COVID-19 calls for a Marshall Plan for health

As we begin to appreciate the full weight of the COVID-19 pandemic, we are coming to realize that we are in the midst of interlocking crises.

First, we have been facing the direct effects of the virus on the physical and mental health of the public. Then, there are the economic consequences of the physical distancing measures we have taken to slow the disease’s spread. The conversation about implementing these measures has now evolved into a debate about when we might end them in order to mitigate the damage to the global economy during this pandemic. This debate is a new version of an old argument: the needs of the many (in this case, economic prosperity) versus the needs of the relative few (those vulnerable to the consequences of coronavirus).

How do we thread this needle?

I would argue that we need to return to our pursuit of the common good. When we approach health from this perspective, we see how the health of the many is tied to the health of the few, and vice versa. COVID-19 has made clear the connections between individuals and populations, showing how poor health among anyone can threaten the health of everyone. Health — for the many and the few — is only possible when we agree, collectively, to prioritize the common good and operationalize it at the policy level, as we did in prior eras. 

The twin crises of the last century — the Great Depression and World War II — nudged us as a country to invest in our collective wellbeing. The New Deal, and its political successor, the Great Society, were ambitious efforts to place compassion and care for the many at the heart of federal decision-making. They reflected an America that embraced the common good, through investment in fundamentals like infrastructure, employment, the arts, a fairer economic system and health.

This is not to say we can somehow copy-and-paste the New Deal onto our current situation. Even the New Deal, guided as it was by a concern for the common good, fell short of the ideal — for example, in how its housing programs deepened racial segregation. Rather than return to past solutions, we should revise them, so they can live up to their full potential by supporting a good that is held truly in common. 

That good is health. Recent weeks have shown just how fast society can change when we feel our health is threatened. But the truth is, it is not the threat to our health that is new, just our awareness of it. Our health was in jeopardy long before COVID-19. It was in jeopardy the moment we began disinvesting in the common good. This emerged from a belief that individual freedom was somehow stifled by the policies and institutions meant for the good of all, a belief which inspired widespread disinvestment in these structures, beginning in earnest during the Reagan administration. These political developments coincided with increased spending on a highly individualized approach to health. Rather than invest in the resources that create health — such as housing, education, a generous social safety net and robust environmental protections — we doubled down on our investment in doctors and medicines, which treat individuals when they are sick but do little to keep populations healthy.  

The resources necessary for health are sustained by collective investment. When we decided this investment was no longer necessary, we left ourselves open to precisely the crisis we are now in. 

It is not too late to change course. The time to do so is now, when — for the first time in decades — we are rethinking the balance between the many and the few and reconsidering our overwhelming focus on the individual. We can change by applying the spirit of solidarity that has emerged from this crisis to the twin tasks of saving the world from the worst effects of COVID-19, then transforming it into a place where such diseases can no longer take hold. 

We can end our vulnerability to poor health the same way we created it. First, by embracing an idea: that health, and the social stability it enables, depends on prioritizing the common good. Once we have done this, it is time for creative and comprehensive investment in the resources that generate health — schools, employment, universal health care, pandemic preparedness, environmental protection, the physical infrastructure of where we live, work, play and more. We need a Marshall Plan for health, a commitment to rebuilding our world with the aim of improving on what came before. 

In borrowing the ambition of past initiatives, we should take care to include what they overlooked — a focus on marginalized communities. COVID-19 has taught us something key about these communities — they are indispensable to sustaining this country. They are the sanitation worker still performing essential functions, the nurse risking her health to preserve that of others, the grandmother whose presence is the glue holding her family together. These are the ones keeping the lights on in America right now. Their experience should inform the policies which will shape our post-pandemic world. 

COVID-19 is an unprecedented crisis which demands an unprecedented response. It is a fact that diseases can permanently alter the physiology of the bodies they attack. One way or another, our society — our body politic — will be irrevocably changed by this pandemic. We have the capacity to choose, at least in part, what that change will mean. We should make it mean a recommitment to the common good, and we should start doing so now.

Sandro Galea, MD, DrPH, is professor and dean at the Boston University School of Public Health, whose latest book is Pained: Uncomfortable conversations about the public’s health. Follow him on Twitter: @sandrogalea