On Monday, the British Government confirmed that it would press ahead with the lifting of all coronavirus-related legal restrictions in England on 19 July. This has been followed by widespread criticism from public health experts and healthcare practitioners, demanding the institution of new and existing public health mitigations to protect us from a devastating ‘exit wave’.
While government messaging has shifted over the past week from heralding ‘freedom day’ to urging ‘caution’, the prospect of a U-turn seems incredibly unlikely. What has emerged is a renewed emphasis on ‘personal responsibility’, or rather the transfer of accountability from the state to individuals. SAGE’s most recent modelling predicts outcomes on the basis of behavioural patterns following reopening, tacitly accepting that the state can no longer bear any responsibility for what happens. And yet, government figures themselves admit that cases are likely to reach over 100,000 a day over the summer, with resulting pressures on the NHS and an enormous infectious burden among the unvaccinated young.
It is no surprise then that many have criticised the government for the re-emergence of a ‘herd immunity’ strategy, where the virus is allowed to run rampant through the population until a certain threshold of immunity is reached. With only half of the UK population fully vaccinated and the prospect of vaccinating children looking increasingly unlikely, it is clear that this threshold will only be reached through widescale infection. The approach has rightly been denounced for creating the ideal grounds for vaccine escape, further burdening an already backlogged NHS, and facilitating mass disruption through Covid-related work and educational absences.
Prior to the pandemic, the Tory government had overseen 130,000 preventable deaths as a result of austerity. This loss of life was distributed along the same lines of structural vulnerability and inequality that have characterised Covid-related mortality; in both instances, it is the poor, racialised, and disabled who have been most adversely affected. And while some heralded Rishi Sunak’s 2020 budget as a hard break from the politics of austerity, its failure to fix the punishing Universal Credit system, and the subsequent absence of meaningful sick pay or isolation support for precarious workers point to a continued disdain for the poor.
Should we be surprised, then, that this government wishes to press ahead with a reckless re-opening that will ravage those communities whom the Conservative Party holds most in contempt? Is it surprising that they offer no means to remedy a crisis already conditioned to afflict the poor, disabled, and minorities? And further to this, should we be surprised that neoliberal logics will hold the most marginalised to blame for their own suffering?
The individualisation of health is not unique to this government. Our lives have become increasingly medicalised as traits like body weight are understood to be the consequence of poor choice, accompanied by an expanding market centred on their regulation. The complexity of intersecting physiological, ecological, and social factors influencing body composition are elided under a rhetoric of ‘personal responsibility’.
Health research’s own susceptibility to neoliberalism has become increasingly apparent with the marketisation of higher education; beyond this, though, is an overreliance on decontextualising, simplistic quantitative measures at the expense of in-depth, qualitative, and longitudinal research. This is not to say that such approaches do not have a critical role to play in public health, but an obsession with ‘evidence-based’ methods, where evidence is reduced to crude variables supposedly able to capture the entirety of rich concepts like ‘culture’ and ‘society’, risks foreclosing the deeper analysis necessary to fully understand the social contexts in which our health is situated.
We have seen all of this play out during the pandemic. The link between infections and inequalities is well documented. If a population is already made vulnerable by wide-scale health inequalities and chronic illness, then a virus acting upon our already hampered immune systems will do enormous damage. Countless studies now point to evidence of heightened mortality and morbidity from Covid among minoritised and deprived communities. This coupled with low vaccine uptake—largely a function of accumulated state distrust and infrastructural neglect—will once again lead to the victims of structural violence being held responsible. This government plans to ‘live with the virus’ as it becomes ‘endemic’. We already know what this means through our experiences of other infectious diseases like tuberculosis as they remain concentrated among the poor in the Global North.
We have accumulated much evidence on the health effects of oppression through innovative and radical social epidemiological and medical anthropological research. Disturbingly, however, this seems to have been ignored by even more critical epidemiological bents during the pandemic. Academics and researchers accuse the government of letting ‘politics’ tamper with public health. But this fundamentally misunderstands the nature and purpose of public health as something that is always political.
This was noted by nineteenth-century German physician Rudolf Virchow, often credited with the emergence of social medicine. Analysing the 1848 typhus epidemic in Upper Silesia, he states that the outbreak could not have been solved by individualised interventions, such as minor adjustments to diet or the use of medication, but rather radical societal change was needed. This led him to famously state that ‘medicine is a social science, and politics nothing but medicine at a larger scale’.
The attempt by some within public health to extricate themselves from politics is itself a political act – one that effectively naturalises conditions of inequality. Science is not a disinterested ‘view from nowhere’ but always bound up in wider political structures that delimit the imaginative possibilities of our health and wellbeing.
While Virchow’s work has remained marginal, the tradition of social medicine has grown over time and facilitated the growth of popular public health movements globally. Such movements find local iterations in campaigning groups like Medact, a UK-based affiliate of the People’s Health Movement, who have fought tirelessly over recent months to highlight the inseparability of public health from economic injustice. We can ill afford to ignore such mobilisations. If public health is to remain meaningful it must allow for critical inquiry into the socio-political structures that determine not only our health, but what we understand health to be – not an individual asset but social harmony with each other and the world around us.