{"title":"A UK wealth tax for better health","authors":"Kate E Pickett, David Taylor-Robinson","doi":"10.1136/bmj.r720","DOIUrl":"https://doi.org/10.1136/bmj.r720","url":null,"abstract":"Revenue could reduce funding gaps and inequalities The UK’s health and social care services are increasingly strained by rising demands and widening health inequalities—in life expectancy, infant mortality, mental health outcomes, childhood obesity, early childhood development, rates of children entering care, educational attainment, vaccination coverage, and more. Our NHS needs “resuscitation,” with a £37bn shortfall compared with peer countries.1 New data show that 4.5 million children in the UK, more than 31%, are in relative income poverty.2 The government has decided to cut welfare benefits for people with disability,3 with the minister for intergovernmental relations defending the cuts by saying you can’t “tax and borrow your way out of the need to reform [the] state.” This is in the world’s sixth largest economy, where private fortunes continue to grow. Could taxing wealth be a viable approach to address these critical challenges and promote equity across the population? In simple terms a wealth tax is a tax on a person’s or a business’s assets, such as their cash and bank holdings, land, and other real estate. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"97 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827703","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Can I work while having IVF?","authors":"Abi Rimmer","doi":"10.1136/bmj.r643","DOIUrl":"https://doi.org/10.1136/bmj.r643","url":null,"abstract":"Going through fertility treatment can be physically and mentally exhausting, especially when working at the same time, but there are ways you can ease the strain, Abi Rimmer hears Divpreet Sacha, general practice specialty registrar, Birmingham and Solihull, says, “In vitro fertilisation (IVF) is becoming increasingly common, yet the mental and emotional toll it takes is rarely discussed. The physical effects of IVF drugs are well known, but the mental struggles—stress, anxiety, and emotional fatigue—often get overlooked. IVF isn’t a straightforward process; each person’s response is different and delays or complications can add even more pressure. As the number of people undergoing IVF grows, it’s important to raise awareness about the physical and mental challenges, especially when trying to balance the demands of work. “I struggled with balancing work and IVF. The emotional weight and physical exhaustion were overwhelming and eventually I had to take sick leave to focus on my mental health. As a doctor, especially in the NHS, there’s a culture of just getting on with it. Workplace pressures can make it harder to admit when you’re struggling. IVF is already a highly personal and emotionally charged journey, and the idea of sharing such private information at work can feel daunting. “My advice is to be kind to yourself. …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Marciano Sánchez Bayle: paediatrician and tireless defender of Spain’s universal healthcare system","authors":"Aser García Rada","doi":"10.1136/bmj.r719","DOIUrl":"https://doi.org/10.1136/bmj.r719","url":null,"abstract":"Credit: Iker González Izaguirre Marciano Sánchez Bayle, a paediatrician and nephrologist, was a leading figure in the defence of Spain’s public healthcare system, dedicating his life to the fight for equitable and accessible healthcare for all. He was founder, former president, and spokesperson of the Federation of Associations for the Defence of Public Healthcare (FADSP). He also held a senior position at Hospital Infantil Universitario Niño Jesús, a leading public paediatric referral hospital in Madrid, where he worked until his retirement in 2018. The FADSP was founded in 1981, when Spain was in the early years of its transition to democracy, and it played a crucial role in the creation of the country’s public healthcare system. Its advocacy efforts contributed to the establishment of the national health system through the General Health Act of 1986. This law was instrumental in universalising healthcare, shifting funding from social security contributions to general taxation. Before 1986, Spain’s healthcare system relied on coverage based on social security, charity hospitals, and private care, resulting in notable inequalities. The 1986 reform marked the transition to a universal public system, ensuring access based on …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"108 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Is there still racism in medical education?","authors":"Duncan Jarvies, Mun-Keat Looi","doi":"10.1136/bmj.r608","DOIUrl":"https://doi.org/10.1136/bmj.r608","url":null,"abstract":"In a recent BMJ podcast interview Clare Owen , director of the Medical Schools Council, discusses racism in medical education with Victor Adebowale , chair of the NHS Confederation ### Biographies Clare Owen is director of policy at the Medical Schools Council. Her work focuses on medical education, and over the past 10 years she has led a programme to widen participation in medicine. Victor Adebowale has been chair of the NHS Confederation since April 2020 and is former chief executive of Turning Point, a social enterprise. A crossbench peer since 2001, he has led commissions on mental health and housing and is co-chair of the BMJ Commission on the Future of the NHS. He holds an MA in advanced organisational consulting and serves as chancellor at the University of Lincoln and as a leadership coach. VA: We’re talking at a time when DEI [diversity, equity, and inclusion] is under attack. Lots of people are saying that it’s a waste of money, even in the health services. Why is it important? CO: We know that there are differential outcomes for people at our medical schools if they’re from a minoritised ethnic background. We’ve just had a pandemic where we saw massive health inequalities in how that pandemic affected people. I like to think that medical schools are staffed by scientists who are evidence driven, and we have data to show that discrimination is a real thing. I think that the people who are trying to pretend it’s not are ignoring very real facts that are right in front of us and that we all know—or we know if we’ve cared to look and investigate. Video 1 Clare Owen and Victor Adebowale VA: Five years ago when we did the first BMJ special issue on racism in medicine there was …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eugene T Richardson, Lulwama Mulalu, Harjeet Singh
{"title":"Reparative justice and COP29","authors":"Eugene T Richardson, Lulwama Mulalu, Harjeet Singh","doi":"10.1136/bmj.r175","DOIUrl":"https://doi.org/10.1136/bmj.r175","url":null,"abstract":"Climate policy needs to take a reparative stance At the 2024 UN climate change conference (COP 29), developed nations pledged $300bn in climate finance annually to support “an insurance policy for humanity.”1 This falls far short of the trillions required to enable vulnerable nations to adapt to the increasingly severe impacts of climate change.2 COP 29 failed to meaningfully address the systemic inequities that underpin the climate crisis: legacies of imperialism, extractivism, and atmospheric colonisation (the process by which a small number of high income countries have appropriated substantially more than their fair share of the atmospheric commons)3 at the heart of vulnerability to climate change. The most vulnerable nations are being offered paltry sums that are disproportionate to both the loss and damage endured and their contribution to the climate crisis. An example is the 2022 floods in Pakistan, which affected more than 33 million people, destroyed or damaged over two million homes, and resulted in the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"75 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143827704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Prevention in healthcare: turning words into action","authors":"Yvonne Doyle, Irem Patel, Shireen Kassam, Claire Palmer","doi":"10.1136/bmj.r597","DOIUrl":"https://doi.org/10.1136/bmj.r597","url":null,"abstract":"Although the words “prevention is better than the cure” are often said, this still largely remains a mantra. The UK government has committed to a shift from “sickness to prevention” in the NHS.1 However, there is vagueness about how programmes that will improve health outcomes will be implemented. Twenty years ago, Derek Wanless, a former banker, was appointed by Gordon Brown, then Chancellor of the Exchequer, to conduct a review of the NHS’s future needs and the likely costs. The Wanless review proposed a “fully engaged scenario,” which placed health improvement and prevention as a crucial element of a strategy to relieve demand on the NHS. If anything, the opposite has happened since the report was published in 2002. On many measures, including life expectancy, the health of the British population has stagnated or has got worse. But part of the problem was that it was never clear how the iconic “fully engaged” population was to become reality.2 So how can we shift the mantra of prevention into reality? It is ever more important that we do so. The UK is experiencing an escalating pandemic of chronic ill health across the population which is resulting in a loss of productivity. In the first quarter of 2024, there were 2.8m economically inactive people in the UK due to long term …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Labour is peddling the “work cure” for mental health—are we back to Victorian times?","authors":"Rhiannon Mihranian Osborne","doi":"10.1136/bmj.r738","DOIUrl":"https://doi.org/10.1136/bmj.r738","url":null,"abstract":"Over the past six months, I’ve worked in primary care, emergency care, and paediatrics. Every day I see people in mental distress—from depression to psychosis to post traumatic stress disorder. Recently, the UK Labour government doubled down on inaccurate, stigmatising, and offensive narratives around mental health. In the Spring Statement, the government announced more than £5 billion cuts in benefits support—a move that will push thousands of people into poverty.1 The government used two primary narratives to support its approach. Firstly, that mental health conditions are overdiagnosed and that people are unjustifiably claiming sickness benefits on this basis. Secondly, that the way to improve the lives of people living with physical and mental health conditions is to cut state support and “encourage” them back into employment. We tend to think of ill health, especially mental health, as an individual issue. This couldn’t be further from the truth. Many aspects of poor mental health are driven or worsened by a deeply inequitable society. It’s easier (and politically convenient) to bemoan the fact that more people are on long term sickness benefits and blame the individuals, rather than analyse why this is the case. Everywhere I work I see the same patterns every day: young …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad S Razai, Maide Barış, Mehmet İnanç Özekmekçi, Hossein Dabbagh, Zohar Lederman
{"title":"The healthcare community has a responsibility to highlight the ongoing destruction in Gaza","authors":"Mohammad S Razai, Maide Barış, Mehmet İnanç Özekmekçi, Hossein Dabbagh, Zohar Lederman","doi":"10.1136/bmj.r741","DOIUrl":"https://doi.org/10.1136/bmj.r741","url":null,"abstract":"A month before Mahmoud Abu Nujaila, a doctor who worked with Médecins Sans Frontières at Gaza's Al-Awda hospital, was killed by an Israeli airstrike along with his colleagues, he wrote on a hospital whiteboard: “Whoever stays until the end will tell the story. We did what we could. Remember us.” 1 Doctors working in Gaza have made urgent pleas, saying that they feel abandoned by the world amid renewed Israeli airstrikes.2 More recently, the United Nations reported that several paramedics and rescue workers were killed and buried in a mass grave by Israeli forces in southern Gaza.3 Over 18 months of relentless attacks, thousands have died,4 and the healthcare infrastructure has been almost entirely dismantled.56 Access to vital medical supplies has been systematically restricted, and basic necessities for life—clean water, food, sanitation, and energy—have also been destroyed.178 The Israeli military’s conduct plausibly violates the Geneva Conventions, which prohibit attacks on medical facilities and …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The honourable doctor—let us learn from this book and listen to those who speak up","authors":"Ellen Welch","doi":"10.1136/bmj.r696","DOIUrl":"https://doi.org/10.1136/bmj.r696","url":null,"abstract":"The year is 1828. Anaesthesia is yet to be invented and tethered to an operating table in the centre of a crowded, putrid theatre at Guy’s Hospital, a patient screams at his surgeon to stop the procedure. An hour into a lithotomy—which should have been over within minutes—the flustered surgeon, determined to retrieve the stone, refuses to stop, until he can hold the stone aloft in front of his audience. His patient endured over an hour of excruciating pain to stoke this surgeon’s ego and died days later. One of the spectators in the onlooking crowd is “The honourable doctor,” our protagonist James Lambert, a doctor who is appalled by what he is watching. From his early training, he has recognised that corruption and malpractice is rife within the medical profession. He joins forces with a group …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"60 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143819083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Will scrapping NHS England contribute to better health and healthcare?","authors":"Victor Adebowale, Parveen Kumar, Liam Smeeth","doi":"10.1136/bmj.r753","DOIUrl":"https://doi.org/10.1136/bmj.r753","url":null,"abstract":"The announcement that NHS England (NHSE) will be scrapped may have surprised the mainstream media, but for many insiders there were indications of the direction of travel. The absence of any serious defence from political parties suggests this move was overdue. The proposed 50% job cuts across NHSE and the Department of Health and Social Care (DHSE) appear arbitrary—more of a political signal than a feasible strategy. However, reductions are inevitable. At its onset NHSE’s mission was wide and included driving the delivery of safe and high-quality healthcare for all; supporting NHS staff with training, data, and tools; and delivering value for money. The key concerns in getting rid of NHSE are what gets eliminated, what remains, and how resulting gaps will be tackled. Where will the “slack” be taken up, and duplication avoided, in an already stretched system within the DHSC. Integrated Care Boards (ICBs) will experience the most significant administrative cutbacks—as much as 50%, which follows the 30% cuts to running costs that they had already been required to make by 2026. A major concern is that such cuts in support could undermine the community services that help reduce demand on acute hospitals. Acute and other provider trusts will not be spared the …","PeriodicalId":22388,"journal":{"name":"The BMJ","volume":"248 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143822854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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