The principal institutions of the EU are:

  • Commission: proposes legislation, implements laws, upholds the treaties; It is appointed by the 28 governments, and is accountable to Parliament.
  • Parliament: scrutinises proposals, amends and passes legislation, holds Commission to account; It is directly elected by the adult population.
  • Council: protects rights of Member States, amends and passes legislation.
  • Court of Justice: interprets the treaties, defines the meaning of laws

What sort of “Brexit” is proposed?

  • Article 50 of Lisbon Treaty.
  • preparation for a second referendum?
  • rights of UK nationals in other Member States not guaranteed.
  • full access to Single Market (like Norway)?
  • partial access to Single Market (like Switzerland); restrictions on services, limitations to research participation?
  • complete independence, seeking new treaties everywhere?

Peace in Europe

  • The first and original objective of the EEC was: promotion of peace in Europe;
  • Would Brexit stimulate Europe`s right wing groups?
  • EU provides an over-arching supranational accountability for democracy, rule of law, etc.
  • The migrant crisis demonstrates the need for cooperative policy across Europe, rather than nationalist reactions in individual Member States.

Public Health consequences of Brexit:

  • Exclusion from the European Centre for Disease Prevention and Control  (e.g. early warning and response systems);
  • Exclusion from the European Food Safety Authority and from consumer product safety legislation;
  • Exclusion from Public Health Programme, which enables shared learning across EU (many UK agencies currently involved);
  • Exclusion from EU`s powerful voice internationally on health affairs;
  • Exclusion from medical devices and medical technology regulation;
  • Exclusion from common standards for handling and movement of human tissues, organ transfer, etc.;
  • Exclusion from common standards permitting easier import of food products, quality of tobacco products, combatting counterfeit medicines;
  • Exclusion from cooperation, e.g. to develop new antibiotics;
  • Exclusion from joint efforts to combat microbial resistance to antibiotics.

Environment and Climate Change

Environmental legislation is almost entirely an EU competence;

  • Air, water, pollutants, the climate itself – all are no respecters of borders;
  • EU legislation has enforced air quality and bathing water improvements in UK; outwith EU, would UK standards fall again?
  • EU has taken lead in combatting climate change; outwith EU, would UK backslide?
  • Exclusion from Registration, Evaluation, Authorisation & restriction of CHemicals  and the European Chemicals Agency?
  • Environmental links with agricultural policy – unlikely to be maintained outwith EU?

Agriculture, food and nutrition

  • Farm production responds to subsidy; what would UK farmers produce outwith EU?
  • €27.8 million is to be invested in UK agriculture by 2020; would UK match this outwith EU?
  • Agriculture affects nutrition and climate; within EU UK can influence policy in these areas;
  • Within the Common Agricultural Policy, to get subsidy farmers must comply with basic standards; would UK maintain these?
  • Legal constituents of food, food labelling, etc., are set at EU level; what would UK do outside?
  • EU regulation currently bans hormones and antibiotics as animal growth stimulators; would UK relax to US standards?
  • UK relies on EU for fruit and vegetable production.

Social dimensions

  • Health and Safety at Work legislation is European; would UK maintain, outwith the EU, standards it has opposed?
  • The Social Chapter provides for maternity and paternity leave, guaranteed four weeks` holiday, equal pay, equal rights for Part Time workers, unfair dismissal protection; all these address the social & economic determinants of health; outwith EU, would these rights disappear?
  • The Working Time Directive guarantees employees` protection from excessive hours; what would UK do?
  • Exclusion from framework to protect children`s rights (sexual abuse, exploitation, victims of crime, trafficking).

Regional Policy

  • After the Common Agricultural Policy,this is  the next biggest EU budget;
  • Many UK areas have benefited from Regional Policy support;
  • Would UK maintain similar transfers of capital from richer to poorer regions?
  • €5,000,000,000 top-sliced for health development; Northern Ireland has drawn on this and other UK health infrastructure developments are drawing upon it.

The Single Market

  • Procurement rules guarantee equal access to all EU markets; Brexit would exclude (e.g. pharmaceuticals) from equal access to EU markets;
  • UK is the pharmaceutical industry centre, and the EU provides companies with 500 million customers; this contributes £billions to UK life science companies;
  • If UK left EU, the big 100 pharmaceutical companies based in UK could be forced to move back into EU.

Free movement of health professionals

  • Skills gaps, both in NHS and the Care Sector, can be filled easily from anywhere in EU; how would Brexit affect the current efforts to increase the medical workforce supply?
  • This also benefits the UK life sciences sector, with UK attracting more university-educated EU citizens than any other MS. Brexit would exclude UK from Erasmus and Marie Curie schemes, providing mobility for young researchers, and from the European Programme for Intervention Epidemiology Training … (training in communicable disease control).

Standardised medicines approvals

  • Approval of new products is by the European Medicines Agency, based in London; Brexit would exclude new UK pharmaceuticals from approval across EU;
  • Previously, approval had to be obtained in each Member State separately: lack of consistency, and no consistency across EU of patient information leaflets;
  • The EU bilateral trade agreements with external markets provide access to UK manufacturers; it would be difficult for UK to negotiate these anew.

International influence on medicines and devices regulation

  • Outwith EU, UK would have lost its “seat at the table”. Norway signs up to EU regulations in the interests of its firms wishing to trade in EU; however it has no voice in the development of these regulations; do we want this for UK?
  • The UK government is able to ensure that UK interests are taken account of, as in the current round of revision of medical devices regulations.
  • In case of Brexit, the European Medicines Agency would have to leave UK.

UK research excellence, and access to research funding

  • UK would be cut off from the most significant PH research community in the world;
  • UK researchers would be cut off from a major source of research funding;
  • UK contributes (within overall EU funding) 11% of EU research budget, but receives back 16%;
  • UK is the biggest beneficiary of research funding: €570 million in last period;
  • EU research funding benefits all of UK (not just London, Oxford and Cambridge!).

Cross Border Healthcare for UK citizens

  • The Cross Border Healthcare Directive enables residents of any Member State to obtain investigation and treatment elsewhere in EU; Brexit would deny this to UK citizens;
  • This Directive creates European Reference Networks (e.g. for rare diseases); Brexit would exclude UK from this;
    Brexit would end emergency medical care arrangements in EU;
  • Brexit would deny 2,000,000 UK citizens resident elsewhere in EU of healthcare; these citizens use more healthcare than do citizens of other EU Member States resident in UK.

Further challenges posed by the internal market

The internal market usually takes precedence over much else in EU; this can be a problem for Public Health;
Sometimes conflict between internal market and Public Health interests (e.g. over tobacco advertising, alcohol minimum pricing, etc.) end up in the European Court of Justice;
Public Health interests have a good record of winning in these disputes, but our European colleagues value the skills of UK PH professionals in these matters: they need us!

Conclusions

  • UK has world class Public Health, in practice and research, but this could be threatened;
  • Brexit would be detrimental to UK population health, hindrance to effective Public Health practice, and a grievous blow to UK research;
  • Brexit could damage severely Public Health practice and research for many years to come;
  • Brexit would result of our losing control of some of the most significant determinants of UK health.
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One Comment

  1. Peter Mayer says:

    Helpful summary. Not sure how much conclusions are evidence based?

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