A further position statement from EHFF on the pandemic September 2020
Since our initial, Board-approved statement on April 10, we’ve kept to our promise and produced regular Bulletins, commenting on various aspects of the impact of the pandemic on the overall health ecosystem. We have published one a month, each containing a number of thought pieces from different contributors.
Now is the time to take stock. Within the ‘New Normal’ we won’t cease to scan the horizon, collect information and try and make sense of what lessons are to be learnt, to improve health systems resilience. However, we’re also interested in tracking what appears to be an emerging acknowledgment within European societies of the inter-relation between systems: between health and well-being, the economy, social cohesion and the environment for example.
Some of these lessons will take a longer time-span before the evidence is there to arrive at definitive conclusions. For example, did the Swedish approach, relying on community cohesion and social responsibility, achieve better outcomes, both in terms of morbidity and impact on the economics of the country do better than alternative approaches relying on state imposed curtailment of civil liberties? Politically motivated responses tend to be focused on public perception and the avoidance of blame, rather than a cool appraisal of the balance of risks for a society. An obvious example was the balance between the benefits of containing disease spread against the damage caused by transferring the majority focus of health systems towards the infection and away from managing chronic disease and cancer management, with the inevitable consequences.
In other respects, the messages are already relatively clear. Much better outcomes have been achieved where there is strong and consistent leadership and messaging, resulting in higher levels of trust and compliance from the public. Well-developed systems of testing, coupled with tracking and tracing, as advised by the WHO all along have shown real benefits (equally the corollary, where such systems weren’t put in place, or only too late), especially coupled with sensible hygiene measures. Finally, there is an issue about health literacy among the decision makers. It seems that governments who relied on health statisticians for advice fared less well than those who heeded their epidemiologists and public health advisors.
The WHO have recently identified three clear areas where success or failure in how Governments managed the pandemic depends on: investment (in public health resources), communication (transparency in public messaging) and engagement with civil society (working with local/regional groups and acknowledging their local knowledge and expertise).
The holistic approach to health and wellbeing in society
One final reflection. No one in their right mind doubts that we have experienced a pandemic which is not yet played out. However, some are quite rightly questioning why the talk is of the ‘New Normal’. Living with the possibility of pandemic (think SARS, ‘Asian flu’ etc.) is not new. It’s part of living in today’s global society. So, what’s so special about COVID? It seems that this pandemic has highlighted the interconnectedness of societal systems in a particular way. No-one could deny that as well as the impact of morbidity and mortality (as some have pointed out, probably, since the initial explosion, of a lesser order than deaths from other causes we accept quite calmly, day to day) everyone has experienced the impact of either the disease itself or the measures taken to deal with it, on industry, employment, education, social interactions, travel and leisure activities.
After all, EHFF had last year, before the pandemic, joined the collaborative ‘all policies for a healthy Europe’ which promoted the interconnectedness of systems and the importance of a health as a theme in all the areas above. From a current European policy perspective, the three chosen themes were the environment (the Green Deal and Farm to Fork – recognising the importance of healthy food), Digital (interesting to see how digital technology has shown its value during the pandemic) and the Wellbeing economy, which stresses again, the importance to society’s wellbeing being not just about wealth creation, but education to fulfil citizens’ potential, looking after the environment (healthy people in a healthy planet) and social justice (tackling inequality: another area highlighted by the pandemic).
Resilience in all policies
Current political slogans such as ‘build back better’ acknowledge that systems that we thought were reasonably resilient have been exposed as wanting by the pandemic experience. The huge challenge for all of us is that although we have some reasonable intelligence about how to improve resilience, not only in health systems, but in the economy or in our relationship with the environment, what it requires would be investments and changes of practices which, unfortunately, politically are often still seen as unacceptable – to all our costs. Despite that pessimistic note, there is still a strong groundswell of bottom up activity dedicated to being about such changes and this is where EHFF aims to focus much of its future interest.