A lot of friends and colleagues keep telling me how they “really wish things would go back to normal” and while I completely understand the sentiment (I mean, who wouldn’t just want to walk among a crowded street, grab a drink in a bar, or meet up for dinner at a friends’ house), I doubt that the old normal is the one we should be aspiring to.
The same way that global debates on health systems, their design and capacities to offer care both during COVID-19 and future outbreaks, are suddenly surging, the same way we should be debating what kind of relationships, nations, societies and health systems we actually want to create. My colleagues often note that crises are windows of opportunity – not just to respond to the tough and unthinkable – but also to reshape what we have and define a new normal. Health systems are not exempt from the influences of globalization, politics, or indeed the communities they are embedded in, and it is critical therefore that we debate the shape, dynamics and desired goals of these wider structures, before debating how to strengthen our health systems.
I wonder for example, whether we can finally put the debates about whether this is, or is not, a globalized world to rest and act accordingly. Sars-CoV-2 is not the worst pathogen that could have hit us and its emergence made it pretty clear, pretty fast, that we are irrevocably connected and reliant on one another. I say this as an immigrant in a country that has recently voted to leave the EU, a decision that brought with it not only reassurances for those vehemently calling for controls on migration, but also a weakened health system as a large number of foreign health workers opted to leave the UK. News of how the UK government failed to take part in an EU scheme intended to secure protective equipment for health workers across the continent is ripe, and points further to the dangers of isolationism in an age where viruses travel faster than the good will of nations working together.
I wonder too about the sudden emergent emphasis on community. In many places, across Europe especially, communities marked by deep seated care and compassion are suddenly re/emerging – societies clapping for health care workers, governments suddenly investing in services for the homeless, volunteers taking shopping to the more vulnerable, runners nodding to each other in the park, long lost family making that extra call to stay in touch. Community is and always has been important, and spending time understanding and building community spirit and identity is critically relevant beyond pandemics. Community behaviours, norms and expectations, or rather the lack of healthy living related emphasis within these, shape the emergence of the chronic diseases which leave a large proportion of our populations vulnerable to COVID-19 in the first place. Where was our community attention on these challenges and how to address them before this outbreak?
And finally, I wonder about literacy and education. A minor spoiler here, I do not have children, but I am equally not speaking about children alone. I am talking about the need for populations as a whole to gain knowledge and critical thinking abilities in relation to risks and opportunity costs. If we want to invest in consumerist societies which largely are substantiated by inequality, then we must accept the risk that that carries in future: in the event of pandemics such as these, a large part of the world’s population will be worse off or die not due to the direct effects of pathogens but to the effects of transmission curbing public health measures such as lockdowns, social distancing and isolation. Similarly, while many would argue that the increasing emergence of pandemics and epidemics is in itself probable, it is inaction on climate change and on tackling wider social determinants of disease emergence, which leave the world more susceptible and vulnerable to the effects of pan/epidemics.
Overall, most of what I think about these days is therefore that I really hope that we don’t go back to normal.