‘I think many people have really undergone a severe bereavement response.’ Martin McKee says, when asked whether he feels a sense of grief, now more than seven years on from the announcement of the infamous 52 to 48 result of the UK’s Brexit vote.
Professor McKee has not become any less animated about the topic in the years that have passed. In his office at BMA House in Euston, central London, he details serious issues around the loss of health workers, Horizon Europe, and becoming a rule-taker with the European Medicines Agency and other regulators, with great authority and pace.
It is blindingly obvious Brexit is a major problemProf McKee
There are few people in the world more qualified to talk about the relationship between Brexit and health. Prof McKee is professor of European public health at the London School of Hygiene and Tropical Medicine, research director at the European Observatory on Health Systems and Policies and a past president of the European Public Health Association, among many other notable roles.
Internationalism and health have been passions of a lifetime. At the age of just 16 the young Prof McKee was asked whether he saw himself as British or Irish during an interview to study at Newcastle University. His response? ‘European.’
Above all, the tragedy Prof McKee – and so many others across the health and care landscape – identifies is that Brexit has had a brutal and immediate effect on the UK economy, with severe knock-on effects for health.
‘It is blindingly obvious Brexit is a major problem,’ he tells The Doctor. ‘But when you have both major parties in England unwilling to confront the reality of Brexit that’s even worse because that undermines public faith in politics. It is clear to everyone this is a grave concern.’
Prof McKee, who has published more than 50 books and more than 1,450 academic papers, also worries where the UK’s relationships with European partners leave the country to deal with incoming threats, all of which have a massive potential effect on health, from conflict and terrorism to pollution, food insecurity and disinformation and artificial intelligence.
In his career he has vociferously argued, for a long period, against austerity politics owing to their effect on health. In recent years those tragic effects have become increasingly clear.
‘The reality is that starting with older people and now with younger people – particularly through deaths of despair (suicide, drug overdose and alcoholism) – we have been seeing a long-term decline in health which has been running for nearly a decade now,’ Prof McKee says.
‘I first wrote about stagnating life expectancy back in 2013 or so and we were among the first to do that. Back then people were saying maybe it’s a statistical blip. There’s been a huge amount of denial. But there can be no more.’
He adds: ‘One of the things we know is that one of the major determinants of people’s health behaviour is their answer to the question: “Do you think the future will be better than the present?” If you think it’s going to get worse, what’s the point in investing in your health?’
Prof McKee played a significant role in the discourse around the COVID-19 pandemic as a member of the group of scientists called Independent Sage who hosted weekly briefings on the latest developments and sought to provide politicians and the public with independent scientific advice. He also worked with the European Commission during the pandemic response.
Prof McKee still feels the UK has not ‘learned the lessons’ – or reflected on and responded to the ‘blunders’ and ‘scandal’ – from COVID-19 including the decimation of public health, the failure to invest in contact tracing, and the ignorance of previous learnings from pandemics.
He also feels significant failings were made in a lack of communication with procurement experts, laboratory staff, and latterly, patients with long COVID.
Green new deal
Hope for the future doesn’t always feel particularly easy to come by given the state of things in health and care, the economy and wider society.
But what are Prof McKee’s hopes – particularly with a general election looming, apparently likely in autumn of next year?
He says: ‘There does basically need to be a green “new deal” and we need to look at what Franklin D Roosevelt did after the Great Depression. There’s a Nye Bevan quote – assuming he did actually say it – from around the time the NHS was set up: “Why do I need a crystal ball when I can read a book?” I think that applies now.
'We know what works. We need a significant Keynesian solution of infrastructure investment and conversations about higher taxes to ensure inclusive growth with all the stakeholders across society involved.’
We have been seeing a long-term decline in health which has been running for nearly a decade nowProf McKee
While Prof McKee would like to inspire action from politicians, he is also hoping to use his tenure as president of the BMA to inspire doctors, too. Each year the BMA president has a specific project focused around something they are passionate about.
For Prof McKee this means a series of podcasts produced by staff at the BMA where doctors who have done inspirational things in their lives in and away from medicine, speak about their ambitions and what drives them.
‘I’m hoping the people I interview will inspire others to follow and to communicate beyond academic journals,’ Prof McKee says.
‘These are people I see as role models – people I truly admire. I hope a generation of young doctors will follow in their footsteps.’