Wherever we work in public health, in local communities, in regional and national organisations, or in international bodies, our first duty is to protect and improve the health of the people we serve.

My personal and professional beliefs have been seriously challenged by the outcome of the United Kingdom's General Election of December 12^th, 2019. The British electorate seems to have rejected all the evidence of what has gone wrong for their health and prosperity over the past ten years: life expectancy has gone down, particularly for women in poor areas, and infant mortality has increased.  Maggie Rae and I presented the case for health, wellbeing, care and planetary health in the election debate, but it was poorly served. There must be doubt as to whether any response will be implemented to prevent climate catastrophe. Food banks received a boost in donations in the wake of the election; at the same time that stock holders were enjoying a further boost in their personal wealth. Inequalities in income, and in health, increased overnight.

In the Conservatives’ landslide victory, large swathes of England where Brexit will cause the most pain, voted to Get Brexit done. Other observers outside the UK can enjoy the schadenfreude headlines like Der Spiegel: Die Gänse haben für Weihnachten gestimmt – …yep! ‘the turkeys have voted for Christmas’. In the public health community, there is no time for recrimination, or heart searching. It isn’t the first time that a group of people or politicians have ignored our overwhelming evidence base. Think about decades of tobacco control efforts. Our duty is to protect and improve health. We must continue to serve our most vulnerable people, seek to reduce inequalities and help people to achieve a better quality of life, for themselves, their children, their community, and their planet.

In a lecture I gave in Maastricht University to master’s students in the global leadership in public health course the morning after this devastating election result, I was asked ‘how do I keep up hope?’ It was very hard to answer, because at that point I was still in that denial point in the grieving cycle….

My answer:

Don’t ever expect too much from politicians, and you won’t be disappointed.

Build from the grass roots. Understand and build on your community assets: build robust community campaigns and organisations–people start to recognise who is making their lives more difficult, who is profiting from their misery, who is distorting their understanding of how the world works… American community organisations have understood this for many years and grassroots resistance can prevent excesses from presidential power, especially led by women.

Understand rights as real and tangible, not theoretical and aspirational–they can and are tested in courts of law–our right to health was more important than the tobacco industry right to intellectual property in the plain packaging ruling in the High Court. Rights can be tested. Understand and use them in the law.

Empower cross-party political coalitions based on the things we all want. Coalitions are needed that can lobby strongly for policies which unite us more than divide us: In rich and poor worlds alike, we need an end to austerity policies; the green new deal to be at net zero carbon before 2050; free social care and universal health services; and we need to build public health services and budgets–they give you a much better return on investment than treatment interventions.  

In short, my nine lessons for Christmas:

1. Speak well of each other and be united.
2. Be respectful of the communities we serve–even where they have taken choices which will damage their health–our job is to minimise the damage.
3. Be true to the evidence–even when others are not.
4. Recognise the power and righteous expectation of our young people and grow their talent, politically, and practically. Give them the skills and a future.  
5. Build community assets and support our local communities, move from the grass roots upwards.
6. Unite around polices we all agree.
7. Understand our rights, and how these can be used in the law
8. Be charitable and be kind.
9. Challenge falsehoods and prejudice and confront bad behaviour but try to do it in a firm and non-violent manner.

So the United Kingdom will leave the European Union on January 31^st 2020. Martin McKee concisely describes the areas of contention for Mr Johnson and his new government for the audience at home and in Europe. There are obvious problems in relation to the Irish border and new battles to be had on acceptance of regulations in the trade deal and concessions over fishing.

The public health community will need to engage as well in securing protections for the health of all our European citizens. The UK Faculty of Public Health campaign to secure our involvement in ECDC, and the European Monitoring Centre for Drugs and Drug Addiction need to be reaffirmed and defended. A shame we can’t guarantee UK involvement in the European Environment Agency or the Food Standards Agency, but we should still try. We also need to build on great work to secure the ‘Do No Harm’ provisions of the Lisbon Treaty for future protection of public health.  This in turn impacts on our vigilance on trade agreements to ensure the maximum possible protection of health, environment and social rights.

We must also address the florid abuse of information as power through social media advertising generating fake news and diversionary news. In the public health community we are increasingly aware of the perverse influence of an unedited and uncontrolled social media in Antivax, e-cigarettes and other areas of our work. But by comparison, disinformation was on an industrial scale in the UK election campaign, and will be even more so in US 2020 Presidential campaign. We are in a state of information breakdown, every bit as serious as climate breakdown.

I have previously observed how I consider the new EU President’s manifesto to be an evidence-based programme for public and planetary health. On the day before the UK election, Ursula von der Leyen unveiled the EU plan for a new Green Deal to get Europe Carbon Neutral by 2050. The new UK government promises more police and punishment, more treatment for more disease and is silent on climate catastrophe. They would do well to look at the European Union programme and consider what the UK will miss out on: prosperity, public health and planetary health.

The public health community must keep its hand on the tiller and steer towards a vision of better health, more caring communities and a better environment locally and for the planet. We should not be swayed from our commitment to respecting all of our citizens equally, we must champion equality and rights, and we must challenge any discrimination, prejudice, violence against minorities of all kinds. We must advocate for, and with, young people, to secure the wellbeing of future generations. Bring it on and build it up.

John Middleton

December 17^th 2019