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Environmental collapse means more crises are coming. How can the NHS resist?

Progressive Review

Sonia Adesara, Chris Thomas

The Covid‐19 pandemic has been devastating. More than 44,000 people have lost their lives in the UK due to the virus; unprecedented social restrictions have been put in place; and the economy is facing the worst recession since the 1930s.Faced with this disaster, it would be convenient to see it as a ‘once in a lifetime’ event: an exceptional case of bad luck. Indeed, some are advocating this ‐ as an excuse to return to business as usual, as quickly as possible. To do this would be a terrible mistake. Pandemics are becoming more common. UK health security has not been this tenuous in modern history.

“UK health security has not been this tenuous in modern history”

A key driving force is a combination of climate change and globalisation. For example, climate disaster is changing infectious disease transmission patterns, and habitat loss has brought people into ever‐closer proximity with animals, increasing the risk of transmission of mutated disease to humans. Globalisation has then brought people into closer and more regular proximity with other people – enabling diseases to spread further and faster.

The consequence is more major disease outbreaks, and a growing risk of pandemics. As early as January, the World Economic Forum showed that the number of countries reporting a major disease outbreak in any given year had more than doubled since 2010(1). The Covid‐19 crisis is not a once in a lifetime event at all. It is part, if not the start, of a wider trend that will continue to threaten UK and global health security.

This comes with a very clear implication – we can no longer indulge our recent complacency on health, care and the NHS. Rather than going back to normal, the crisis should catalyse a moment of change.

That is truer for the UK than for most countries. Our Covid‐19 mortality rate is among the highest in the world(2).

In combatting the virus, we have seen widespread disruption to other aspects of healthcare, with long‐term ramifications. There has been a dramatic drop in general practitioner (GP) referrals for suspected cancer, alongside disruptions to cancer screening and treatment. Mental health services are buckling under rising demand. Operations were cancelled, with NHS waiting lists projected to reach 10 million by the end of this year(3). And we couldn’t even get personal protective equipment (PPE) to the workers we were asking to staff the front line. In the face of continued security risks to our health – including those driven by environmental disaster – we need a paradigm shift that takes us away from a National Health Service (NHS) that can barely cope, to one ready for whatever the next decade throws at it. This article outlines what must happen if we are to move towards a more progressive and resilient healthcare system that is fit for the future.


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