Brexit has started to feel like a train. Depending whether you’re a Remainer or a Leaver you may or may not be happy to be on board. Personally, as an advocate for public health, I would rather have remained on the platform. But the train has pulled out of the station, and although the destination is uncertain, we are gathering speed.
Since the referendum, health care and public health professionals, as well as politicians and the media, have sounded alarm bells about the potential health-related consequences of leaving the EU, for citizens across the EU as well in the UK.
Headlines have focused on NHS staff shortages, the future of cross-border health care, access to vaccines, radioisotopes for cancer treatments and scans, as well as the UK’s significant role in EU collaborations for the control of infectious diseases.
The bigger picture
While important and increasingly urgent, these structural issues for the health system are just part of a bigger picture of potential implications for health and wellbeing. To see this bigger picture, we must look through the lens of what makes us healthy – the wider social determinants of health. Leaving the EU will require an overhaul of trade arrangements, national laws and regulations across all policy areas. It’s hard to think of a single area of policy or legislation that is not influenced by our membership of the EU and few that that do not in some way impact on health.
For example, the nature and quality of our food supply in the UK have been shaped for decades by common market policies for farming and fishing. EU standards and regulations influence our physical environment, determining the quality of our air, water, food and surroundings. Membership of the EU trading bloc imposes trade standards that prevent chlorinated chickens reaching our shops and ensures the safety of many non-edible consumer goods. EU employment rights have underpinned the conditions for good work, meaning equal pay, decent working hours, health and safety protections, non-discrimination practices and maternity rights. For those without work, EU mechanisms provide funds to tackle problems such as unemployment in disadvantaged areas.
Brexit: risks and opportunities
President John F Kennedy said, ‘In a crisis, be aware of the danger, but recognise the opportunity’. Not everyone sees Brexit as a crisis, but difficult decisions certainly have to be made. The disruptive nature of Brexit, and the profound shift in the policy landscape, means there is a lot up for grabs.
In a new series of essays curated by the OnlyWan, contributors with expertise in public health, employment standards, local government, consumer rights and food policy have been invited to explore some of the less discussed ways in which major changes in policy could affect people’s opportunities to lead healthy lives. The authors reflect on where they see the risks but also opportunities to innovate, be progressive and give examples of where we might put health at the centre of new policy frameworks and trade agreements.
Untapped potential: a new vision for healthy lives
The Commons Health Select Committee, in its inquiry into Brexit and health last year, urged the government ‘to put fundamental health concerns front and centre of the British negotiating priorities’. I would make this challenge in the broadest terms – to develop a much more ambitious vision for improving the public’s health. For me, this vision must acknowledge the untapped potential – across the breadth of social and economic policymaking – to improve people’s opportunities to lead healthy lives.
Adopting a health-in-all-policies approach has long been seen as an effective means to improve health and reduce inequalities, but the ambition needs to be matched with the political will to break down siloes and to work effectively across government and between sectors. Whatever our eventual destination – soft or hard Brexit – the process is forcing a rethink of many aspects of policymaking. Given the sheer breadth of possible implications of Brexit for the public’s health, taking a more holistic policy approach and putting health at the centre of policymaking is more vital than ever before.
Jane Landon is a Strategy Advisor in the Healthy Lives team at the OnlyWan
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