Healthier In the EU

The National Health Service will face budget cuts, falling standards and an exodus of overseas doctors and nurses if the UK leaves the European Union, according to the health secretary Jeremy Hunt.  This rare lucid monent from the the health secretary is very welcome and backed by Norman Lamb, Liberal Democrat MP and previous health minister.  

My Mum's main nurses were from the EU, lovely Irish and Spanish girls who cared for her in our local acute trust during the diagnosis of her final illness.  They made everything so much more bearable for her.  

Leaving the EU will create risks which could trigger a loss of key staff.  The struggling NHS needs a strong economy and most of us realise that Brexit will be highly destabilising.  The CBI, the London School of Economics and Oxford Economics, have all published surveys indicating an adverse impact on the UK economy and the government’s ability to stick to high levels of funding for public services.

McKee and Galsworth writing in the Journal of Public Health recently argued convincingly that Brexit threatens public health.  They point out that contrary to popular belief EU laws are made jointly by democratically elected national governments, in the Council of Ministers, and the directly elected Members of the European Parliament.  They add that EU legislation has protected our physical enviroment in a variety of ways.  These include establishing limits on the sulphur content of fuels and also the quantity of sulphur emissions from power plants and industrial sites, which led to an 80% fall in emissions.  In addition concerns about the health effects of airborne particulate matter led the EU to act on vehicle engine standards and, by 2005, it was estimated that total emissions from road traffic were 63% lower than they would have been in the absence of EU standards.  Furthermore, EU directives have also addressed water quality, both for drinking and bathing, including the now well-known Blue Flag system for beaches.  The EU has been especially active against tobacco, which is among the leading causes of premature death among Europeans. Despite sustained challenges from national governments including, for many years, the UK, it has banned advertising in all those settings. Another example is road safety.  In 2001, the EU set a target of halving the yearly number of road deaths by 2010, the resulting interventions are viewed as contributing to the 43% decline in road traffic deaths that has been achieved.  There would be huge pressures to engage in removal of public health protections in an economically struggling post-Brexit world.

Research will also suffer.  The current 7-year EU science programme, Horizon 2020, disburses €80 billion and facilitates collaborations worldwide. The UK is, for now, at the epicentre of this global collaborative hub and participates in more projects than any other member state. Post-Brexit, the UK might be able to participate, as do Switzerland, Norway and Israel, among others, by buying into the programme but it would have no input to policy. Moreover, its participation would depend on what the EU would allow. When Switzerland recently took measures to reduce immigration from the EU its involvement was reduced by 40%. 

There are also structural benefits in the form of health-related EU institutions. British public health specialists have played important roles in the European Centre for Disease Control and Prevention which compiles surveillance data from across Europe, develops shared methodologies and standards, and co-ordinates emergency responses. The European Medicines Agency, based in London, has a streamlined approach which avoids the need for national approvals of medicines in all 28 member states.

I conclude that the threats to our health are clear.  The rest of the debate csn seem confusing and both sides can give convincing but opposing arguments.  But it also boils down to ideology.  

Do we want to be isolated from Europe psychologically and practically or do we want to be part of it for better (usually) or for worse (sometimes, but we will have a voice to influence things)? Right now Europe is opening it's eyes to the need to work together for our peace and security. We must be part of this. 

References 

Martin McKee and

 

Michael J. Galsworthy 

Brexit: a confused concept that threatens public health J Public Health (2016) 38 (1): 3-5 doi:10.1093/pubmed/fdv205