Brexit: Self harm or a shot in the arm?

The Choice

I believe we now face a fundamental choice as a country. Whether we are to be “a kind and generous” country, as Theresa May phrased it in her speech to staff at the Department for International development last week; open to the world, mindful of our mutual dependence. Or whether we are to be an insular country, holding our sovereignty close to our chest, suspiciously eyeing our neighbours, both near and far.

Nowhere is this choice more clearly expressed than in the debate around the UK’s commitment to spend 0.7% of GNI on overseas aid.

The UK is now one of just six wealthier countries to be meeting this long-standing UN target. In 2015, the UK provided a total of £12.13 billion in overseas aid. This coming Wednesday, the UK will announce that our contribution increased by an additional £1 billion in 2016. And next week, the OECD will publish their global comparison figures, which will show that the UK has seen the largest increase in overseas aid spending the world over.

It is a profound and impressive contribution. It is both kind and generous.

The Chicken

This 0.7% investment is of course, underpinned by a searing logic, which speaks of our national interest. If a chicken sneezed thirty years ago, so the joke goes, it would have been bad news for the chicken and its relatives, but nobody else would have taken much notice. Today, our increased understanding that human, animal and ecosystem health are inextricably linked combined with our ease of travel, means that such a sneeze will be heard in every capital of the world.

Ebola is often cited as the wake-up call which taught us that the health of one country is dependent on the health of another. Arguably, it’s not the first wake-up call. HIV and AIDS was such a call, as the 33 million people who died from AIDS-related illnesses can testify. Hopefully, Ebola will be the last such call:

The world is awake. It is time to put together a new landscape that will deliver universal health coverage to all its citizens. And UK overseas aid has a crucial role to play in this. It is in our national interest.

The Media

However logical this sounds, it cannot be taken for granted. The 0.7% commitment is under unprecedented attack. Just in January, the Mail on Sunday persisted in its campaign for overseas aid to be re-directed to support the NHS. And it’s not just the Mail. It’s The Times and the Express. In fact, it’s many of the papers that campaigned vigorously for Brexit.

For THET, the choice the Daily Mail gives is one that speaks very poignantly to our vision of a world where everyone has access to healthcare. The decision between investing in ODA or the NHS, is not an either or, they can and should go hand in hand.

The Future

We need to fight for an internationally-focused NHS. At the heart of this is the challenge of ensuring that, as we learn to identify the benefits we can derive from an internationally-minded NHS, to too we must think carefully about how these align with the benefit derived from host countries.

All this means asking and answering difficult questions: not just around how we balance the interests of the NHS with those of overseas health services. But how, for example, we transition from aid dependency to grasping the opportunities for commercial activity overseas which could produce valuable income for the NHS.

To travel on this journey involves making a choice. The choice I talked about at the beginning: about what country we want to be a part of.

Theresa May’s speech last week set the standard by which we can now judge our government’s promises, exemplified by our commitment to spend 0.7% of our national income on overseas aid.

We too need to express this choice, individually and organisationally, to grapple with this complexity to produce an outward facing NHS, one that brings benefit both to countries overseas and to its own patients. In Our Mutual Interest.