Better Health For All

A summary  

More than 350 people registered for the Faculty of Public Health emergency webinar on the impacts of a Crashout Brexit on October 19^th.  They came from more than 20 countries  and  three continents reflecting the huge international as well as UK interest in this imminent potential disaster.  The webinar was made all the more timely by  growing  concerns about the risks of a crash out,  from food, manufacturing and haulage sectors. The Prime Minister’s speech on October 16^th made the subject all the more urgent and compelling.   

Professor Tamara Hervey, Jean Monnet Professor of European Law at Sheffield University presented current legal implications of Brexit and crash out. The European  Union is a rules-based organisation. The European Parliament must agree trade deal proposals recommended by the European Commission for implementation by January  1^st 2021.  So time runs out soon. Key sticking points are fisheries, ‘level playing field’, and the governance of the agreement. We risk a crash out  Brexit by default, or by accident. No deal means trading by the World Trade Organisation’s rules, which do not prioritise health. Tariffs are automatically applied on traded goods. The EU has published over 100 sector-specific stakeholder preparedness notices during the Article 50 negotiations with the United Kingdom, suggesting it is serious that no deal could happen. Even if a deal is struck there is no provision for cooperation on broader public health matters, such as tobacco regulation or communicable disease control. Brexit, and specifically the UK Internal Market Bill, affects Scottish and Welsh government aspirations for Continuity with European regulations and may jeopardise existing public health measures there, such as minimum alcohol unit pricing. 

Dr May Van Schalkwyk reprised some of the concerns of her paper with the FPH president and others and added in a few more up to the minute and with a COVID pandemic now added to the mix. Uncertainty always affects mental health. Multiple shocks as we would potential see with Crash-out Brexit on top of the COVID second wave would compound and accelerate each other. A poor or weak deal would only be marginally better than no deal in terms of the disruption anticipated at our ports and the far reaching negative impacts on our economy. There would be disruption to  trade and to supply chains in many aspects of the  economy and important  institutional  links will be weakened or broken. There is strong possibility of shortages of food,  medicines, and components for manufacturing industry. There will also be the possibility of civil unrest., consequent on food shortage and  continuing austerity.   

Maintaining public morale, is intricately linked to public mental health, and community engagement and involvement, and trust, is vital. The WHO has emphasised that the science alone will not beat the pandemic, and that authorities need courage and empathy, and that community participation will be critical in our ongoing public health efforts – the importance of community involvement will only be heighten in the event of a no deal Brexit.  We also need to maintain communication within the UK,  and internationally. Public health, NHS and care services need to be fully involved in Local Resilience Partnerships.  

Professor Tim Lang highlighted the potential catastrophe ahead for food supplies in the short term. The UK is poorly prepared, totally reliant on private sector food retail supply and just-in-time supply chains.  Food poverty is rocketing. Food resilience is not seen as a government or collective problem but as a more individualised and ad hoc challenge for charity. Even without shortages, the fear of shortage and panic buying are a known possibility from this year’s COVID experience. UK food supplies are heavily reliant on the  EU.  Key foods likely to be disrupted are fruit and vegetables coming in and Welsh and Scottish lamb and beef going out. Under World Trade organisation rules, tariffs are automatically applied.  The average import tariffs  from the EU could be  20%. Welsh and Scottish lamb and beef could attract a 48% charge on export to the EU.     

In a no-deal, the immediate impact will be build up of trucks at Dover; a two minute delay to throughput quickly leads to a lorry queue of up to 7000 trucks, according to the “reasonable worst case scenario”.  

There are public health implications: air pollution and congestion, frustration, anger, local unrest and with sanitary provision only just being considered for truck drivers.   

Tim went on to describe a vision for an alternative vision for a post Brexit Britain, noting the continued absence of the much-delayed (English) National Food Strategy, now expected in early 2021.    

Gary McFarlane, Director for the Northern Ireland Chartered Institute of  Environmental Health described similar concerns for food, environmental and consumer safety. He feared a burgeoning workload for EHOs in local authorities , generally in response to COVID and then with added possible Crashout. Some EU systems are still central to for example, food safety. For example the EU RASFF system provided  vital early warning on  food  safety concerns. In a crashout scenario we could lose this and ist still unclear whether a viable replacement exists. Even as part of the EU food crime still goes on. The EU had not been able to stamp  out food crime, as exemplified by the ‘horsegate’ scandal,  but coming out of the EU  will make control of criminal activity even more difficult. CIEH was concerned that even within the EU inadequate progress had been made with regard to securing healthier diets, for human and planetary health. In the current emergency, CIEH was concerned for all aspects of environmental health control at all UK ports-extension of inspection times, congestion, increased air pollution and poor sanitary conditions.for truck drivers. The concerns that have been articulated in terms of delays at channel ports could/will also apply to ports like Holyhead and Liverpool where goods will move from GB to Ireland and Northern Ireland. And we must remember the potential consequences of no trade deal on the availability and price of food in Northern Ireland if it is coming from GB. CIEH would work with FPH to develop food standards to aim for Tim’s vision of an exemplary food policy for Britain. 

What can the Faculty of Public Health do?  

In the short term, the Faculty should advocate for, and reinforce the need for actions locally and regionally, funded and supported from central government. They could work with other public health bodies such as CIEH to amplify this message. 

Public health professionals at local authority and regional level should ensure Local  Resilience Forums have active public health involvement. The LRPs should incorporate food resilience planning in their emergency plans. Children’s Safeguarding Boards should also be mindful of the mental health needs of children,  the need to plan for local food insecurity and children’s food poverty and hunger and address it.   

LRPs need to be aware of the state of local public mental health, severely challenged in the COVID lockdowns. LRPS need to plan for more visible and widespread civil unrest in the light of a no-deal Brexit.  

Public health professionals should advocate for greater financial and service support  to local community groups, to enable enhanced mutual aid programmes to be delivered.   

In the longer term    

FPH should continue to advocate for a National Food Policy. This should promote sustainable diets as basis for food policy at all levels – linking nutrition to ecosystems, social and economic criteria. FPH should also support the https://www.sustainweb.org/news/oct20-future- british-standards-coalition-interim-report/.  

Leaving the EU creates an opportunity for public health experimentation, from which other countries can learn, and for attuning policy and law very closely to population needs in Scotland and Wales, where health is a devolved power. But the Internal Market Bill takes away this opportunity, and disrupts the UK’s devolved constitutional settlement in a way which it is difficult to challenge legally, given the way that the Supreme Court treats these constitutional rules. 

FPH will need to reactivate its lobbying to keep the UK as part of the European Centre for Disease Control and Surveillance ECDC and other European  public health institutions like the European Monitoring Centre for Drugs and Drug Addiction EMCDDA, Lisbon.  Our government can pay the subs to rejoin. 

We will also need to see where we can judiciously test the  ‘Do no harm’ criteria  to future trade regulations– even if the lobby seems like it was from a different era.   

The legal implications for public health are in one sense the same as they have always been. Brexit is bad for the NHS and bad for public health. 

Brexit, in any form, is a form of major social change and transition and has, and will continue to have, major impacts on people’s lives and the wider determinants of health. Public health has a role in keeping health on the agenda at times of transition and at the heart of policy debates and implementation. It has never been more needed. 

Postscript   

Since our Webinar,  EU  negotiator  Michel Barnier has  been in London for a further round of talks;  there is speculation that Prime Minister  Johnson will  hold off any decision on a crashout Brexit until after the  US election; and a large scale national campaign, led by footballer Marcus Rashford to  provide free school meals  has received widespread local authority support– perhaps  providing the impetus fro local  food  distribution platforms of the kind envisaged by FPH. 

Written by

Professor John Middleton, Hon FFPH
President, Association of Schools of  Public Health in the European Region, (ASPHER)  john.middleton@aspher.org 
Immediate Past President,  UK Faculty of Public Health 

Professor  Maggie  Rae  
President, UK Faculty of  Public Health  
President@fph.org.uk  

With thanks to the presenters, Professor Tamara Hervey, Dr  May  Van Zwalwyck, Prof Tim Lang and Mr Gary McFarlane.  

Especial thanks  to the staff team at the UK Faculty of  Public Health who made it happen Mag Connolly, Keith Carter, David Parkinson and  James Gore.  

Thanks also to Paul  Lincoln and  Heather  Lodge, for  PETRA and  Dr Ibraheem Alghamdi for  helpful comments.