{"id":38841,"date":"2017-03-31T11:14:07","date_gmt":"2017-03-31T10:14:07","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=38841"},"modified":"2017-06-27T13:59:15","modified_gmt":"2017-06-27T12:59:15","slug":"john-ashton-brexit-trump-and-public-health","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2017\/03\/31\/john-ashton-brexit-trump-and-public-health\/","title":{"rendered":"John Ashton: Brexit, Trump, and public health"},"content":{"rendered":"

\"\"This speech was delivered as a TED Talk for University of Liverpool. Finsbury Square, London. 29th March 2017<\/em>.<\/p>\n

This has not been an easy time for me. My 13 year old has been making\u00a0his GCSE subject choices at school and has chosen PE over history. It has\u00a0brought back vivid memories of my choices at the same age.\u00a0First between history and chemistry, then later between arts\u00a0and science. My passion was social history and especially the\u00a0politics. I managed to keep up history by studying it after school. In the\u00a0sixth form, my headmaster had the last word. “If you can do the\u00a0sciences, you should,” he told me. “You can return to the humanities later.\u00a0You can’t move the other way round.” He was right!<\/p>\n

The next watershed was my application to university. My mother\u00a0had me down for a vet from the moment I passed the 11+. My\u00a0uncle John had other ideas. “You should do medicine,” he told\u00a0me with authority, “for three reasons:\u00a0Firstly\u2014it is well rewarded and prestigious.\u00a0Secondly\u2014it is a passport to the world.\u00a0And thirdly\u2014because you don’t need to decide what you really want to\u00a0do for another five years.” He was right on all three counts.<\/p>\n

Years later, having qualified as a doctor and specialised\u00a0in psychiatry, family medicine, and sexual health, I found myself on the\u00a0MPH at the London School of Hygiene and Tropical\u00a0Medicine listening to lecturer Sidney Chave talking about\u00a0social history, politics, and public health. I knew that I had come\u00a0home. Home\u00a0 to a place where all that had gone before would make sense.<\/p>\n

And at the London School, I discovered that public health was about\u00a0more than food and water, housing, drains, and epidemics\u2014important and\u00a0interesting as these were. It was about poverty and inequality\u00a0and the fight for social justice. It was also about the contribution of a wide\u00a0range of people to public health with multi-disciplinary teams deploying\u00a0technical skills and the arts of advocacy on a journey of improvement in\u00a0the human condition.\u00a0It was about war and peace, economics and security, and touched on every\u00a0aspect of everyday life. Above all I discovered that public health was the\u00a0political wing of medicine and of the environmental and social\u00a0sciences, and that Parliament was its dispensary.<\/p>\n

Forty\u00a0years on I look back on my own small span of social history and\u00a0how it has impacted on public health. As a 1947 baby boomer, I\u00a0was part of the post-war demographic wave that swept all before it. We\u00a0had benefited from war time solidarity with equality of rationing and the\u00a0best nourished cohort of pregnant mothers ever, and now we benefited\u00a0from a remarkable post-war settlement. The generation that had grown up\u00a0and lived through the pre-war years of recession and austerity, had\u00a0fought fascism and seen family and friends perish for freedom, were\u00a0determined to build a better, secure, and peaceful future for their children.<\/p>\n

Here, in the UK, we benefited from the advent of the National Health\u00a0Service and the welfare state, the miracle of universal immunisation and\u00a0the demise of many fatal childhood illnesses so well known to our parents.\u00a0But it didn’t stop there. They created the United Nations, the World Health\u00a0Organization and the UN’s other Agencies and in Europe, the European\u00a0Union\u2014all institutions to act as bulwarks against poverty, disease, hatred,\u00a0war, and death. They were all public health initiatives.<\/p>\n

The opening up of educational opportunity meant that millions of us from\u00a0humble backgrounds could aspire to university and dream big; I have had a\u00a0wonderful life and career. I have been privileged to play\u00a0a part in many of the contemporary public health issues and dramas of the\u00a0times from alcohol and drugs to the sexual revolution, HIV, and Ebola. I\u00a0have seen frontline action in public health disasters and emergencies. I\u00a0have met Presidents, sovereigns, and celebrities; enjoyed a comfortable\u00a0standard of living and travelled the world. I can take satisfaction from\u00a0having made a difference in some ways. At its best public health work is\u00a0amazing, with never a dull moment, thinking on your feet and responding\u00a0to new challenges. As I am fond of telling my students “it’s the most fun\u00a0you can have with your clothes on!”<\/p>\n

But I am restless and ill at ease. I am still not sure what I really want\u00a0to do. Uncle John wasn’t quite right on this point.\u00a0What I do know is that the world is in trouble and that the implications for\u00a0the public’s health are immense.<\/p>\n

Last summer I joined a group of walkers with Sir Anthony Seldon, vice-chancellor of Buckingham University to make a pilgrimage along the\u00a0Western Front of World War 1, from Switzerland to the English\u00a0Channel. Our ambition was to pave the way to international recognition of\u00a0this secular pilgrim path as a permanent reminder of the horror and futility\u00a0of war. Day after day we made our way along tracks, through woods and\u00a0villages and past the relics that marked the deaths of millions of men from\u00a0around the world.<\/p>\n

Our walking was punctuated by cemeteries, stories,\u00a0solemn moments, and tears as we reflected on the causes of the carnage;\u00a0the last hours and days of a generation of young men.<\/p>\n

On the morning of 23rd June we woke to the news that the British had\u00a0voted to leave the European Union. \u00a0We were all in shock. There, in\u00a0France, immersed in the practical reality of the implications for peace in\u00a0Europe and the world, we could not believe what had just happened. With\u00a0events in the Ukraine, in Turkey, \u00a0across the Mediterranean and beyond,\u00a0the fracture lines that lay behind the events of 1914, were\u00a0only too visible again. The EU was one possible bastion against history\u00a0repeating itself.<\/p>\n

Throughout the summer the Syrian refugee crisis continued to play out\u00a0with old fears of the foreigner and of the “other” surfacing as though they\u00a0had never gone away; racism and xenophobia bubbling away in a dozen\u00a0national cauldrons. And then in November, America did the unthinkable.\u00a0It elected as President a reckless, insular, and provocative man with no\u00a0understanding of the world’s fragile human and natural ecology.\u00a0Public health is once again in peril.<\/p>\n

Against a background of global warming, and denial of the overwhelming\u00a0weight of scientific opinion, it seems that we are in a lemming rush to self\u00a0destruction. Hatred and war are once again the greatest immediate dangers to health\u00a0and the quality of life. In the 17th century military deaths accounted for\u00a019 out of every million deaths. By the 20th century this had risen to 183. In\u00a0the 21st century the prospects look bleak, especially as these statistics\u00a0don’t give the full picture. Seventy five percent of casualties are now\u00a0civilians, compared with 10% in World War 1. And in the train of conflict\u00a0and war, of mass movements of refugees, comes mass death from the\u00a0classical public health causes of starvation, squalor, and epidemic disease,\u00a0and with it a long trail of psychological trauma,\u00a0misery, human trafficking and slavery, and further violence.<\/p>\n

If this all seems bleak we should take comfort from the track record of\u00a0humans fighting back against all the odds. In this there is a tradition of\u00a0public health workers playing an active part. Credentials in public health\u00a0can be a ticket to being heard. Throughout my career\u00a0I have got up every morning wishing to change the world. I\u00a0have been inspired by many who have gone before. Not least among these\u00a0was my late friend and colleague Slobodan Laing, medical officer of health for Zagreb. At the height of the disintegration of\u00a0Yugoslavia, Slobodan stood between Serbian troops and striking miners\u00a0in mediation. He went on to have\u00a0a key humanitarian role throughout the\u00a0Balkans civil war. His inspiration gave me the courage to intervene on\u00a0behalf of the innocent at Hillsborough, with President Clinton to evacuate\u00a0medical refugees from Kosovo, and to bring the fuel protesters to their\u00a0senses here in the UK.<\/p>\n

At this stage in my career, one of the things I really want is to\u00a0encourage many more committed people to find their passion in the\u00a0protection of public health by following in Slobodan’s footsteps. There is\u00a0plenty to do and the task is urgent. As the last of the noble wartime\u00a0generation that gave us hope and opportunity passes on, it is time for the\u00a0boomers who benefited to ensure that the torch of solidarity, peace, and\u00a0public health is passed on to the millennials. That we see off the threat of\u00a0small minded cynics and xenophobics\u00a0 who have recently been in the\u00a0ascendancy.<\/p>\n

I invite you all to join in this crucial work.<\/p>\n

To quote the American civil rights leader Benjamin Mays:<\/p>\n

“It must be born in mind that the tragedy of life doesn’t lie in not reaching\u00a0your goal,
\nThe tragedy lies in not having any goal to reach.
\nIt isn’t a calamity to die with dreams unfulfilled, but it is a calamity not to\u00a0dream…..
\nIt is not a disaster to be unable to capture your ideal, but it is a disaster to\u00a0have no ideal to capture.
\nIt is not a disgrace to reach for the stars, but it is a disgrace to have no\u00a0stars to reach for. Not failure, but low aim is the sin.”<\/p>\n

And I know that my young son who will enjoy his PE\u00a0still has time to\u00a0discover a passion for history.<\/p>\n

Postscript<\/strong>: My uncle, John Ashton, was Edward Heath’s right hand man in the Department of Agriculture during the Brussels negotiations leading us to joining the Common Market. He flew with the Fleet Air Arm\u00a0in the second world war, and dedicated his career to post-war reconstruction through agriculture and was the first professor of agricultural economics. This piece is dedicated to uncle John and his selfless generation.<\/p>\n

John Ashton<\/strong><\/a> is a professor at University of Liverpool, Liverpool School of Tropical Medicine, London School of Hygiene and Tropical Medicine, and visiting professor at a number of other universities. He was regional director of public health and regional medical officer for the North West of England.\u00a0<\/em><\/p>\n

Conflict of interest<\/strong>:\u00a0John Ashton is a specialist adviser to the House of Commons Health Select Committee on Brexit.\u00a0He voted to Remain in the European Union on 23rd June 2016. His uncle John Ashton was one of Edward Heath’s principle negotiators for entry into the Common Market.\u00a0<\/em><\/div>\n","protected":false},"excerpt":{"rendered":"

This speech was delivered as a TED Talk for University of Liverpool. Finsbury Square, London. 29th March 2017. This has not been an easy time for me. My 13 year […]<\/p>\n

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Finsbury Square, London. 29th March 2017. This has not been an easy time for me. 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