David’s blog #49.5: Stresses and Strains

I hope this finds you well in these challenging times. Facing the realities of the Covid pandemic, individuals and organisations alike are experiencing significant difficulties. Being confined to your home on your own, with a partner, family or flatmates is not easy. Then there are the pressing concerns about income and paying the bills. Relations with the neighbours can also become fraught. Niggles and minor problems, usually diluted in the routines of normal life, are magnified and tempers can fray. The same, it seems, is also true at the international level.

As the world faces its most significant health challenge in generations, many have called for a co-ordinated international response. However, what we have seen is the President of the USA decide to freeze funding to the World Health Organisation, accusing them of mismanagement over the initial stages of the crisis and being biased in favour of China. In Europe, international solidarity was also in short supply as the scale of the pandemic first unfolded, prompting the European Commission’s President to offer a “heartfelt apology” to Italy. While efforts have since been made to improve co-operation within Europe, there are numerous examples of countries blaming various institutions or groups for the spread of Covid-19. Different nations have pursued divergent approaches. Within countries, we have seen different groups blamed- often migrants or those from minorities. Politically, we have examples of national leaders being in dispute with those at state, regional or city level. Within the public health world different experts have their own take on what should have been done - or on what needs to be done now.

Within the political sphere we can reliably expect the blame game to continue for some time- in fact, that seems only appropriate. The scale of the human and economic impact will demand a proper accounting. The emergence of a threat of this kind was not unexpected, indeed there have been various exercises run over many years to model the impacts and identify responses. In many countries and organisations, it seems that either lessons were not learnt, or preparations were lacking.

While it will no doubt prove uncomfortable for many - not just political leaders- it must be right that the circumstances that have led us to this position are properly explored. Inevitably, some responses and health care systems will have proved more effective than others. For some organisations there may be damage to reputations and a need to reconsider priorities. We are already seeing graphs looking at national and city-wide impacts, and although direct comparisons may be complicated, it is totally valid to identify which approaches worked well and determine other significant factors. This is in all of our interests. There will be other global and national challenges to face in the future. One of the first is likely to be the risk of massively increased health inequalities across many countries, fuelled by the health and economic impacts of the novel Coronavirus. Significant evidence is already emerging that the burden of this pandemic has fallen hardest on the most disadvantaged sectors of our society.

It is also true that some of the most inspiring responses to the threat posed by Covid-19 have focussed on our most vulnerable individuals. Across the world NGOs, public sector and health bodies are working to protect those with mental health issues, who are homeless, lack food security, have problems linked to alcohol or drugs, or are impacted by any of the wide range of problems that afflict our communities. The scale of the problem has seen bold steps taken, new ways of working developed, and a focus on what works. Harm reduction is the order of the day – and, contrary to the criticism often made, there is no lack of ambition. In London there is work going on to try and maximise the gains of having contact and support in place for over 1,000 rough sleepers who we have historically struggled to engage with. The potential benefit to individuals and communities is immense. I know that nationally, across Europe, and worldwide there are thousands of projects that are working to deliver similar outcomes for their target groups. There is a huge amount of exciting new work, often building on established principle but being delivered in new ways or new situations, that we absolutely need to capture and share.

Current circumstances make this exchange of information, ideas, and experience more challenging than usual - not least as there will be few traditional in-person conferences this year! However, we can still collaborate, maintain, and develop our networks. I am very grateful to the organisers of City Health International for ensuring that the event will continue online at https://cityhealthinternational.org/. Please do join us, as I am convinced that now, because of all the stresses and strains being faced, is the time for those working across the broad spectrum of public health to come together and support each other. While national governments and international bodies are engaged in the politics of blame, and many embracing isolationist tendencies, it is down to us all to realise the potential of global partnerships.