Our Not So Public Health

During the period of partial lockdown, it may have appeared as though the economy was being sacrificed in the name of public health. However, the global attempt to halt the spread of the pandemic ultimately never departed from the basic logic of capitalist politics: politics in the interest of business.

by Kathrin Schödel

Collage by the IotL Magazine

 

[dropcap]W[/dropcap]ith the ongoing spike of COVID-19 cases in Malta, discussions about the best measures to contain the disease have entered a new level of urgency. While the government, or at least its health minister, had previously been praised for doing well in implementing necessary measures, during the summer, a clash between health care professionals together with concerned members of the public, on the one hand, and government officials, especially the PM and the Minister for Tourism, on the other, developed. 

Is this the abrupt ending of a short period in which politicians—previously eager on privatising health care provision—fostered public health? Has the government shifted its priorities back from public health to the economy, or worse, “a few greedy businessmen”? 

No, I’d argue, the same logic informs both the measures to contain the spread and their lifting – even if with drastically opposite effects on public health. 

 

Public Health vs. the Economy?

Public health measures have been contradictory from the start because they always had to square business interests with health considerations. 

During the period of partial lockdown, it may have appeared as though the economy was being sacrificed in the name of public health. However, the global attempt to halt the spread of the pandemic ultimately never departed from the basic logic of capitalist politics: politics in the interest of business.

 

 

There were crucial differences in the strategies adopted by different governments, and the timely implementation of measures to halt the pandemic or the lack thereof was a difference of life and death. However, unfortunately, this does not mean that there is a fundamental exception to the overwhelming logic of economic considerations.

Those governments which acted more responsibly in view of public health considerations were not exempt from this: It was the expectation that an uncontrolled spread of the virus would severely disrupt societies and hence the economy. Thus, economic reasoning—not a simple concern for the health of all—was behind the decisions of governments to implement lockdown and isolation measures. 

A case in point is the continuation of construction works throughout the pandemic in Malta. While in other fields home office work was recommended or enforced, construction works carried on despite difficulties in maintaining a safe distance from one another while working at building sites.

In contrast to other jobs relevant to food provision, health care etc., there was no immediate need to carry on building accommodations. In fact, construction noise endangered the well-being of people having to isolate in their private homes—a health consideration not deemed relevant enough for implementing further measures. Indeed, health and safety are hardly a main concern for the construction industry and those entrusted with its regulation leading to a shocking string of fatal accidents. 

In general, measures to contain the spread were not implemented in a way that fully considered public health as its top priority. Otherwise, decisions would not have been so contradictory, for example, with workplace measures in many sectors, such as construction, being far less strict than those measures affecting social life. In addition, a full consideration of public health would have necessitated a much more holistic approach to the effects of the measures and more support for different social groups affected by them and having to implement them. 

The lifting of COVID-19 measures was even more explicitly linked to boosting the economy. Hence, a consideration for enabling social interaction—missed by many during the quarantine—while simultaneously keeping the virus at bay was not part of the planning. Public health only mattered in as much as it would not interfere with the renewed economic activity.

And again, the main reason for reintroducing restrictions was the fact that a high rate of infections is bad for business, too, combined with the aim of not losing or regaining popularity with voters. 

 

 

Otherwise, as with the welfare state in general, public health measures are geared towards a bare minimum dictated by the interest in maintaining social order and ‘business as usual’. Beyond this minimum, every concession has to be fought for. Strong welfare states were the outcome of strong workers’ movements: even if not necessarily fulfilling all their aims but, to the contrary, governments often providing  a level of workers’ protection with the explicit aim of quelling further revolutionary impulses. 

 

‘Thanks, but No Thanks!’ to Strike

It is fitting, then, that the recent struggle over the implementation of measures to stop the  current spike of infections in Malta took the form of threats with industrial action. The planned strike action by health care professionals, who had only recently been praised as national heroes, is not always met with popular support, though. For example, a marathon organised to “show gratitude to Malta’s frontliners” was cancelled as “a protest against the doctors’ strike”. This decision is representative of a wide-spread attitude of people who are happy to applaud ‘frontliners’ for their sacrifices, but not to support them politically.

This contradictory message of ‘thanks, but no thanks to strike’ is typical of a widespread rejection of industrial action in neoliberal societies. It is linked to the general erosion of solidarity with workers—here, even privileged professionals, usually respected, but apparently not so when they act in the role of a political opponent to the ruling classes. 

The values of heroism and sacrifice and their rather cheap compensation with applause and gratitude are connected to a foregrounding of individual responsibility and morality rather than political solidarity. Instead of demanding better working conditions for those working in areas most affected by the pandemic, which would reduce the need for sacrifice, the bravery of frontliners is praised. 

 

 

Instead of collective solidarity with their demands to contain the spread of the virus, and thus to avoid a worsening of working conditions in the health care sector—as well as of the conditions for patients—the expression of gratitude is cancelled in the face of industrial action. 

Doctors, it seems, should continue to make sacrifices rather than fighting to improve their own—as well as our—situation. Such a perspective is based on an opposition between morality and political action: it is perceived as more moral to keep working quietly and to endure individually than to organise collectively in order to fight for a change for the better.

 

A logic of individual responsibility and putting questions of morality into the centre is prevalent in (neo-)liberal societies. It is also the main logic currently applied to health: individual behaviour, such as party-going or mask-wearing, is the focus of attention, not the necessary public-political conditions for health. 

Such a one-sided concentration on individual morality relieves the state from responsibility and is thus a convenient justification of the current system. Its negative consequences are blamed on the individual rather than on social, political and economic conditions.

Political actors as well as those whose interests they protect are spared from blame by shifting it to all of us equally. This equality in blame, however, disregards vast inequalities in power and means. It also disregards the systemic contradictions between public health and well-being and an economic system based on inequality, exploitation and competition. 

 

‘Greedy Businessmen’ versus the Economy?

Even in unions, the fundamental issue at stake seems badly understood, when the president of the Malta Union of Nurses and Midwives was, for example, quoted as saying: “We are informed that the actions of the prime minister for allowing mass events are not in favour of the economy but in favour of a few greedy businessmen that are fattening their pockets with money which is more important than the lives of the vulnerable people and the healthcare workers.” 

The opposition between ‘the economy’ and ‘businessmen fattening their pockets’ moralises what is in fact the fundamental set-up of the capitalist system. It is not just the ‘greedy’ who want to make profits, but it is the basic principle of this economy that some are able to fatten their pockets through the exploitation of the rest. It is true, though, that political interventions in economic matters may privilege some to the detriment of others. 

 

 

However, this is also a basic principle of capitalism: economic competition, which always includes bankruptcies, usually of smaller businesses, failed investments, which can mean the financial ruin of the investor, and a general heightening of the unequal distribution of wealth as a rule. Therefore, political decisions in favour of this economic system, necessarily involve such outcomes. But the concern for maintaining this system, for ‘the economy’, is shared by those having protested against the lifting of measures for the sake of tourism and the current failure of this strategy. 

So, the recent plans for industrial action were far from revolutionary. However, any fight for improving working conditions is, nevertheless, an example of the scope of politics within capitalism, i.e. a fight for at least less exploitative conditions. At the same time, politically organising to demand more adequate measures to curb the pandemic, is an important step towards putting public health into the centre. 

 

Solidarity with Strikes for Better Health Care Conditions

Solidarity with striking health care workers would, indeed, mean to join their fight for improving public health for everyone. At the moment, though, the tendency to reject strike action seems to prevail, even among those concerned with health issues. The following headline quotes a committee member of the National Parents Society of Persons with Disability stating that “‘Union directives are a slap in the face for children with a disability’”. It is fully understandable that people affected by industrial action in the care sector are turning to the public. 

However, instead of blaming those demanding better working conditions, or as in this case, better pay, it would be possible to join them in a pledge for an improvement of the situation for all. When the quoted article reports that “most therapy services stopped or were greatly reduced—first due to the novel coronavirus and now because of union directives”, the two reasons named show a disregard for the political realities surrounding both the effects of the virus and union directives. 

There is neither a simple cause and effect relation between the pandemic and therapy stopping completely—ways of continuing therapy could have been found if public health in a full sense had been a top political priority. Nor is the union itself the underlying cause of the necessity for strike action, but rather the government creating the conditions protested against. Solidarity in this case would mean that those affected by the strikes in the care sector would support those working there in order to demand better conditions for all—workers and their clients. 

 

 

If we are serious about thanking ‘frontliners’, adequate pay in this sector should be the least we should help them fight for. This could easily be connected to other demands for the necessary improvements of the services for those in need of them also mentioned in the quoted article. Such a joint protest could be an example of fighting to improve public health in a holistic way. 

 

Democratic Public Health

Indeed, when workers and employees in different professions—teachers, too, for example—and other social groups start organising to raise their own demands regarding health measures a truly democratic approach to public health becomes imaginable.* Public health would then become as complex as it really is.

The interests of all people involved in a particular area—as opposed to those of competing lobby groups—would have to be considered. Requirements of containing Covid-19 would have to be combined with all other aspects affected by them, especially, material conditions for the majority—instead of profits for the few—psychological wellbeing and social needs.   

The sudden shift to online teaching in spring, for instance, showed clearly how the situation would have to be tackled in a much more holistic way in order to avoid a range of negative effects, such as an increase in inequality when children depend on their home’s equipment and help from parents far more than before, an overburdening of families with children suddenly at home all day, a lack of possibilities for children to fulfil their various needs and desires, and an increased workload for teachers having to adapt to rapidly changing situations and trying hard to mitigate these negative effects.

However, even now, months after the start of the pandemic, instead of an engagement with the complex situation of school under such conditions, “courage” is demanded of teachers. As with other ‘frontliners’, individual sacrifice and work as usual is the order of the day rather than the joint care for health.  

The important sector of education is a pertinent example as to how differentiated measures would have to be if they were to consider public health in a more far-reaching way: simple political decisions on restrictions—and their lifting—place the full burden of the details and the means of their implementation on individual actors.

Teachers having to reinvent their teaching, families to reorganise their lives, children to understand ever new rules while being supposed to continue ‘performing’ as usual. Similarly in other sectors, with isolated elderly people having to fend for themselves, and smaller businesses to struggle to comply with measures or simply to survive their economic and health consequences. 

Organising democratic public health from below would mean to involve all those concerned in the decision-making process and to support the realisation of health measures through material aid and collective organisation. 

To take a recent example: mass events and parties—a democratic approach to these would neither be the moralistic blanket condemnation of party-goers as egotistic youngsters endangering the vulnerable, nor the, indeed, selfish insistence on partying without any restrictions.

What an approach to public health from below could mean, can be seen in the organisation of people working in the field of clubs and nightlife campaigning for plans—for instance, the use of outdoor public spaces—which allow a continuation of urban nightlife while complying with the requirements to curb the spread of COVID-19. Such initiatives which recognise the need to adapt to the pandemic and creatively come up with solutions are encouraging. They point towards an engagement with public wellbeing going far beyond the simple ‘stay at home’ directive, which ultimately privatises the care for public health. 

 

 

The contrasting protests against COVID-19 measures under the banner of individual ‘freedom’, on the other hand, are worrying. They are also far less radical: after all, they insist on a freedom we usually already have—the freedom to be left to our own devices for good or bad. Provocatively speaking, this is the freedom to become sick and to make others sick. One that, for now, the government in Malta is still partly upholding. 

A protest movement against this kind of fatal freedom, combining calls for measures to contain the virus with demands for their socially and psychologically healthy realisation could be the start of approaching public health democratically. Ultimately, this would further the aim of creating a society which would put the needs and desires of the people at its core, not the prerequisites of an unequal economy. 

*This has partly been inspired by ‘New Public Health’ approaches discussed in German here. 

Kathrin Schödel lectures at the Department of German, University of Malta; her research interests are literature and politics, depictions of revolutions, constructions of gender roles, discourses of migration and utopian thought. She is a member of CAUR (Centre for Applied Utopian Research).