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Editor's Choice

UHC and climate provide rebels with a cause

BMJ 2020; 368 doi: (Published 09 January 2020) Cite this as: BMJ 2020;368:m49
  1. Kamran Abbasi, executive editor
  1. The BMJ
  1. kabbasi{at}
    Follow Kamran on Twitter @KamranAbbasi

Tedros Adhanom Ghebreyesus, the first African head of the World Health Organization, experienced universal health coverage (UHC), in the form of the NHS, when he studied in London in 1991. In an Essay (doi:10.1136/bmj.l6790), Tedros passionately champions UHC, and WHO is pushing for universal health coverage as never before, with impetus given by the UN sustainable development goals.

Much of the world marvels at the great experiment that is the NHS. Delivering UHC is hard, complex, and driven by local and national politics. As demand outstrips resources, it becomes harder, more complex, and more political. “Health is a political choice,” believes Tedros. “But without political will at the highest level, UHC will remain just a goal for many countries.”

While Tedros remains an optimist on UHC, Martin McKee’s concerns for the NHS are not eased by the UK’s general election (doi:10.1136/bmj.l7001). He doesn’t believe Boris Johnson’s promise that Brexit will “get done” by the end of 2020. He doesn’t trust government figures of 50 000 new nurses and 40 new hospitals.

Johnson’s plans are complicated by electoral success in northern England. His new MPs represent voters hopeful that Johnson will deliver his pledge on the NHS of more funding, hospitals, and nurses. But, says McKee, they join existing MPs who supported austerity measures that created many of the NHS’s current problems. The future of the NHS is hard to predict, but it seems certain to be “less welcoming to people from abroad, whether they are seeking care or providing it,” McKee argues.

Such an outcome is against the principles of UHC and its aim of leaving no one behind. But what can health professionals do to protest? Might we learn from the experience of Extinction Rebellion? Can protesting damage your career? As Australia burns, and a new study links short term exposure to pollution with hospital admissions (doi:10.1136/bmj.l6572), Shivali Fulchand asks what motivates doctors to engage in non-violent protest for climate action and what advice they receive about declaring police arrests to the GMC (doi:10.1136/bmj.l6875).

It is no longer enough to keep your head down and just focus on asthma guidelines (doi:10.1136/bmj.l6934), the latest guidance on prophylaxis for gastrointestinal bleeding in critically ill patients (doi:10.1136/bmj.l6722, doi:10.1136/bmj.l6744), or new evidence on cardiac rehabilitation for heart failure (doi:10.1136/bmj.l5456). Today, many clinicians also acting to save the NHS and, primarily, the planet.

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