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Ekkehard of Meißen's appropriation of the feast prepared for the sisters of the late emperor Otto III was a turning point in the succession contest to determine the next ruler of Germany in 1002. Ekkehard's arrival at the feast has been construed as an insult to the Ottonian sisters, marking the point at which he lost the succession race and paved the way for his own murder. However, there is no convincing explanation in current scholarship for why Ekkehard thought publicly insulting the family of the former emperor and breaking the regulated structure of Ottonian politics was a good move. This article sets Ekkehard's actions at Werla into the broader context of Saxon politics by tracing the relationships between those present at the feast and the author of our account, Thietmar of Merseburg. In doing so, we can see that Ekkehard was not trying to offer an insult, but rather aggressively claim the support of one of the sisters by emphasizing their connections and mutual friends. By reassessing the disastrous feast at Werla, this article stresses the importance of taking into account the context in which demonstrative acts and disruptions of usual political conduct took place.

IN COMPLEX SOCIETIES FORMAL POWER, LEGITIMACY, AND RESPONSIBILITY ARE TYPICALLY ALLOCATED TO COUNCILS, OR GOVERNING BOARDS. THIS IS AN OLD STRAND IN AMERICAN POLITICAL CULTURE, STRENGTHENED BY THE GROWTH OF PRIVATE NOT-FOR-PROFIT ORGANIZATIONS AND CONCERN FOR CITIZENS' REPRESENTATION. IT IS ALSO A GROWING TREND IN GREAT BRITAIN, WEST GERMANY, AND OTHER MODERN SOCIETIES. SUCH BOARDS ARE OFTEN TAKEN FOR GRANTED; WE THINK WE UNDERSTAND THEM, HENCE THE VALUE OF INVESTIGATING THE "OBVIOUS." IN THIS ESSAY THEY ARE EXAMINED WITH RESPECT TO THEIR EXTERNAL AND INTERNAL RELATIONS(OR STRUCTURE), THEIR PROBLEMS AND PERFORMANCE (OR PROCESSES), AND THE BLURRED NATURE OF THEIR AUTHORITY IN AN "INTERPENETRATED" SOCIETY WHERE PUBLIC AND PRIVATE INTERESTS ARE INEXTRICABLY INTERTWINED. ILLUSTRATIONS ARE DERIVED FROM THE AUTHOR'S RESEARCH IN THE GOVERNANCE OF LABOR UNION LOCALS, MUNICIPAL GOVERNMENTS AND REFORM MOVEMENTS, URBAN RENEWAL EFFORTS, COMMUNITY MENTAL HEALTH CENTERS, AND PRIVATE HOSPITAL GOVERNING BOARDS.

US Presidents make their mark on health, for better or worse. Donald Trump campaigned on a populist platform to "make America great again". While the actual policies his administration will pursue-and the priority he will place on each of them-remain in many ways uncertain, both his statements and his nominations for key government posts suggest that his presidency could have profound implications for health. His proposal to repeal and replace the Affordable Care Act with a "better reform", his stance on reproductive rights, and his approaches to other areas, such as science policy and climate change, coupled with his stated intention to put "America first" are creating anxiety and uncertainty about America's domestic health policies and its global leadership role in areas such as security and development. We propose criteria on which the global health community can judge the success or failure of a Trump presidency, based on a selection of the 17 Sustainable Development Goals that apply to health.

All forms of Brexit are bad for health, but some are worse than others. This paper builds on our 2017 analysis using the WHO health system building blocks framework to assess the likely effects of Brexit on the National Health Service (NHS) in the UK. We consider four possible scenarios as follows: a No-Deal Brexit under which the UK leaves the EU on March 29, 2019, without any formal agreement on the terms of withdrawal; a Withdrawal Agreement, as negotiated between the UK and EU and awaiting (possible) formal agreement, which provides a transition period until the end of December, 2020; the Northern Ireland Protocol's backstop coming into effect after the end of that period; or the Political Declaration on the Future Relationship between the UK and EU. Our analysis shows that a No-Deal Brexit is substantially worse for the NHS than a future involving the Withdrawal Agreement, which provides certainty and continuity in legal relations while the Political Declaration on the Future Relationship is negotiated and put into legal form. The Northern Ireland backstop has varying effects, with continuity in some areas, such as health products, but no continuity in others. The Political Declaration on the Future Relationship envisages a relationship that is centred around a free-trade agreement, in which wider health-related issues are largely absent. All forms of Brexit, however, involve negative consequences for the UK's leadership and governance of health, in both Europe and globally, with questions about the ability of parliament and other stakeholders to scrutinise and oversee government actions.

The process of leaving the European Union (EU) will have profound consequences for health and the National Health Service (NHS) in the UK. In this paper, we use the WHO health system building blocks framework to assess the likely effects of three scenarios we term soft Brexit, hard Brexit, and failed Brexit. We conclude that each scenario poses substantial threats. The workforce of the NHS is heavily reliant on EU staff. Financing of health care for UK citizens in the EU and vice versa is threatened, as is access to some capital funds, while Brexit threatens overall economic performance. Access to pharmaceuticals, technology, blood, and organs for transplant is jeopardised. Information used for international comparisons is threatened, as is service delivery, especially in Northern Ireland. Governance concerns relate to public health, competition and trade law, and research. However, we identified a few potential opportunities for improvement in areas such as competition law and flexibility of training, should the UK Government take them. Overall, a soft version of Brexit would minimise health threats whereas failed Brexit would be the riskiest outcome. Effective parliamentary scrutiny of policy and legal changes will be essential, but the scale of the task risks overwhelming parliament and the civil service.

While policy attention is understandably diverted to COVID-19, the end of the UK's post-Brexit 'transition period' remains 31 December 2020. All forms of future EU−UK relationship are worse for health than EU membership, but analysis of the negotiating texts shows some forms are better than others. The likely outcomes involve major negative effects for NHS staffing, funding for health and social care, and capital financing for the NHS; and for UK global leadership and influence. We expect minor negative effects for cross border healthcare (except in Northern Ireland); research collaboration; and data sharing, such as the Early Warning and Response System for health threats. Despite political narratives, the legal texts show that the UK seeks de facto continuity in selected key areas for pharmaceuticals, medical devices, and equipment [including personal protective equipment (PPE)], especially clinical trials, pharmacovigilance, and batch-testing. The UK will be excluded from economies of scale of EU membership, e.g. joint procurement programmes as used recently for PPE. Above all, there is a major risk of reaching an agreement with significant adverse effects for health, without meaningful oversight by or input from the UK Parliament, or other health policy stakeholders.

While policy attention is understandably diverted to COVID-19, the end of the UK's post-Brexit 'transition period' remains 31 December 2020. All forms of future EU−UK relationship are worse for health than EU membership, but analysis of the negotiating texts shows some forms are better than others. The likely outcomes involve major negative effects for NHS staffing, funding for health and social care, and capital financing for the NHS; and for UK global leadership and influence. We expect minor negative effects for cross border healthcare (except in Northern Ireland); research collaboration; and data sharing, such as the Early Warning and Response System for health threats. Despite political narratives, the legal texts show that the UK seeks de facto continuity in selected key areas for pharmaceuticals, medical devices, and equipment [including personal protective equipment (PPE)], especially clinical trials, pharmacovigilance, and batch-testing. The UK will be excluded from economies of scale of EU membership, e.g. joint procurement programmes as used recently for PPE. Above all, there is a major risk of reaching an agreement with significant adverse effects for health, without meaningful oversight by or input from the UK Parliament, or other health policy stakeholders.

The UK's relationship with the European Union (EU) is now embodied in two principal legal instruments: the EU–UK Trade and Cooperation Agreement, which formally entered into force on 1 May 2021; and the Withdrawal Agreement, with its Protocol on Ireland/Northern Ireland, which continues to apply. Using a 'building blocks' framework for analysis of national health systems derived from the World Health Organisation, this article examines the likely impacts in the UK of this legal settlement on the National Health Service (NHS), health and social care. Specifically, we determine the extent to which the trade, cooperation and regulatory aspects of those legal measures support positive impacts for the NHS and social care. We show that, as there is clear support for positive health and care outcomes in only one of the 17 NHS 'building blocks', unless mitigating action is taken, the likely outcomes will be detrimental. However, as the legal settlement gives the UK a great deal of regulatory freedom, especially in Great Britain, we argue that it is crucial to track the effects of proposed new health and social care-related policy choices in the months and years ahead.