Constrained Integration in European Union Public Health Law: Competence, Rights, Administration and Unequal Access

European Union (EU) public health law is often described either as an extension of internal-market regulation or as an emerging health union. This article argues that neither description adequately captures the legal and administrative structure of the field. Using doctrinal analysis; structured comparison of EU, European Convention on Human Rights and selected national case law; institutional analysis; and descriptive official data, it develops a framework of constrained integration. The framework links four dimensions—competence channels, constitutional constraints, a fundamental-rights overlay, and adaptive governance—to seven operational questions concerning legal basis, transnational justification, proportionality, rights, administrative capacity, accountability, and distribution. Case clusters on product regulation, cross-border care, reproductive health, vaccination, serious medical risk, emergency governance, and digital health show that formal rights and competences frequently depend on information, evidentiary standards, inter-institutional dialogue, and implementation capacity. Official indicators on unmet need, workforce scarcity, cross-border reimbursement, and the European Health Data Space expose the distance between legal entitlement and usable care. The article concludes with time-phased recommendations for competence-and-implementation statements, administrative usability review, agency accountability, inclusive digital-health implementation, and rights-sensitive cooperation.