Going Postal and Decolonising the Future

Euan Lawson

doi:10.3399/bjgp20X713129

The BJGP has come to a minor fork in the road. This is the first issue where a printed hard copy will not be posted automatically to all RCGP members. To be clear, the print version is still available but you will need to opt-in if you wish to receive it. Everyone will continue to have access to the digital flipbook version and, as ever, all the online articles, podcasts, and videos. The reduction in printing is a small environmental benefit, much requested, but wider transformation in our societies is definitely in the post. It will either come this decade as we scramble to reconfigure to a low carbon economy or the future may take on a dystopian hue if we don’t succeed.

Public philosopher Roman Krznaric has written on the future, the need for us to embrace long-term thinking, and how to be good ancestors.¹ His remarkable book encourages us to think beyond our limited horizons into ‘deep time’. This is not about our own children, or even their grandchildren, but for generations beyond that. He discusses the concept, almost entirely missing from discussions of inequality, of intergenerational justice. Climate change is, of course, the most pressing example, but it can be applied to all our endeavours, not least medicine and primary care.

It is easy to look back through a rose-tinted safety visor at general practice of yesteryear. We need to recognise the fallacy of extrapolation where we assume the future will be very much like the present. Only maybe with hovercars. It won’t and we are, shockingly, colonising that future. Krznaric points out: ‘We treat the future like a distant colonial outpost devoid of people, where we can freely dump ecological degradation, technological risk and nuclear waste, and which we can plunder as we please.’¹

There are, one hopes, many billions of people yet to be born. Yet they are voiceless. What responsibility should we take, as doctors, for the health of people born many decades, even centuries, from now? As just one example, antibiotic prescribing is a clinical topic begging for an intergenerational perspective.

The world of medical journals has been turbulent in recent years and future changes pose an existential threat. The RCGP’s support of the journal should be considered a fine example of Krznaric’s ‘cathedral thinking’. Research is usually a long game of accumulation and accretion. The College grants editorial independence to the journal, no small thing, and an essential component of the BJGP ’s work for these past 60 years. This is a real gift in a transactional culture where cynicism dictates that everything has a price tag.

So, while a hard copy of the BJGP will no longer land on every single College member’s doorstep, the work does continue and there are immediate benefits for us all now. Perhaps more importantly, it may serve future generations in some measure.