Francesca Tomasi received her B.A. from the University of Chicago and is currently a microbiology researcher.
On June 23, 2016, the UK voted 52% to 48% in favor of a referendum that would allow them to leave the European Union. The series of events leading to and following the vote have been nicknamed “Brexit” for obvious reasons. And while the referendum will not turn into practice for at least another two years (with some experts even arguing that it may never actually happen), now is a great time to be weighing the pros and cons of the UK’s withdrawal from the 28-nation politico-economic European Union. Of course, we hope the voters of Brexit did in fact do this prior to June 23rd and that each ballot cast reflected a careful consideration of the advantages and disadvantages of its verdict. At Infective Perspective, we are interested in the whole story; but we are especially intrigued by Brexit’s implications on public health and scientific research.
The Journal of Public Health published an editorial earlier this year in which they discuss these very issues. Both authors of the piece are faculty at the London School of Hygiene and Tropical Medicine, and make several important points. Overall, they caution against Brexit due to its potential public health repercussions. For starters, it is important to examine the main issues leading to the referendum. The most talked about topic has been immigration. The European Union preaches the free movement of people, goods, services, and capital. This is its one of core values, and is a tenet of European citizenship. Some residents of the UK, however (and multiple other countries), have taken issue with possible economic ramifications of this principle. They argue that allowing foreign nationals (from within the European Economic Area) the same benefits and work opportunities as British citizens would cause mass immigrations and drain the country’s resources. One such resource is the UK’s National Health Service, which proponents of Brexit think would lead to a reduction in healthcare quality for UK and non-UK citizens alike.
The Journal of Public Health article quickly shuts down these claims, citing research from 2014 by University College London that concludes the opposite: “Between 2001 and 2011 recent EEA immigrants contributed to the fiscal system 34% more than they took out, with a net fiscal contribution of about £22.1 billion. In contrast, over the same period, natives’ fiscal payments amounted to 89% of the amount of transfers they received or an overall negative fiscal contribution of £624.1 billion.” Basically, immigrants from the European Economic Area have made positive fiscal contributions in the UK, even during period of UK financial deficit. Meanwhile, non-immigrants have overall made negative contributions. Despite their bad rap, immigrants in the UK have paid their dues and then some for public health services. Blocking immigrants would arguably harm the UK’s economy, potentially depleting the region’s national purse.
There is a reason the tenet “It takes a village to raise a child” is a long-standing mantra across so many cultures. Even if the saying was not first coined in the name of public health, it is the manifestation of a fundamental pillar of healthcare: especially today in such a globalized world, the free movement of information across borders and large-scale policy implementations are essential for robust public health infrastructure. European Union legislation runs on a democratic system and has played a major role in environmental and physical health, holding to the “it takes a village” practice. Neither disease nor pollution respect boundaries: just as an outbreak in one country can easily spread to other countries, emissions from one nation can have detrimental effects in other nations. One commonly cited example is sulfur dioxide emissions from the UK, which has been linked to damaging acid rain in Scandinavia. To address this, the European Union set limits on the sulfur content of fuels and emissions allowed per power plant. As a result, European sulfur emissions have dropped 80%. Similarly, vehicle emissions have been more strictly regulated with increased engine standards. Emissions from road traffic were reduced by 63% with European Union legislation standardizing emission across the continent. Water quality, both in homes and in nature, has also improved significantly through European Union legislation. The EU has also pushed to cut the use of tobacco, a leading premature killer of Europeans, by limiting advertisements, sales, and the ability to smoke in public places. The European Union works across countries to establish health policies and exchange information about things that may play an important role in the general well-being of its citizens.
With this in mind, it is likely that the UK will retain such public health policies even following Brexit: no country would actively worsen its living conditions. However, it is possible that in the economic downturn following the exit of the UK from the European Union, certain public health measures would be waned in favor of increased economic production (read: sulfur and other factory emissions).
What about research? The UK is well known for its prestigious universities and other scientific programs. One of the perks of being a part of the European Union is being a member of its science program. The European Union is one of the world’s biggest hubs of scientific activity that embodies the importance of international research cooperation. Its 7-year science program, Horizon 2020, manages 80 billion euros in funds and facilitates international cooperation. The biggest player in Horizon? The UK. Countries that are not members of the European Union – such as Switzerland, Norway, and Israel – get to participate in Horizon. However, they have been able to do so only by buying into the program, and they have no say in the program’s policies. Everything they do is contingent on European Union approval. It is therefore likely that following Brexit, the UK would lose research funds and, possibly, international collaborations.
Lastly, what are the implications of Brexit on disease surveillance? The European Center for Disease Control and Prevention (ECDC) is based out of Stockholm, Sweden. British public health specialists have made significant contributions over the years to the ECDC’s infrastructure, including coordinating surveillance data from across the continent, developing common standards of control and care, and coordinating emergency responses. Hopefully, in the name of public health, a Brexit would not also mean an expulsion from the ECDC. “It takes a village” these days should probably be changed to “it takes many villages,” if not many countries. Overall, we can reasonably say that no one knows exactly what will happen following Brexit, if the referendum pans out over the next few years. There is plenty of room for speculation and pro/con lists. Daunting or maddening as it may be, this kind of speculation is essential for individuals and governing bodies to consider when making final decisions. No one would ever consciously decrease national health standards or intentionally hinder scientific progress; nonetheless, certain important factors contributing to a strong scientific and medical infrastructure could be tainted by Brexit, and by similar referenda that may be lurking in the future.