The coronavirus pandemic has laid bare a range of structural inequalities that contribute to poor public health. Covid-19 is a huge challenge in and of itself, but its impact has been made significantly worse by a number of pre-existing issues that have exacerbated physical and mental health problems over the past nine months. The impact of the pandemic stretches far beyond rates of infection for the virus alone; it is causing knock-on effects in backlogs of patients suffering from other conditions, due to the intensified competition for staff and resources, while also having a major effect on the economy.
In December, the New Statesman’s Spotlight policy supplement gathered a panel of experts, comprising policymakers and influencers as well as healthcare professionals, to discuss the lessons to be learned from the pandemic and how these could inform better public health strategies moving forward. The virtual round-table event, chaired by former New Statesman deputy editor Jon Bernstein, was sponsored and supported by our partners Johnson & Johnson, Cognizant, DrDoctor and Pfizer – the pharmaceutical company that has developed a Covid-19 vaccine with BioNTech.
While the vaccine is being rolled out – challenge in and of itself in terms of sheer logistics – there was a broad consensus from attendees that a generally healthier society is one of the best ways to mitigate the spread of Covid-19.
Alex Norris, the MP for Nottingham North and the shadow minister for prevention, public health and primary care, noted the need to rethink in terms of the public’s health “when we rebuild post-Covid”. Wrongly, he said, public health is too often talked about “in a deficit”, and there is a tendency to “individualise” concerns such as obesity. Rather, he suggested, the conversation should be framed around “environmental factors” that make certain health problems, such as obesity or depression, more likely.
Sashi Padarthy, a consulting partner at Cognizant, said that for a long time the public healthfocus in the UK had tended to be on “metabolic diseases” – issues like smoking cessation and weight management. Not enough “consideration”, he said, had been given “at least in the Western World… to communicable diseases”, but the pandemic has made people see these things differently. Pardathy said he see these issues from the “transformation perspective”, focussing on “value-based care” and “digital strategy”. He noted that if the “primary determinants of disease are mainly economic and social”, then the solutions developed for them should be as well. “We can’t drive innovation without the necessary social and economic changes,” he said.
Dr Jeanelle de Gruchy, president of the Association of Directors of Public Health, echoed this sentiment, also noting long-standing instances of public health “systems not being funded adequately through austerity and other reasons”. She cited “profound inequalities that have exacerbated poorer outcomes from Covid”, pertaining “in particular to population groups or localities”. De Gruchy said this would “continue to be exacerbated as a consequence of Covid”. She pointed to the “north-south divide” in terms of how jobs and wealth are unevenly distributed in the UK, as well as to the other structural inequalities, including people working in “front-line manual jobs”, who are less likely to be able to work from home.
De Gruchy also said that “poorer”, “crowded” or “multigenerational” housing is a contributor to poor health. These are “real endemic issues” exacerbating health problems and issues of inequalities in those communities. Tom Whicher, the CEO and founder of DrDoctor, a cloud-based patient engagement platform, agreed. “We like to think about value-based care,” he said. He talked about “personalising that journey for the individual in order to help people be ‘weller’ through their life”.
Baroness Susan Masham, co-chair of the All-Party Parliamentary Health Group, lamented that so many health services have been “put on hold” over the course of the pandemic. She called for clinics and services to “reopen with renewed energy” and noted that “fundraising for specialised groups has been a disaster”.
And while she made clear that the issue extended beyond that, Helen Donovan, the professional lead for public-health nursing at the Royal College of Nursing, highlighted the importance of funding for a “robust and sustainable public-health system in the future” that could be better prepared for another disaster scenario. Donovan also pointed out that the Covid-19 vaccine rollout will require a “much wider workforce”. “Obviously, yes, GPs and other professionals will be brought in,” she said. “But most of the Covid vaccines given are likely to be given by the nursing staff or overseen by the nursing staff.”
The “inclination” of the Conservative government, according to Baroness Judith Jolly, the Liberal Democrat spokesperson for health, has tended to be “very non-interventionist”. But the Covid-19 pandemic, she suggested, may provide the motivation needed to take a more proactive approach to public health. Jolly mentioned the example of “adding folic acid to flour”. This reduces the risk of babies born with “neural tube defects”, she explained. She name-checked New Zealand, Canada and Australia as having taken such a step and that people in those countries “actually get it [folic acid] without knowing about it”.
Similarly, Hugo Breda, managing director of medical devices for the UK and Ireland at Johnson & Johnson Medical Devices Cos, wants the pandemic to be viewed as an opportunity to inject fresh urgency into some of the most common public-health issues. “I immediately think smoking, drinking, obesity,” he said, highlighting the latter as having “the highest sense of urgency”. Breda said there is “a huge need for an end-to-end approach for prevention” to guard against comorbidities, “including different types of cancer”. According to an international study conducted by the University of North Carolina this year, being obese doubles the risk of hospital treatment from coronavirus and increases the likelihood of death by almost 50 per cent.
Lisa Cameron, a former clinical psychologist who is now the Scottish National Party’s spokesperson for mental health, said society has become “very individualistic”. The pandemic has meant “we have had to re-evaluate the importance and value of community support”, she said. Cameron noted the sustained investment in cybersecurity and defence. She said the government should consider investing similarly in “health security” with international partners to improve “pandemic preparedness” going forward. Resilience and general wellbeing are key factors, she noted. “I think we can see the long-term impact of the pandemic,” Cameron said, “not just on physical health but really upon people’s mental well-being. And we need to continue to invest in mental health and make sure that when people need support, that’s available to them at the time that they need it.”
Ben Osborn, UK country manager and managing director at Pfizer, noted that as the company has reflected in recent weeks on national vaccination programmes and the rollout of the Covid-19 vaccine, “importance of trust and confidence at a local level” have become very clear. Understanding of various public-health issues could be enhanced, Osborn suggested, by engaging “local trusted faces” in the community, “in religion settings, in education, in sport, even in the local pub”, to help “persuade” people in their areas to make positive lifestyle choices, including following Covid-19 guidelines, engaging with a public vaccination programme and other future public-health interventions.
Ultimately, participants in the event agreed, better public health hinges on meeting two major challenges: awareness and accessibility. Awareness involves spreading more clear and comprehensible messaging around what is and isn’t good for people. Accessibility may relate to better synergy between national and local authorities, sharing information and leveraging technology to help people access the support they need more quickly.
Covid-19 has undoubtedly been a crisis everyone would have rather avoided, but it has also offered an opportunity to reflect on how public-health strategies can be approached differently. As Christina Marriott, chief executive of the Royal Society of Public Health, put it: “If not now, when?” She said there has to be a shift from understanding health as “illness or lack of illness” and rather that it should be considered an “asset that underpins our economy and underpins our enjoyment and quality of life”.