I am sure I am not alone in feeling utterly despondent about the state of British politics today, just a few days into the aftermath of the EU referendum. Like most people I have found it difficult to differentiate fact from fiction on both sides of the argument. I am deeply concerned about the implications of these political events for the health of families in the UK.
I offer these thoughts distilled from 30 years of working in the NHS and observing the impact of politics and policies on the health of the public.
- On the fallacy that the market acts as a global force for good. We live in a world dominated by consumerism and market forces. In a true free market all the costs of producing a good or service are directly reflected in the price of that product or service. In reality, we have is a system rigged in favour of profit-making by big business and their shareholders. This flawed system minimises any negative social and environmental costs of business in order to maximise profit. Another sleight of hand involves shifting production costs to developing nations where labour is cheap and health and safety legislation is minimal. This practice is neither good for the local economy nor the economy that has lost employment and undermines self sufficiency. Another example would be carbon-based energy production which directly harms human health through air pollution, then indirectly through the health impacts of climate change in the long term.
- Economic policy can harm health and peace. The global downturn of the economy in 2008 was precipitated by deregulated banks and businesses and has resulted in increasing inequalities in health and wealth across the world. Austerity measures, a political choice, have served to further compound these inequities. Once again the most vulnerable in society have borne the brunt of maintaining the banks and big businesses. It is not surprising that people living in straitened circumstances feel vulnerable, succumbing easily to erroneous and facile arguments that migration represents a threat to their security and way of life.
- Health is not a marketable good. Health is not a marketable good - the rules of depreciation and discounting simply do not apply; the complexities of health interventions lead to an asymmetry of information, so what you need is not necessarily what you get. As health service policy has become increasingly market orientated, patients and profits are negotiated and traded as goods rather than people with complex health needs and values. It’s all too easy for Trust financial viability, especialy in times of reduced public funding, to morph into a profit-making enterprise detracting from patient care, minimising the value of our human enterprise as a public good based on compassion. Externalising costs, shifting costs, minimising costs; these profit driven strategies so easily undermine holistic patient care. Not good for health. Not good for people.
- People increasingly alienated from the democratic process. The public is losing confidence in our political representatives. Politicians who are whipped into obeying the political mantras and the commands of party leaders no longer represent the interests of their constituents. Where is the genuine public engagement in health policy development? People feel isolated and stripped of power to influence their worlds Where are the political leaders that people can trust? It is time for a change in the process of our democracy. A single transferable vote and an elected second chamber could be potential steps in the right direction. Regular meaningful public debates and informed votes on major policy issues should certainly become integral part of life in the UK.
- Europe and the misattribution of blame. Why would people vote against European regulation that protects the health of people and the environment? Or resist the European Court of Human Rights that holds governments to account and ensures their human rights are upheld? Or protest against legislation that enables people to move and work to improve their lives and those of their families? Or refuse economic subsidies and investments in impoverished post-industrial towns and cities? The European Union does much to protect life and health. Yes, of course, it could do better. Food policy, for example, must change to help tackle complex health challenges like obesity which are better addressed collectively, keeping a very clear focus on the benefit of people, and not food industry or other corporate interests. The European Union appears to be blamed for UK economic policy and the pain of austerity measures. Arguments about regaining control appeal to disenfranchised alienated people who have been let down by their own government and now leaving Europe will likely leave them more vulnerable as European regulation to protect the population moves on without us.
We have good reason to feel despondent. Both the left and right of the political spectrum are imploding. The Prime Minister has resigned and the opposition has imploded. While the political world is in turmoil, now is the ideal time to rethink the purpose of politics. "Today's decisions, for tomorrow’s children" should become our mantra. We should put families first and take a long-term, whole system approach to decision-making. Our constant focus must be on protecting and promoting the health and wellbeing of both the people and the planet.
Community paediatrician, co-chair BACAPH