There is no time for recrimination—our duty is to protect and improve health

My personal and professional beliefs have been seriously challenged by the outcome of the UK General Election 2019. Large swathes of England, where Brexit and continuing austerity will cause the most pain, voted to “Get Brexit done.” The evidence over 10 years of austerity policies in the UK, is overwhelminglife expectancy has gone down, particularly for women in poor areas, and infant mortality has increased. With some irony, food banks received a boost in donations in the wake of the election, at the same time that stock holders were enjoying a further boost in their personal wealth. Inequalities in income, and in health, increased overnight.  

Other observers outside the UK can enjoy the schadenfreude headlines like Der Spiegel: Die Gänse haben für Weihnachten gestimmt—”The turkeys have voted for Christmas.” However, in the health service, and in the public health community particularly, there is no time for recrimination, or navel gazing. It isn’t the first time that a group of people or politicians have ignored the overwhelming evidencejust think about decades of tobacco control efforts. Our duty is to protect and improve health.  

We have to rebuild from the grass roots and understand and build on community assets. We must build robust community campaigns and organisations. People need to start recognising who is making their lives more difficult, who is profiting from their misery, and who is distorting their understanding of how the world works. American community organisations have understood this for many years with grassroots resistance trying to prevent excesses from presidential power

We need to understand health rights as real and tangible, not theoretical and aspirational. These rights can and are tested in courts of law. For example, our right to health was more important than the tobacco industry’s right to intellectual property in the plain packaging ruling in the High Court. 

We need to empower cross-party political coalitions based on the things we all want, especially around protecting the NHS.  We need politicians to lobby strongly for policies which unite us more than divide us, and put health, wellbeing and care at the top of the political agenda. Boris Johnson can be part of those solutions too by ending austerity, bringing forward the green new deal, and helping the UK achieve net zero carbon before 2050. He could fund free social care, perhaps using a bit of that £34 billion promised for the NHS. Properly funded social care will relieve NHS winter pressures. And he could reinstate public health budgets, which provide a much better return on investment than treatment interventions.   

If we are to protect our health and wellbeing, we must also address the misinformation that is spread through social media advertising, which generates fake and diversionary news. We are increasingly aware of the perverse influence of unedited and uncontrolled social media in stories about vaccines, e-cigarettes, and other areas of our work. Disinformation was widespread in the UK election campaign, and is likely to be even more so in USA 2020.  

In a column in The Guardian, George Monbiot also asks we support charitable work, because it will be needed even more as social welfare disappears. This is now the reality. Food banks are not going to decline for many years to come. As a member of the Fabians Food and Poverty commission I believed that food banks were a failure of policy and a necessary, but  temporary response to the evils of austerity and changes of universal credit. Now I must accept the existence of food banks, donate to them, support them. I hope they become a focus of discontent, a place of subversion and a spark for rebellion against the cruel policies of austerity. Volunteering and supporting Citizens Advice bureaus, and legal rights organisations is another natural route for health professionals to offer their knowledge and support. 

There are some protections we must pursue at a national and international level. The UK Faculty of Public Health campaigned to secure our involvement in the European Centre for  Disease Prevention and control (ECDC), and the Lisbon drugs monitoring agency which were part of Theresa May’s unsuccessful EU Withdrawal Bill.  The UK must remain part of these public health agencies. It is a shame that we can’t guarantee our involvement in the European Environment agency or the Food Standards agency, but we should still try.  We also need to secure the “do no harm” provisions of the Lisbon treaty for future protection of public health. This, in turn, informs our vigilance on trade agreements to ensure the maximum possible protection of health, environment, and social rights. 

The health community must avoid recrimination and steer towards a vision of better health, more caring communities and a better environment locally and for the planet.  We should not be swayed from our commitment to respecting all of our citizens equally and must challenge discrimination, prejudice, or violence against minorities. We must advocate for, and with, young people, to secure the wellbeing of future generations.  

John Middleton, President, Association of Schools of Public Health in the European Region.

Competing interests: None declared.