Never have the complexities of the relationship between human health and economic wellbeing been more apparent than during the COVID-19 crisis. How can we enforce life-saving social-distancing rules without destroying livelihoods? Why are some groups suffering so much more than others, both clinically and economically? What are those who face lower risks willing to sacrifice for the common good?
With no vaccine or cure for COVID-19, social-distancing protocols, together with mask-wearing and hand washing, quickly emerged as our best defense against the virus. For some industries, the adjustment was relatively straightforward: close down offices and have employees work remotely.
As it turns out, far more work can be done remotely than was previously thought. Physical proximity has long been viewed as essential to the collaboration that is so essential to running a business, let alone innovating. Yet during the pandemic, I finished a joint paper without meeting my co-authors in person; participated in many fruitful online meetings and conferences; and even advised Japanese Prime Minister Shinzo Abe from my home in New England, rather than flying to Tokyo, as I have done in the past.
My case is hardly rare. Just a few months ago, no one would have imagined that news reporters or talk-show hosts would be broadcasting from their homes. And while some economic activities are likely to move back into shared office spaces or studios as soon as possible, others may remain fully or partly remote. Many companies, including tech giants like Twitter, have already announced plans to keep employees at home indefinitely.
Yet plenty of activities cannot be done remotely. Social distancing has thus meant temporarily closing many businesses, from restaurants to factories, and limiting travel. This has had serious economic repercussions, including supply-chain disruptions, declining demand, and rising unemployment. The International Monetary Fund now expects global GDP to contract by 4.9% this year.
Many have accepted the economic hit, in the interest of “flattening the curve” of infection. After all, unless and until the virus is contained, economies cannot reopen fully. New Zealand has emerged as an exemplar of this approach, though many other countries, as well as some US states, have embraced it. In the meantime, governments, particularly in the advanced economies, have offered unprecedented monetary and fiscal stimulus to keep their economies afloat.
Yet not everyone has been willing to prioritize public health above economic considerations. Yes, in some places, such as India, blanket lockdowns had their own serious public-health consequences. But in others, leaders made the callous calculation that protecting the economy – specifically the stock market – was more important than protecting people from COVID-19. Here, US President Donald Trump and his Republican enablers, such as Senate Majority Leader Mitch McConnell, are the worst offenders.
Those rushing to save Wall Street may subscribe to the logic of Jeremy Bentham, the father of modern utilitarianism, who argued that the goal of public policy must be to ensure the “greatest happiness of the greatest number,” measured by a country’s total income. Those who would place protecting public health first affirm the Harvard philosopher John Rawls’ theory of social justice, which requires public policy to be “to the greatest benefit of the least advantaged.”
Ultimately, however, meeting either standard will require societies and governments to go far beyond social distancing or stimulus payments to tackle deeply embedded systemic inequalities. While the virus itself does not discriminate by wealth, race, social status, or any other such markers, it has disproportionately affected the poor, as well as racial and ethnic minorities. In the US, black and Latino populations in the US face significantly higher COVID-19 infection and mortality rates.
This is partly because members of minority groups are more likely to hold the “essential” jobs that have been exempted from shelter-in-place rules, such as grocery-store workers, bus drivers, couriers, and home health aides. According to one study, black workers comprise nearly 12% of all employees in the US, but 17% of front-line workers.
Such professions are not only likely to be lower paid, but also frequently offer few benefits, such as paid sick leave or health insurance. Social and economic factors, including higher poverty rates and higher likelihood of living in under-resourced neighborhoods, compound the health risks, as do long-standing inequities in health-care access and outcomes.
This is not only an American phenomenon. A recent study showed similar racial disparities in the United Kingdom. And all over the world, the poorest groups – unable to stay home, living in crowded environments that may lack piped water, and without access to medical facilities – are suffering the most. Many are face growing food insecurity.
Beyond a public-health crisis, COVID-19 is a social and humanitarian crisis – one that is exposing and widening our societies’ fault lines, as the protests over racial injustice in the US and elsewhere have shown. But addressing systemic inequities is extremely difficult, not least because members of the privileged group are likely to cling to their advantages.
Rawls captured this dynamic by basing his theory of justice on an “original position”: What choices would people make about the social contract if they didn’t know any of their individual attributes, such as wealth, race, values, or capabilities? Behind this “veil of ignorance,” they would presumably choose a system that ensures the security and dignity of all.
In the real world, however, no such veil exists, and people tend to resist challenges to their unfair privileges. Still, there are some glimmers of a growing commitment to social justice. Beyond the willingness of millions to follow social-distancing guidelines, the US Supreme Court recently ruled that employers may not fire someone for being homosexual or transgender, and recognition of systemic racism in the country seems to have gone mainstream. One hopes that these developments – not the backlash against them – are indications of what is to come.
Koichi Hamada, Professor Emeritus of Economics at Yale, is a special adviser to Japan’s prime minister. This content is © Project Syndicate, 2020, and is here with permission.
14 Comments
It's highly likely that we will find the lockdowns have generated a much more grievous health impact than the virus itself, so spare us the partisanship. For example NZ scientists are estimating at least 300 additional cancer deaths from the diagnostic and treatment delays, these won't be all amongst the elderly either. Academic studies have proven the negative health effects on general mortality from recessions, this is not counting the intangibles from this specific one like social isolation etc.
Covid-19 deaths are highly concentrated amongst the old and infirm, for everyone else it's more or less a bad flu. Isn't this the group that we're trying to kill off anyway via our new euthanasia laws? There is no reason to shut down society, we should just be isolating the vulnerable groups until a vaccine is found.
Met someone yesterday who told me he has an eye problem that requires regular visits to a specialist. He had an appointment the day after the lockdown ended - he was told he had to have an eye operation within a week or be blind within a couple of months. In other words sheer good luck he isn't blind. My Chinese Kiwi friend had so much pain in her knee she couldn't move and was lucky to have her operation the week before the lockdown. How many have not been so lucky. 300 cancer deaths but that doesn't include major cancer treatment thay might have been fairly trivial if operated on asap. How many heart troubles were missed?
I do feel for people who got caught out by normal services being available and if I was one I would be pissed. However at the risk of sounding completely insensitive this is collateral damage for the good of the rest of us. If we had become a Italy, Spain or NY more suffering could/would have occurred. In my opinion we took the best option at the time.
Agreed. It was the best policy at the time. With hindsight much would have been different - masks compulsory, big store of well tested PPE, staff at rest homes well trained and paid emergency bonuses, airport prepared for Covid arrival, quarantine enforced, thousands of civil servants trained in contact searching, national database, etc. However that will all get detailed when we have a royal commission headed by a Taiwanese expert.
I'll take issue about your comment regarding Rest Homeworkers. Those folk who choose to work at those establishments are the most dedicated healthcare workers you could find. They do the best they can with limited resources. It's time we started to value our Resthome caregivers and the ancillary staff (cleaners, cooks and catering staff) way higher than what they are currently valued at. Put yourself in this situation.. Do you want to be cared for by someone on GMI or someone who is well paid for their efforts
But then you see the same and worse effects that ineffective mitigation is having in the USA. Reduced availability of hospital and specialist care when volumes ramp up, and reduced ability for or willingness of weaker and immunocompromised patients to enter environments where they may put themselves at grave risk.
No simple dichotomy.
Covid 19 effects are wide and varied, some extremely serious across a number of age groups.
The flu comparison is poor science and generally a trope designed to minimise the impact of covid, and promote the economy over actually addressing the pandemic and flattening the curve.
https://www.vox.com/science-and-health/2020/5/5/21246567/coronavirus-fl…
The flu isn't generally known to cause strokes or an irrational immune response resulting in lungs being swamped
Kill off with our new euthanasia laws? That's an over-simplification, but I take your point. For everyone else it's a bad flu, even less certain about - the after effects seem to be a lot worse than a bad flu.. whilst the death statistics do trend higher for older age groups it's the increased risk of long term organ damage that hasn't really been discussed. I'd still rather not take the risk of opening up our borders if it means merely maiming ourselves than statistical death rate across all age ranges.
Mr Hamada is not alone in wanting change in society as a result of the pandemic. We find all sorts of utopian dreams, but I doubt human nature will change over the longer term. The "haves" will still want to "hold"; and the "have nots" will still want to get their "share" of perceived wealth.
Perhaps there will be change in similar manner to the black death plague, but I would suggest that change will be gradual and relatively unpredicted by the current crop of "experts". And 'change' may be very relative to where one sits. I liked the interview of the Wall Street street protester during the GFC. When asked what he was protesting for...he replied "fairness...the capitalists have far to bigger share of the nation's wealth".
"Oh," said the reporter, "you want to give away your own wealth?"
"Whadda mean?"
Well as a US citizen you are considerably wealthier than the poor in many countries...obviously in fairness you will want to share your wealth with them!"
(Protester melts into the crowd. )
"people tend to resist challenges to their unfair privileges" Says it all really. Technology accelerates the trend, first in the Old World and then in the New.: https://www.smithsonianmag.com/history/aracheology-wealth-inequality-18…
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