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The Knife's Edge: Balancing Health and the Economy During Covid-19

30 July 2020

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Reported by Kate McNeil, CSaP Communications Coordinator

What can we learn from the way that government decision making has sometimes framed economics and public health as competing goals? How can decision-makers consider economic and health outcomes holistically? What can we learn from the different approaches taken by governments to contain covid-19 while minimizing economic impact?

In the first of three seminars which seek to explore our understanding of the twin policy drivers of health and economics, we took a closer look at how decision-makers are balancing these priorities, and whether these policy drivers should be seen as complimentary.

As governments seek to find a balance between protecting public health and reopening the economy, John Hopkins health economist Professor Daniel Polsky has characterised the environment in which policymakers are making decisions as "a knife's edge. Like fire prevention during fire season, it could only take a single misstep to end up with a forest fire". Yet, he suggests that health outcomes and economic outcomes should not be treated as opposing goals. Rather, public health policy is economic policy.

This approach has been echoed by Cambridge economic epidemiologist Dr Flavio Toxvaerd, who has suggested that it is "fundamentally unhelpful to think of heath versus the economy". In his view, the economy is just one tool to create wellbeing, with health being another. While the conversation surrounding health and the economy throughout the pandemic has often been framed in terms of trade-offs, Dr Toxvaerd has challenged this view with a metaphor: "What is the best possible chocolate cake? It is not a question of 'what is the trade-off between butter and flour'. We want all of them in the right in the right proportions, and then we will make the best chocolate cake. And so that is the way we have to think about it."

So, how do we best move forward as a society, when the risks posed by covid-19 are not expected to go away anytime soon?

Professor Polsky has emphasised that rather than letting things "go wild" and placing our hopes in a vaccine, governments need to take steps to control the spread of disease. While he believes that zero cases and a 100% lockdown are not realistic choices, he suggests that the most viable economic policy going forward is to introduce mechanisms which can help society move towards collective action in taking steps to mitigate the spread of disease. Moreover, Dr Toxvaerd has noted that as we strive to formulate better policies, we need some specific production of knowledge which explores the interaction between economic and epidemiological issues from both a macro and micro perspective.

As we go forward, Professor Polsky has argued that investment in mitigation strategies, efforts to control the spread of covid-19, economic relief, and public health protocols are a short-term investment which will result in long term gain. Meanwhile, Dr Toxvaerd has highlighted the longer term need to think carefully about how to build our health service infrastructure going forward, including our ability to test large numbers of people on short notice, and to have a well-functioning track and trace app ready for the next epidemic.

Emerging Lessons from Pandemic Responses:

According to Professor Martin White, Programme Leader within Cambridge's Population Health Interventions unit, learning from certain countries' successes during the pandemic will require rigorous analysis of a variety of factors. Already, he suggests, there are at least three key areas to which those undertaking this analysis should be paying close attention:

1. Metrics: How do we measure what a good government response looks like? Professor White describes there as being a variety of factors that might be of significance, including: incidence of disease mortality; the wider effect of government pandemic policies on inequalities such as food poverty; costs to the health and social care sectors; and the consequences of ill health upon economic productivity.

2. Ideology vs. Science: At the start of the pandemic, evidence-informed decision-making about covid-19 was much more difficult, given the limited amount of information we had about the virus. However, in the months since, the evidence-base has rapidly grown. If we are to learn as a global community how to manage pandemics in the longer term, Professor White suggests we need to learn from the countries that were hit by the virus earlier, and to explore the extent to which ideology trumped facts and evidence in the responses of those governments. Here, he suggests that those governments who chose to prioritise health appear to have been long-sighted, while those who chose to focus on re-opening the economy have now in some cases seen the virus rebound.

3. Future Resilience: Professor White suggests we need to take a serious look at existing paradigms in the health sector and the economy and ask whether they are fit for purpose. He suggests that we've seen severe problems with resilience across the economy and in sectors such as the health sector, and notes that the pandemic may prove to be an opportunity to do things differently and build a better future going forward.


Cover Photo by Morning Brew on Unsplash

Kate McNeil

Partnership for Conflict, Crime & Security Research