McKee, Martin

Martin McKee

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European Journal of Public Health

Health professionals must uphold truth and human rights

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McKee, M (2017) Health professionals must uphold truth and hu-man rights. European journal of public health, 27 (1). pp. 6-7. ISSN1101-1262 DOI: 10.1093/eurpub/ckw243Downloaded from: http://researchonline.lshtm.ac.uk/3482725/DOI: 10.1093/eurpub/ckw243Usage GuidelinesPlease refer to usage guidelines at http://researchonline.lshtm.ac.uk/policies.html or alterna-tively contact researchonline@lshtm.ac.uk.Available under license: http://creativecommons.org/licenses/by/2.5/Second, capital is flowing out of rich countries. Standardeconomic theory predicts that capital would flow from rich, highlabour cost settings, to poor, low labour cost settings. Thus, as jobsflow to India and China, it is unclear where new employmentopportunities will come from for those sectors of the economythat are clear ‘losers’ from globalisation and trade integration.Both Brexit and Trump’s campaigns tapped into the sense thatpeople were being deprived of opportunity by powerful forcesoutside their control. Both placed blame on elite politicians. Bothwere anti-globalisation (and specifically anti-trade). Brexit’s slogan,‘take back control’, and Trump’s narrative, ‘make America greatagain’, exemplify this sense of loss (and coincidentally the samePublic Relations company developed both sets of slogans).This narrative would not take hold if there were not an element intruth and did not connect with what people already feel and want tobelieve. So far, political responses in Europe have failed to articulatea viable alternative. Austerity measures, far from improving people’ssituations, have further stripped away opportunities for progress inEurope.This group of people are the ‘dispossessed’. They have been leftbehind by globalisation and excluded from the benefits ofdevelopment. They believe, justifiably, that opportunity has beentaken away from them, and their traditional party leaders havefailed to respond with a coherent alternative narrative. They aresuffering, in relative terms. It is not just the USA and UK. France,Germany, Sweden and the Netherlands, among others, are all seeingmarked rises in support for far-right policies.What can the European public healthcommunity to respond?First, we should not sugarcoat the reality; the politics of hatredtowards immigrants and antagonism to health protection is a realthreat. A failure to respond is a tacit acceptance. Our accompanyingpaper gives practical advice on how practitioners can deal withauthoritarian regimes.Second, despite the clear downsides, as with any period of policychange, Brexit and Trump’s election create windows of politicalopportunity. The shared concerns about these events could helporganise the public health community in Europe around collectivegoals. To take advantage of this moment, the European PublicHealth Association is now leading a process of developing a set of‘public health asks’ and scorecards for various governments, inpartnership with national public health associations. Thisscorecard can be used to hold them accountable, monitoring andreporting on public health outcomes.Third, a robust public health response will employ the tools ofepidemiology to better understand the forces of globalisation andthe root social causes of discontent. At the very least, it willdocument the harms to health of the far-right policies that arenow receiving media and policy attention. More fundamentally, itwill mean expanding multi-level and macro-epidemiologicalthinking to better understand the harms associated withglobalisation and identify feasible interventions that can amelioratethem. For researchers, this will mean further developing anepidemiology of resilience and precariousness. This moves beyondconventional social determinants of health to understand thestructural changes that are systematically placing people are real orperceived risk of adverse events (precariousness) and underminingtheir capacity to respond in an optimal way (resilience).The Vienna Declaration, which updates the landmark OttawaCharter, now refers directly to the powerful forces of globalisationand commercial determinants of health.6 It sets the agenda forevidence and practice. Now signed by over 50 organisations at theEuropean Public Health Association Conference held in Vienna inNovember 2016, it is a place start. We hope you will join us in ourefforts.References1 Department of Health and Human Services. http://www.hhs.gov/about/news/2016/03/03/20-million-people-have-gained-health-insurance-cov-erage-because-affordable-care-act-new-estimates (accessed 4th December 2016).2 Peeters S, Costa H, Stuckler D, McKee M, Gilmore AB. The Revision of the 2014European Tobacco Products Directive: An Analysis of the Tobacco Industry’sAttempts to ‘break the health silo’. Tob Control 2015; 25: 108-17.3 Case A, Deaton A. Rising morbidity and mortality in midlife among white non-Hispanic Americans in the 21st century. Proc Natl Acad Sci U S A 2015; 112: 15078-83.4 The Economist. Trump succeeds where health is failing. http://www.economist.com/blogs/graphicdetail/2016/11/daily-chart-13 (accessed 4th December 2016).5 Pierce JR, Schott PK. Trade Liberalization and Mortality: Evidence from USCounties. Yale mimeo; 2015. http://faculty.som.yale.edu/peterschott/files/research/-papers/mortality_58.pdf (accessed 4th December 2016).6 McKee M, Stuckler D, Zeegers Paget D, Dorner T. The Vienna Declaration onPublic Health. Eur J Publ Health 2016: doi: 10.1093/eurpub/ckw194.David StucklerOxford University, Oxford OX1 3PA, UKCorrespondence: e-mail: david.stuckler@chch.ox.ac.ukdoi:10.1093/eurpub/ckw244. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .The European Journal of Public Health, Vol. 27, No. 1, 6–7 The Author 2017. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . .Health professionals must uphold truth and human rightsThe election of Donald Trump, a candidate who has attacked women,migrants and people with disabilities, and growing evidence ofelectoral support for populist politicians promoting divisive andauthoritarian policies in Europe has generated concern amonghealth professionals in many countries. Even in countries with along history of democracy, some politicians are threatening thesafeguards that have protected the vulnerable for decades. Howshould health professionals respond to the threat posed by authori-tarian regimes that reject ideas of evidence and truth?History offers important lessons. In different places underdifferent times, they were either complicit or, in some cases, activeparticipants in gross human rights abuses.1 The most extremeexamples were under the Third Reich, such as a Nazi official whoviewed extermination of Poles infected with tuberculosis as a meansof controlling the disease,2 or those who oversaw programmes inwhich those with disabilities were sterilised, experimented upon andmurdered.3 However, there have been many other examples of grosshuman rights abuses, such as in Soviet psychiatry, detention of drugusers in South-East Asia, and the involvement of psychologists in theuse of torture by US interrogators in Iraq and Afghanistan.4Meanwhile, leading British politicians have called for the UK towithdraw from the European Convention on Human Rights, itself6 European Journal of Public Healthwritten with substantial input from British lawyers in response to thehorrors of the Nazis. Given the publicly stated views of certainextremist politicians in Europe, some who stand a realistic chanceof achieving power, health professionals, and especially thoseworking in government and public health agencies must beprepared for the possibility of being told to do things they knowto be wrong.Timothy Snyder, a professor of history at Yale and expert on theHolocaust, has offered Americans living under a Trump presidency aseries of twenty lessons drawn from the experience of Europe in the20th century.5 Not all of them are directly applicable to Europe, butmany are. Here are some of the most important.First, we must defend the institutions that safeguard our rights.These include an independent judiciary. This is already under threat,with Turkish judges being removed from office. In the UK, seniorjudges hearing cases on Brexit have been subject to vitriolic attacksin some leading newspapers, while ministers have remained con-spicuously silent. Other such institutions include human rights com-missions and trade unions.Second, we must never offer unconditional obedience. Theargument that one was ‘only obeying orders’ was dismissed compre-hensively at Nuremburg. Health professionals, just like the militaryunder the Geneva Conventions, should never obey an illegal order.Clearly, this is most relevant for those, such as communicabledisease or radiation specialists involved in the response to bioterror-ism, but it applies equally to all.Third, ensure that your organisation has developed, andpublicised, a clear code of ethics. It is important to do this beforean authoritarian regime accedes to power.Fourth, beware the abuse of language. Terms such as terrorismhave many meanings. This is especially important given the manygroups that benefit from exaggerated fears about ‘terrorism’, givingthem a strong incentive to exploit the inevitable anxiety.6 It is alsoessential to realise how labels are applied differently, depending onthe ethnicity and religion of the perpetrators. The judge trying thekiller of the British politician Jo Cox was clear that it was an act ofneo-Nazi terrorism, yet a British newspaper portrayed it as a mentalhealth issue.Fifth, do not over-react to crises. There are many who will exploitacts of violence or disease outbreaks linked to migrants and others.Avoid anything that stokes the fires of hatred.Finally, value evidence and truth. Both the UK referendum andthe US Presidential election were characterised by a blatant disregardfor facts. In both cases, the media failed the people. In the interestsof ‘fairness’, they left unchallenged statements that, with a fewminutes of fact checking, could be shown to be untrue. Health pro-fessionals have a duty to speak out when policy is being driven bylies.We live in worrying times. The parallels with events in the 1930sare all too obvious. Health professionals must learn from the lessonsof the past if they are to avoid repeating them.References1 McKee M. A crisis of governance? J Public Health (Oxf) 2007;29:3–8.2 United States Nuremberg Military Tribunals. United States of America vs. KarlBrandt et al. The ‘‘Medical Case’’. Opening statement of the prosecution. ByBrigadier General Telford Taylor, 9 December 1946.3 Evans RJ. The Third Reich in power. London: Penguin; 2006.4 Guterman L, McKee M. Severe human rights abuses in healthcare settings. Br Med J2012;344:e2013.5 Snyder T. 20 Lessons from the 20th Century on How to Survive in Trump’s America2016. Available at: http://inthesetimes.com/article/19658/ accessed 5th December2016 20-lessons-from-the-20th-century-on-how-to-survive-in-trumps-america.6 McKee M, Coker R. Trust, terrorism and public health. J Public Health (Oxf)2009;31:462–5.Martin McKeeLondon School of Hygiene and Tropical Medicine, London, UKCorrespondence: e-mail: martin.mckee@lshtm.ac.ukdoi:10.1093/eurpub/ckw243Viewpoints 7

Health professionals must uphold truth and human rights.

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Health professionals must uphold truth and human rights.

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