History teaches that population-wide behavioral patterns change infrequently, and slowly. After all, little changed in how we behaved after the last global disease disruption, the flu pandemic of 1968, and perhaps most dramatically, societal behavioral changes after the 1918 flu pandemic were few and far between. What is most striking about how we act in the future is how similar our behavior looks to what it was like in the past, and that is true whether we have lived through a national trauma or not.
What did change after the 1918 flu pandemic was our appreciation of the need to move beyond considering health as an exclusively individual responsibility, and to set up the structures needed to help promote health collectively. A number of countries created health ministries after the 1918 pandemic and centralized healthcare delivery schemes, which unfolded in different ways in different nations. Russia, for example, was first to follow the 1918 flu pandemic with public healthcare, funded through state-run insurance. The UK, France, and Germany did much the same soon after. In 1922, the League of Nations Health Committee and Health Sections were established—forerunners of the World Health Organization (WHO).
This teaches us that the moment creates, yes, an opportunity for change, but that change is unlikely to be predominantly about individual behavior. Somewhat like New Year’s resolutions, eagerly made, just as quickly broken, individual behavior change is evanescent. What large-scale traumas like the 2020 Covid-19 pandemic create an opportunity for is system-wide change that can, over time, have a slow but critical influence on collective human behavior. This means that we have now an opportunity to be deliberate about what those changes could be, and how we can set up our world to change for the better. What will our post-Covid-19 legacy be? Will we finally recognize that having millions of people without ready access to affordable healthcare exposes them, and all of us, to the worst consequences of infectious disease and that the US needs guaranteed health insurance for all? Will we better fund public health agencies so that they have the resources to tackle novel infectious disease outbreaks? Will we finally realign our decision-making processes so that we recognize that all policies—from transportation to finance, from housing to the environment—matter for health?
It would be a pity not to use the moment to create a better world; our effort to do so may be much more fruitfully focused on how to build the structures that do so than to wonder what we, if left to our own devices, might do differently.
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.