Is it better to dig a strong foundation or build a solid house?
Say that again. You can’t build a solid house without a strong foundation. They’re inseparable. The question is ridiculous.
It’s not as ridiculous as you might think. The United States is currently embroiled in a vitriolic political debate over a question that is just as nonsensical – should we favor public health or the economy? It plays out as a contest between relaxing COVID-19 lockdowns cautiously based on public health advice and repealing them quickly to encourage economic growth.
Disease mitigation and economic revival are both, of course, desperately needed, but they are inseparable. Just as a house can’t be solid if the foundation isn’t, an economy can’t be healthy if the population isn’t. A house with a weak foundation may seem substantial but only until a storm hits. An economy without a robust public health infrastructure may seem prosperous but only until widespread illness strikes.
If we have learned anything from the horrors of this pandemic it is that lesson. Economies don’t flourish despite public health. They flourish because of it.
It is a lesson that is hardly new. We have seen it demonstrated time and time again over the centuries.
To take a local example, in 1793 an epidemic of yellow fever brought the economy of Philadelphia to a halt as business activity ceased. Sound familiar? Those who could, left the city or avoided visiting, including such notables as President George Washington and Vice President John Adams. Years later, mosquitoes were identified as the source of transmission, leading to preventive measures and eventually to a vaccine. Yellow fever epidemics no longer threaten our lives and economy.
Mosquito control came to the rescue again in the early 20th century to conquer the greatest obstacle to completion of the Panama Canal. The spread of yellow fever and malaria from mosquitoes sickened thousands of workers and almost brought construction to a standstill.
More recently, the Ebola epidemic of 2013 and 2014 not only took thousands of lives but also stunted economic growth in several West African countries. The SARS outbreak in 2003 crippled tourism, an economic engine for Hong Kong, as did MERS for South Korea in 2015 and H1N1 influenza for Mexico in 2009.
It is not just during epidemics that economies need strong public health support. Research across countries shows that those with weak health systems have more difficulty sustaining economic growth. It also shows that countries whose populations enjoy better health status tend to have higher incomes.
Today, it is public health that will support recovery from the economic devastation of COVID-19 lockdowns. Reopening state economies without measures like testing, contact tracing, and disease tracking risks waves of disease resurgence that could lead to even greater economic disruption and the need for new lockdowns. Public health support can lay the foundation for a more sustainable economic revival.
Relaxing lockdowns too rapidly may not even help in the short-term. Recent polling shows that just 23% of Americans would be comfortable going out to eat or visiting a shopping mall. Only 12% would be comfortable attending a concert. Business won’t return to anything approaching normal until the public is reassured that it is truly safe to venture out, and only continued public health support and guidance can provide that reassurance.
As we have learned over and over in the past, economies need strong public health foundations to grow and thrive. No one benefits if our reopened economy is built as a house of cards.
Robert I. Field holds a joint appointment as a professor of law at the Kline School of Law and a professor of health management and policy at the Dornsife School of Public Health at Drexel University. He is an expert in public health law and policy and a member of The Inquirer’s Health Advisory Panel.