The paradoxes of public health

 First published in LibDemVoice.

The promotion of public health is a liberal policy. It is an effective tool in the development of fairness and equality, it contributes notably to health and happiness (thereby reducing the need for, and the expense of, medical care; and reducing the cost to businesses of time off work), it enables people to have much more effective control over their own lives, and many of the activities associated with it resist financialisation, which is one reason why it is so unpopular in right wing circles.

It is also a wide ranging field. Healthy populations need good quality, warm, dry housing; good education; good food; good opportunities for both rest and exercise. On the other hand, reduction of social housing, the obsession with reducing education to league tables, corporate control over food prices and ingredients, the selling off of parks and playing fields, all contribute to reductions in public health.

Fundamentally, good public health reduces the impact of poverty, ignorance and conformity in people’s lives.

Public health requires a community based rather than an individualistic response. This again is a liberal value. While we champion the freedom of individuals, we also champion the notion that we live together in communities, and that we affect, and must support, each other. It is an effective sphere for government to do what we cannot do so well ourselves. It utilises “the power of government to change conditions that are constraining people’s freedom”.

As a country we allow the debate to be dominated by advocacy of a freedom that takes no responsibility, by far too much misinformation, and far too little information. (A very clear example at the moment is when both government and media notice that the number of people off sick has notably increased recently, and wonder why. Without ever mentioning Covid, which we know has severe long term consequences for many who have had it.) As a party we allow ourselves too often to be trapped within those terms rather than campaigning to change them.

The party currently has very creditable policies on public health: well thought out, detailed and workable. (I encourage you to go and read them.) I doubt that they will gain much prominence in a LibDem manifesto in the near future, any more than any other party’s. (I understand the reasons for this; the bandwidth in an election campaign is severely limited.) But perhaps we, as the foot soldiers of liberalism, should be making a much more concerted noise about the benefits of public health as well as the possibilities for local as well as national action in that sphere.

The shadow of covid

 First published in LibDemVoice on Long Covid Awareness Day, March 15th, 2024.

Today is Long Covid Awareness day. It is strange that such a day should be necessary, given how many people’s lives Covid and Long Covid have touched in this country and around the world. Yet it is very necessary as the prevailing public discourse is that Covid is over, and it was never much of a problem to start with. Yet it still kills every week throughout the year, and an estimated 2 million people have Long Covid, affecting their health, and the country’s economy.

The ongoing Covid pandemic is a catastrophic example of the failures of the UK’s public health system. (I refer here primarily to English experience. The devolved administrations have done better than England, but are still affected to a large and tragic extent by the factors discussed below.) Covid requires both treatment and prevention, both medical and public health intervention, and both short and long term strategies with public, professional and political support.

The NHS did immensely well and the government moderately well in the initial phases; the public in general also did well in dealing with the restrictions and exigencies of lockdown. But there were clearly right from the beginning several negatives, which broadly compromised the capacity of public health approaches to be as effective as they could, and have badly compromised government action and professional and public response in the years since the emergency phase:

a) the instinctive reaction of our right wing governments that private provision must be better than public, so wasting billions of taxpayers’ pounds employing immensely expensive private firms to set up a ramshackle test and trace system rather than using existing public health capacity.

b) corruption in government, making sure for instance that funds for the provision of PPE went to their friends rather than to companies with proven track records in such provision.

c) vociferous anti-science and anti-clear thinking conspiracists given far too much air time on both social and traditional media.

d) a kind of neoliberal reductionism in which marginal increases in economic activity like enabling people to go to pubs again are valued far more than keeping people healthy; and school attendance is valued far more highly than reducing transmission – which has resulted in current high rates of absence of both children and teachers through sickness.

e) a refusal from government to take simple steps that might reduce transmission, such as ensuring air filtration in all classrooms and other public spaces which could easily and relatively cheaply have been done in the last four years.

f) short term and blinkered thinking in government and in public debate, in which the most important, and sometimes, the only important metric is death rates, leading us to ignore the creeping epidemic of long term illness and other forms of severe damage which Covid is wreaking on millions of people. We seem to be terrible at assessing long term risk: the fact that we got over a bout of Covid means we ignore the mountain of evidence that it will have done damage to one or more of our organs, which we will regret in ten or fifteen years time.

This is a massive failure on the part of our entire social and political system. All parties, including the LibDems, are complicit in downplaying and denying the damage this disease has done and is still doing to our health. Is it not time for the LibDems to find a bit of non-conformist spirit, and start saying what no other party will say – that Covid is still here, and we need to be taking it seriously?