Europe has seen off moves that could have harmed the NHS and offers plenty of other benefits, says former chief medical officer Harry Burns
Not for the first time, Nicola Sturgeon hits the nail on the head. In asking for some common sense in the statements being made by both sides in the EU debate, she speaks, I think, for most of us.
Most doctors and scientists I know believe we should remain part of the EU, benefitting from the research carried out in its institutions
As well as being historically inaccurate, comparisons of the EU with Nazi Germany seem inept given that the Brexiteers will be hoping for favours from the EU should their side of the argument prevail.
In fact, Hitler was strongly opposed to a united Europe. He condemned the idea of a pan-European state as “ a fantastical, historically impossible childishness”. So ridiculous are some of the statements being made to justify Brexit that it can only be a matter of time before someone predicts a zombie apocalypse unless we close the borders.
My views on EU membership are not shaped by hysterical claim and counter-claim but by studies of how health and wellbeing is created in our society. These studies suggest that wellbeing in any society is associated with characteristics such as high levels of social cohesion, citizens who have a reasonable degree of economic security, who feel they have a purpose in life. In some respects, these qualities may be commoner in countries within the EU than that in those outside.
Health and employment
The Glasgow Centre for Population Health examined the impact of loss of industry across Europe in the latter decades of the 20th century. Their hypothesis was that the relatively poor life expectancy in West Central Scotland emerged as a result of the collapse of traditional industries.
The failure of policymakers to support communities damaged by unemployment seems to have had an adverse impact on the health of the population. Other regions of Europe experienced the same loss of jobs but have not experienced the same adverse impact on their health.
A possible explanation for this difference is that better health in European regions is supported by better social protection for the unemployed. Despite the belief in the UK that our benefit system is the most generous in Europe, this may not be the case.
The social protection available in many European countries, together with more active attempts to find jobs for the unemployed, protects the health of those who lose their jobs more effectively than the UK welfare state. Many European countries do more to help the unemployed that we appear to have done, and their health is better as a result.
These different attitudes to work across the EU are reflected in the rights accorded to workers. Limits are applied to hours employees can be required to work, working parents have the right to take leave to look after their children, and temporary agency workers and workers with fixed-term contracts are entitled to the same basic conditions as comparable workers with permanent contracts.
These are all aspects of EU employment law which makes life better for families and enhance wellbeing.
Would laws protecting employees’ rights be dismantled following Brexit? Does anyone doubt that a Conservative government would try to repeal laws which protect workers rights at the expense of company profitability?
The issue of migration
Migration seems to be one of the main concerns of those supporting Brexit. In 2003, two economists working in France published a paper in which they examined the argument that free movement of labour would mean poor workers would inevitably gravitate to the British welfare state system system. Their analysis suggested that the more effective social protection arrangements in countries such as Germany might be more likely to encourage migration away from the UK.
Those who support Brexit talk of the burden placed on the NHS. Yet if you see a migrant in a NHS hospital, they are far more likely to be treating you than competing for a place on a waiting list. By harmonising professional qualifications and creating mechanisms to ensure the quality of those moving within Europe, we have been able to recruit health workers we need for the NHS.
The same is true for academic researchers. The UK is a world leader in research, but 20 per cent of the academic workforce are nationals of another EU member state At a time when many hospitals struggle to fill all their posts, this doesn’t seem like a good time to make it more difficult to recruit from abroad.
Funding for research
The UK receives 17 per cent of the total EU health research budget, making it the largest beneficiary of any member state. We get over €570 million, €30 million more than Germany. Those who support Brexit argue that if we stopped paying our contribution to the EU research budget we could spend more on ourselves. Given that we contribute 11 per cent of the research budget but get back 17 per cent of it, their arithmetic is questionable.
Our researchers collaborate with leading experts across Europe and scientists come here and strengthen our own research capacity. It would be possible to collaborate with them from outside the EU as Norway, Switzerland, and Israel, among others do – but they pay for the privilege. We would have to as well, so it is not clear that we would see any savings.
The threat from infectious disease
In recent years we have seen outbreaks such as pandemic flu, meningitis and Legionnaires’ disease in the UK brought back from holidays by UK residents. This year, Zika virus may make an appearance in the UK as a result of travel to warmer countries.
Even the most convinced Brexiteer must realise that the UK could not hope to quarantine itself in the face of a major pandemic. Europe needs effective surveillance systems which can monitor the emergence of outbreaks, putting the information together, and responding rapidly.
The EU has established the European Centre for Disease Prevention and Control in Stockholm. It co-ordinates communicable disease control networks across member states, develops consistent reporting mechanisms, and provides training for public health practitioners across Europe. If we left the EU, our defences against infectious disease would be weakened.
Free healthcare in Europe
From the 400,000 British pensioners who have retired to Spain to tourists who fall ill on holiday and use their European Health Insurance Card to get treatment on the same basis as local residents, UK citizens access health care in other member states all the time.
Many patients with rare illnesses are sent abroad by the NHS for highly specialised treatments. There are many diseases which are so rare that even the biggest countries have only a few cases. It makes no sense for everyone to try to establish treatment facilities.
The EU has created a network of centres of excellence to provide the best available treatment. Many of these arrangements could be renegotiated if the UK left the EU. In the meantime, hundreds of thousands of British citizens would face uncertainty and cost.
Privatisation of the NHS
In 2014, in the weeks before the independence referendum, concern was raised about the Transatlantic Trade and Investment Partnership, or TTIP. This is a treaty being negotiated between the US and Europe which looked as if it might lead to privatisation of health services in the UK. The Conservative government was dismissive of these concerns. The EU took them seriously.
A particular concern is that corporations will be able to take governments to secretive tribunals, where decisions are not made by judges and where powerful corporations dominate. The EU is insisting on a new investment court that would be led by judges. The hearings would be in public and all documents would be online. The UK government seemed happy to let big business have its way with healthcare. The EU action protects our health service.
Overall, it is hard to see how our healthcare system and the aspects of society which create wellbeing would be improved by leaving the EU. Most doctors and medical scientists I know believe we should remain part of it, supporting care for patients and benefitting from the research carried out across EU institutions.
• Sir Harry Burns is professor of global public health at University of Strathclyde and was Chief Medical Officer for Scotland from 2005-14.