Jonathan Cohen: Covid-19 and the power of public health

We all crave the moment when the spotlight swivels towards our line of work, when the professional expertise we’ve been amassing over years in obscurity becomes the stuff everyone hangs onto for dear life. Though I am far from an infectious disease specialist, my position in public health leadership gives me a sought-after perspective on covid-19 and its impact. Whenever public health makes front page news, I can feel the pedestal rise beneath my feet.

This is not a pedestal I crave. While it’s reassuring to see people put their faith in public health professionals—even elevating some of us to superhero status—we never pretended to have all the answers. 

I do not question the fundamentals of infectious disease control, like testing, contact tracing, isolation, and quarantine. But these tools only work if another set of fundamentals are in place. These are the fundamentals of a just society.

Almost the moment self-quarantine and social distancing became the order of the day, the inequity of these public health strategies revealed itself. How can someone without paid sick leave take time off work to avoid infecting others? How can someone without a home be expected to “shelter in place”? How can someone locked in a crowded jail practice social distancing? 

Making people choose between their salary and the safety of their co-workers, telling homeless people to shelter in place, or quarantining people in places without proper infection control is not just cruel and unethical. It is dangerous.

The public health framework tells us that covid-19 was caused by a novel pathogen, not by population density, weak, and fragmented health systems, and other social processes that turned a pathogen into a pandemic.

Public health tells us that covid-19 is spread by droplets, not by denial, wishful thinking, and epic failures in political leadership.

It tells us that covid-19 impacts people with “pre-existing vulnerabilities,” not people who have chronic disease because of histories of structural racism, people who are forced by poverty and marginalization into unhygienic living conditions, and people without health insurance.  

It tells us that covid-19 is solved by human behaviors—isolation, quarantine, and social distancing—not by political accountability, global cooperation, and a social safety net.

Addressing covid-19 through human behaviour is a bit like trying to end climate change by recycling one bottle at a time. Of course we should recycle. But while we punish ourselves for not recycling enough, the real culprits—the carbon emitters and their political enablers—go unpunished. This is a way of arrogating public policy to the private sphere, of devolving a collective responsibility to individual people, many of whom are powerless to comply. 

The narrow framing of covid-19 as a public health issue is an example of what philosopher Michel Foucault called “biopower”—a theory of power used to control entire populations. Biopower renders human problems into medical ones. It narrows our frame of reference so that powerful actors have license to control our bodies. 

Biopower favors technological magic bullets—vaccines, diagnostics, therapeutics—and restrictions on human behavior over the messy work of social change. It’s a small wonder that autocrats are seizing on covid-19 to shore up power through mass lockdowns, emergency decrees, and official censorship—as they have done in in Brazil, China, Egypt, Iran, Israel, Hungary, and the Philippines.

It can be challenging to differentiate between authoritarian measures whose purpose is to save lives, and those whose purpose is to consolidate power. Tracking the GPS location of people who have tested positive for covid-19, as South Korea did, sounds like a public health necessity—until people’s private information gets into the wrong hands. Paradoxically, even people who are suspicious of power—activist friends who have spent their lives on the front lines of social justice, human rights lawyers who believe deeply in freedom from government overreach—seem to believe that some measure of authoritarianism is necessary to save their democracies.

I have to pause when human rights activists demand obedience to social controls as though the real enemies are political leaders who want people to move freely.

Of course, by the time poor planning results in an uncontained pandemic, it’s “too late” to fix the problems that complicate the public health response.

We don’t have the luxury of applying urgent public measures to the society we want. We have to apply them to the society we have. That means that public health cannot offer magic bullets, as alluring as superhero status might be.

Jonathan Cohen is the director of the Open Society Foundations’ Public Health Program where he oversees grant making and advocacy to improve social inclusion in public health policy and practice.

Twitter: @JonCohenNYC 

Competing interests: None declared