Some observations on the history of public health, on the nature of politics, and on Brexit

Amidst all the talk of the 'unprecedented' nature of this pandemic, it is worth remembering that this phenomenon has occurred before. In the late medieval and early modern eras, as historians such as Paul Slack, Andrew Wear, Carlo Cipolla and Sheldon Watts have documented, Italian city states pioneered public health responses to the repeated outbreaks of bubonic plague from 1348 until the end of the 17th century. These included lockdowns, quarantine, testing, contact tracing, distancing, and support for workers who had been adversely affected by the cessation of economic activity. The concentrated populations of these city states, their wealth, and their rich communal life (churches, guilds, confraternities) all contributed to the successful implementation of these policies. These policy responses were not prompted by 'following the science'. Pre-scientific medical theories, prevalent until the 19th century, preoccupied as they were with 'humours' and 'miasmas', could not illuminate, but rather obfuscated, the causes of disease transmission. The state's interventions in public health depended on empirical observation. (By contrast, the pandemic of so-called 'Spanish flu' in 1918-19 was a step backwards. This can be explained by the overwhelming preoccuopation with the First World War, which overshadowed all other threats to human life ; and by an exaggerated belief in the potential of modern medicine, which encouraged informed people to overlook the insights of centuries of experience of public health). The administrative and public health measures which are reccommended by the World Health Organisation stem from the public health insights of the early modern period, confirmed by contemporary medical science.

The government has made much of 'following the science', and has assumed, in its public statements, that, as the situation was 'unprecedented', scientific opinion on the virus was evolving at he same time as the pandemic. To some extent this was true, but the fundamentals concerning the containment of infectious disease have been known for centuries. The decisions about whether the state should act on this knowledge are, and have always been political. In the medieval and Renaissance Italian city states, the Ottoman Empire and Tudor England, people were used to being told what to do. Libertarianism, or even liberalism, would have been incomprehensible to them. The capitalist economy was in a nascent stage (even in Italy), and had not assumed the immense hold on public priorities which it enjoys at present.

The failures of contemporary public health policy have also been political, and cannot be traced to lack of scientific knowledge. The government has often been accused of 'incompetence' and 'indecision' in its public health policy during the panedemic. On the contrary, it has been very determined in its pursuit of its objectives, which have had nothing to do with public health. The decision to 'outsource' contact tracing to private companies, and the by-passing of the public health expertise of local government ; the absence of preparations for pandemics, as confirmed by Exercise Cygmus in 2016 ; the sacrifice of the inhabitants and empoloyees of the care home sector on the altar of the cost-cutting imperatives of the private-equity owners of much of the care sector ; the underinvestment in public health capacity ; the abolition of Public Health England, and the stripping away of its responsibilities for diet, nutrition and obesity ; and the decisions on the timing and easing of 'lockdown' were all intensely and entirely political decisions, informed by the government's intense desire to prioritise the health of capitalism over human life. This policy may not be successful in stemming the growth of unemployment, but the health of capitalism is compatible with high unemployment. Indeed, in some circumstances, the health of capitalism may require unemployment. Other countries, such as Germany, South Korea and the Nordic states have managed their responses to the pandemic so far so that there is no contradiction between the requirements of the economy and those of public health. However, their conceptions of capitalism and of the state are fundamentally different from the short-termist, speculative, de-regulated and hyper-individualist British version of capitalism. The government's slogan ('Protect the NHS') barely concealed the fact taht, in the absence of a coherent public health strategy, the NHS was the only part of the health system which worked.

Of course, the relationship between government and scientific advisers who are also civil servants is complicate may lead to advice being modified by political considerations, as the medical journalist Richard Horton has pointed out in his polemic, 'The Covid-19 Catastrophe' (2020). However, in this case, the problem was not to do with the science but with the impact of political pressures on science. Much of the disagreement between the various categories of scientists on policy responses to the pandemic has been over the relative importance of the various policy responses to the pandemic. Very few responsible scientists believed that there should be no response, but this extreme laissez faire instinct determined the government's response until late March.

Decisions about public health, like many other political decisions, are to do with the distribution and allocation of resources, and the inevitable negotiations and compromises which flow therefrom. 'Following the science' is only incidental to it. One is tempted to say that, in our lamentable negotiations over Brexit, such economic considerations are not even secondary. 'Sovereignty' has become non-negotiable, but the government does not recognise the logical consequence of its position. The prime minister's notorious lack of attention to detail explains only part of this mystery. Brexit has been elevated beyond the realm of politics (the stuff of which is compromise) to an article of theology. The almost inevitability of a 'no deal' Brexit flows from this. In the government's attitude to public health, capitalist economics has supplanted all other considerations. As far as Brexit is concerned, the principles of capitalist economics are nowhere to be seen. They have been supplanted by nationalist-populist ideology. The contrast between these policies reveals the utter ideological disarray of this government, its unfitness to govern, and the general crisis of the global Right.