The struggle to improve the health of the public is never-ending. As the pandemic has shown, there are always new threats that can emerge. Looking ahead, it is apparent to all but the most determined denialists that these threats will increase in scale and number, driven by the damage that we are doing to our planet. And those whose actions undermine health, such as the corporations trading in harmful commodities, the perpetrators of state and nonstate violence, and those who benefit from corruption and organised crime, have not gone away. Yet, mostly, those of us engaged in the struggle for health have drawn encouragement from the knowledge that our governments, for the most part, have been with us. Of course, they could have done more and, as ministers are only human, they are susceptible to the temptations placed in front of them. But, in the long run, they have accepted the view that it is part of their job to take measures that safeguard the health of their populations. Yet, as history tells us, there have been exceptions.
Within living memory, there have been governments that have engaged in mass murder. Others have pursued policies that have prioritised other goals, such as the industrialisation of the Soviet Union, giving rise to what has been described as ecocide. And others have simply abandoned large swathes of their population, such as the victims of deindustrialisation in the American rustbelt who have experienced years of what have been described as deaths of despair, a phenomenon also experienced in some parts of the UK.
So how should we respond when it seems like our government is giving up? This is a real question for those of us living in the United Kingdom. Freedom Day has come and gone. Admittedly, the dramatic increase in infections has not materialised, perhaps because many people, and especially those most vulnerable, have declined the government’s invitation to return to the pre-pandemic normal. Yet we are still seeing several hundred deaths every week. In effect, it is as if a jumbo jet was crashing every few days. This is a toll of suffering and misery that, we are told, we must simply live with. After all, we have lived for many years with large increases in deaths every winter. Why are we suddenly getting so concerned? Yet we ignore how some other European countries, especially Nordic ones, have maintained high building standards and ensured that large numbers of their older population are not living in poverty, thereby avoiding this seasonal toll. But maybe the politicians have a point. Where was the public clamour as life expectancy of older people in the United Kingdom stagnated or declined during the 2010s?
But there are other examples. Having failed to “save Christmas” in 2020, the UK prime minister, Boris Johnson, is anxious not to disappoint his supporters again. A combination of the pandemic and, mainly, a hostile climate for migrants due to Brexit, has threatened the food supply (as we predicted in the aftermath of the referendum). A lack of agricultural and food processing workers means that the British public may have to forgo traditional Christmas products such as “pigs in blankets” (for readers elsewhere, these are sausages wrapped in bacon). A shortage of heavy goods vehicle drivers threatens the supply of children’s toys. The government’s response has been to relax the testing standards for drivers. No longer will they have to show they can reverse safely or couple and decouple a trailer. It had already relaxed limits on driving hours. What could possibly go wrong?
It is not just shortages of workers. The water industry is concerned about potential shortages of chemicals to treat effluent, again due to post-Brexit problems with the supply chain. The response is to relax standards to allow sewage that has not been fully treated to be discharged into the environment. When it was a European Union member the United Kingdom often faced the threat of enforcement action on account of its environmental failures. No longer. It has now taken back control. Whether this is in our collective interest is, of course, another question.
Of course, if a government is adopting policies that will harm health, there is an easy solution (at least in the short term). Stop publishing data. This is what the Soviet Union did in the 1980s. In fact, the quality of data in the United Kingdom is, and long has been, remarkably high. However, there are some important gaps. Unlike some other countries, such as France, we fail to record work-related suicides. And there are already voices calling for a stop to the publication of the daily covid-19 figures. Of course their interpretation is challenging, given differences in testing rates, the impact of high vaccine uptake and much else, but at least they make expert analysis possible.
But, the government can do what it wants, especially with an 80 seat parliamentary majority. It is tearing up long established norms in many areas, most notably in the measures it is taking that will make it more difficult to vote and to restrict the independence of the Electoral Commission. As the examples above show, it is no longer constrained by European law and, indeed, has made much of its new ability to diverge from EU standards in areas such as food safety. Perhaps we can look to its commitment to the internationally agreed targets to improve health set out in the Sustainable Development Goals? Yet, as we have seen in the aftermath of Brexit, ministers no longer feel committed to international agreements, even to the extent of stating their intention to Parliament to break international law, although only “in a very specific and limited way.”.
The government says that its first duty is to keep people safe. This is the rationale for spending money on defence. It can, of course, decide that it no longer wants to assume the responsibility for safeguarding us from threats to health. But if it does, it should at least be honest about it.
Martin McKee, Professor of European Public Health, London School of Hygiene & Tropical Medicine.
Competing interests: MMK is a member of Independent SAGE.