I don’t have time for a fully formed post or column on this, but I want to make note of a few ways in which the COVID-19 pandemic is intersecting with drivers of health (which include social determinants and health system factors). The following list is not necessarily exhaustive and my focus is on the U.S.
- Right now the health system cannot offer anything to prevent the consequences of COVID-19 infection. Prevention is entirely within the realm of public health measures and personal behaviors. In this way, this is a lot like HIV/AIDS before the mid-1990s. If one were engaged in an exercise of attributing COVID-19 deaths to various factors, personal behavior — degree of social distancing, hand washing, etc. — would get a significant share.
- But, individuals do not fully control their own COVID-19 destiny. Not everyone can avoid all risk of exposure. Food and other necessities need to be brought into the house. We want some people to work (e.g., health care workers, those involved in producing and transporting food and medical supplies). Not everyone can control the behavior of everyone else in their household. Teens and young adults might sneak out, despite what their parents say.
- Among those at highest risk will be people who don’t have the privilege of working from home. They need income and can’t get it without leaving the house. Peeling this onion leads back to the customary markers of socioeconomic status (education, income, rank/class, etc.) as drivers of health.
- Those with privilege are more likely to find ways to get testing, care, and going forward, probably will be among the first (after health care workers) to get vaccinated. This is how it has always been in the U.S.
- Policy clearly plays a role. Where leaders were slower to implement changes to increase or require social distancing, outbreaks are more widespread (relative to the counterfactual of those changes made sooner). Even national policy makers were slow to recognize the importance of preparing for a pandemic. Mistakes were made. Balls were dropped. So, policy/government is a driver, of course.
- Finally, the health system clearly plays a role, not in prevention but in treatment. People can be saved, if the resources are there to save them and they can be accessed. Where and for whom health care is more available and accessible, people will be better off. This is complex because of the intersection of the effectiveness of health care, its accessibility (which is reduced for people losing job-based insurance, otherwise un- or under-insured, or without the resources to pay cost sharing, etc.), and the degree to which the health system has prepared for such a pandemic (which intersects with policy and health economics). So, the health system should get some blame/credit for deaths/saved lives, but it’s not so clear how much.
Fundamentally, it’s interesting how much we are reliant on collective resources — government through policy and shared health care infrastructure. The best thing we can do for ourselves individually is to engage in safe behaviors. But we also need collective action for our future well being. Yes/and, not either/or.
