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The British political ship is set to weather another storm. On 20th February, the Prime Minister, David Cameron, announced the start of the race towards the June 23rd referendum on the United Kingdom’s (UK’s) membership of the European Union (EU). This hews consistently with Cameron’s political manifesto presented last election: that the Conservative Party would seek to renegotiate Britain’s EU membership and hold a referendum by the end of 2017.

Many of the current debates have been confined largely to freedom of movement, a core principle of the EU that perpetuates inward migration. The tensions are also constructed around three fundamental freedoms: free movement of goods, capital and services. What remains scarce, however, is dialogue tackling issues that will clearly be impacted if the UK departs the 28-nation economic bloc.

This article traces the potential impact of a Brexit (a euphemism for Britain exiting the EU) on public health, outlining, first, how progressive EU policies on air quality have greatly improved the health of the population across the Continent, including the UK, and how a Brexit might obstruct this trend; why a vote for a Brexit would remove the safety seal that protects consumers from negative externalities emanating from the farming industry, which is interconnected with the food manufacturing industry; the potential loss of subsidies to the UK farming industry; and the resulting missed opportunities for the public health community as a catalyst in championing the preventative health agenda within Europe, were Britain to bid it adieu.

Halting Good Progress

A Brexit threatens further progress in improving the air quality across the region. For the last 40 years, the EU has calibrated various environmental standards, correcting negative market externalities, and limiting the adverse impacts on the health of the population across the Continent. Since 1970, EU policies have succeeded in limiting air pollution to 35% of fine particles in the atmosphere, saving 80,000 lives across Europe every year. Within the EU system, the UK benefits from acceptable environmental standards thanks to the pressures for accountability.

But such an impact can only be possible through interstate collaboration that transcends the limits of state boundaries. These crucial standards have now become completely entrenched in the ways in which market externalities are regulated across the European region, and a Brexit would mean that this progress could be halted.

Correcting Negative Externalities

A Brexit could remove important protection measures—the UK’s safety net from negative market externalities. This is particularly pertinent when the UK government favours deregulation at home in an attempt to stimulate market production. For instance, the European Parliament is ready to debate the restriction of the liberal use of antibiotics in livestock. In particular, the proposal pivots on the prohibition of the mass prophylactic application of antibiotics and the mandatory justification for using antibiotics in the absence of animal infections. These issues are essential for slowing down antibiotic resistance and ensuring a safer food chain for consumers.

Rather than viewing the measures from a compliance mind-set, which can supress effective implementation, the rules encourage businesses to be more ethical, responsible, and accountable by internalising the real costs of their activities upon the health of the wider population. At the same time, they stimulate a more explicit regulatory discourse and ensures that the public health agenda remains on the radar of public scrutiny, rather than simply being left to the market mechanism to dictate. A Brexit, on the other hand, will remove the protective layer afforded by the EU in pursuit of a greater market efficiency, and inevitably cost the UK consumers in the long run as the health of the population would become a suboptimal consideration compared to profitability.

Loss of Subsidies

A Brexit could potentially create losses in financial subsidies for the farming industry. UK farmers are set to benefit from a subsidy of £27.8 billion from the EU’s Common Agricultural Policy (CAP) between 2014 and 2020, from which a large portion of the money is earmarked for protecting and enhancing the environment. In addition, the funding has been ring-fenced for the development of rural areas, for instance, through the promotion of biodiversity, development of natural farming and forestry systems, and the maintenance of traditional agricultural landscapes. This subsidy will allow the Treasury to redirect its fiscal focus towards other areas, particularly at a time when the neoliberal politics of austerity are being constantly orchestrated.

Economic partnerships usually operate quid pro quo: If a Brexit were to go ahead, the UK would inevitably witness reductions in these subsidies to farmers —at least in the medium term— and expose the farming industry to the risk of market volatility. Equally, the EU could impose the same environmental standards on the UK as a trading partner, irrespective of its departure from its EU allies. Here, farmers could be put under pressure relating both to the economy and environmental protection. This might then trigger fiendishly complex renegotiations on a national level between the government and the industry, which would be politically costly. At the same time, one can only speculate how far the loss of the subsidies would be reflected in the price for the consumers.

Missed Opportunities

Finally, a Brexit could decimate the UK’s potential to bequeath the gold standard in delivering public health interventions across Europe. This is particularly prevalent in the upstream, top-down policy approach that can affect large populations through the preventative mechanism that could affect a wider population.

Many fail to realise that the UK has driven multiple progressive policies aimed at improving the health of the population, whether plain packaging for cigarettes, minimum pricing units for alcohol, or the most recent sugar tax. Often, these measures exceed recommendations of the EU legislators. The potential loss of persuasive power across Europe, then, cannot be underestimated —particularly when the UK leadership wishes to be the catalyst in both shaping and standing as a model of excellence with respect to the preventive health agenda. Authoring this ripple effect for these approaches in the EU can only be sustained if Britain stays within the EU structure: doing this collectively will be more effective rather than operating in silos.

Conclusion

This article has illustrated the benefits of the UK being within the EU structure from a public health perspective, which are perhaps more nuanced than has been appreciated. From hampering the progress in correcting market externalities to the missing fiscal and developmental opportunities, the evidence suggest that the UK would be “stronger in” not out of the EU system. Even with the finish line in sight, this political ship can be steered in either direction. The findings above are aimed to enrich this essential debate for such an important milestone for the country.

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