The possible impact of Brexit on European public health – and why we should be wary

Insights from the World Congress on Public Health

Much has been said about Brexit’s impacts on healthcare and medical research in the UK – from the fabled £350 million that the Leave campaign had promised to the NHS, to the 40,000 nurses that the UK may need to replace. However the effects on Europe’s public health and on what has been described as a “fantastic natural laboratory”[1] are far less clear. As it turns 60, the EU faces many socio-demographic and epidemiological challenges such as ageing, obesity, and the sustainability of health systems, as well as economic and political pressures that threaten its existence. For many observers, 2017 and the Brexit negotiations will be a litmus test, not just for its contribution to the health of its citizens, but also for the EU itself.

Although the EU institutions have certainly contributed to the wellbeing of citizens in Europe, by promoting economic development and democracy across the continent, they have only a limited legal mandate directly related to health. Their authority is largely restricted to a shared or residual competence on “common safety concerns in public health matters”.

These complement broader powers indirectly related to health, including competences on shaping the internal market; coordinating social security systems and fiscal governance; and on environment, safety at work and consumer protection. The former brought us laws on pharmaceuticals, medical equipment and technologies, blood, organs and human tissues, tobacco, occupational safety, and infectious diseases. The latter has embedded public and human health in EU policies, providing access to healthcare in all states, product safety, healthcare professionals’ mobility, high labour standards and a cleaner environment.

The European Commission Directorate General for Health and Food Safety (DG SANTE) plays a pivotal role in promoting healthy lifestyles, facing cross-border health threats and ensuring innovative, efficient, sustainable and accessible healthcare. It fosters cooperation on health threats, determinants and information, and coordinates priority setting, knowledge sharing and infrastructure. Technical expertise is provided by agencies such as the European Medicines Agency (EMA), European Centre for Disease Prevention and Control (ECDC), and the European Food Safety Authority (EFSA). The EU’s role is even more prominent in research, not only through R&D spending and project coordination but also as a united policy voice that creates synergies between social needs, research excellence and industrial leadership.

The presentation provided only a glimpse of how the EU authorities contribute to public health. But clearly much of it could be at stake because of Brexit. The EU will not stop being a key driver and protector of public health, but it is unclear to what extent Brexit could undermine or hamper this role.

Regardless of any new relationship, all estimates are that the effects of Brexit are going to be negative, meaning economic pressure – the proverbial ‘hard times’ – on health priorities and research funds. Let us hope that political meddling, negotiation tactics or trade gambles do not trump the fantastic achievements we can build upon.