Politics in a public health crisis?

Who should lead on the response to a public health crisis such as the COVID-19 pandemic?

In a commentary in The American Journal of Medicine noted public health experts have said that appropriate concerns – not fear – should play a significant role in the emerging pandemic, and political leaders should empower public health officials to drive the response.

Our political leaders are quick enough to say they are 'being led by the science', but this is to a large extend disingenuous. Science cannot tell politicians what to do. It can only advise and given assessments of the probable consequences of decisions. But those decisions must be taken by politicians.

The decisions are based on balancing different objectives - the economy, social impact, the effectiveness of any course of action, public attitudes and compliance - there is no one set of expertise on these. Psychologists, sociologists, public health experts, epidemiologists, clinicians, economists, logicians, so much knowledge is required.

I am not convinced that 'empowering' public health officials to make decisions is the answer to the problem.

The authors of the commentary make the point that

"in the United States (US) today, health care providers seem appropriately confused about the present and future issues concerning coronavirus disease 2019 (COVID-19)."

So they would be. Confusing messages are coming from the top, from a President who seems unwilling to grasp the seriousness of the pandemic.

Trump likes to sound optimistic. He knows that positive messages are better than negative ones from the view of a populist politician. He wants to call something red when to most people it is green. What is perhaps strange is his ability to get his followers to believe him.

Trump's message is inevitably confused as much as it is confusing. But the answer is not to assume that empowering pubic health experts. Public Health experts would have to agree on a strategy, and no doubt there would be some mixed messages that came from that process.

A key question, then, is how best can the public be informed about the decisions taken. What will the priorities in health care be, and how will these be decided, and on what basis?

Leadership isn't merely about being an expert. Many experts would fail miserably at making decisions and conveying those decisions to a sceptical or anxious public. This is politics as well as it is public health.

Yes, there is an urgent need for leadership. But that reflects a political void more than it does a lack of public health leadership.

Political leadership in a crisis requires trust. Many people are willing initially to put their trust in their political leaders, but leadership comes when that trust becomes fragile. People need to pull together to beat COVID-19.

As the number of deaths rises, as it inevitably will, people will question the strategy.

In the United Kingdom, there is talk of some kind of government of national unity, or cooperation across parties, reflecting wartime Britain.

Such cooperation is required because the government has taken exceptional powers to control peoples lives. There isn't a pearl of unique wisdom on one side of the political spectrum. We are feeling our way through this crisis. Difficult decisions will have to be made.

Ian Duncan-Smith says he wants to make those on benefits 'better people'!

By any account, the government's austerity strategy is utilitarian. It justifies its approach by the presumed potential ends. It's objective is to cut the deficit, but it has also adopted another objective which is specifically targeted. It seeks to drive people off benefits and 'back to work'. The two together are toxic to the poorest in society. Those least able to cope are the most affected by the cuts in benefits and the loss of services. It is the coupling of these two strategic aims that make their policies ethically questionable. For, by combining the two, slashing the value of benefits to make budget savings while also changing the benefits system, the highest burden falls on a specific group, those dependent on benefits. For the greater good of the majority, a minority group, those on benefits, are being sacrificed; sacrificed on the altar of austerity. And they are being sacrificed in part so that others may be spared. Utilitarian ethics considers the ba

Prioritising people in nursing care.

There has been in recent years concern that care in the NHS has not been sufficiently 'patient centred', or responsive to the needs of the patient on a case basis. It has been felt in care that it as been the patient who has had to adapt to the regime of care, rather than the other way around. Putting patients at the centre of care means being responsive to their needs and supporting them through the process of health care delivery. Patients should not become identikit sausages in a production line. The nurses body, the Nursing and Midwifery Council has responded to this challenge with a revised code of practice reflection get changes in health and social care since the previous code was published in 2008. The Code describes the professional standards of practice and behaviour for nurses and midwives. Four themes describe what nurses and midwives are expected to do: prioritise people practise effectively preserve safety, and promote professionalism and trust. The

The unethical language of 'welfare dependency'

It is unethical to stigmatise people without foundation. Creating a stereotype, a generalised brand, in order to demonize a group regardless of the individual and without regard for the potential harm it may do is unfair and prejudicial. It is one reason, and a major one, why racism is unethical; it fails to give a fair consideration of interest to a group of people simply because they are branded in this way. They are not worthy of equal consideration because they are different. It seeks also to influence the attitudes of others to those stereotyped. If I said 'the Irish are lazy'; you would rightly respond that this is a ridiculous and unfounded stereotype. It brands all Irish on the basis of a prejudice. It is harmful certainly; but it is worse if I intend it to be harmful. If I intend to influence the attitude of others. And so it is with 'the unemployed'. All I need do is substitute 'work-shy' and use it in an injudicious way; to imply that it applies to

The Thin End

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