Abstract
Data forms an integral part of the future imaginaries of healthcare's digital transformation. To this end, the EU is launching the European Health Data Space (EHDS), intended to improve care provision and research by facilitating the exchange of patient health data within a pool of citizens spanning the European Union. This article explores this meeting of public healthcare systems with data economies, focusing on how the European Commission intervenes in future imaginaries of digital health through promotional videos. These imaginaries, which envision a future shaped by data circulation, market-making capacities, and secure data sharing, play a crucial role in shaping the digital transformation of public healthcare. The analysis suggests that while the EHDS aims to enhance patient care and research through data sharing and cross-border healthcare, it also raises concerns over data security and assetization, the extent of Big Tech involvement, and the potential commodification of health data. This study contributes to the field of critical data studies by highlighting the implications of these developments at a supranational level and suggesting a relational approach to studying the scales at which data markets and governance operate.
Introduction
There is a growing interest in the intersection between the welfare state and data economies (Dencik, 2022; Kaun and Masso, 2025). In the data welfare state, nation-states’ imagined usages of data in welfare contexts become important to study, particularly since citizens have no way of withdrawing from their engagement with the welfare state without significant costs and risks (Bagger et al., 2023). In the context of health, studies have focused on the merging of health data and data economies in biobanking and for Electronic Health Records (EHRs) (Birch, 2017; Fortun, 2008; Petročnik, 2022; Tupasela, 2021) and the insurance industry's interest in health data (e.g. Metcalf and Sadowski, 2024). Data thus forms an integral part of the future imaginaries of healthcare's forthcoming digital transformation (Stevens et al., 2018). Due to the large amounts of data about our lives that (public) healthcare systems contain, Big Tech 1 is becoming increasingly interested in public healthcare (Lanzing, 2023; Ozalp et al., 2022; van Eerbeek, 2025), as seen in the interest in the United Kingdom's National Health Services (NHS), being the “largest single integrated healthcare provider in the world, its stock of patient data holds substantial value for health research” (Cheung, 2020: 1). At the intersection of the public healthcare system and data economies, the NHS has been subjected to processes of platformization enabling it to leverage various assets (Faulkner-Gurstein and Wyatt, 2023), among them its public health data (Vezyridis and Timmons, 2021), but these efforts have been contested (e.g. Vezyridis and Timmons, 2017).
These processes of digitalization and datafication form part of broader welfare state transformations (Taylor-Gooby et al., 2017), including the integration of public healthcare systems into a common European welfare market (Crespy, 2016). Adding to these transformations, the European Union (EU) has recently initiated reforms toward a European Health Union. The European Health Union aims to better protect citizens’ health, improve prevention, address future pandemics, and improve the resilience of European health systems, wherein the European Health Data Space (EHDS) is one of the central building blocks (European Commission, n.d.-c). The EHDS is intended to improve care provision and health and medical research by facilitating the exchange of patient health data within a massive pool of citizens that spans the entire European Union. Simultaneously, it aims to be a secure data sharing infrastructure where individuals have control over their health data, and to facilitate the creation of a European single market. The need for increased health data sharing was highlighted during the COVID-19 pandemic when the EU partnered with Google and Apple to develop contact tracing apps (Lanzing et al., 2022). Tracing the trajectories of digital health and health data organizing in the EU, Gross and Geiger (2023) suggest that such entanglements between public and private actors have long been institutionalized. However, how particular imaginaries of future healthcare are shaped by supranational institutions, such as the EU, in entanglements with other policy goals and public and private entities, warrants further investigation as the EHDS is materializing.
Chandrashekeran and Keele (2024) urge us to pay closer attention to the “enabling role of the state in digital markets” (p. 288). Inspired by them, in this article, I look beyond the state to focus on the supranational scale of a union of (welfare) states. I do so by analyzing promotional videos about the EHDS produced by the Euronews news channel, in collaboration with the European Commission, to explore how these videos form part of the larger policy goals of the EU, shaping imaginaries of the future with the EHDS by intervening in the regulation and enabling of patient health data sharing infrastructures. Visions of the future are performative as they concretely construct the future “in different constellations and contexts” (Mager and Katzenbach, 2021: 224). Reading and watching between the lines of these videos provides insights into the explicit and implicit visions and imaginaries the European Commission holds regarding the future of European healthcare and the EHDS that go beyond the formulations found in policy documents. As such, promotional videos can complement policy analysis by providing thicker descriptions of the rationales and imaginaries that underpin policies, but that are also intended to intervene in contemporary policy landscapes. In addition, I contribute a different scalar perspective by showing how imaginaries, however partial, are developed and distributed on a supranational scale. A relational scalar approach can provide insights into how the EU supranational scale shapes and imposes constraints on health data governance in its member states, at the same time as national regulation and ethical standards ultimately ensure (or not) the viability of such supranational projects. I thus suggest that critical data studies could benefit from a relational approach to scale, as it holds potential to provide insights into data markets and governance across scales from the individual to the global.
European politics of sovereignty in the digital sphere
The European Union is attempting to establish itself as a more ethical and human-friendly middle way between China's authoritarian and the US liberal governance of the digital sphere and technology companies. Policies aimed at achieving and bolstering digital (technological/data) sovereignty have proliferated within EU institutions over the past years (Monsees and Lambach, 2022; Roberts et al., 2021). While digital sovereignty is a slippery concept (e.g. Pohle and Thiel, 2021), it is promoted in a wide range of EU policies (Roberts et al., 2021). Achieving digital sovereignty thus means digital governance according to European values and empowering European businesses. As part of this policy, in 2020, the EU launched “A European Strategy for Data” (European Commission, 2020). The strategy builds on the idea that “data is an essential resource for economic growth, competitiveness, innovation, job creation and societal progress,” envisioning a future entailing “data-driven applications [that] will bring various benefits to both citizens and businesses” (European Commission, n.d.-d). Additionally, it aims to “create a single market for data” to ensure “global competitiveness and data sovereignty” (European Commission, n.d.-d). These policies have prompted the introduction of new regulations, that is, the Data Governance Act, the Data Act, the Artificial Intelligence Act, the Digital Services Act, and the Digital Markets Act.
Creating a single market for data will be achieved by establishing several Common European Data Spaces (European Commission, n.d.-a) to “ensure that more data becomes available for use in the economy and society,” meanwhile keeping those who “generate the data in control” (European Commission, n.d.-d). Fourteen strategic fields have been identified, ranging from tourism to agriculture to public procurement. The first Data Space is the EHDS (European Commission, 2022). The Commission envisages the EHDS achieving three goals, to (1) “empower individuals to take control of their health data and facilitate the exchange of data for the delivery of healthcare across the EU,” that is, primary use of data, (2) to “foster a genuine single market for electronic health record systems,” and (3) to “provide a consistent, trustworthy, and efficient system for reusing health data for research, innovation, policy-making, and regulatory activities,” that is, secondary use of data (European Commission, n.d.-b). The Council of the European Union and the European Parliament reached an agreement in 2024 (Council of the European Union, 2024). The EHDS regulation entered into force in March 2025 and will gradually be implemented over the next 10 years (European Commission, n.d.-b).
The medical community has long suggested the importance of access to health data to provide integrated care (Genovese et al., 2022), as well as for health and medical research (e.g. Horgan et al., 2022). Skovgaard et al.’s (2019) review of studies suggests that the European public is positive to sharing their health data for purposes other than treatment. However, they also find that this support is conditional and premised on data being used for the common good, whereas commercialization of data, and data being used against the interests of the people providing it, gives rise to concern (see also Kalkman et al., 2022). The EHDS proposal has met harsh criticism. Overall, this critique centers on the lack of integration of broader ethical issues concerning data sharing and individual control of data, data misuse, and the distribution of benefits in the proposal (Dove, 2024; Staunton et al., 2024). More specifically, the critique concerns the lack of procedures for consent to secondary uses and onward sharing of health data in the first draft (Association for Patients Defence et al., 2023; European Digital Rights, 2023), as well as the broad definition of health data 2 and overly general purposes for permitting data use (European Digital Rights, 2023). Other critiques concern the risks of diminishing individual control over data, not keeping the public good in focus (Marelli et al., 2023; Petročnik et al., 2023), and data sharing, misuse, and its impact on public trust in research (Shabani, 2022; Slokenberga, 2022). In a survey conducted in Denmark, it was found that some of the goals of the EHDS, such as “transnational data sharing, commercial involvement, and use of data as national economic assets” (p. 1), are precisely those that the public finds most controversial (Skovgaard et al., 2024). So while the public is generally positive toward health data sharing, the goals of the EHDS risk undermining the long-term legitimacy and sustainability of infrastructures for health data sharing (Skovgaard et al., 2024).
Given these policy developments at the EU level, and the public opinions and concerns about health data sharing, it is relevant to explore how the European Commission intervenes in these future imaginaries around data and the digital sphere. Next, I will outline theories of imaginaries, the methods and material, and detail how promotional videos provide a useful entry point into studying interventions into broader future imaginaries.
Shaping imaginaries of the future
To explore the interplay between political power, science, and technology in spawning collective visions of (un)desirable futures, Jasanoff and Kim (2009) propose the concept of “sociotechnical imaginaries.” Imaginaries, however, are not only about “seeing what does not exist” (Williams, 2015: 111), but they materialize in concrete innovations and technologies that are made possible by institutional backing and resource allocation (Arnelid, 2025; Jasanoff and Kim, 2009). While initially focusing on how imaginaries are established and promoted by nation-states, further discussions have highlighted how multiple imaginaries articulated from various positions can co-exist in a society, some of which are more powerful than others (Jasanoff, 2015). Mager and Katzenbach (2021) add that sociotechnical imaginaries are “multiple, contested, and commodified […] and increasingly dominated by technology companies” (p. 223). Narrowing these ideas down to data, Beer (2019) develops the idea of data imaginaries as part of larger social imaginaries encompassing how people imagine their social existence and social relations. Data are imagined as a means to reveal new insights that can help improve and develop efficient solutions to many of our problems (Beer, 2019). Data imaginaries can thus provide ways to explore how the potential uses of data by different actors are “powerful in defining ideals and norms” and how such visions “shape what is done” (Beer, 2019: 42). Studying visual materials can be a fruitful way to explore these imaginaries as it provides an entry point into exploring the ideas, understandings and visions that go beyond the strictly legal and policy developments underpinning the EHDS. In the following, I provide some information on the site of production and the audiences of the promotional videos I analyze, particularly in relation to their social modality (Rose, 2007). Promotional videos are key to branding a product as they hide “an implicit promise” (Danesi, 2013: 472 in Bednarek and Caple, 2015). I thus attempt to give a sense of their (political) intentions and the debates in which they intervene, before giving a general description of the visual material used.
I analyze promotional videos published under the heading
Between May 2022 and October 2023, 38 videos were published, 3 each between 1 and 5 minutes long, most either 1 minute and 30 seconds or 4 minutes in length. The videos are a hybrid of news items and promotional material. They address a wide range of subjects, e.g., rare diseases, the price of and access to medication, wastewater cleaning, e-prescriptions, digitalization, and innovation in healthcare. Over time, the focus of the videos has shifted from digitalization in healthcare and the EHDS toward broader health issues. The news item character of the videos has variations. The longer videos allow in-depth description of current problems and future solutions, while the shorter videos are often compressed and snappier. As such, they range from boosterish to more explanatory, though rarely the type of detailed harms-and-benefits regulatory analysis that brings in critical voices. Five of the shorter videos consist entirely of interviews with single individuals. The visuals of the videos interweave description of problems by a speaker's voice with expert interviews with medical doctors, IT professionals, heads of various public and/or private entities, politicians, or with patients and others affected by a particular problem and/or health condition. Shots of those speaking are interluded with stock footage of urban landscapes, airports, pharmacies, meetings in meeting rooms, lectures in classrooms, and press conferences by the European Commission. There is also more intimate footage of doctor–patient meetings, people picking up prescriptions from the pharmacy, virtual clinics/digital meetings, or close-ups of cables and the flashing lights of servers in data centers. Sometimes this footage is interspersed with illustrations showing diagrams, maps, connections between data points in different countries, etc., illustrating how the digital COVID certificates functioned or how the EHDS will connect data across different places, and other times the footage is overlaid with illustrations in the style of the television series Crime Scene Investigation (CSI) type of dashboards and infographics showing DNA strings and diagrams of electrocardiograms, numbers, letters, text, and networked dots.
These elements of the Euronews reach (at least in the upper echelons of European society) and future imaginaries as portrayed through news logics make these videos conducive to exploring how the European Commission attempts to shape future imaginaries of European healthcare. Additionally, they communicate the core visions and imaginaries of developing policies in a direct and accessible manner. Analyzing this material can thus reveal other aspects or angles of emerging policies that go beyond the purely legal and formalistic descriptions of desirable futures in legal and policy documents. More specifically, analyzing promotional videos that portray visions of the future (with) EHDS, can render important insights into the broader social imaginaries in which the EHDS is developed and how these policy developments are motivated as necessary and in the European public's common interest.
The analysis was conducted in several steps, first watching all 38 videos to get an overview of the themes addressed. Second, focusing on the videos around digitalization, data, and new technology in healthcare resulted in a selection of 20 videos. 4 The videos were transcribed using the University of Oslo's Autotekst transcription tool based on OpenAI's Whisper v. 3. I developed close familiarity with the data by reading and re-reading the transcribed texts, which provided the groundwork for the next stage of generating codes (Ryan-Vig et al., 2019). The repeated reading gave me some initial ideas of the issues the videos addressed. When coding, I thus focused on how the three main goals of the EHDS proposal were represented and problems expected to be solved, allowing me to explore how they are imagined and what reaching them is envisioned to achieve. This thematic analysis resulted in three main themes, revolving around circulation (of people and data); markets and market-making; and secure sharing and cooperation. Less prevalent themes concerned quality and continuity (of healthcare), language and translation, consent, public interest, and reducing costs. Alongside the thematic analysis of the transcriptions, and deviating from Ryan-Vig's et al. (2019) approach, I kept watching the videos to keep the connections between the text, who gets to speak, and the visuals accompanying the speech. While inspired by Bednarek and Caple (2015) combination of verbal-visual analysis, my approach is not a full-fledged visual analysis but rather intends to convey an impression of the visuals employed to shape the imaginaries of digital health in Europe. The videos, titles, links, and corresponding numbers are available in Appendix 1.
Imagining the European Health Data Space
The imaginaries emerging from the analysis correspond with the three main goals of the EHDS; however, they engage these from different angles. This section explores the imaginaries surrounding these goals: circulation in cross-border healthcare markets (related to the first and third goals), the market-making capacities of data (second goal), and secure data sharing and altruism (third goal).
Circulation in cross-border healthcare markets
One goal of the EHDS is to “empower individuals to take control of their health data and facilitate the exchange of data for the delivery of healthcare across the EU” (European Commission, n.d.-b). This is a salient theme in the videos, with terms like “exchange,” “fluid access to,” “free movement,” “without borders,” “transnational use,” “cross-border,” “mobility,” and “travel.” These descriptions form an imaginary revolving around “circulation.” Imagined as circulating are patients as citizens of European countries seeking healthcare services (or getting ill while traveling), as well as their health data. Health data will circulate in two ways: accompanying the traveling patient seeking healthcare provision, and through pipelines and stored in bubbles for future extraction by researchers, policymakers, and innovators/businesses, touching upon the third aim—facilitating secondary uses of data. While this imaginary is firmly focused on the individual patient, not addressed is who this traveling European citizen is, nor how these types of circulation will affect healthcare practitioners and systems, as well as the challenges such increased circulation will cause. In the following paragraphs, I will explore this imaginary in more depth.
Two recurring words in the videos is “cross-border healthcare.” While this term is mainly associated with the physical person traveling, across the various videos, it relates to different aspects of healthcare across borders, ranging from accessing prescription medicine to having your health data readily accessible when traveling. Video 15 epitomizes this imaginary with the title “Diseases have no borders, so why should EU patients?”, where we get to follow a Portuguese woman's visit to the doctor in Luxembourg as she fell ill while traveling. During the interaction between them in the doctor's office, we get a glimpse at what a patient summary looks like, followed by an interview with the doctor. Throughout the video, there are several shots of urban streets bustling with people and healthcare settings with busy healthcare personnel going about their work, sometimes overlaid with graphics. Several videos outline different types of digital infrastructures that will enable cross-border healthcare. The reasons behind and an example of this are described in video 13, where the speaker's voice suggests that citizens’ mobility within the EU is a reason to “ensure efficient cross-border healthcare for all citizens,” accompanied by images of people moving around on busy urban streets before turning to images of entrances to a pharmacy and emergency ward with an ambulance. After an interview with an information systems agent at the Directorate-General for Health and Food Safety about the digital infrastructures for sharing patient health data that are being developed, the speaker's voice states that this allows the “European citizen traveling through the EU to receive care as if it were in their own country”. Video 10, in which the former EU Commissioner for Health and Food Safety Stella Kyriakides speaks from the chair in her office with an EU flag prominently in the background, follow a similar theme when talking about the success of the Digital COVID Certificate, allowing people to travel during the COVID-19 pandemic by carrying their essential health information with them. Also video 5, where we get to see an interaction between a customer and a pharmacist in a pharmacy, describes the e-prescription system that currently allows Finnish and Estonian citizens to pick up prescription medicine in both countries, followed by interviews with both the pharmacist and the head of health division at the public Health and Welfare Information Systems Center in Estonia that is operating the system. Wrapping up video 5, the speaker's voice echoes the interviewed head of health division when suggesting that “In the future, cross-border health services in Europe should be like mobile phone roaming. Patients’ medical data and prescriptions will follow them when they are abroad, guaranteeing better care and treatment”, that is, it should be easy. These videos exemplify how the EHDS is imagined to improve access to cross-border healthcare provision for EU citizens while traveling across Europe. At the same time, they portray an image of a particular EU citizen who is highly mobile and for whom traveling across Europe is normal, not only for pleasure, but also for accessing healthcare as any other consumer goods, which is connected to certain subject positions related to age and class. This is maybe not surprising, given how Euronews frames itself as the main news provider for the European elite, but worth noting.
Interwoven in this imaginary is the idea of health data about European patients circulating within the EU, sometimes attached to the patient, sometimes detached, traveling alone. The first is seen in videos 10 (described above) and 9, explaining how the data contained in the Digital COVID Certificates’ QR codes remains on the certificate and is not stored in any other place, thus circulating with the bearer. The video illustrates this through shots of airports where travelers’ digital COVID certificates are checked, overlaid with graphics, but also by showing the control room and close-ups of cables and the flashing lights of servers inside a data center, a common illustration of data centers (Taylor, 2017), along with interviews with experts at the World Health Organization and the EU. Video 1 on the other hand, while illustrated with much similar images of people in urban spaces, healthcare settings and data center close-ups, describes data traveling alone. This is exemplified in the interview with the chairman of the board of directors of the Portuguese Health Ministry's central purchasing and IT authority, who suggests that “what we want is for this data, once it's been entered into the system, to generate information that actually feeds the entire system” thus transforming healthcare. These videos point toward how patients’ health data is imagined as traveling in different ways, relating to the question of “why EU patients should have borders when disease has none” posed in video 15, but leaving open whether it is the patients themselves or their datafied personas who should have no borders.
These diverging types of data and uses of circulation envision different benefits for different stakeholders. While one relates to biomedical and (digital) technology companies’ market for new treatments and technologies, the other envisions integrating national healthcare systems with their particular idiosyncrasies within an overarching European single healthcare market, furthering the attempts to integrate Europe through healthcare (Crespy, 2016), disregarding public healthcare systems being national responsibilities with varying organizations across countries (Immergut et al., 2021). However, this imaginary does not address the effects of increased circulation on national healthcare systems nor the healthcare practitioners working within them. This is in line with research showing that the work required to make data intelligible (Gitelman, 2013; Kitchin and Dodge, 2011), performed by both patients and healthcare practitioners, usually remains obscured (Fiske et al., 2019; Hoeyer et al., 2024; Torenholt et al., 2020). This imaginary of circulating patients and health data is closely related to how the EHDS is imagined, creating a single European market, to which I will now turn.
Market-making capacities of data
Another goal of the EHDS is to “foster a genuine single market for electronic health record systems” (European Commission, n.d.-b). This goal is reflected in the imaginary of market-making, which is related to the circulation of detached patient health data. The imaginary of market-making contains ambiguous ideas that do not always add up. Video 2, which consist of an interview with the chairman of the board of directors of the Portuguese Health Ministry's central purchasing and IT authority, captures the interconnection between these imaginaries when stating that “It is essential that there is a much more intense circulation of data and that there is a much more effective exchange of health data to ensure that we have a true single market in healthcare.”
The proposal is explicit about the goal of creating a single market for EHRs, but there is ambiguity in the above statement about what type of market the EHDS is intended to create. While it is a “single market in healthcare,” it is data, not people, who are intended to circulate in this market. This ambiguity pervades several videos that oscillate between describing the creation of a
The “fragmented market” as a problem reappears. While video 11 suggests that this fragmentation is detrimental to European citizens, video 12 features an interview with the same director from video 11 about how this fragmentation also impedes European companies’ attempts to operate at the European level and the need for a scaled-up and robust single market. He contrasts the fragmentation in Europe with North America and Asia, implying that European companies are losing out in the competition. This problematic of a fragmented market thus seems to be one rationale behind the barrage of new EU regulations around the digital market and artificial intelligence, as they intend to create a market for these technologies and services at the same time as it is a means to establish European digital sovereignty in relation to the United States and China (Monsees and Lambach, 2022; Roberts et al., 2021). The EHDS is also an attempt to overcome this fragmentation, as it “will provide access to a data catalogue from all data existing in Europe in terms of health data. It is fundamental to ensure that health data is available for those who need it, when they need it…” (video 14) according to the same information systems agent interviewed in video 13 (see p. 9), and illustrated with images of healthcare personnel at work and data centers. Making health data available hints at the market, not only of digital products and services, but the market of data that the EHDS is envisaged to create. While not stating who “the ones who need it” are, beyond the primary use by patients and the healthcare practitioners treating them, the broad range of users are stipulated in the proposal, including researchers funded by and working in public universities, but also the larger sphere of “innovation”; the pharmaceutical industry, eHealth and medical technology companies and ultimately Big Tech companies, making up the single market.
To understand why fragmentation is problematic, we must consider attempts to theorize the growth and functioning of digital economies. Scholars have described this in terms of a turn to rent-seeking (see e.g. Sadowski, 2020). Birch (2020) concept “technoscience rent” describes a process by which “‘things’ such as infrastructure, data, knowledge, bodies” (p. 3) are reconfigured into assets, through which value can be appropriated through the control or ownership of such capitalized property. Much research has explored how personal data is turned into assets in different ways across sectors of the economy (e.g. Birch et al., 2021; Chandrashekeran and Keele, 2024; Geiger and Gross, 2021; Van Doorn and Badger, 2020). In public healthcare systems, electronic health records (EHRs) are one of the main ways in which patients’ health data has been turned into assets by opening it for use by multiple research actors, including private-for-profit research as seen in the United Kingdom (Vezyridis and Timmons, 2017; 2021; Wyatt et al., 2020). Remedying European fragmentation in the digital healthcare market through standardizing EHRs thus seems to fulfill two promises at once. First, it contributes to the assetization of patient health data from an unprecedented pool of citizens, the entire EU, far outnumbering the NHS, which is valued for its size (Cheung, 2020). Second, it marks a protectionist stance toward global multinational technology firms, that is, Big Tech, by allowing European companies to build up their own data assets through legal structures and infrastructure provided by the EU and thus contributing to the EU's digital sovereignty (although the achievement of this is highly uncertain).
Following from this is another ambiguity in the imaginary of market-making, concerning who benefits from the creation of a single market. Citizens would benefit, in line with the assumption that the lack of a single market is detrimental to European citizens. However, who the operators in this market will be is not entirely clear; several videos suggest that it is European enterprises, and particularly small and medium-sized enterprises (SMEs), that will benefit from a single market. Video 11 ends with images of people walking and cycling along Thessaloniki's promenade while the speaker's voice says that “Once fully implemented, the EHDS should open up Europe's health market and enable small and medium-sized firms to work with each other to develop innovative new products” (see also videos 12 and 16). In other videos, the focus lies more with pharmaceutical companies that will benefit from access to health data (see videos 32, 36, and 37). Hinting at the importance of the pharmaceutical industry to the European economy, video 37 describes one European SME and their high costs of innovation being part of the “€37 billion annual research investment and around 800,000 direct jobs that pharmaceutical innovation is creating in Europe” the speaker's voice explains over images of a laboratory with scientists looking in microscopes and extracting liquids from test tubes. Video 36 features an interview with the director general of the European Medicines Agency (EMA) describing how they strive to be transparent and accessible, which is important particularly as “small and medium-sized enterprises are our superheroes,” she states in reply to the question posed by the speaker's voice of how the EU is working to make “its pharmaceutical sector more innovative.” There is thus not necessarily a contradiction between SMEs and the pharmaceutical industry. However, the ambivalence is most acute when, despite the recurrent focus on SMEs, some videos highlight the importance of Big Tech, that is, video 11 entitled “How Big Tech will empower Europe's healthcare systems” and video 2 with its title “Dawn of a new healthcare era: ‘Data is the new oil’” that connects this oft-repeated metaphor relating to Big Tech and Big Data (Couldry and Mejias, 2019; Nolin, 2020) to the single market in healthcare. This slide, or slip, is noteworthy given the focus in the broader digital policy landscape of establishing European competitiveness in the face of American and Chinese Big Tech.
For data to circulate in a single market, it first needs to be shared, to which I turn in the next section.
Secure data sharing, cooperation, and data altruism
The imaginary of secure data sharing is an oft-recurring theme, connected to two goals relating to “sharing” in the EHDS proposal, the first about the primary use of data concerned with healthcare delivery, and the second about secondary uses of data for research and innovation. As the chairman of the board of directors of the Portuguese Health Ministry's central purchasing and IT authority explains in video 2 with the modest title “Dawn of a new healthcare era,” efficient exchange of data is essential. In several videos, data sharing and the attendant collaborative aspects of the EHDS are envisioned to do exactly this, usher us into a new digital, more efficient, smarter era of healthcare. The speaker's voice in video 1 states that this smarter healthcare “is set to revolutionize medicine as we know it, marking a new era of cooperation. European countries are already exploring ways to harmonize rules and standards, while also making sure that patient health data is kept safe.” Data sharing is thus portrayed as enabling cooperation across countries, and the EHDS contributes by harmonizing rules and standards and promoting interoperability. At the same time, keeping the data secure while sharing it is portrayed as vital to create legitimacy for the EHDS. Meanwhile, issues of consent and individual rights and ethics are largely absent from the videos. While what is meant by data sharing is not made explicit, in focus is a long list of potential benefits of this data sharing revolution.
What are these benefits? Video 1 provides a list of these: “ensure continuity of care,” “more efficient care and better diagnostic capacity,” “boost scientific research and enable European companies to create more tailored medicine, health devices and services,” as well as “lead to better and more informed policymaking.” Ultimately, as the speaker's voice in video 1 states, “Exchanging clinical information can be crucial for both treatments and better patient recovery. It's why digitalization and data sharing are now seen as key for public healthcare systems.” Many of these benefits are returned to in other videos, that is, the contribution to tailored medicine (video 7), improved policymaking in response to emergencies (video 9), and to “foster growth in the digital health sector” (video 11). During an interview with a data engineer at the public interest group Health Data Hub in Paris in video 3, she suggests that “Artificial intelligence means being able to move from healthcare that treats you when you’re already ill, to healthcare that alerts you to the risk of hospitalization.” The data sharing possibilities of the EHDS are thus imagined to take preventive medicine to unprecedented levels using AI. These imagined benefits of data sharing are indirectly linked to citizens, and particularly patients, thereby connecting the secondary uses of data to the primary uses, that is, connecting research to its practical implications in the treatment of disease, and thus hinting at the public good of data sharing.
However, data sharing also appear in video 18 describing digital patient questionnaires where the video ends with the speaker's voice stating that “At a time when the sharing of medical information is a critical issue for our healthcare systems, patients have more say than ever in helping the medical industry create products and services that are tailored to their experience.” Video 16 presents a similar argument, when the speaker's voice suggests “the EHDS initiative will add momentum to the digital transformation of the healthcare systems. Moreover, in that new scenario, sharing data with digital health companies will help to deliver more patient-centred healthcare solutions,” a statement accompanied by images of healthcare professionals walking in hospital corridors and a patient waiting room. Here sharing appears in the guise of “helping” the medical industry, thus reversing the relationship of secondary uses of data for research contributing to the primary uses of delivering healthcare. Instead, by sharing the data from healthcare delivery, the patient can help the industry, but without any clear picture of the potential public good of such sharing. Data sharing in this sense comes closer to the idea of “data altruism,” the voluntary sharing of data based on consent by the data subject, that is established in the Data Governance Act, one of the new EU regulations of the digital sphere, although the concept of data altruism is not explicitly addressed in any of the videos. However, the Data Governance Act has been criticized by activists and legal scholars for imposing further regulation and requirements that risk impeding “data altruism” (Ruohonen and Mickelsson, 2023; Veil, 2021) and further complicate data sharing already made difficult by the existing GDPR regulation (Graef and Gellert, 2021). Similarly, one of the main critiques towards the EHDS has been the way that data sharing is reconceptualized outside the realms of GDPR (Shabani, 2022; Slokenberga, 2022). This data sharing imaginary thus seems to envisage all the benefits of sharing data that the EU wants to accomplish without being clear on who the beneficiary of such sharing is—the patient or the industry—and what public values should underpin sharing of health data collected through public healthcare systems (see also Gross and Geiger, 2023).
Connected to sharing is the issue of keeping the data secure, portrayed as vital for the legitimacy of the EHDS. This reflects the proposal and some of the critique, suggesting that its focus is solely on the right to data protection, but ignoring broader ethical issues related to data sharing (Dove, 2024; Staunton et al., 2024). This is exemplified in video 13 when, after interviewing several experts explaining how the EHDS will function without any central database and how the data will stay where it was collected, the speaker's voice states that “In such an outstanding technological ecosystem, security and data protection will play a crucial role in gaining the trust of all citizens.” How this security will be achieved is never explicitly outlined, beyond the scientific director of the Health Data Hub in video 4, talking in general terms about having several systems that ensure that no one has access to identifiable data, and the data being encrypted with “extremely high levels of encryption.” When data security is addressed more specifically in video 3, it is by resorting to metaphors, for example, the speaker's voice suggesting “pipelines to connect health databases” and the same scientific director explaining data security in terms of “open secure bubbles for each research project […] that are totally sealed off from each other […] there is no way to take the data outside of this bubble.” Metaphors to describe data are common (Nolin, 2020; Stark and Hoffmann, 2019), but in contrast to metaphors that paint a picture of data as a resource to be consumed (Puschmann and Burgess, 2014) or as a natural force impossible to contain or regulate (Lupton, 2013), these metaphors describe how to keep the already tamed data out of harm's way. Nevertheless, the inherent limits to securing data are sometimes recognized, for example, when the scientific director of the Health Data Hub states that “When data circulates inside a computer, there is no such thing as zero risk” (video 4). There is thus a contradiction between data sharing and data security that recognizes risks, but broader ethical issues concerning consent and the public interest rarely appear and are given minimum attention in the videos. However, these issues have been the focus of much political debate between the European Commission, Parliament and Council (Eccles and Peseckyté, 2024), and efforts by particular interest groups to lobby for or against an opt-out or opt-in function (AIDS Action Europe, 2024; European Federation of Pharmaceutical Industries and Associations, 2023), as well as scholarly critique. Ultimately, the videos attempt to create legitimacy for the EHDS by foregrounding the data security elements within data sharing infrastructures, while reflecting the proposal itself in leaving untouched many of the broader ethical issues concerning individual rights and control over data, as well as individual and collective stigmatization and discrimination that could be consequences of health data sharing (Staunton et al., 2024).
Discussion
What imaginaries of future European healthcare do these videos intervene in? While they are often ambiguous and sometimes even contradictory (in relation to the actual policy or self-contradictory), the imaginaries they paint of the future European healthcare are ones where citizens and their health data are highly mobile. This imagined European citizen is traveling around Europe and needs their health data to be readily available—on-demand—whenever needed, either just-in-case of emergencies, or to bring along in the suitcase when traveling in search of better, faster, or more accessible healthcare, a commodity that
The wide-ranging imaginaries the videos convey speak to the importance of health data and its valuation. While research has shown how data might not be valuable today, its speculative future value is evident across various sectors of data economies (Birch, 2017; Birch et al., 2021; Newlands et al., 2019; Sadowski, 2020) and increasingly also in public healthcare (Faulkner-Gurstein and Wyatt, 2023; van Eerbeek, 2025; Vezyridis and Timmons, 2021). The EU is now drawing the enabling contours of launching European citizens’ health data into data economies. Repurposing of citizens’ value from being producing subjects in productive economies, toward holding (speculative) value in terms of being data points in data economies (Tupasela, 2021) is another step along the road already trodden by some European welfare states. The EU is thereby aiming to extend the “Nordic data goldmine” (Tupasela et al., 2020) to a European scale by adding a fifth freedom of movement to the existing four of goods, services, people, and capital; the freedom of data to flow within the EU. In this way, the EU is both contributing to the assetization of its own citizens’ health data as well paving the way for others to do so as well. Enabling others to turn health data from public healthcare systems across Europe into assets is legitimized by its benefit to European SMEs. However, as the videos point out, the European digital health market is fragmented, but also geographically uneven between and within European countries. One can thus expect some European countries and/or companies to be in a more advantageous position to reap the benefits of the freedom of data that the EHDS is establishing. Additionally, there is no safeguards that European companies will be the benefactors, the EHDS could play into the hands of Big Tech's own health data imaginaries, as there is no mention of how to handle conflicts of (public) interest nor clear limitations as to who can request the data and for what purposes (Marelli et al., 2023; Staunton et al., 2024). Thus, both the economic and the geopolitical intentions of the EHDS project are fragile.
While implementing EU-wide policies is a complex process, this analysis has focused on how the European Commission attempts to intervene in imaginaries of the EHDS and future digital healthcare. With the caveat that the analysis does not reflect the complexity of EU policy imaginaries, its merit lies in using one of the few publicly available materials, besides legal documents, to analyze this policy imaginary. The analysis thus portrays the visions of the EHDS, and provides a critical analysis of an ongoing policy process, hinting at aspects to explore further in the development of future Data Spaces, such as the relatively limited audience they target.
Conclusion
In this article, I have explored the imaginaries surrounding the EHDS proposed by the European Commission as part of the European Strategy for Data and the European Health Union, the first of several Data Spaces to be created. There are three imaginaries envisioning the EHDS as a transformative space where health data circulation, a single market, collaboration, and secure data-sharing converge. The first imaginary about circulation revolves around improving the possibilities for European citizens to receive healthcare while in another European country by making digital health data more portable, as well as the possibilities for health data to circulate across the EU detached from its “subject.” Not addressed is how these types of circulation will affect healthcare practitioners and national healthcare systems, and future research should explore these practical implications further. The second imaginary concerns the EHDS market-making capacity, particularly how the circulation of detached patient health data is imagined to benefit the creation of a single market in healthcare. This portrays a range of ambiguous imagery that does not always fit neatly together, such as the creation of a market in healthcare, while it is mainly health data that is intended to circulate, the fragmented European digital health market and the EHDS as an attempt to boost the EU's digital sovereignty by allowing European companies to build up data assets shielded from global competition. To create a single market and build data assets, data must first be securely shared, which is the third imaginary in the videos.
While these imaginaries are important findings in themselves, as they are likely to shape the implementation of the EHDS and with it the material conditions of European healthcare to come, this article also highlights the importance of looking beyond the nation-state and Big Tech when studying data governance and economies. A relational approach to how data governance and economies play out at different scales, ranging from the individual to the supranational, could enable exploring how policies at different scales intervene in other regulatory contexts. An example of this would be Staunton's et al. (2024) discussion on the lack of ethical guidelines in the EHDS proposal that risks colliding with national ethical standards and thus creating deadlocks that impede reaching the EHDS goals. Such a relational scalar approach can move beyond exploring the role of the state in enabling data economies (Chandrashekeran and Keele, 2024; Fortun, 2008; Snell et al., 2023) and extend the view to supranational entities such as the EU, as well as data governance at more local scales and the relational interplay between these various scales in future analysis. This article contributes to such a perspective by showing how the EU, as a supranational organization, enables data economies at a European scale, in a sector that has traditionally been the remit of the nation state, with a range of potential consequences for public healthcare systems and those working within and depending on them, as well as economic and geopolitical implications. The imaginaries suggest that the future European Data Spaces are likely to be oriented toward market making logics and shaped by geopolitical pressures, ultimately adding data as an implicit fifth freedom to the EU project (next to goods, services, capital, and people). The development of the European Data Spaces thus warrants further research to explore how geopolitical concerns merge with data governance practices as the EU aims to strengthen its digital sovereignty.
Footnotes
Acknowledgements
Thanks to the anonymous reviewers for their insightful comments. The author would also like to extend a thank you to Christoph Lutz, Ericka Johnson, Anne Kaun, Peter van Eerbeek, João Florêncio, the Center for Medical Humanities and Bioethics and the P6 seminars at the Department of Thematic Studies, Linköping University, for constructive feedback on earlier drafts of this article.
Ethics approval
Per Swedish law, this article does not require ethical approval as all empirical material is in the public domain. The larger project it is a part of does however have ethical approval from the Swedish Ethical Review Authority with no. 2023-06372-01.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was funded by the Swedish Research Council, grants no. 2021-06653 and 2024-01837.
Declaration of conflicting interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Notes
Appendix 1: Video material as of 2025-06-11:
The videos that have been excluded from the analysis are marked as such in this list.
The videos are part of the information about EHDS at the bottom of the following websites: https://health.ec.europa.eu/ehealth-digital-health-and-care/european-health-data-space_en
https://audiovisual.ec.europa.eu/en/event/66374 https://audiovisual.ec.europa.eu/en/search?mediaType=VIDEO&sortField=search_date&sortFieldDirection=desc&projects=66374