HERA-Research: Access to Healthcare in Europe

In 2019, the HERA network, along with the European Commission, invested €20 million in 20 European research teams as part of its fourth joint research program ‘Public Spaces: Culture and Integration in Europe’. "Healthcare as a Public Space: Social Integration and Social Diversity in the Context of Access to Healthcare in Europe" is one of the funded projects.

"Healthcare, understood as a medical space, is an excellent example of a public space that models the processes of social integration and social equity", says Prof. Dr. Florian Steger, HERA-Project Leader at Ulm University in Germany. 

Although the issues of minorities’ equality are central to European Institutions, European guidelines are mostly still not observed in the national legal regulations and healthcare practice. Our key question is: How is access to healthcare shaped in Germany, Slovenia, Croatia, and Poland?

Steger is Director of the Institute of the History, Philosophy and Ethics of Medicine at Ulm University.

Due to the COVID 19 pandemic, access to healthcare in Europe is more important than ever. This project explores various barriers of access to health services before and during the pandemic. The crucial question is: Is it really true that everyone with chip card gets access to health services and is cared for? Not at all, as the HERA project shows. "We see social inequalities at both the national and international level that do not allow equal access to healthcare", Steger states, "This depends on social determinants such as ethnicity, religion, gender or sexual preference".

Essential: Humanities and social sciences

Prof. Dr. Florian Steger, HERA-Project Leader at Ulm University in Germany

Prof. Dr. Florian Steger, HERA-Project Leader at Ulm University in Germany

Elvira Eberhardt, Ulm University

"Our institute as well as our HERA-project, which is conducted through the collaboration of four national project groups, are an oasis of diverse scientific cultures", Steger states. His interdisciplinary and international team includes physicians, political scientists, medical ethicists, anthropologists, philosophers, to name a few disciplines. And this diversity of knowledge is needed to answer the fundamental questions concerning access to healthcare. "Healthcare is a public space, a political space, a cultural value space and a medical knowledge space. In order to clarify, how access to healthcare is shaped, it is essential to include all these areas. To do so, we need the knowledge from the humanities and social sciences". This insight, that the humanities and social sciences must have a firm place in the healthcare system, was also a result of the Healthcare Roundtable at the European Humanities Conference 2021 which took place in May 2021 in Lisbon, where Steger presented his HERA project.

Diversity and access to healthcare

"Healthcare can connect diverse groups of a society under the common idea of health and illness. However, depending on its organization, it can also influence societal segregation of minority groups", Steger says. Therefore, the research focusses on the concept of diversity in different European countries. Aspects of ethnicity, religion, gender, and sexual orientation are viewed both in the general social context of healthcare as a public space, as well as in the specific context of medical institutions conceptualized as public locations.

Special focus on Eastern Europe

The aim of the HERA project is to gain knowledge about how and to what degree the European norms and guidelines concerning diversity are implemented in national legal regulations in Germany, Slovenia, Croatia, and Poland and how they are applied in clinical practice in these countries. There are four levels to be considered, as Steger outlines: "First, guidelines and legal regulations of the European Institutions (EU primary and secondary law) and second, their implementation in national laws will be analyzed. Third, the project will evaluate how they are implemented in hospitals. And forth, in-depth interviews will be conducted with healthcare managers, professionals, and patients. The interviews will contribute crucial information on ethical issues raised by the phenomenon of social diversity in healthcare and how these questions are resolved in everyday practice. All that allows us to see what is really being implemented."

First Results

As one of the first project activities, the Croatian research group organized the International Conference Healthcare as a Public Space: Social Integration and Social Diversity in the Context of Access to Healthcare in Europe, which took place in September 2019 in Rijeka (Croatia). As the conference report shows, there are still certain ethnic groups and minorities in Europe, who have no access to healthcare, such as Roma people, asylum seekers, and other minority groups. Here are some interesting findings from the conference: The Roma population in Croatia and Slovenia faces many barriers and inequalities in getting access to quality healthcare. These include lack of health insurance, lack of access to preventive programs (e.g. vaccinations for children), and sexual and reproductive health services. Another issue is discrimination against transgender and intersex people in accessing health services in Poland. Also of interest is, that according to German law, asylum seekers have a right to medical treatment for acute illnesses and pain conditions, but not the prevention of mental illness. To read more about the results of the HERA project, please see links below.

Better understanding, better access

"Better understanding of the concept of diversity in healthcare can lead to reforms in legal systems aimed at improving access to public services", Steger emphasizes, "Moreover, it also allows a more sophisticated social perception of the phenomenon of diversity. Last but not least, it can improve medical procedures and thus reduce the cost of healthcare in general."

By focusing on ethical issues and the humanistic perspective, the results of the project will improve the quality of life and health of minority groups in the countries under investigation and in the European context. The project's findings will also provide healthcare professionals with critical knowledge on how to pursue and integrate the issue of social diversity into their medical practice.

HERA Public Spaces: Culture and Integration in Europe Programme (2019–2022)

The funded projects deal with a variety of subjects ranging from housing, healthcare, and transportation to cemeteries, festivals, and urban culture. This research is expected to provide new insights that promote the full potential of citizens’ engagement with European public and cultural spaces; to stimulate public and political and scholarly debate about the future prospects of European integration, and to study new modes of interactive and reciprocal engagement between academics and various types of stakeholders including those working in the media, creative industries, and heritage sectors, as they have proved to be the true vehicles of European integration. Further information: HERA-Website

HERA Webinars are available on the HERA website, for example Exploring new digital worlds. Field research challenges in pandemic time. It is hosted by a number of researchers and Early Career Researchers from FESTSPACE, Food2Gather, HcPubS (Healthcare as a Public Space), PuSH (Public Space in European Social Housing) and Intoxicating Spaces (PSPR). The panellists discuss how the Public Spaces projects dealt with the research and methodological challenges during the Covid-19 pandemic, when public spaces that they were supposed to research drastically changed.

Healthcare as a Public Space. Social Integration and Social Diversity in the Context of Access to Healthcare in Europe

Project lead: Prof. Dr. Florian Steger
Project researchers: Dr. Marcin Orzechowski, Dr. Marianne Nowak
Duration: 2019–2022

In cooperation with:
Prof. Dr. Paweł Łuków, Center for Bioethics and Biolaw, University of Warsaw (Poland)

Prof. Dr. Amir Muzur, Department of Social Sciences and Medical Humanities, University of Rijeka (Croatia)

Prof. Dr. Zvonka Zupanič-Slavec, Institute of the History of Medicine, University of Ljubljana (Slovenia)

Funding: The project is funded under HERA Public Spaces: Culture and Integration in Europe Programme (2019–2022) and the European Commission in the scope of the European Union's Horizon 2020 research and innovation programme under grant agreement No 769478, and receives national contributions from the German Federal Ministry of Education and Research (BMBF), National Science Centre, Poland (Project No. 2018/28/Z/HS1/00554), Ministry of Science and Education of the Republic of Croatia/The Croatian Academy of Sciences and Arts, and the Slovenian Ministry of Education, Science and Sport from the funds of the Humanities in the European Research Area (HERA).