Learning From November 3: A Wake-Up Call for Public Health

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      eridani
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      https://www.milbank.org/quarterly/opinions/learning-from-november-3-a-wake-up-call-for-public-health/

      First, this moment teaches us humility in how we think about the importance of health. While the COVID-19 pandemic has been overwhelmingly an issue about health, and while it has captured public attention, with poll after poll showing that people care deeply about the pandemic, it is not at all clear that voters were willing to take the necessary steps to mitigate the virus. It is not at all clear that the steps involving widespread economic shutdown were palatable to the population despite its concern with the virus. This should be a critical wake-up call for those in public health. Simply speaking, health, on its own, was not enough to sway the election, and voters showed, decisively, that despite overwhelming concern about the pandemic, they were not willing to put aside everything else in the service of maintaining their health. This runs dramatically counter to public health thinking around the importance of the approaches necessary to contain the virus, which often involve substantial economic sacrifice, including lockdowns. This was seen, for example, in the recent John Snow Memorandum, which was drafted to repudiate the Great Barrington Declaration, the latter document suggesting a different approach to the pandemic that de-emphasized widespread lockdowns. Fundamentally, public health’s call in the past year has been premised on the notion that we should do nothing but ensure, to the best of our ability, that as few people as possible get the disease, and that anything falling short of this goal is unacceptable. The election shows us that message is not well received, and we have failed to articulate a message, through the political fog, that is well received and is responsive to what a large swath of the population wish for their health.

      Second, I think this moment also teaches us about the deep divisions that characterize the country. I realize much has been written, and much more will be written, about how these divisions influence the electorate, and the implications of this for the election, in general, and for public health, in particular. I would argue that centrally, in the COVID-19 context, these divisions have widened the gap between those who are socioeconomically advantaged and those who are socioeconomically disadvantaged, with the former group largely advancing approaches to contain the pandemic that have disproportionately affected, and indeed harmed, the latter group. The economic challenge of COVID-19 has been deeply unequal, with job losses suffered by higher earning populations early in the pandemic largely returning, and lower earning workers remaining out of work. Simply put, those of us who are in a position of privilege have been perceived as proposing efforts to contain the virus that fundamentally affect and hurt those who are not in a position to make these recommendations or to implement these policies. This is, of course, a reflection of the undercurrents of socioeconomic division—which often overlap with racial/ethnic divides—that characterize the country. It is a stark reminder that there are socioeconomic divides in the country that are inextricable from the public perception of any public health decision or recommendation, even those that address the most consequential pandemic of this century.

      In articulating these observations, I am simply trying to extract insight from this moment that is relevant to how we think about health. It seems that, at core, health is understood among the public to be a means to an end, not an end in itself. That end is being able to live a life as full and unencumbered as possible. Despite the public’s concern about sustaining the means to this end, the population is not overwhelmingly willing to sacrifice all aspects of their life at the behest of health. This seems particularly to be the case when the burden of sustaining these means falls disproportionately on a group that is not dictating the terms of what these measures must be.

      Comment by Don McCanne of PNHP:  Sandro Galea is one of the great intellectuals in public health in the world today. With our worsening health care crisis due to the COVID-19 pandemic, and with the failure of the most important players in the pandemic – the people – to join together to ameliorate and eventually end this crisis, there is a compelling need to listen to the words of Professor Galea.

      We are in the third and worst wave of this crisis. People are understandably very unhappy in being exposed to the potentially disastrous impacts on their health, not to mention the profoundly negative social and economic impact of the pandemic. Yet far too many have decided to abandon the best recommendations of our public health experts, and, instead, politicize it by following the bizarre lead of our president who has rejected health policy science in favor of… well, whatever it is that he is trying to do. It is no coincidence that the divide in our responses to the pandemic seems to match the political divide demonstrated by the election results this week.

      But the concerns about the health of the nation are not evenly divided. When you find that you are in places where pandemic precautions are an imperative, the mask count is very high. Yet political functions led by our president have a very low mask count and exhibit entirely inadequate social distancing. Though most of us have at least some concern, it is difficult to know what percentage of our nation is willing to throw caution to the wind and ignore the best advice of our public health experts.

      Some of us were actually naive enough to believe that the belligerent rejection of public health science by our president – a position that has contributed to the tragic trends noted in the pandemic curve above – would cause Americans to reject this callous carelessness by replacing our current president with someone who presumably would acknowledge the seriousness of the crisis and attempt to address it with essential government functions that are absolutely required to reduce the terribly tragic impact of the pandemic. Yet the nation remained split on what type of leadership we need in this time of crisis.

      There are no simple answers, but everyone should try to understand Galea’s message. That is the first step we must take as we then come together to heal. It takes only a few to propagate the novel coronavirus. How are we going to bring them into our community tent designed for all if half of us support their ways through our political choices?

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

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