Ahead of the 2024 US presidential election, BMJ Today, it launches a forward-looking series highlighting the lessons that can be learned from the U.S. experience with the coronavirus and the actions needed to prevent the loss of another million citizens in the next pandemic and to improve and protect population health.
The articles, written by leading clinicians and researchers across the United States, explore topics such as how systemic racism and economic inequality have contributed to disparities caused by the coronavirus; mass incarceration and poor health in prisons as a driver of the epidemic; inequality in the labor market; and the effect of “emptying the state” (reducing the role of the public sector).
The authors call for a set of critical systemic reforms, which they believe should be central to the manifestos of the 2024 US presidential candidates.
Most importantly, the goal of this series is not to assign blame; There is a lot to go around -; But look to the future and lay out the critical steps that must be taken to transform U.S. public health and prepare for and improve population health. Widely.
In an editorial to launch the series, guest editors Gavin Yamey of the Duke Global Health Institute and Duke University and Anna V. Des Roux of the Drexel University Collaborative for Urban Health How the United States has suffered during the devastating global COVID-19 pandemic from “the eyeballs”—extremely high death rates compared to peer nations.
The 1.16 million Americans killed by COVID-19 represent 16% of global deaths in a country with 4% of the world's population, they wrote. It is estimated that about 300,000 children have lost one or both parents, and there is a high burden of long Covid.
The series documents the many complex and interconnected reasons for the weak US response to the pandemic, underpinned by two main contexts.
The first is the country's pre-existing structural and systemic features, which have contributed to the pandemic's devastating outcomes. These include gaps in healthcare and public health systems, absence of social safety nets and workplace protections, entrenched social inequalities, and systemic racism.
“These are the main reasons why the nation has suffered higher COVID-19 death rates than its more equal counterparts, and why pandemic deaths in the United States have been closely shaped by social class and race,” the authors wrote.
The second reason is that although the United States had many scientific resources, the government showed an alarming inability to generate trustworthy information, transmit it in a timely and consistent manner, and translate it into sound policy.
Yami and Diez Roux say these failures start at the top. President Trump has repeatedly lied about the pandemic, and his suggestion of using bleach to fight COVID-19 was “symbolic of the chaotic presidential communications of the pandemic's first year.”
Miscommunication of existing evidence also contributed to confusion and delay in proceedings. Such communication errors are one reason for partisan differences in how quickly states act to establish public health protections and in excess death rates during the pandemic. Especially in the period following the availability of vaccines.
They add that poor communication of evidence has also led to inappropriate action.
For example, even after studies showed that transmission through objects (objects and surfaces) was rare and that transmission outdoors was much less common than indoors, some municipalities or states kept parks, playgrounds, and beaches closed.
After research showed that schools could reopen safely with basic public health measures, many jurisdictions kept schools online only.
Moreover, communications failures have been exacerbated by federalism – the division of power between the national government and the 50 US states – which has ensured that the response to COVID-19 depends on zip code, illustrating the limits of federalism in the face of the coronavirus. The deadly epidemic.
But despite these failures, they point out, the pandemic has also shown the United States how a different role for government and society in protecting health is possible.
For example, in addition to the rapid development of vaccines, which was publicly funded, strategies such as expanding unemployment benefits, food assistance programs, expanding health insurance coverage for children, Medicaid enrollment, and federal funding to upgrade public schools helped curb Suffering and death.
“It has particular relevance to the 2024 US presidential election, as it demonstrates how a range of government actions, beyond health insurance, can be crucial to protecting health in the next pandemic and beyond,” the researchers concluded.
In the first article in the series, David Michaels of George Washington University and colleagues examine how COVID-19 is affecting front-line workers in the United States and what needs to be done to ensure they are better protected in the future.
They argue that COVID-19 has disproportionately affected low-wage workers who have had to leave home and go to work to keep society functioning, and they say actions taken by U.S. occupational and public health agencies have fallen far short of what is needed to make workplaces safe during the pandemic.
They acknowledge that temporary social and economic interventions during the pandemic have provided some relief for these workers, but they say protecting workers' health in the next pandemic requires action now for paid family and medical leave, better social supports, and better workplace protection policies.
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Magazine reference:
Yami, J. et al. (2024). Pandemic lessons for the 2024 US presidential election. BMJ. doi.org/10.1136/bmj.q150.
