The (false) trade off between the economy and health

A few months ago I had the privilege of delivering the @ScHARRSheffield 2021 Pemberton lecture  

During the q&a at the end someone asked me to explain my statement that the trade off between saving health and protecting the economy was a false choice I gave a pretty poor answer Here I'll try set it out more clearly 

In "normal times" (remember them) I've been here quite a few times, most recently here  

The onset of illness in working age is very common Multi morbidity (more than one thing wrong with you) more common in poorer populations & earlier onset, see Barnett 2012 also more common numerically speaking in those of working age than those beyond retirement age.

 

for England (chart below from the Health Foundation) 

In Sheffield broadly the same holds true Those with lowest income spend more of their lives, often within working age, in less than good health. When considering Healthy Life Expectancy, in Sheffield, the healthiest areas for example Bents Green & Millhouses, a man could expect to live to 86 with 73 years in good health, or 13 years of poorer health. This equates to a seventh of that mans life in poor health.  

In our least healthy areas for example Firth Park a man can expect to live to about 73 of which 52 years will be in good health, or 21 years of poorer health. This equates to nearly a third of that mans life in poor health.

The National data is here

If lots of folk unable to work or not at 100% because of poor health that's 1) bad for them, 2) bad for families, 3) may lead to avoidable poverty, may lead to 4) demand for the welfare system, and 5) demand for NHS and social care. It is also 6) bad for economy (lost productivity on account of poor health at earlier ages), Finally 7) it's also unfairly distributed- thus an enormous social justice issue.

application of the false trade off in covid times

The CMO recently commented on the trade off between covid and other health care "sometimes said by people who have no understanding of health at all- and when they say it, usually because they want to make a political point."  

In short, if the urgent gets so overwhelming then there becomes no option but to prioritize that in a fixed capacity machine  Much the same applies to other parts of society.

There are those who argue in favour of fewer or no restrictions in order to protect the economy. Taken to the edge this is the  let it rip strategy, commonly known as the Great Barrington Declaration.

In that view there is a fundamental misunderstanding of 1) how to control spread, 2) what will and wont make a difference and 3) the consequences of the choices based on that misunderstanding.

If covid spread becomes so overwhelming the NHS becomes overwhelmed and the government have no choice other than long lockdown to get R below 0.

The HoC Library published on the Economics of lockdowns 1) longer lockdowns risk doing more harm than good. 2) the later we lockdown, the longer it will need to be to have the same effect  

There are plenty in the business community who have told me that the current space (they frame as  lockdown lite - appeal to public behaviour but no support to business for lost takings) doesnt seem essentially supportive of the economy.

TDLR - there are two (often many more) sides to any discussion and the counterfactuals matter. Alot

So in summary

If your definition of "the economy" is the ONLY the wealth creation function of the activity in the private sector then the trade off is clearer to see.

If in the definition of "the economy" includes all benefits and all costs to the whole of society over a long term time horizon are on the balance sheet - then its easy to see how we get to the notion of the trade off between "health" and "economy" is a false choice or trade off.

Any which way round it seems that to say there is a trade off sets up the perpetuation of false narrative.

All up, any which way round I'm struggling to see narrative that what is before us is a choice between public health and the economy is in any way a true choice It is put forward alot by right wing media, but it simply perpetuates a false narrative.

A thread version is here