Globalisation and health: Looking backward, looking forward

This piece was originally written for Policies for Equitable Access to Health, an Italian-based site that now offers a valuable ‘weekly snapshot of public health challenges’.  It is reposted here with their kind permission.

Much of my academic work over the past 20-plus years has focussed on the processes of globalisation and what they mean for population health.  One of the early (2007) major products of that work, co-written with long-time colleague Ronald Labonté, came out of analysis done for the WHO Commission on Social Determinants of health.  It took the form of a three-part series in the journal Globalization and Health, discussing in turn historical context and methodological background; the role of the global marketplace; and prospects for promoting health equity in global governance.  (The later work on globalisation that informed the WHO Commission appeared in book form in 2009.)   In view of the cataclysmic world events of the last 30 months (at this writing) and my pending retirement from salaried academic life, I thought it useful to look back on some of our analysis to see what it got right, what it neglected, and how future research should learn from such reflections.

The work focussed, quite rightly in my view, on how the emergence of a global marketplace and the associated worldwide spread of neoliberal economic ideas and institutions transformed opportunities to lead a healthy life and the options for public policy to reduce health inequalities.  Indeed, we perhaps did not focus intensively enough on neoliberalisation and its transformative impact, about which I have written elsewhere.  The figure below shows (in blue) the seven interacting ‘clusters of pathways’ that we identified in Globalization and Health, and (in red) how I think this analysis needs to be modified and added to in light of recent events.  The rest of this post concentrates on three areas, obviously in insufficient detail.  

The first of these relates to the consequences of global environmental change, now observable in daily headlines about such climate-related phenomena as shrinking polar ice cover, heat waves, megadroughts and wildfires.  As conspicuous as these impacts are, the reflect only one dimension of what is now widely described as the Anthropocene Epoch – a new era of geologic time marked by the scale and extent of human-induced changes in the natural environment, exemplified by (for example) the prospect of the transformation of the Amazon rainforest into savannah as a result of continuing deforestation.  A key concept in the Anthropocene literature is the Great Acceleration, a multidimensional speeding up of economic activity and the associated biophysical transformations beginning, on many reckonings, around 1950 with the post-World War II period of economic growth.  Until recently, that growth was concentrated in the (mostly high-income) OECD group of countries.  Formidable questions of global justice are raised by the implausibility of sustainable growth within planetary boundaries if the rest of the world were to continue pursuing anything like the standard of living taken for granted within the OECD.  Anthropologist Jason Hickel has been one of the most vocal and articulate proponents of ‘degrowth’ in this context; whether intentional degrowth is feasible under any kind of democratic political arrangements is a question yet to be resolved.

The second area of neglect relates to the continued, indeed enhanced danger of transnationally dispersed pandemics.  With 20-20 hindsight, there was little reason for this.  Journalist Laurie Garrett had been warning of the prospect since 1994, and in 2019 – just a few months before the start of the Covid-19 pandemic – published a prescient article warning that: ‘The world knows an apocalyptic pandemic is coming … But nobody is interested in doing anything about it’.  This problem does not appear at first directly connected with the global marketplace, but in fact it is.  Public health infrastructure is one of the key prerequisites of societal survival that the so-called free market cannot and will not provide; it is one of the few truly public goods for health.  The neoliberal turn in public policy is thus implicated in the neglect of public health infrastructure to the extent that Matthew Sparke and Owain Williams recently (and correctly in my view) identified Covid-19 as a ‘neoliberal disease’.  Incredibly, if predictably given the current UK government’s tenuous hold on reality, it  has not learnt from the pandemic: in April 2022 the government announced staff reductions of 40 percent at the Health Security Agency, responsible for pandemic planning and response, at the finance ministry’s insistence.  In the same month, again predictably, a scientifically illiterate US Congress refused to continue Agency for International Development funding for vaccine delivery in low-income countries. 

Third and finally, researchers like myself took too seriously and literally the idea of a ‘Borderless World’ put forward by Japanese economist Kenichi Ohmae.  The book in question, originally published in 1990, remains an iconic paean to a world in which governments have become largely irrelevant; ‘if a corporation does not like its government, it can move its headquarters to other, more hospitable places’; and the future resembles nothing so much as a global duty-free shop.  Many elements of this vision, notably its focus on the footloose corporation and its tacit acceptance of rising inequality, remain accurate if dispiriting descriptions of the world economy.  At the same time, nationalism and geopolitics continue to render the world anything but borderless, and political institutions anything but irrelevant, in many respects.  In 2016, UK voters narrowly supported leaving the European Union and its single market, an act of economic self-harm that will have consequences for decades, most of them magnifying existing inequalities and their destructive effects on health.  And several European countries, Germany most particularly, appear to have believed that the world really was borderless for purposes of energy policy.  This catastrophic inattention to geopolitics led directly to today’s vulnerabilities associated with reliance on Russian natural gas supplies and may yet pave the way to deep recession, widespread social unrest, and domestic political pressure to accept Ukraine’s dismemberment.  Much of this could have been avoided through careful attention to a long list of books drawing attention to Russia’s internal political transformation, going back at least to the late Anna Politkovskaya’s 2004 Putin’s Russia. (She was murdered shortly after its publication.)

Much more can and should be said on all these matters, and others.  For example, global health researchers have not yet come to grips with the implications of a widespread retreat from democracy and drift into autocracy in which, according to the respected Varieties of Democracy Institute, ‘the last 30 years of democratic advances following the end of the Cold War have been eradicated’.   As historical sociologist Margaret Somers points out in the US context, this trend is not unrelated to the hegemony of neoliberalism, although the connections are likely to vary among country cases.   Faced with such complexity, many researchers will be tempted to retreat into the familiar territory of health systems design and what might be called global medicine.  This tendency should be resisted, not least because – as Martin McKee notes in an important recent article – ‘politics is at the heart of public health’.  This is even more true in the global frame of reference than at the national level about which he was writing.  

Whistling past the graveyard of dreams: Hard truths about the likely post-pandemic world

This post originally appeared on 2 November in the excellent global health blog Policies for Equitable Access to Health; it is reproduced here by permission, with minor edits. All views expressed here are exclusively those of the author.  Others quoted here do not necessarily agree with them.

Whistling past the graveyard is a long-ago expression that describes the behaviour of people who are afraid of ghosts, but like to pretend that they are not.  So, they whistle as a show of nonchalance while walking past graveyards late at night.  The expression well describes the current behaviour of academics and apparatchiks alike, in much of the world, as they respond to the coronavirus pandemic.  The malevolent spirits that they try to ignore are long-term economic and health implosion and possible state collapse.  No one really wants to admit how bad things could get, and how long the damage could persist. On the part of political classes and oligarchs, such behaviour is perhaps understandable; they want to risk neither riots nor collapsing financial markets.  On the part of academics who should stand up for serious scholarship, it is inexcusable.

In June 2020 – how long ago that now seems! – I argued in a webinar that the best available model for understanding the probable long-term consequences of the pandemic is the experience of post-Soviet Russia, where over a period of a few years the economy shrank by about 50 percent; social provision mechanisms and large portions of the health care system crumbled; and life expectancy  plunged by several years.  Subsequent economic recovery was accompanied by drastic increases in inequality and massive capital flight, so that half of all Russians’ financial wealth is now held offshore, and the emergence of a new stratum of politically connected billionaire oligarchs.  They now own, among much else, substantial chunks of London.  The leading authority on the post-Soviet mortality crisis and colleagues have pointed out that a quarter-century later, Russian life expectancy still did not reflect the country’s economic recovery.  In other words, it was several years lower than would be expected given its GDP per capita – years lower than in (for example) slightly poorer Brazil, Chile and China.  Back to this model later.

The UK has been an especially disturbing case thanks to the fecklessness, despotic inclinations and corruption of Prime Minister Johnson’s Conservative government.  These have been ably described by George Monbiot, whose commentaries are essential reading. The most disturbing aspect of events over the past few weeks, in Europe in the first instance but not only there, is the demonstration they have provided of just how widespread the evisceration of basic public health capabilities has become.   It helps to understand this process by way of a political science construct known as the Overton window – an idea emanating from a right-wing think tank that was concerned, in the first instance, with ways to soften public opposition to privatising education.  The window frames the universe of public policies that are considered at least plausible, rather than beyond the pale.  ‘Shifting the window’ means that, over time, policies that once were well outside the mainstream, on either end of the left-right political spectrum, come to be considered plausible and, eventually, just common sense.

President Trump’s destruction of a range of political norms is one illustration of shifting the window.  Over the longer term, decades of well-funded neoliberal efforts to shift the Overton window rightward, the trajectory of which is clear for those willing to do the necessary reading, have led to a situation in which maintaining basic public health infrastructure needed for pandemic preparedness came to seem like an extravagance, an unnecessary expenditure on a too-large state, despite authoritative warnings about the economic and public health importance of that infrastructure.  In much of the world, Covid-19 must therefore be understood as a neoliberal epidemic – a phrase my colleague Clare Bambra and I coined in 2015.  As another colleague, public health physician Allyson Pollock, has put it, austerity in the UK has led to a situation in which ‘[n]ational and local expertise has been lost and many of [her] colleagues in communicable disease control were made redundant.’  

The unwisdom of such abandonment of precaution was articulated in 2015, on a small scale, by 267 economists led by Lawrence Summers – Lawrence Summers, of all peoplewriting about the benefits of universal health coverage: ‘The debilitating effect of Ebola could have been mitigated by building up public health systems in Guinea, Liberia, and Sierra Leone at one-third of the cost of the Ebola response so far.’  If there really were such a thing as the international community, it might usefully reflect on how much it would have been worth investing in measures that could have mitigated a pandemic now anticipated to result in the loss of more than US $12 trillion in economic output in 2020 and 2021 alone, according to the International Monetary Fund.

According to projections from the Institute for Health Metrics and Evaluation at this writing (30 October, 2020), on current trends the virus will have killed approximately 2.5 million people as of 1 February 2021, with a wide variation in outcomes possible depending on what precautions are taken, and where.  This projection deals only with the short term, and cannot address the longer term health consequences of the pandemic, for at least two reasons.  

First, it does not include deaths attributable to reduced access to treatment or prevention for other conditions among people not infected by the virus.  In the UK alone, a former Conservative health secretary is warning of ‘tens of thousands of avoidable deaths within a year.’  Second, it does not and cannot anticipate health impacts of the economic depression and ratcheting-up of inequality that will follow the locking down of major segments of entire economies and societies.  Unfortunately, and despite everything we know about the social determinants of health and health inequalities, in much of the academic world arguing for consideration of these health impacts is immediately equated with callous indifference to human life.  This should not be the case.    

This is why I am more convinced than ever of the distinctive relevance of the Russian experience.  As the UK enters another nationwide lockdown, with an economic cataclysm that will be life-threatening for some certain to follow, all that will remain of some local and regional economies, and millions of individual futures, is wreckage.  Much the same can be said for many other jurisdictions.  It is possible, of course, that an effective vaccine will be developed and rolled out sooner rather than later, avoiding some of the more disastrous scenarios.  But there is no vaccine for the inequalities that were already devastating lives before the pandemic.  As just one illustration, in 2011 – at just the start of the UK’s decade of viciously disequalising Conservative austerity – the ‘Great British Class Survey’ found that one-third of British households, supported by low-wage or precarious employment, had an average of just under £1,000 in savings.   

Even in the best possible post-pandemic world, inequalities that have been further magnified will be remediable only through huge programmes of public investment and direct redistribution, realistically financed by way of long-term borrowing at current low interest rates and progressive income, wealth and land value taxes.  Such policies, for the moment, remain well outside the Overton window anywhere I know of, despite important advocacy by agencies like the United Nations Conference on Trade and Development.   In a world of increasingly ungovernable private wealth and the opportunities for capital flight and tax avoidance offered by a borderless financial world, it is far from clear that most governments even have the political capacity to undertake them.  Many dreams of the young and the old alike will be consigned to the graveyard referred to in my title.  Truth-telling on this point is long overdue.

More important reads from across the web: Bank Holiday edition

A sobering look at what the pandemic is likely to mean for efforts to control HIV, tuberculosis and malaria in sub-Saharan Africa, by a McGill University communicable disease epidemiologist

A United Nations Development Programme report envisioning the first worldwide decline in the Human Development Index since UNDP started calculating the index in 1990

Human development is facing an unprecedented hit

Source: United Nations Development Programme

University of Warwick researchers point out that including capital gains in estimates of income inequality means that income distribution in the UK is even more unequal than previously thought

A list of heavyweight social scientists argue, rather optimistically, for democratizing work in the post-crisis world

A preview of a new book on the 1965-66 US-backed mass murder carried out in Indonesia by supporters of Suharto

And an intriguing argument by David McCoy, from Queen Mary University London, that in the post-pandemic world ‘we need a manifesto’, not just a coronavirus disease control plan

Superb virus reads from around the Web – 10 May update

A Canadian Broadcasting Corporation news team – yes, a state broadcaster that still does real journalism! – takes a look inside the slaughterhouse that has produce one of Canada’s largest clusters of cases, and the working conditions that virtually guaranteed its spread.

A team of Scottish researchers and Martin McKee point out that the pandemic response itself will have negative health effects, which seems bleedin’ obvious, but for some reason most of the health research community prefers to ignore the point, and indeed much else about the post-pandemic future.   

Naomi Klein points out that big technology firms in the US are using the pandemic as a platform for new systems that will ratchet up inequality, making the billionaires even richer and expanding the precariat.  (The Intercept, where this piece appeared, is proving indispensable for truth-seekers in these times.)

Two articles in The Atlantic, which is making its coronavirus coverage free at the moment, are also valuable.  One offers a succinct description of how South Korea dealt with the virus, and what should be learned from its experience.  The other is a searing examination of the racism revealed in multiple ways by the US response to the pandemic.  For anyone still under the impression that it’s a civilised country, this is a must-read.

Finally, The Times – unfortunately behind a paywall – offers a thoughtful take on the question ‘Supermodeller Neil Ferguson: should we trust his science’?  One might question the description of what the Imperial College crew do as science in the first place, but that’s a topic for another day. 

More in good time.  Meanwhile, stay safe.

Realism versus Monbiot: Thoughts on possible worlds of post-pandemic reconstruction

George Monbiot is only one of many commentators who have argued the need for a post-pandemic programme of economic reconstruction that will address environmental concerns as well as the imperative of restoring and securing the livelihoods of literally hundreds of millions of people. The importance of this latter imperative cannot be overstated. In the US alone, unemployment by the end of April quadrupled to 14.7 percent, with 20.5 million jobs lost.  In the UK, the Bank of England has warned of a doubling of unemployment to nine percent and a shrinkage of the economy’s overall output to a 300-year low.   The UK unemployment figures are less horrific than they otherwise would be because of a massive debt-financed programme of wage and salary compensation that the Chancellor of the Exchequer has correctly characterised as unsustainable. 

Against this background, Monbiot (and I am not picking on him here; he is rather the most articulate and best informed proponent of this perspective, and therefore the most difficult target) argues that ‘[g]overnments should provide financial support to company workers while refashioning the economy to provide new jobs’ outside the automobile, fossil fuel and airline industries.  It is now a commonplace that after the financial crisis of 2008, governments bailed out many of the financial institutions that had caused the crisis – that is, their shareholders, managers and workers – rather than those who bore the worst consequences.  Monbiot argues that: ‘This is our second great chance to do things differently’.  But with government debt and expenditure levels relative to GDP already approaching twentieth-century wartime levels, just to finance short-term remediation, the unavoidable question is:  do things differently with what? And where will the investment necessary for such new jobs, and the financing needed to support workers’ transition to them, come from?

It is nice to envision, as a team of luminaries including Nobel laureate economist Joseph Stiglitz and climate economics authority Sir Nicholas Stern has recently argued based on an expert survey, that post-pandemic reconstruction can contribute to reducing climate impacts through investment  in ‘clean physical infrastructure, building efficiency retrofits, investment in education and training, natural capital investment, and clean R&D’, whatever that is.  The authors do not explain where the money will come from, in a world where the estimated US$2.5 trillion annual investment needed to meet the Sustainable Development Goals before the pandemic was nowhere in sight.

It is possible, in theory, to envision mobilising the needed resources by way of income and wealth tax rates that were prevalent after the Second World War, responding to wartime government debt and expenditure levels.  Many of these are now probably infeasible because of the concentration of ultra-wealth in financial instruments and tax haven real estate, and because of possibilities for capital flight that can best be limited through transnational cooperation in a world where a corporate-financed US Congressional candidate has claimed that ‘[f]reedom and democracy are best secured when banking secrecy and tax havens exist’.

If the ultra-rich are probably beyond the reach of national public policy, then the menu of policy options shrinks considerably.  When many dividends have already been cancelled, whose income does Monbiot propose to reduce, whose assets to tax or seize, and how?  What happens to firms that cancel dividend payouts when investors flee their shares, making it impossible for them to raise new capital in response to lockdown-created shortfalls?  How can green jobs be created by seizing foreign oligarchs’ London property holdings, their financial assets having long ago been safely shifted elsewhere?  How many of the Russell Group universities’ 508 senior staff who were paid more than the prime minister in 2018-19 will agree to salary cuts or marginal tax rate increases for the greater good?  Will their response be representative of their broader posh demographic?  Will clinicians who own second homes be content with strongly progressive taxation of their increased value over the years?  What are the legalities of much-needed retrospective wealth taxation?

In short: How are these dreams to be paid for? 

These are not rhetorical questions, and they should be the starting point for conversations that substitute serious consideration of political economy for cheerleading. Even in high-income countries, the post-pandemic menu of policy options is likely to be circumscribed by the International Monetary Fund’s role as a gatekeeper to financial markets – a role that low- and middle-income countries (LMICs) have experienced with often bitter consequences over the past decades, with the impacts compounded by capital flight.  Given the dire situation of LMICs, what justification can the high-income world offer to the world’s majority outside its borders for not taking advantage of fossil fuel prices that have sunk to the pre-1973 levels that enabled today’s rich to get that way, unless its development assistance agencies and investors are willing to increase their commitments by at least an order of magnitude?   Such conversations may have begun, but I am not hearing them. 

Virus reads from around the web

Intriguing looks at the Swedish approach to pandemic response from Vanity Fair and Nature

An argument that the pandemic is revealing varieties of ‘structural violence’ by government including the UK’s neglect of its health services under austerity, by two professors at Queen Mary University London (this is from Counterpunch, which has provided numerous valuable commentaries on the politics of the pandemic)

A debunking of the idea that UK government is ‘following the science’, pointing out that this claim doesn’t even make sense in the uncertain world of public health policy

And a fine, plain-language guide to the wonderful world of World Health Organization decision-making and finance

From tragedy to farce

The Telegraph, whose coverage of the coronavirus pandemic has been consistently excellent, reports today (21 April) that UK firms are shipping millions of pieces of personal protective equipment (PPE) to Europe, while frontline NHS personnel do without; UK firms cannot get a reply to their offers of supplies; individual hospitals are ‘sidestepping the government’s procurement process’ (thank heavens); and central government longingly awaits imports from Turkey.

If accurate, the report confirms that the UK’s response to the pandemic has descended past tragedy into homicidal farce.  Sadly, having now observed British universities for seven years, I can understand what’s probably going on within the similar bureaucracy of NHS procurement: quality is a byproduct, although it may be achieved (and in universities, as on the NHS frontlines, it often is); the real concern is ticking boxes, Following Procedures and not annoying superiors.  Those managing the process have little stake in the outcome.

With a brief hiatus after the initial shock of panic buying and lockdown, within days the shelves at Tesco and Sainsburys were filling up again: these and other companies, unlike the NHS, have experience with doing logistics on the fly.  As hard as it is for a committed social democrat to say this, it is hard to avoid the conclusion that turning PPE procurement over to private sector logistics contractors, with RAF aircraft at their disposal if necessary, would have produced a superior outcome and saved lives.*  The government will have to try this route if it is to have any hope of protecting professionals and the public as a step towards a lockdown exit strategy, before the economy collapses beyond hope of repair. 

And on that note Prof. Carl Heneghan of Oxford, one of British medicine’s most conspicuous overachievers, was quoted yesterday as having told BBC Radio 4 that ‘the damaging effect now of lockdown is going to outweigh the damaging effect of coronavirus’.  Indeed, the social science tells us precisely that.  The question now is who will listen.

* Update: The Times reported on 22 April, unfortunately behind a paywall, that the NHS has in fact simplified its PPE supply chain to involve both the armed forces ‘and Clipper Logistics, a private contractor’, but that the military are ‘appalled’ by continuing inability to procure PPE and deliver it where it is needed. Clearly managers cannot get even the simplified logistics right … the fatal farce continues.

Testing and tracing – not here

So, here we are into week four of a lockdown that threatens to turn the UK into a Third World economy.  There is widespread agreement among those knowledgeable about public health that intensive testing and contact tracing are the least unsafe routes out of the lockdown.  In its 18 April issue, The Economist reports that to carry this out effectively in the US, more than 260,000 people would need to be trained and hired to do a job that is not especially demanding – “anyone with a secondary-school education can be trained in a day”.  It further reports an estimate that paying the first 100,000 hires paid for a year, after the costs of training, would cost US$3.6 billion – ‘a rounding error on the cost of shutting down the American economy’.

I’ve done a simple transposition of these numbers to the UK context.  The UK’s population is about one-fifth that of the United States, so the need is for 52,000 contact tracers, with an initial tranche of 10,000 – a small fraction of the number of people with requisite qualifications who have been idled by the mandated economic shutdown.  Assuming comparable wage costs, after training this first tranche would cost less than £600 million – again, a rounding error in the costs lockdown is now inflicting on the UK economy.

There is no indication whatsoever that the UK government is contemplating the basic measures that, on the best available evidence, would provide a safe route out of lockdown.  Instead, we get reports that: ‘A Department of Health spokesman said the UK was “one of the most prepared countries in the world for pandemics”’ – meaning only that anyone with an official connection to central government is lying, which we already knew. 

The lack of any semblance of preparation lends itself to one of three explanations:

1.  The government is incompetent and has no idea of what it is doing – troubling, since constitutionally it is almost impossible to replace for four years.

2.  The government is well aware of what it should be doing, but also aware that despite the sweeping powers it has granted itself, it lacks the administrative and logistics capacity in Whitehall and perhaps the basic intelligence at senior levels to organise tasks such as repurposing idled industrial capacity to produce protective equipment and setting up training programmes using existing educational institutions.  A government run by normally intelligent grownups would have started on these tasks weeks ago, bringing in private sector expertise as needed.

3.  The government’s objective is to create conditions under which current lockdown conditions will be extended for many months, using public health as a justification – meanwhile, distracting attention from all its earlier failures to take measures that would avoided the continuing crisis.

Take your choice – and if you are fortunate enough to have the choice, organise your own ‘exit strategy’ from what may become an unlivable jurisdiction if and when the lockdown ends.

Unemployment and the dark future of the post-pandemic world

I have previously mentioned Andrew Sorkin’s DealBook blog, which I regard as indispensable.  Here’s an example: The first paragraphs of today’s (16 April) update about the situation in the United States:

Think about the short- and long-term health implications of that last figure, and the situation in many other countries, which will no doubt be comparable.  If you take the social determinants of health inequalities at all seriously, you can’t ignore them, even though too many of my colleagues would prefer to do so.

Against Covid-19 fetishism, and other musings

Herewith a few equity- and policy-oriented musings about the latest state of the pandemic world.

1.  Media, and many researchers who should know better, seem obsessed with the number of deaths from Covid-19, or associated with Covid-19.  Good reasons exist to want to know this over the short term, for purposes of tracking the spread of the virus, but apart from the fact that in most countries the current chaos makes it impossible accurately to determine this number, it is largely irrelevant in terms of the overall health impacts of the pandemic.

The most basic indicator that matters is the all-cause mortality rate (age-adjusted or not, and both figures should be presented), and the inequalities in this indicator amongst various age, class, gender, race/ethnicity and regional demographics. Over time, all-cause mortality rates will reflect not only the short-term health system dislocations and dysfunctions associated with the pandemic, but also the longer-term impacts on social determinants of health of the depression that will follow the lockdown. In a few years, those of us still alive will be able to compare the effectiveness of various national responses … and to restate a point it is all-cause mortality, and not the number of deaths directly attributable to Covid-19 or among people tested positive, that matters. Dead is dead, whatever the cause.

2.  In the UK, I continue to be baffled by the utter lack of comprehension among people professing a concern for equity of what economic downturns of the magnitude now apparently envisioned by Treasury – and of course these anticipations are all dependent on the assumed length of the lockdown, the nature of the exit strategy, and the economy’s subsequent response – will mean for everyday life and for the economic substrates of health inequalities.  The cynical me suspects that most people in a position to prognosticate with anyone paying attention have gardens and can comfortably work from home, unlike much of the rest of the population.

Let me suggest just one example of probable impacts:

Concern about the fate of high street commerce has long been unmatched by meaningful policy response.  Mr. and Mrs. Range Rover, who matter most in political terms, usually shop online or in the suburbs.   Post-pandemic, for hard financial reasons, it is likely that local authorities will simply cease providing services to low-occupancy commercial high streets, and utilities will be released from whatever obligations they have to provide services in those areas.  There will be few users, and fewer still who are able to pay their bills or council taxes. 

A fantasy?  Not at all.  A variant of this policy was partially adopted as “planned shrinkage” in New York City in the 1980s, and much more recently in post-bankruptcy Detroit.  There will be no-go high street wastelands of abandonment, at least until some far distant future when they will become attractive for reinvestment (beyond the lifetimes of many of us).

Alternatives can be imagined, in abundance (and will be the topic of a future post), but it is hard to think that any UK government will pursue them in the near future, especially as the country’s post-pandemic economic policy may well be managed jointly by the International Monetary Fund, as gatekeeper, and China, as the only external actor with the resources necessary to provide direct investment on the scale necessary.

3.  Even if the UK’s post-Brexit departure from the single market and customs union is delayed, as it should be, the full scope of the dislocations will become clear at the start of next winter, when it becomes clear how many Britons simply cannot afford to heat their homes.  Watch the all-cause mortality rate carefully as that happens. 

This post was updated on 15 April.