Covid-19 has shown us that the present—the today—can be, at times, overwhelming in its salience, and there is little that we can do, or indeed should do, that does not focus on the needs of the moment. At the beginning of the Covid-19 pandemic, in the first terrifying few months of a disease that we did not understand, it was appropriate that we invest every bit of our effort in mitigating the immediate threat we faced. But at what point does tomorrow matter more than today?
There are multiple ways in which one can approach this question. Economists approach it through time discounting, the study of how the value of rewards is shaped by their temporal proximity. Benefits that accrue in the present tend to matter more than those that may accrue in the future, losing value the more distant they become from the present moment, simply because, all things being equal, we put more value on the bird in the hand. There are, of course, alternative perspectives. If we prioritize the needs of future generations– any parent who invests their money into college funds for their children rather than buying a new car does this—we are valuing the future more than the present.
The Covid-19 pandemic shows us how an over-investment in the present can cause us to lose sight of challenges that will affect our health in the long-term. Data are emerging about excess mortality during the Covid-19 period due to a range of other diseases, from Alzheimer’s to heart disease, mortality likely due to a combination of lack of resources in our health care system taken up with hospitalizations and infectious disease precautions, and changes in behaviors that were influenced by fear of Covid-19. The consequences of this increased mortality will be felt for years to come. And we know that social isolation that accompanied Covid-19 mitigation efforts is linked to a dramatic increase in poor mental health, whose consequences will be with us for a long while after the pandemic ends.
This choice between the needs of today and tomorrow, between the urgent and the important, is resonant in health. We are charged with creating health for as many people as possible throughout their life-course, which requires a need to focus on the present, but also to move beyond that moment to focus on the future as quickly as possible. Once we were clear that Covid-19 was not having its lethal effect on children, shouldn’t an awareness of the needs of tomorrow have influenced our collective decision-making around keeping K-12 schools open? The balance of the urgent and the important requires constant recalibration. This time, during a year like no other, we were perhaps too slow at thinking into tomorrow as we were acting on the urgencies of today.
Michael Stein & Sandro Galea
As we re-emerge from the pandemic, 2021 stands to be a turning point year for public health. In The Turning Point’s weekly essays, we reflect on what we learned during 2020, and what we are learning during 2021, that can guide us to the creation of a better, healthier world.
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