- Jennifer J K Rasanathan, head of scholarly comment
- The BMJ
As a global community we have never been more interconnected. Depressingly, floods and intense heat (doi:10.1136/bmj.p1647) link more and more of us together through shared experience of the climate emergency.1 Polarisation and divisiveness are also growing in tandem, at times invoking religious differences.
Religion is often considered divisive with respect to sexual and reproductive health and other health areas, but Ellen Idler and colleagues (doi:10.1136/bmj-2023-076817) conceptualise religion as a determinant of health with “real, contradictory, and complex” effects.2 Religion as a social determinant is unique in its ability to both benefit and harm health, and much of religion’s “public health ‘good’ may come with complications,” they write. Evidence supports a protective effect of religious beliefs and affiliations on individuals’ health, but at community and country level the effects of religion on health are mixed. Whereas religious leaders were instrumental in containing the 2014 Ebola outbreak in west Africa and encouraged covid vaccine uptake in the UK, for example, religious institutions can jeopardise health when policy making codifies the view of a single religious community.
Yet, Idler and colleagues say the overall goals of religious institutions and public health are shared, in that both “strive to improve the quality of life . . . they are mission driven.” Consequently, “partnership and engagement are critical to reducing tension and to forging mutually beneficial solutions.”2
The same may be true for “robust” debates about new clinical roles featured in NHS England’s workforce plan (doi:10.1136/bmj.p1630).3 While training requirements for all healthcare workers should be transparent, the underlying problems of the NHS won’t be solved by blame, bias, and resentment among different kinds of health professionals who share the same caring mission. Similarly, allowing “women and ethnic minority doctors [to] have worse experiences” working in the NHS (doi:10.1136/bmj.p1616) and failing to systematically tackle the financial, legal, and social challenges faced by international medical graduates (doi:10.1136/bmj.p1618) get us no closer to an adequate, resilient workforce.45
In contrast, mutual respect for the contributions of all colleagues may help foster alliances and identify common goals for collective advocacy. Efforts to support colleagues—new to the NHS or not (doi:10.1136/bmj.p1247)—and to care for patients (doi:10.1136/bmj.p1615) stem from our ability to understand others’ lived experiences and act empathetically.67 Respectful attempts to reconcile different beliefs and perspectives may not always change minds but may, over time, build trust and working partnerships.
Last week’s “final offer” from the UK government for a pay increase for doctors (doi:10.1136/bmj.p1650) does little to build trust when the same government seems to be able to afford a plan to scrap inheritance tax.8 Full pay restoration for doctors in training, efforts to alleviate hunger, or investing in general practice would be better uses for an expendable £7bn, writes Helen Salisbury (doi:10.1136/bmj.p1639).9 Abandoning efforts to negotiate will not move the NHS closer to meeting patient safety standards that are already in jeopardy (doi:10.1136/bmj.p1636).10
Some tensions in health—between editorial boards and journal owners (doi:10.1136/bmj.p1576), or between private equity firms aimed at maximising profit and people and organisations who are principally concerned with health outcomes and quality (doi:10.1136/bmj-2023-075244), for example—seem irreconcilable, but striving to bring all sides together may still yield common ground.1112 As efforts to meaningfully engage with religion’s varied influences on health have shown, we may miss out on mutually beneficial solutions if we foreclose opportunities for international learning (doi:10.1136/bmj.p1613),13 dialogue, and debate.