Power and pandemics: A thought experiment

Imagine you’re a far-right government bent on a particular political project, whose lead minister for domestic affairs is on record as saying governments are not responsible for poverty, and you have to respond to a fast-moving contagious disease, after a decade of austerity has left the national health system overstretched even under normal circumstances and eviscerated local authorities’ ability to respond to public health crises. 

You are also committed to leaving the customs union whose members buy almost half your exports and supply about 30 percent of the nation’s food, in nine months, with or without a replacement set of arrangements[1] and despite the social and economic disruption that may ensue, including disruption of food supply chains whose precariousness the epidemic is already demonstrating. 

What might your sharpest-minded strategists do? 

Well, one approach would start by playing down the seriousness of the epidemic.  The Prime Minister might urge people to minimise social contact, whilst sometimes ignoring his own advice.  As the scale and speed of the epidemic became clearer, you might go ‘evidence-based,’ relying on a particularly apocalyptic set of model predictions that ignore the possible benefits of basic public health measures such as contact tracing, clinical observation, and testingperhaps to avoid drawing attention to austerity’s effects on the country’s ability to carry those out. 

Now invoking wartime imagery, you would close schools and most businesses and public facilities countrywide.  Within a few days, enabled by a hapless simpering Parliamentary opposition that did not oppose, you would enact a 348-page piece of legislation that centralises almost all power in the hands of the political executive for at least two years, and among many other extraordinary measures gives police the authority to use roadblocks and drones to prevent non-essential travel, indeed to define it, with criminal prosecution as a backstop. You would also, quite understandably, commit to massive borrowing and spending in order partially to compensate for lost jobs and business revenues, and to keep the economy from collapsing completely.

Oh, wait – the UK has such a government, and it just did all that.  Lancet editor Richard Horton has written that ‘basic principles of public health and infectious disease control were ignored, for reasons that remain opaque’; the following day, former Conservative Secretary of State Jeremy Hunt made a similar point, noting – about countries that tested early and intensively – that ‘[t]he restaurants are open in South Korea. You can go shopping in Taiwan. Offices are open in Singapore’. Abundant evidence now shows that permissible movements are now determined only by police acting on their interpretation of the orders of the political executive. When the other shoe drops, in the form of post-pandemic, post-Brexit austerity that will solemnly be defended on grounds of fiscal prudence, resistance may be difficult if not dangerous.  Methinks that far from blundering, the Conservative response to the pandemic has been extremely calculating and politically sophisticated.  I desperately hope I’m wrong.

[1]   Thanks to the US, the World Trade Organization now is nothing more than a talking shop, but that’s another story.

This post was updated on 31 March

Snapshots and casualties from the pandemic

On the morning of 18 March, Andrew Ross Sorkin’s indispensable Dealbook blog asked ‘what a “wartime” economy looks like’, pointing to the roughly US$2.5 billion in stimulus spending that the United States, the UK, France, Germany and Spain had offered as of yesterday; warning that it might not be enough; and calling the ‘spending plans unlike anything seen during peacetime’.

Actually he’s not quite correct on that last point.  The Bank of England pointed out in 2009 that in response to the financial crisis, the US and UK governments quickly mobilised an estimated US$14 trillion in cash and credit guarantees to rescue financial institutions, ‘equivalent to about 50% of annual GDP in those economies, although that does not equate to losses as in some cases these obligations were offset by holdings of assets’.  It is becoming clearer by the day that a commitment of that magnitude, if not larger, will be needed to avoid a depression.  And the blog points out that during the Second World War, the UK and the US ran budget deficits equivalent to more than a fifth of their respective GDPs.  By 20 March, The Economist was citing a figure of US$7.4 trillion (about 23 percent of GDP) as the combined commitment from the US, the UK, Germany, France and Italy; warning that conventional fiscal policy is likely to have limited impact; and observing that ‘new financial tools need to be deployed, and fast’. An optimistic view is that Green New Deals may achieve a breadth of political support unimaginable two weeks ago.

On the other hand, Toronto’s Globe and Mail offered an important commentary pointing out that many people already living paycheque to paycheque and now facing the probability of job losses cannot afford to stockpile a fortnight’s worth of food and will probably have trouble keeping a roof over their heads – an obvious point that seems to have escaped most of the mainstream media.  Both the New York Times, whose epidemic coverage is now out from behind its paywall, and the Guardian offered ominous frontline accounts calling into question the National Health Service’s ability to cope with increased caseloads after a decade of austerity-induced fragility. Similar accounts are now emerging from (among other places) the United States and Italy. And outspoken Lancet editor Richard Horton excoriated the British response as ‘a collective failure among politicians and perhaps even government experts to recognise the signals’ emanating from China and India.  He concluded that ‘when we have suppressed this epidemic, when life returns to some semblance of normality, difficult questions will have to be asked and answered’. 

We must now confront the possibility that, if economic policy is mismanaged and some health services collapse, that return might take, not a few years, but a generation.

This post was updated on 20 March

COVID-19, state desertion and neoliberal epidemics

In these times of plague, at least as they are categorised by some, spilling more digital ink on COVID-19 smacks of either hubris or irrelevance, and many others are better qualified than I to comment on the outbreak’s epidemiological dimensions – although, interestingly enough, they don’t always agree, and media are stretching the category of ‘scientists’. In keeping with the blog’s theme, here are a few equity-related observations.

1.  In some jurisdictions, the outbreak is a neoliberal epidemic – the term Clare Bambra and I coined in 2015 – for at least two reasons.  The first of these is the lack of access to paid sick leave for literally millions of low-wage US workers in retail, hospitality, and grocery sectors who either have no entitlement to paid sick leave or do not think they do, as reported by The New York Times.   Of course, in the real world, for workers without a strong union this ‘entitlement’ is really at the employer’s discretion, regardless of what the law says.  In the UK, the fusion of executive and legislative power gives the government of the day the ability to remedy the comparable problem instantly, if it chooses to do so.   Will it?

The current outbreak is also a neoliberal epidemic because of reliance on a profit-motivated pharmaceutical industry for vaccine development.  A recent journal article points out that this model for vaccine development has systematically hindered the development of vaccines for so-called neglected diseases; it may now be doing so with regard to COVID-19.  In a long and important piece in The Guardian on 27 March, US researcher Peter Hotez described ‘a broken ecosystem for making vaccines’, and claimed that he might have had a COVID-19 vaccine to offer today if his team had been able to find funding for a clinical trial based on their previous (2011-2016) research on SARS. If we take seriously the broadly shared view in political theory that the most basic prerequisite for political legitimacy is a government’s ability to protect its subjects against basic threats to life and security, then the development of scientific capacity for developing diagnostics and vaccines from basic research through to production and free, not-for-profit distribution should be regarded as a national security imperative for countries able to support such initiatives, and as a development assistance priority. Will this lesson be learnt from COVID-19?

2.  Focussing on the UK context, we are now seeing the consequences of a decade of austerity during which the NHS was starved for resources and the budgets of the local authorities that since 2012 have had statutory responsibility for public health have been gutted.  It remains to be seen whether the NHS will be able to cope, and how high the casualty count will be both among those infected with COVID-19 and those whose care needs are displaced by COVID-19 patients in intensive care units.  Rest assured, there will be casualties.  In the United States, journalist Laurie Garrett has been warning for decades about the dangers of neglecting domestic public health infrastructure.  In January of this year, she broke the important story that President Trump had disbanded the country’s pandemic response capability.  Some mainstream media, although by no means all, have since picked up the story.  Clearly, this was regarded as less important than covering promises of building big, beautiful walls to keep out threats originating in deranged racist imaginaries.  Our media in the UK, and what has passed for a political opposition over the past decade, have not done a whole lot better.

3.  At this writing, one UK proposal is to respond to the outbreak by isolating people over 70 in their homes for up to 16 weeks, ‘for their own protection’, which among other shortcomings defies every principle of natural justice.  At this writing, it is unclear how draconian the restrictions would be, but if they are implemented, then one wonders how many deaths of despair will result not from COVID-19 infection, but from that isolation in the context of a care infrastructure that is completely unable to provide necessary support – again, after a decade of austerity.

Over the longer term, the economic impacts of the pandemic may prove to magnify health inequalities in ways that are as yet impossible to predict.  For example, what happens if lengthy school closures result in job losses for parents choosing between work and leaving their children home alone?  What happens to literally millions of workers in (initially) the transport, hospitality and retail sectors as their jobs disappear? What happens if, or more probably when, equity market declines mean that defined-contribution pension plans across the high-income world collapse in value and defined-benefit plans can no longer meet their obligations and face insolvency?

It is possible to envision creative and progressive (as the term is used in public finance) policy responses to all these questions, and other related ones.  An International Monetary Fund researcher has called for ‘substantial targeted fiscal, monetary, and financial market measures to help affected households and businesses’ (author’s emphasis).  Whether such policies will prove to be politically viable domestically and internationally given the sums involved – realistically, into trillions of US dollars – and the desirability of strongly progressive finance mechanisms is quite another question.  Within their own borders, both the United States and the United Kingdom have in recent years systematically and intentionally magnified inequality and redistributed resources and opportunity upward within their social structures. Time will tell.

This post was selectively updated on 29 March; many aspects have now been overtaken by events.

Starting a conversation: Evidence-informed polemic and the need for a new social movement

I am re-reading, not for the first time, some of the work of legal scholar Catharine MacKinnon.  (I used to refer to her as a feminist legal scholar; I don’t do this any more, since the adjective can be read as a qualifier, or a denigration.  Scholarship is scholarship, full stop.)  Her work has been an inspiration to me for a long time, since she combines impeccable, meticulously documented philosophical argumentation and legal reasoning with incandescent critique of injustice, gender inequality and misogyny.   

But MacKinnon is much more than a hyper-accomplished academic.  Among a host of other achievements, she was co-counsel in the first US Supreme Court case that recognised workplace sexual harassment as a form of discrimination; contributed to the development of Canadian equality law under the country’s Charter of Rights and Freedoms; was co-counsel in the suit that won a landmark US damage award against Serbian warlord Radovan Karadzic, establishing rape as an act of genocide in the context of ‘ethnic cleansing’; and subsequently served as the first gender adviser to the International Criminal Court.  MacKinnon’s advocacy played an important role in generating what is now widespread recognition of rape as a weapon and crime of war.  She has written extensively about these experiences, and much else, in a style I think of as evidence-informed polemic. [1]

The literature on health inequity includes at least a few examples of this style.  For example, in 2013 David Stuckler and Sanjay Basu argued (in The Body Economic) that: ‘The price of austerity is calculated in human lives.  And these lost lives won’t return when the stock market bounces back’.  Immodestly, in 2015 Clare Bambra and I put forward (in How Politics Makes Us Sick) the idea of neoliberal epidemics, specifying neoliberalism as a fundamental cause of health inequalities.  And in 2017, Lancet editor Richard Horton memorably described austerity as ‘a political choice that deepens the already open and bloody wounds of the poor and precarious’.   Outside the academic bubble of citation counts, these interventions (we) have had approximately zero impact in the real world. This post is an effort to start a conversation about how to change that.

One obvious observation is that MacKinnon’s impact results from a combination of advocacy and creative litigation using existing bodies of statute and doctrine.  One of the researchers interviewed by Katherine Smith characterised health inequalities as ‘the most fundamental abuse of human rights in the developed world. [I]f you imagine locking up a substantial proportion of your population for the last five or ten years of their life without any justification at all, well actually this is worse than that, it’s like executing them arbitrarily’.  Stated thus, the point seems obvious, but it’s hard to see avenues for turning it into a basis for litigation.  Maybe concerned academics have simply not connected with the right litigators, but issues of causation might present formidable barriers to success, given courts’ (and many epidemiologists’) tendency to set standards of proof that are often inappropriately high

At least in the UK, the deliberate corruption of universities by organising priorities and career paths around generating research income means fewer and fewer academics – mainly those near the end of their working lives, without dependents or with independent wealth – can engage in evidence-informed polemic rather than forelock-tugging before funders without fear of reprisal.  Professionals working in public health in government are likely to be even more limited in their ability to speak out, however sophisticated their private understandings of the origins and politics of health inequality (and in many cases, again in the UK at least, these are very sophisticated indeed).  The tendency of too many health promoters to acquiesce in the popular conception of poor health as somehow the fault of the individual affected does not help. 

Perhaps the most important issue is suggested by Sir Michael Marmot’s call, after the release of the 2008 WHO Commission report, for ‘a social movement, based on evidence, to reduce inequalities in health’.  That movement has yet to materialise.  Writing about women’s resistance to workplace sexual harassment in the United States, Carrie Baker defines social movements as ‘a mixture of informal networks and formal organizations outside of conventional politics that make clear demands for fundamental social, political, or economic change and utilize unconventional or protest tactics’.  Crucially, many coalitions that formed to fight sexual harassment connected women who were not otherwise similarly situated in socioeconomic terms.   Another, much more recent manifestation of such a coalition is the powerful anti-violence performance ‘A rapist in your path’, which originated in last autumn’s Chilean protests against inequality and has now gone viral in much of the world.  

Here’s the rub.  As I wrote a decade ago in the Canadian context, effective social movements need not only evidence and coalitions, but also rage, hopelessness, desperation, hope, shared passion, shared vulnerabilities, or some combination of these.  That’s where their energy comes from.  If one adopts a suitably precautionary standard of proof, as suggested by the human rights frame, there is no shortage of evidence – certainly not of the damage done by the past decade’s systematic upward redistribution of resources and opportunity.  What possible coalitions could move the health equity agenda forward, and how can the necessary emotional energy be mobilised?  Let the conversation begin.

[1] A selection of MacKinnon’s earlier work appears in Feminism, Unmodified (1988); somewhat later work in Are Women Human? (2007); and her landmark explication of feminism as political theory in Toward a Feminist Theory of the State (1991).  A very recent open access introduction to her perspective is available here.