Offline: B-day—time to get real

Abstract

It wasn't 9/11. But it felt like it. The shock of waking up on June 24, 2016, was palpable. Bewilderment and bereavement. Those of us who believed in the UK as an outward-looking European nation couldn't accept the fact that by the slimmest of majorities (51·9% vs 48·1%), Britain had voted to leave the European Union (EU). Even today, that sense of incomprehension, even trauma, is still felt by many. The Liberal Democrats have promised a final public vote on a Brexit settlement, together with an option to vote to stay in the EU. A great deal can certainly happen in 2 years. But how should the health community respond to Brexit now? So far, our reaction has been disappointing. The immediate response by some senior figures in the health and medical scientific communities was selfish self-regard. They were worried about their potential loss of access to European funding. They were anxious about their loss of professional prestige. For a community that prides itself on asking questions, we had no questions to ask. For example, why? Why did so many of our fellow citizens feel disenfranchised by the EU? Why had they lost hope? Why did they feel their opportunities had been eroded by the EU? No questions, and so no answers. The Society for Social Medicine brought together a small group of public health professionals, scientists, and policy makers last week to begin to address these questions. The prevailing view was bluntly summed up by Tamara Hervey, Jean Monnet Professor of EU Law at the University of Sheffield: “Brexit is a disaster for health.” The Great Repeal Bill—or GERBIL—is neither great nor a repeal. Scott Greer, Professor of Global Health Management and Policy at the University of Michigan, argued that the vote was “a national own goal of stupendous proportions”. And whatever the British Government may say, “the UK cannot escape deeper integration with Europe”. Brexit is tantamount to Britain attempting to repeal the law of gravity. Worse, thanks to a renewed Franco–German axis, the UK will be negotiating with an EU that will be more social democratic than it was before June 23, 2016. EU negotiations will likely be more inimical to UK demands today than they might have been a year ago. That said, “there is still a lot to play for”, said Greer. Inertia, an unwillingness to unravel 40 years of European cooperation, will help us. And the skills that Britain offers, especially in science and technology, will remain magnets for international collaboration (unless restrictive immigration and rising xenophobia destroy any lingering goodwill). Still, the overriding anxiety was that our government was “drowning” in the complexity of the task. Politicians were paralysed and civil servants lacked the skills and capacity to deliver. So what should we do? First, we need to recognise the political context—the UK election on June 8, 2017, will most probably result in a government committed to a hard Brexit. Second, we need to offer a confident vision for the future—to protect and advance the NHS, public health, and the life, clinical, and public health sciences: the foundations of our nation's health and prosperity. Third, we need a strategy—soft Brexit, not as a slogan, but as a set of tangible policies. What policies? One option is Association Status with the EU, a relationship forged by countries such as Israel. Association Status would preserve our cultural and research relationships with the EU, without the toxic spectre of economic and political integration. But even associate membership might be too much for extreme Brexiteers. Instead, Hervey proposed a “series of relationships” that would allow separate negotiations in areas that garner wide support (eg, in science and health). And finally, to build confidence among the public and politicians for a softer Brexit, we need quick wins. One quick win would be to protect the rights and interests of health workers, many of whom come from EU countries. Another quick win could be to protect the science base. A third would be to invest in the UK's global leadership—eg, in global health security. Now is not the time to remain silent. Now is the time to propose practical policy options that deliver real benefits to the UK population. No shock. No anger. No recrimination. Just a clear statement of values and an optimistic offer for our common future. Health and science can be powerful forces to rewrite the relationship between the UK and the EU. Let's get real. And let's get on with it.