Coronavirus Made It Clear: Our Health System Needs More Compassion
‘A fairer, healthier system can emerge from this crisis,’ according to the dean at the Boston University School of Public Health
As the Covid-19 pandemic unfolds, the world has taken dramatic steps to slow the spread of the disease. Physical distancing has kept large segments of the population indoors, closing schools and workplaces and effectively pausing the global economy. These disruptions have sparked a debate over how long they should remain in place. Already in the U.S., there have been calls to “reopen” the economy and return to the pre-Covid-19 status quo. President Donald Trump originally wanted the country “opened up and just raring to go by Easter.” Thankfully he’s changed his intentions and says distancing measures will remain until at least the end of April. Critics of moving too quickly back to normal functioning have cited the risk such a move may pose to public health. There have even been claims that callousness is behind the calls for resumed productivity, with the suggestion that some people would rather let others die than threaten the country’s bottom line.
This debate is about something more fundamental. It’s about what a return to normal will look like after Covid-19.
It is worth noting that, while the science is fairly clear that an abrupt end to physical distancing would interfere with slowing this disease, the debate we are seeing has little to do with the science of this pandemic. If it did, it would be a conversation less about whether to end physical distancing and more about how to do it properly. And if the argument for resumed functioning was really all about the economy, advocates for an Easter revival would be less concerned about stock prices and more focused on the low-wage, often marginalized workers that this crisis has revealed to be the backbone of our collective fiscal health.
No, this debate is about something more fundamental. It’s about what a return to normal will look like after Covid-19. Will we return to the same state of affairs that left us open to the present crisis? Or will we build a healthier world out of the mistakes and opportunities this challenge has revealed? These questions have largely been mere subtext in our current conversation for understandable reasons. In the midst of a pandemic that has us focused on what we must do in the near term, it can be difficult to look beyond the present moment. Yet we must do so and do so out loud.
First, a look at where we stand. There are several scenarios of how this pandemic may unfold. Projections by the Centers for Disease Control and Prevention (CDC) suggest that, over the course of months or a year, between 160 million and 214 million people in the U.S. could become infected with the virus, and 200,000 to 1.7 million people could die. Then there are the mental health consequences of this pandemic. We know from studies of hurricanes, terror attacks, and past outbreaks that large-scale, traumatic events can create a substantial mental health burden as can the steps taken to mitigate these threats. After the 2003 SARS pandemic, our team studied the mental health effect of the quarantine used to slow the outbreak. We found the experience of quarantine was linked with risks of depression and post-traumatic stress disorder (PTSD).
In the midst of a pandemic that has us focused on what we must do in the near term, it can be difficult to look beyond the present moment. Yet we must do so and do so out loud.
Preventing the worst-case Covid-19 scenario will depend in large part on the success of the physical distancing currently underway. However, the economic disruption will also have consequences for health. There is a robust association between employment, income, and health. Jobs, money, and the macroeconomic forces that shape them are what determine whether we can access the resources we need to be healthy. Good housing, nutritious food, quality education — such factors are core to our ability to live healthy lives. Whether or not we get them depends on how much money we have. Even the simple presence or absence of savings can shape health. Our recent study found people with low family savings had a 50% greater chance of having depressive symptoms.
For these reasons, economic downturns can significantly undermine public health. The Great Recession, for example, was linked with reduced fertility and self-rated health and greater morbidity, psychological distress, and suicide, an effect tempered somewhat by strong social safety nets. A study of the Brazilian economic crisis found that between 2012 and 2017, higher unemployment accounted for 31,415 excess deaths in the country. Last week, nearly 3.3 million Americans filed for unemployment. These numbers, as well as indicators that we may already be in another recession, suggest a difficult road ahead for our economy and for health. We cannot disentangle these consequences from the steps we must take in the present to slow the spread of Covid-19. One need not be greedy or callous to fear the long-term effects of an economic downturn, especially its effects on public health.
How, then, can we make the seemingly impossible choice between the health consequences of this pandemic and the long-term health consequences of economic stagnation? Why is it so hard for us to acknowledge how larger socioeconomic forces threaten health while we intuitively grasp the health threat of a pandemic?
While empathy tends to be concerned with individuals, compassion focuses on societies and the web of interconnectedness that binds our world together — a web that Covid-19 has made impossible to ignore.
A key reason may be that we tend to view suffering through the lens of empathy. Empathy places us in the shoes of others, helping us to see what they need in the moment to alleviate their pain. It has inspired extraordinary acts of solidarity in recent weeks. It is a good thing. We should never lose our sense of empathy. But its perspective can be limited, rooted in the here and now, rather than in the future, or even in the structures that underlie the present. Empathy is about the person in front of you right now and what she is going through, not the larger forces which may have, over time, contributed to her distress.
But there is another approach to alleviating suffering — the way of compassion.
While empathy helps us identify with the suffering of another, compassion helps us see the conditions that caused that suffering. Empathy motivates us to help someone in the moment. Compassion calls on us to change the world at the fundamental level so that no one needs to suffer in the present or the future. Martin Luther King Jr. once said, “True compassion is more than flinging a coin to a beggar; it comes to see that an edifice which produces beggars needs restructuring.” While empathy tends to be concerned with individuals, compassion focuses on societies and the web of interconnectedness that binds our world together — a web that Covid-19 has made impossible to ignore.
Now that we have seen this web, we need to follow where it leads — not just from person to person but from populations to the structures that underlie our collective health. Compassion exposes our common vulnerability to the conditions that worsened this pandemic — for example, our failure to produce enough Covid-19 test kits. Seeing this, we can then think of solutions that address these underlying conditions. The federal government could, perhaps, engage private industry in partnership to ramp up producing more kits, linking resumed economic activity to measures that will support health in the near term. In this way, a perspective of compassion shows us that the conditions that created this crisis are complex, and the most effective solutions will be ones that engage with this nuance.
The same is true when it comes to helping the populations most vulnerable to Covid-19 and its economic consequences. The low-wage workers currently holding the U.S. economy upright were uniquely vulnerable to poor health before this crisis struck and are uniquely vulnerable now that it is here. There is, for example, a 10- to 15-year gap in life expectancy between Americans at the top of the economic ladder and those at the bottom. We have long ignored this health gap, perhaps thinking it irrelevant to our overall collective health. But an infectious threat like Covid-19 shows how such pockets of poor health are bad for everyone. Compassion shows how these pockets are created — by an economic system that concentrates wealth in the hands of a few and by a political system that feels little compunction about threatening the social safety net on which so many rely, the same safety net that can help mitigate the health effects of an economic downturn.
This crisis has shown how unsustainable this status quo is, to the point where ideological foes of a generous welfare state have nevertheless supported a stimulus that includes sending funds directly to Americans in need. These lawmakers would likely say they acted out of necessity, and so they did. However, compassion shows us that this necessity is not limited to the time frame of this pandemic. It has long existed, creating an unequal society primed for poor health. True recovery means closing these health gaps for good. Doing so will require the kind of bold, large-scale policymaking this pandemic has already begun to elicit. We should make outreach to the vulnerable not a temporary feature of a crisis but a fixture of federal decision-making. Maybe then we will see the emergence of policies we need to build a future that is radically healthier than the past — a generous, expansive social safety net, universal health care, even a universal basic income.
Compassion provides a new way of thinking about the present challenge and the choices necessary to steer us out of it. It shows us we do not actually face a binary choice between keeping the economy shuttered and staying healthy or reopening it and getting sick. Returning the economy to full functionality does not have to mean returning it to business as usual. A fairer, healthier system can emerge from this crisis. In order to see how, we need to look with compassion, then apply this new perspective to the challenges we face.