Saturday, 25 June 2016

The revolt of the dispossessed

The vote in favour of Brexit appears to have surprised everyone, not least the Brexiteers themselves. As politicians across the political spectrum in Britain and Europe scramble for answers to the question 'what next', the reactions from those in the Brexit camp and those in favour of staying in the EU could not have been more different. After a strangely sombre Boris Johnson addressed the media yesterday, trying to look presidential and like a PM in waiting, the Brexiteers have now gone into hiding. As the BBC correspondent Norman Smith noted, not one of them could be reached for comment at this critical moment and as the economic warnings of Remain campaigners come true. The reason is clear. Neither Johnson nor Gove ever had a plan of what to do next. Their campaign was predicated on questionable assumptions and base prejudices against immigrants. Now, that clear policies and a coherent strategy is required, they are nowhere to be seen.

Gurnos Estate in Merthyr Tydfil with a life expectancy of 58.8 years 

As for the other side, consider Nicola Sturgeon's response to the recent vote. Her cabinet made it clear that they will explore how to keep Scotland in the EU, something that conveniently overlaps with her overriding policy goal to take Scotland out of the UK. It helps that she has also quickly reassured Europeans who live in Scotland that they are welcome there. It is this inclusive political tone by Sturgeon that is such a far cry from anything Johnson can ever muster. 

As for the actual culprit in the room, the vote has made one thing crystal clear to anybody who wants to see it: Jeremy Corbyn has not got a chance in hell to ever make it to Downing Street. Whilst his anti-capitalist rants carry some favour with a small vocal left wing group in London, it cuts no ice in the traditional Labour heartlands which reel from cuts to local services and feel left behind. In that sense, the revolt of the poor in Merthyr Tydfil and Yorkshire was just as much a revolt against the Westminster elite as one against a Labour Party that had cocooned itself in anti-capitalist rhetoric and shadow boxing with their Blairite wing. If Britain is heading for a snap election in about a year's time, the Labour Party will likely to disappear from large parts of the country as an electoral force. 

Saturday, 11 June 2016

Why 'Leave' are winning

If you had asked me 6 months ago what the outcome of the EU referendum would be, I would have ventured an unambiguous answer: 'Britain will vote to remain in the European Union'. How wrong this answer would look today. The latest poll puts the Leave camp 10 points ahead of Remain.

Whether or not you believe the polls, everyone agrees on one thing: it's going to be close. Very close indeed. And it shouldn't be. So how did we get here?

There is now a consensus that the gravest threat to a Remain vote is the rapid decline of Labour in its heartlands. The Guardian and the BBC recently travelled into these areas where deprivation, long term unemployment and general hopelessness have dominated the political landscape since the 1980s. South Wales is a good example. Asked why they support Leave, the answers come thick and fast. And they are all of one kind: immigration. Whilst there used to be hesitation to discuss this issue, covered by the thin veil of British politeness, now people openly voice xenophobic and at times even racist prejudices.

Their opinions are peppered with flagrant falsehoods such as: 'immigrants get a grand in cash when they get here' or 'they get free housing', or 'most of them scrounge on benefits'. But the tenor is remarkably similar. The message is simple, straightforward and repeated up and down the country. And it is one that comes from one source alone: UKIP.

Neil Hamilton, of 'cash for question' fame, now sits in the Welsh Assembly for UKIP
Foto: WENN

Although the Labour Party does not want to hear it, its voters are abandoning Labour in droves. More and more Labour supporters have moved to the far right, taking the electoral fortunes of their party with them into an abyss of xenophobia and narrow-mindedness.

Why did this happen? And why now? There are essentially two reasons for this. The first is that UKIP has gone unchallenged for decades when it peddled its falsehoods and distortions about foreigners and migrants in the UK. The Conservatives felt largely insulated from the UKIP threat due to the first-past-the-post electoral system. And the Labour Party thought the UKIP message to run counter to the ideals of solidarity and mutual support that defined the party in the post-war period. So no one thought it worthwhile spending political capital on challenging the UKIP narrative (with the valiant exception of Nick Clegg, anyone remember him?).

The referendum changed this drastically. It gave Farage and his minions a national stage to articulate publicly the simple message that had already sunk into the nation's (sub)consciousness: It's the migrants' fault.

The second reason is of tactical nature. The Leave campaign settled early on a simple message and managed to define the terms of the debate: control, sovereignty, immigration. It shaped the content and nature of the terms by positively associating false choices like 'control' versus 'Brussels' with democracy. There are too many ironies in this to list them all here, ranging from the claim that the British political system is a beacon of democracy (House of Lords anyone?) to ignoring role the EU has played in democratising large swathe of the post-communist and post-Franco landscape since 1975.

Defining the terms of engagement is the key ingredient for political success and the Leave campaign understood this well. Once the campaign started Brexiters could rely on a solid foundation of animosity towards others, xenophobia and outright racism that was put in place long time ago by UKIP. All they had to do is to bring in their harvest of division and resentment.

Friday, 3 June 2016

Why the NHS should not fund PreP

PreP stands for Preventive Exposure Prophylaxis. It is medication that prevents the infection of HIV with a 85% probability for those who may be exposed to high risk with infected partners. PreP is therefore an important armour in the arsenal against the spread of HIV amongst gay men. NICE, the body in England that reviews the effectiveness and economic benefits of medication for the NHS has recently recommended not to prescribe PreP on the NHS and NHS England has declined to do so. Its analysis of costs and benefits suggests that its costs simply outweigh the benefits. This calculation may change soon and there has been a significant outcry from AIDS campaign groups such as Terrence Higgins about the decision. They have branded NHS England 'irresponsible' and 'shameful'. But lets look at this in a bit more detail.

Personal responsibility or a matter for the NHS?
Foto: Science Library BBC

PreP is not medication for people who have contracted HIV but it is a preventive substance for those who are at high risk to contract the disease because they engage in unprotected sex. The groups that typically come to mind that may benefit from this medication are sex workers and people in the porn industry. However, both industries have extremely by now low infection rates. In fact, the porn industry is highly (self-) regulated now and has only seen few (less than 40 compared to more than 400 in the previous year) infections in the last four years. Porn stars (gay or straight) need to undergo regular tests and prove their HIV status to be allowed to work.

So, PreP is not a medication for people who professionally may put themselves at risk. S, who is it for? In essence, it is for a group of gay men who deliberately decide to have unprotected sex. This is crucial in the argument for or against public funding of PreP as there is in fact a simple and cost-effective means to prevent HIV contraction, it's called the condom. However, at the moment, some men decide not to use a condom which exposes them to a higher risk of contracting the disease. At present, many of them self-fund PreP (at about £400 per month).

The argument for publicly funding PreP through the NHS is thus an argument about whether or not to spread (or socialise) risk. One may argue that we do this all the time. We are all exposed to the possibility to have an accident in our lives, say to break a leg when cleaning the gutter on the house. Emergency care is provided free at the point of use in the UK and the costs are borne by everyone through taxation that funds the NHS. The critical difference between an accident and risky sexual activities however lies in the role of agency. In the case of the latter, some men deliberately expose themselves to risks even though they do not need to. Terrence Higgins and others argue that society should pick up the tab for this. I disagree.

So what's the rationale behind their case for public funding of PreP? It appears that they mainly employ a public health argument: to prevent the disease from spreading, those men who decide to have unprotected sex have a right to draw on public funding to reduce the risks. This seems to me to reduce those men to mere recipients of public assistance, when in fact they are actually the agents and initiators of the risks they want others to mitigate for them. The interpretative framework that is often invoked here is that of human rights. It is, so the argument goes, their human right to be free from risk. But human rights are the sort of set of rights that are easily invoked only once active agency is discounted. It has a patronising undertone. Men who decide to have unprotected sex are not like those who have no choice, say women within an abusive marriage who are coerced to have unprotected sex with their unfaithful husband. Gay men do have a choice. They simply decide not to exercise it to the benefit of their health.

My suspicion is that the NHS will eventually fund PreP for everyone. Mainly because the cost-benefit argument that NICE bases its decision on is relatively weak in the face of moral pressure and fake indignation from organisations such as Terrence Higgins. What we really need is a debate about the limits of mutual beneficence and the obligations we ourselves have to maintain our own health.

Wednesday, 1 June 2016

The price of friendship

The debate about the EU referendum appears to have had mainly one effect; to turn most people off politics. By now, I actually dread turning on the radio in the morning to listen to the Today programme, afraid that I will have to hear one more time how the economy will tank if Britain dares to go it alone, or how those pesky immigrants will invade Sutton Coldfield if we stay in the European Union.

The battle lines are well and truly drawn and both sides have settled on the most soporific arguments they could muster. I have previously written HERE about how difficult it is for anybody living in Britain to actually develop a feeling for European integration, let alone a positive sentiment towards those French drinking their lovely wine just across the channel. The main reason is that Britain is an island and, here, borders are not just a function of us being outside Schengen but a simple fact of geography. That is different for a French popping over to his neighbouring village which happens to be in Belgium, to stock up on some cheese (to continue the national stereotyping). Borders signal where our ability to move ends, and there could not be a stronger signal than a big fat cold mass of water, only to be overcome by some madcap celebrity in the pursuit of a charitable cause.

Bringing Europe closer by swimming - David Walliams in the Channel

In short, what is missing in the debate is the experience of living in Europe, as living with others that are different yet are also the same. In that vein, I would like to point to a dimension of us being in Europe that should matter to anybody thinking about where to put their cross in the referendum. I am talking about the incredible privilege to be surrounded by friends, who are willing to listen and debate with us what would and should happen in the common space we inhabit: Europe.

Many of us may take this for granted yet it is nothing but. The European Union has created and maintained the institutions which gives the British government the ability to articulate its demands, wishes and desires to its European friends. And Europe, above all, has developed an enormous stock of  mutual trust that allows us and our European neighbours to call each other friends, for good or ill. That should count as something. How unique this is in foreign relations can be seen by looking across at the recent spat between Venezuela and its neighbours. Yes, Europe costs. But it gives us so much more: friends who do not question our motifs when we raise an issue. That's something to celebrate, and to preserve.