“Do or die”: No-deal Brexit fears for the UK's health and nutrition industry

24 Jul 2019 --- As hard-line Brexiter Boris Johnson assumes the position of UK prime minister, NutritionInsight explores the potential implications of a no-deal Brexit scenario – which Johnson has not ruled out – for the nation’s health. Experts speculate that there could be both long- and short-term implications ranging from limited access to specialized nutrition and medical supplies to hospital staffing shortages. This is fuelling fears that nutrition and diet-related health initiatives, and the subsequent funding they receive, may take a back seat.

As Johnson takes office to charge on with renegotiating with the EU to deliver Brexit, or leave on October 31 with a no-deal scenario, concerns about how he will prioritize health policies are growing. 

Given his less-than-positive remarks on so-called “sin taxes,” some are wary over the level of attention the health industry may receive during this unpredictable and often chaotic Brexit era. Specifically, Johnson recently promised a review of whether levies on foods high in salt, fat and sugar are effective. Industry experts further highlight how slow the progress has been so far on many previously planned health initiatives. 

 There could be both long- and short-term implications of a no-deal Brexit.This slow uptake was highlighted in the industry responses to a Green Paper that was published just hours before Johnson took office. The paper details health and prevention strategies and lays out several planned government initiatives. These included banning the sale of energy drinks to under-16s and potentially extending the sugar levy to high sugar milk drinks. 

Brexit’s implications reach further than just the political sphere
Brexit could have a major impact on the types of food we eat and our access to specialist nutrition products. This is because, depending on the trading agreements that are yet to be made, Britain may see food price increases, a lack of availability of certain food groups (including fresh produce) and a potential different set of trading rules for imports and exports.

This may be particularly concerning as the new head of state is a hard-line Brexiter and has promised to deliver Brexit by the October deadline “do or die.” This is a situation which seemed an unacceptable, if not unprecedented, outcome at the start of the Brexit negotiations, but may now be a reality. 

Mark Dayan, Policy Analyst and Head of Public Affairs at UK independent health think tank Nuffield Trust, tells NutritionInsight that a short-term implication of a no-deal Brexit could be a serious problem in getting medicines and medical supplies into the country.

“Estimates suggest a reduction of possibly more than half in the volume of trade able to cross the Channel at the main crossing, and two-thirds of medicines used by the National Health Service come from the EU. Extensive plans are in place to address this with new ferry routes and air freight. However, even if this works, I would estimate that the additional complexity of the new regulations will add around £2.3 billion (US$ 2.88 million) in costs to the health service budget per year.”

While in the long-term, serious problems could come in the form of staffing. At the end of 2018, the government announced a more restrictive migration system that would be put in place during a no-deal Brexit. 

“This would block almost all migration of social care workers from anywhere in the world, and mean a majority of nurses were not able to stay in the UK permanently. There would be the risk of a substantial worsening of the situation – I have estimated that the gap could reach 70,000 by 2025.”

Meanwhile, speaking to NutritionInsight, Tom Embury, British Dietetics Association (BDA), Public Affairs Officer emphasizes the risk of a reduction in access to healthy foods.There could be a serious problem in getting medicines and medical supplies into the country.

“The BDA’s biggest concerns are how this will impact on the cost and provision of healthy food into the UK. And, in particular, how it will impact on the provision of specialist nutrition products.”

He explains that half of the food eaten in the UK comes from abroad, with the vast majority of that 50 percent coming from the EU. “Those likely to be hurt most by any increase in prices or reduced availability will be those least able to afford it – our most vulnerable and economically deprived populations. Providing healthy hospital food that is appropriately tailored to specific medical needs may become more difficult, for example, specialist allergy diets or texture modified foods.”

Examining a no-deal scenario 
In a first-of-its-kind study, Imperial College, London, researchers looked at the impact of Brexit on public health by analyzing how food imports may be affected.

The findings, published in the journal BMJ Open, revealed that all the trade scenarios they looked at would reduce fruit and vegetable intake in England. Under all scenarios, the price of fresh produce imported would increase substantially due to additional import tariffs and trade costs. For example, under a no-deal Brexit the cost of bananas would rise by approximately 17 percent, citrus fruits by 14 percent and tomatoes by 15 percent.

The largest negative impact of a no-deal scenario was on public health. The team’s models suggest these price hikes would lead to the British public eating between 3 percent and 11 percent less fruit or vegetables, depending on the agreed deal. 

In a no-deal situation, the drop in fruit and vegetable intake contributed to over an average of 4,110 additional deaths of coronary heart disease (causing heart attack and heart failure) and 8,290 stroke deaths between 2021-2030. The researchers add that while their study focused on England, similar impacts are likely in Scotland, Wales and Northern Ireland.

“The UK’s exit from the EU has long been framed in terms of its political and social importance. But this study shows that the impact of Brexit will reach far beyond the economy and may affect people’s risk of disease,” says Professor Christopher Millett, from the School of Public Health at Imperial, who jointly led the research.

We need “structural change”
Prior to Johnson’s new position being announced, the government released a Green Paper which has spurred mixed reactions from the industry. The paper could, in some ways, indicate how the Conservative government led by Johnson will approach the nation’s health. Slow progress in this space, however, was a recurring theme across responses.

Despite “prevention” being one of the Health Secretary’s key priorities, the industry has been waiting for some time for these plans “which appear to have been buried in the dying days of the current Government,” says Helen Donovan, Royal College of Nurses (RCN), Professional Lead for Public Health.

Structural changes that address the way less healthy food is marketed, promoted and sold, is needed.The Obesity Health Alliance (OHA) reiterated in a statement on the paper that real progress will not be made in preventing obesity-related ill-health without structural changes that address the way less healthy food is marketed, promoted and sold. 

“That’s why we need the Government to swiftly and fully implement plans announced over a year ago to introduce calorie labeling on menus, restrict unhealthy promotions and introduce a 9pm watershed on junk food adverts on TV and online.”

Indeed, Children’s Food Campaign Co-Ordinator Barbara Crowther also notes that the paper leaves many outstanding issues in the Childhood Obesity Plan Chapter 2 unresolved and highlights the slow progress that has been made.

In addition, the plans already start at a disadvantage, as the Health Foundation suggests there will be a 25 percent cut in public health spending per person by 2020/21. 

Caroline Bovey, BDA Chair, also noted in a statement that the proposed plans are being undermined by government steps such as falling Public Health Budgets. The economic weight of a no-deal Brexit could also undermine plans further,

According to the calculations from the Nuffield Trust, a no-deal brexit scenario would mean £2.3 billion (US$2.9 billion) in extra costs for the NHS by the end of 2019/20. 

“In healthcare, our goal is to think of a person’s wellbeing over an entire lifetime, not just in the short term. It’s once again disappointing that short-sighted government policy still doesn’t reflect this,” Donovan adds.

What did it do right?
Both Crowther and the OHA, however, applaud that the proposal addresses important areas such as the content and marketing of infant food and clear labeling to support families to understand the nutritional content of food they consume. It also welcomes the recommitment to consider extending the sugar levy to high-sugar milk drinks and to increase focus on infant feeding.

The clear labeling review should include reviewing the use of cartoon characters such as Peppa Pig, Paw Patrol and Disney characters on packaging of foods high in fat, salt and sugar. This was highlighted by a coalition of health groups are calling on the UK government to ban the practice in June this year. 

However, as the Brexit saga continues, a large degree of uncertainty will remain regarding funding and government action in terms of policy. On a positive note however, Dayan predicts that even in a no-deal scenario, health would likely remain a government focus. “The NHS is politically central in the UK and political issues including Brexit are often seen through their impacts on it.” The social care sector, unfortunately, is more prone to being ignored during periods of distractions, he explains, despite the fact that it is in urgent need of reform at the moment. 

By Laxmi Haigh