Naren Patel and John Middleton: Brexit must “do no harm” to the public’s health

The government needs to secure in statute its commitment to the public’s continuing health

Next week crossbench peer Lord Warner will propose a landmark “Do No Harm” amendment to the European Union (Withdrawal) Bill. It will be supported by peers from across the House, including co-signatories: Lord Patel (author of this article), Lord Hunt of Kings Heath, and Baroness Jolly. The amendment proposes a new clause for the public’s health, which says that:

“In carrying out their duties and functions arising by this Act, a Minister of the Crown or a public authority must have regard to the principle that a high level of human health protection must be ensured in the definition and implementation of all policies and activities.”

The amendment appears simple and straightforward, but it is of profound importance to the health of future generations. It would give the government a golden opportunity to demonstrate to Parliament and the public health community that Brexit will “Do No Harm” to the public’s health. In the referendum, voters across the country, whether remainers or leavers, viewed their health as being of paramount importanceand this is the government’s chance to continue to reassure them that they do too.

We welcome assurance from the current secretary of state for health that the government is committed to maintaining “participation in European cooperation on disease prevention and public health,” but this commitment is not yet secured in statute. The public health community still has concerns about the potential negative impact of the bill on the public’s health. Without the safety net of EU law, and in the context of significant cuts to public health and wider health budgets, the sector is concerned that there is a continuing erosion of existing public health legislation, policy, and practice, which is vitally important. Lord Warner’s amendment therefore represents a major opportunity to secure a high level of protection of the health of the public.

After Brexit, we will need to seize the opportunity for a “new era of cooperation and partnership” between the UK and the EU so we welcome Lord O’Shaughnessy’s commitment that the UK will continue to play “a leading role in promoting and ensuring public healthin Europe and around the world.” The UK has been at the forefront of many public health drives, including tobacco control, antimicrobial resistance, and communicable disease. Through this amendment the UK can signal to EU members that it remains committed to maintaining our public health agenda to the high standards we have established togetherbecause, ultimately, the public health agenda is most effective when it can operate well across borders to similar standards, priorities, and expectations.

The “Do No Harm” amendment is vital during the Brexit negotiations and their aftermath, and an opportunity to guarantee and protect the nation’s health nowand for our future generations. The EU (Withdrawal) Bill is where constitutional stability and certainty is to be secured within the UK’s legal system.

The health of UK citizens is not simply about the health and social care that they are entitled to receive, and something which can be changed only through a future Health and Social Care Bill. Health protection and health improvement are secured through public policies that prevent people becoming illbe they economic, environmental, educational, or other public policies. These are the major influences on our health and the protection of our health depends on the recognition and protection of health through law and the rights the law represents.

The amendment draws on Article 168 of the Lisbon Treaty of the European Union and therefore has existing legal precedent and interpretative guidance on which to draw when determining the meaning of the new clause. However, the clause is not about preserving EU law and regulation in aspicit would be for the British courts, based on our doctrines of parliamentary sovereignty, to decide the specifics of future interpretation in concrete cases.

This is about acknowledging that we have made huge progress in public health during our time in the EU and that, as we leave, this government and future governments are committed to ensuring we do not roll back from the progress we have made. Such an approach would have the strong support of the public health and wider health sector, and would be welcomed by the public.

Professor Lord Naren Patel is a crossbench peer in the House of Lords. He chaired the Long-term Sustainability of the NHS Committee until April 2017. He is a retired professor of obstetrics and consultant obstetrician, and former president of the Royal College of Obstetricians and Gynaecologists.

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: retired professor of obstetrics; member of professional advisory committee, Vopulus Limited (medical education technology); member, UK-Israel Science Council.

Professor John Middleton is the president of the UK Faculty of Public Health, honorary professor of public health at Wolverhampton University, and formerly director of public health in Sandwell in the West Midlands of England. Twitter @doctorblooz

Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: president, Faculty of Public Health (FPH); honorary professor, Wolverhampton University; member of council, Royal College of Physicians (RCP) London; member of the Academy of Medical Royal Colleges. No pecuniary interests in health services, pharmaceuticals etc.