From the start, the WHO Commission on Social Determinants of Health built its case for taking action on the social determinants of health, unashamedly, on principles of social justice. Quite simply, the Commission stated that health inequities in the sense of avoidable and preventable differences in health between countries, and between groups within countries according to income, occupation, education, ethnicity or between men and women, are unjust. Taking this position has brought praise and blame: praise for the Commission’s boldness in putting fairness on the global health agenda1 in the face of the dominant global model of economic growth as an end in itself, and blame for the Commission’s unworldliness in apparently not recognising that economic arguments push the political agenda.

In the Lisbon Agenda, the European Union’s member States have committed themselves to invest in becoming the most competitive economy in the world. In this paper we review the evidence on whether investment in health should be part of this process. Concentrating on microeconomic studies, we show how better health can increase productivity and labour supply. In addition, there is an indirect positive effect through the investment that healthy people make their own education. Governments pursuing sustainable economic growth – broadly defined – should include the health of their population along with education and physical infrastructure in a balanced investment strategy.

Over a four-decade long period, a health gap has opened up between European countries, in particular along the East/West dimension. One could speak of a European health divide. The divide is growing larger and, at the same time, shifting eastwards, leaving countries such as Russia, Ukraine, Belarus and Moldova at an increasing health disadvantage. Health inequalities, or differences between social classes, within European countries also seem to have been growing for the last couple of decades. Those countries that were previously led by communist regimes today show larger health inequalities than do countries in Western Europe. The countries that were once part of the Soviet Union demonstrate the most alarming health trends, with large segments of the population actually experiencing falling life expectancies. Reducing global and European health inequalities so that the health chances of a newborn child are not dependent on which country and social class he or she is born in, is a truly formidable task, which implies an entirely new way of seeing human development.

The Liverpool City-region Health is Wealth Commission was established to examine the growing divergence between the City-region’s public health status and its marked economic growth, specifically looking at links between health and productivity, identifying knowledge-gaps, and encouraging a more focused and collaborative alignment between the business, research and public health agendas. Over 18 months of investigation, Commissioners considered a wide range of research-based and plenary evidence from a number of key witnesses. The Commission made 12 final recommendations within six core themes: Alcohol, Smoking & Obesity; Incapacity Benefit; Wellbeing at Work; Beyond the Built Environment; Procurement; and Knowledge Capital. The Commission’s findings were published in September 2008, as part of Liverpool’s European Capital of Culture programme.

Alcohol is an important part of European culture and Europe currently has the world’s heaviest alcohol consumption. There is some evidence for harmonisation of drinking habits across Europe, particularly in the total per capita consumption, types of beverage and frequency of teenage drunkenness. As part of this pattern, increasing consumption and deleterious health effects have been particularly noticeable in the United Kingdom and Ireland, and deaths from cirrhosis in these countries now exceed EU averages. This is a difficult area for Governments where the tension between regulation and personal choice is conspicuous and widely debated. In the UK, regulation has been weak but there are signs that the appetite for tackling the twin drivers of price and availability may be increasing.

Excessive alcohol consumption is linked to a variety of major health problems, including the severe inflammation of the pancreas, which may lead to premature death of the individual.1 Hospital admissions in the United Kingdom due to acute pancreatitis were recently shown to have doubled over a 30 year period,2 in parallel with an estimated doubling of alcohol consumption in this country, and the incidence of the disease is dramatically increasing. Within the European Union, acute pancreatitis may attain an incidence of up to 1 per 1000 individuals per year. In accord with trends in drinking lifestyle in the UK, admissions of younger people and women have correspondingly escalated over the last few decades, and alcohol-related problems have placed a heavy financial burden on the healthcare system. So-called ‘binge drinking’, a prevalent feature of the current ‘drinking culture’, is commonly linked to patients presenting at clinic with episodes of acute pancreatitis, often manifested initially as excruciating abdominal pain and vomiting. Of these individuals, approximately 20% will develop a more extensive form of the disease with significant pancreatic necrosis triggering a systemic inflammatory response syndrome (SIRS) that may cause multiple organ failure; up to a third of these patients will die. The extent of necrotic cell death in these patients is a major determinant of the severity of acute pancreatitis and disease outcome.3 However, the precise way in which alcohol triggers the cellular damage that forms the basis of this severe and debilitating disease has remained elusive.

As part of their conflict handling repertoire, political systems possess a range of mechanisms to suppress or avoid conflicts. A closer look across Europe would yield a broad tapestry of mechanisms for handling the thorny issue of European integration, with most governments and political systems relying on some version of conflict avoidance. In this picture, one should expect that a country such as Norway, which has rejected EU membership twice, has an active and vocal anti-membership organization, and where polls consistently show a ‘no’ majority, would stand out as the exception, in the sense that there would be no need for the Norwegian political system to take any measures to suppress the issue. But reality is more complex. Since the early 1990s, when Norway entered into the EEA agreement with the EU, Norway’s relationship to the EU has changed dramatically. Norway’s current arrangement with the EU is perhaps best labelled as ‘tight incorporation without formal membership’. This situation is managed through arrangements not to raise the EU membership issue. In this article, I rely on Stephen Holmes’s notion of ‘gag rules’, as a particular means of issue avoidance. This mechanism speaks of how actors seek to remove debate on a controversial issue that does not go away: it is a matter of stymieing debate on the issue but not stopping to deal with it. If anything, the lid on debate on EU membership helps the political system to keep alive an active process of Norwegian adaptation to the EU, with serious implications for Norwegian democracy.

This article addresses the critical issue of how constitutional designing of the EU is related to the expression of collective identities. A European collective identity is perceived in terms of the discursive representation of the underlying demos of a European democracy. Against the common view that holds the self-identified political community as prior and independent of constitutional designing, it is claimed that democracy rather operates through the identification of popular subjectness. The demos is signified and recognised as distinct and internally coherent through democratic practice. In the empirical part, it is tested out to what extent public debates on EU-constitution-making were linked to the identification of the popular subject of democracy. By drawing on a comparative media survey of constitutional debates from 2002–2007, the article distinguishes different markers of collective identities (national, European or multiple) that were used for representing and signifying democratic subjects in the EU.