health concerns.
  • Following on the above point, regions tend to focus more on “soft” cross-sector investments - such as those affecting public health - as they become more developed (and consequently, their eligibility for large-scale infrastructure interventions under Structural Funds regulations becomes limited).
  • The socio-economic implications of public health are more clearly seen at the regional and local levels. Local and regional authorities and actors are more likely to develop cross-sectoral approaches that address public health concerns: greater participation by these authorities and actors in discussions for the preparation of operational programmes will thus be valuable.
  • In many regions, Structural Fund programming has overlooked and failed to capture the health gains from non-health investments. In the next cycle, programme managers and health officials have an opportunity to publicise health benefits, and ultimately to optimise them through more targeted programmes and projects. Moreover, programmes should seek to identify address potential negative health impacts.