Do all Lives Matter in Public Policy?

Commentary, COVID-19, Government, David Leis

Many nations, including Canada, have taken the unprecedented step to undertake an economic lockdown of much of the nation’s economy in the attempt to slow the spread of COVID-19. But in doing so, these drastic decisions taken in the name of health will likely and irrevocably impact the health and lives of many more Canadians for years to come. 

In an attempt to rightly protect vulnerable populations from the virus, including the frail, the elderly and those with preexisting conditions, Canadians rallied quickly and supported every effort to prepare for the worst, practise good hygiene and social distancing, and not overwhelm our healthcare system. Fortunately, the catastrophic projections of millions of deaths foretold by experts were not realized and, in the Canadian context, our hospitals were almost universally underwhelmed and quiet. 

But what is extraordinary, is that many Canadian governments went one step further like many other nations, and did the unthinkable. Instead of only focusing on protecting the vulnerable and carefully monitoring the progress of the virus, authorities undertook, depending on the provincial jurisdiction, an economic lockdown strategy. Given the unknowns of the virus and known evidence of how our economy impacts human health, did this extreme option taken immediately at the beginning of this crisis really make any remote sense?

At this point, the economic impacts are still unfolding. Federal authorities such as the Budget Office now forecast a disastrous federal deficit alone of $252 billion while Canada’s economy is projected to contract by 14 percent. Over 8 million Canadians have applied for the emergency benefit, not including the myriad of other programs. 

Time will tell if Canadians ever see the confidential analyses that guided decision-makers during this crisis. So far the decision-making models and data have oddly been a black box for the most part. The question is, despite the fact that the brutal health impacts of mass unemployment have been well researched and documented over decades, was this reality even taken into account? Indeed, it is surprising that an economic lockdown strategy would have even been considered a viable option.

One such example of many national research projects illustrating the profound impact that economic health has on human health was published by Oxford University Press by researchers Vagero and Garcy. Using a massive original data set from Statistics Sweden and the National Board of Health and Welfare the conclusions are profound. Indeed, one wonders if this study may have guided Sweden’s approach to this virus and not to undertake an economic lockdown.  

Vagero and Garcy concluded that after Sweden’s 1992-96 recession, “alcohol-related and external mortality was elevated among men and women suffering unemployment during the recession, even when their prior medical history had been taken into account.” For men, the risk of alcohol related death more than doubled, for women, it doubled, and for the long-term employed the risks of suicide increased markedly by 40 percent. The risks of becoming unemployed again also increased along with remarkably high rates of long-term state dependency as well as drug dependency. Among many data relationships determined, a one percentage point rise in the country’s unemployment rate was linked to an additional 0.95 opioid overdose ER visits per 100,000 residents or a 7.0 percent increase.  

The researchers went on to conclude that the health impacts are even larger among the young, the unmarried, and those of lower income and education. Not surprisingly, this research cautions decision-makers against any economic policies that allow mass unemployment as it imposes mortality risk on a sizable segment of much of our population and their health. It is important to note that these consequences occurred in Sweden despite its many generous social welfare programs. In other words, just because unemployment occurs within a welfare state such as Canada with its Emergency Benefit cheques, it does not mean the health consequences will not occur as in Sweden.  

As the Canadian economy heads towards an unemployment rate likely north of 20 percent, it is possible that in terms of health impacts, our nation will experience much worse than those identified in the Swedish analysis. For instance, Canadian decision-makers immediately selected to cancel and delay, despite the known risks, large areas of the health system, such as elective surgeries and other allied health practitioners. Oddly, Canadians were allowed to safely shop at their local grocery and liquor stores but could not go safely to a podiatrist, a dentist, nor a physiotherapist, as they were deemed too risky. For some reason, decision-makers believed that pursuing two goals at once was largely not possible – namely to pursue public health measures while at the same time ensuring a largely open, safe economy. This all despite the known horrendous impacts on people. 

In addition, decision-makers immediately cancelled elective surgery despite a profound impact on Canadians. In BC alone, it is estimated by the Ministry of Health that it will take over a year or more to catch up on these important surgeries. Anecdotal evidence is already coming in that some Canadians have had their health severely compromised and may have died due to these decisions. As Dr. Ashish Jha, Director of the Harvard Global Health Institute has stated, “There’s absolutely a danger that we’re going to ignore the people who critically need health-care services who don’t have COVID.”  

Moreover, Canada continues to face many major structural economic challenges; a struggling energy sector, low business investment, stifling regulations, inefficient legal processes, and low labour productivity remain. Despite massive economic stimulus, these factors, along with record levels of consumer confidence, will arguably form the basis for a slow recovery, low growth, persistent high unemployment and a lower standard of living. Canada’s current economic situation also makes previous recessions look mild in depth. According to the recent IMF Fiscal Monitor, the fiscal and liquidity support that has been undertaken significantly exceeds actions undertaken in the 2008 financial meltdown. The severity of our current self-imposed recessionary path could easily be much worse and as a result, its health impacts.  

Furthermore, the public health strategy employed, its use of social isolation and education disruption will also incur additional health impacts, particularly on children, across all segments of the population. With children out of school and child care, it further undermines the ability of many parents, particularly single-parent households, to work and seek employment. Oddly, it was decided that children would not be going back to school, yet every evidence for many weeks now shows the likelihood of children dying of the virus is very low.

It will take some time to understand the enormity of the health impacts of Canada’s many economic lockdown strategies and learn from these decisions. Tragically, based on readily accessible research, the economic choices made immediately during this crisis will profoundly impact Canadians’ health and well-being and prompt the question of how public health leaders made these decisions. Many of those Canadians negatively impacted by government decisions will be in the working class – the uneducated, the young and in lower socio-occupational classes and largely in the private sector. Sadly, their lives and their health were not really considered during this crisis and that needs to change now.

 

David Leis is the VP Development and Engagement for Frontier Centre for Public Policy.