Trust in the future, trust as the future

from Jamie Morgan

Part 3 of six part Pandemic aware economies, public health business models and (im)possible futures

Whatever path is chosen it can still be pursued more or less effectively, and in an evolving world this matters for how things turn out. Governments need to project competence but they need also to translate this into actual competence; ‘demonstrated competence’ is an issue of logistics and practical procedures that follow from adequate planning at a national and local level. A government that was initially ill-prepared can become better if it manages the situation. It is no use simply suggesting ‘we are trying as hard as we can’. Trust relies on real consequences and incompetence has additional consequences. Governments have their public relations experts too, and are deeply aware of the pitfalls, but this does not prevent missteps, as the fractious relationship between the White House and the individual states of the USA or that between Downing Street and the devolved governments of Wales and Scotland illustrates.

Demonstrated incompetence, vague, contradictory or infeasible messaging, and a contrast between statement and what we observe, leads to lack of trust, which leads to the perpetuation of ‘Cortisol communities’ whose anxiety leads to continuous social and economic dysfunction. Any society can become trapped in its own ineptitude until a vaccine rescues it. In the meantime ‘R’ levels can oscillate, waves of contagion can come and go, health services may or may not be overwhelmed, but cumulatively avoidable deaths rise and this evolves according to different vulnerabilities – the vulnerability some of us have to Covid-19 because of our health and age; the vulnerability some have because they cannot avoid continual or repeated exposure to risk of infection because of the type of work they do, the conditions they live in and/or their financial circumstances.

It is, unfortunately, manifestly not the case that we are all equal in the face of Covid-19 because we are not equal in society and we are not all the same. A bus driver cannot work from home, a domiciliary social carer on minimum wage with no money in the bank and bills to pay, has dependents and responsibilities that are in obvious conflict. Remedial policies can try to mitigate worse effects, but they cannot turn back time and create necessary resources and personnel instantaneously. It is trite to simply state ‘we are where we are’, and this platitude should not distract us from the fact that competence now matters for how trust is restored. ‘We leave it to you, exercise your common sense’, seems insufficient as a way to create the conditions for trust to be given. Creating conditions for trust to be given starts with scaling up the production and sourcing of PPE not just for health workers, but for any person likely to be exposed through work (and that is likely to be millions in most countries in the next few months). It extends to an adequate distribution (perhaps rationing) system for PPE. It extends to pervasive testing to create adequate information, which can work in tandem with effective contact tracing and subsequent isolation. All this is ‘well known’ (we are all experts now, seemingly) but proper follow-through, rather than mere rhetoric, is now basic if the goal is to achieve a pandemic aware society in which trust can be given. It is, of course, a different kind of normal than we are used to and so government officials have started to talk about a ‘new normal’.

What is our ‘new normal’ likely to be? Well, its immediate form is likely to vary by the nature of healthcare provision, demographics, population density, economic structure and government willingness to support people (in economic terms rather than simply support the ‘economy’ in abstract terms). As many people have pointed out, it is a false dichotomy to suggest we can choose the economy or choose lives; the dead do not work, save, invest or consume and a reckless return to work risks eventual economic dysfunction and social fracture, as cumulative deaths and illness mount (affecting every household). The eventual economic damage of choosing ‘the economy’ can readily be counterproductive – to say nothing of the human cost. Human cost, however, cannot be reduced to just those who die from Covid-19, there will be those who die because of how we have responded to Covid-19 (the ‘excess deaths’ compared to the rolling average adjusted for population characteristics) and there will be those who live shorter or lesser lives in terms of their well-being (life chances, mental and physical health). The politics, as any perusal of the recent press makes clear, is all about choosing possible futures against this backdrop. Lockdown’s flatten curves and buy time, but the question becomes what happens later and what is done with the time bought. And it is not definite that longer lockdowns must lead to later loss of well-being, this too is a false dichotomy; longer lockdowns risk worse outcomes later, but do not lock them in. This too is about current and future policies and whilst social scientists talk about ‘path-dependencies’, the very purpose of explaining and understanding them is to be able to influence them, though that too is not simple.

Tomorrow: Part 4 – Public health business models