Analysis Of The Effects Of The Continuing COVID-19 Induced Lockdown On The Welfare Of An Average Nigerian.
IGBOKWE, Daniel O.F _(President, Joint Health Science Students’ Association[JOHESSA];
Public Health Student, ABSU).
Mail: [email protected]
Contacts: 08139710126; 09095677595
_”One of the things that makes Public Health fascinating to me is the fact that it is often controversial, depending on political decisions as well as scientific evidence. The politics are frustrating to many practitioners, but it is often the politics that put Public Health in the headlines”_ – Mary-Jane Schneider.
The mission of Public Health as defined by the Institute of Medicine report, The Future of Public Health – “fulfilling society’s interest in assuring conditions in which people can be healthy” – is such a broad scope as these conditions tend to include many factors not thought of by many as relevant to Public Health. For instance, the factor most significant in determining the health of any community (be it homogeneous or heterogeneous) is its economic status. People with higher incomes tend to be healthier for a variety of reasons. This expansive view of Public Health is not new.
Winslow’s 100-year-old definition of Public Health specifically includes as part of Public Health’s role, “…the development of the social machinery which will assure to every individual in the community a standard of living adequate for the maintenance of health”.
Public Health is also viewed as a broad social movement – this might sound odd but remain undisputable.
Dan E. Beauchamp, a noted Public Health philosopher, once wrote “Public Health should be a way of doing justice, a way of asserting the value and priority of all human life”.
However, political conservatives have tended to resist this broadened scope. They would rather prefer to limit Public Health to a technical enterprise focused on controlling communicable diseases or as a safety net that provides medical care to the indigent, and all others vulnerable to negative health outcomes.
Such kick-against sadly is been sponsored by physicians who are more concerned about government encroachment on their economic and professional independence – an aged long struggle still ongoing.
The expansive view of Public Health(scope) and the corresponding cuts it is greeted with together generates considerable controversy all over the world, mostly in developing nations. The notion that government has an obligation to provide healthy conditions for citizens who are unwilling or unable to provide such conditions for themselves – and indeed to provide medical care for those who need it as most industrialized countries do – has often been debate topic in our part of the world. But then, many health problems have their roots in unhealthy behaviours that are so personal and intimate that moralists oppose even discussing them. These issues and many more explain why our health has always been at the mercies of preventable health conditions which more often than not end up claiming lives of our esteemed compatriots in their thousands.
*Why Public Health Is Controversial:*
Public Health is controversial because in its definition lies tasking challenges on people’s values, and demand for sacrifices while at same time portray a nature that protect their very best interest as much as possible. The expansiveness of the scope asks people to give up a degree of personal liberty for the common good while the envisaged restrictions propagated by political conservatives and their likes tend to limit the scope and provisions. Could the cut then mean reduction on the demands of Public Health measures on its subjects? Your answers are just as good as mine.
At its most idealistic, Public Health as a broad social movement is a campaign to maximize health for everyone in the population through distributing benefits and responsibilities in an equitable way.
Note the ‘responsibilities’ as integral to health as physics would uphold, ‘to every action, there is equal and opposite reaction’.
The yet-to-be-assimilated truth remains that the responsibilities – demand to give up a degree of personal liberty for common good, and challenging people’s values – are all to the credit of the people but they find it difficult to perceive such as that. There lies the lacuna. Hence, three issues – economic, individual liberty (libertarian’s view), and moral/religious struggle – tend to come up repeatedly in any debate over Public Health actions, and activities owing to their vitality to life and wellbeing.
Analysis Of The Effects Of The Continuing COVID-19 Induced Lockdown On The Welfare Of An Average Nigerian:
Using the three major issues of concern mentioned earlier – economic, individual liberty, and moral/religious struggle -.
•Economic Impacts: Largely, the controversial nature of Public Health measures is as a result of the economic impacts they present. Most Public Health measures (COVID-19 induced lockdown order for instance) have negative economic impact of some kind on some if not all segments of the population. Consequently, any new proposal for a Public Health regulation is likely to inspire opposition from some quarter, on the grounds that it might cost jobs, add to the price of commodities, and services or require tax increment. This explains why it is as though some individuals and organization resist change or violate government orders: In the face of the COVID-19 lockdown order, physical distancing, and all other recommendations in place people still sneak in and out to carryout their normal daily activities. This is because the people or organization who must pay the price see themselves as not the ones that will benefit from the new protections. Costs are usually more concrete than benefits. Moreover, the prices need to be paid sooner while the benefits are perceived as may not be achieved until later. This was simply the reason certain industries and persons resisted change years back: milk producers resisted pasteurization, landlords resisted building codes, automobile manufacturers resisted design changes to improve safety etc. There are several reasons why these conflicts are particularly difficult to resolve.
The difficulty in dealing with the economic impacts of Public Health measures have been illustrated greatly by the poor compliance of the populace to the government stay-at-home orders to contain the pandemic, and halt the spread. Despite the daily update, instruction, warning, and reminders; road transport workers, and traders among others still report to their duty posts with every readiness to flee at the sight of enforcement teams – well that is if these operatives(the infected minds though) will not ask for an offering, and take a bow once obedience is gained.
These traders – set of clever and smart folks who even in their 50s and 60s are willing to display unimaginable acrobatic techniques at the appearance of uniformed men. Do we hold them guilty who in a time of economic difficulty are unwilling to pay short-term costs in order to obtain a benefit in the long-term? I leave that to you.
Truth be told, vast majority of Nigerians presented with the lockdown order depend on daily wages who such policy invariably have forbidden to cater for themselves in the time being yet with little or no external support for survival. That said not without taking cognizance of series of support measures pledged by the government and certain kindhearted individuals to ease the financial pain for the most vulnerable and indigent but because there have been widespread complaints that not enough is being done for those facing hunger. To cap it all, most of the products(especially food items) the people could secure for themselves at considerable prices with daily struggle outputs they now without the usual income serve the stress of purchasing at prices as high as double of what is has been or even more. We have examples in a paint of garri/eba (processed cassava), the alcohol based sanitizer, and the nose mask to mention but a few which presently have their prices blown out of proportion for same poor masses(in some parts of the country) on activity break. Whatever ‘economics’ justification attached to the increment I must state is more of deceit in the now.
A well structured analysis of the condition cannot then help but admit that an effort to protect health might have a negative impact on health overall because health is welfare/wellbeing and the latter is naturally expansive covering conditions so tasking.
•Individual Liberty (Libertarian’s View): One of the primary purposes of government is to promote the general welfare. Health, and safety together with the economic wellbeing are the major factors that contribute to the general welfare. While government cannot guarantee health and safety for each individual, its role is to provide for maximum health and safety for the community as a whole. One of the central controversies in Public Health is the extent to which government can and should restrict individual freedom for the purpose of improving the community’s health. There has long been general agreement that it is acceptable to restrict an individual’s freedom to behave in such a way as not to cause direct or indirect harm to others. Laws against assault and murder for instance are found in the Bible. However, controversial are governmental restrictions in our days on people’s freedom to harm themselves.
Government restrictions on behaviour that cause indirect harm to others is the way to prevent what Garrett Hardin, in 1968 called the “tragedy of the commons”. Hardin described a pasture open to all herdsmen in a community. The land can support a limited number of grazing cattle. If each herdsman tries to maximize his gain by keeping as many cattle as possible on the pasture – the common – the pasture will be overgrazed. Therefore the only way for the community to save the pasture is then to agree to restrict the freedom of the herdsmen, placing fair and equitable limits on the number of cattle each can keep there.
In our present day situation, the “common” include the markets, institutions of learning, places of worship, public vehicles, social gathering spots/ceremonies, and other elements of the environment that all people share. Because no individual has the power to control the quality of his or her own personal environment independent of the behaviour of his/her neighbours; government actions are therefore required to protect these common resources. But then while the general principle of protecting the “commons” is accepted by most citizens, there is plenty of room for controversy in defining what to include among the protected resources as well as how extensive the protective measures should be.
Most controversial of Public Health measures are requirements that restrict people’s freedom for the purpose of protecting not just their own health and safety but that of others too who may not be their blood such as we have amid the COVID-19 pandemic – sit at home and if you must leave the house, wear face mask; wash your hands frequently and thoroughly with running water and soap; in case where water and soap are not available, apply alcohol-based sanitizer; maintain social distance etc.
Such laws inspire allusions to “the tyranny of health” and “the health police”, although restrictions on many drugs such as heroin, marijuana etc have been generally accepted. Such restrictions on individual behaviour are often criticized as “paternalism” – one form of it generally accepted is that children and young people can be restricted in their behaviour on the basis that they are not yet mature enough to make considered judgements as to their own best interests.
Libertarians, in the words of John Stuart Mill, argue that “the only purpose for which power can be rightfully exercised over any member of a civilized community against his will is to prevent harm to others…In the part(of his conduct) which merely concerns himself, his independence is…absolute”.
Most Public Health advocates believe that there are more fundamental justifications for restrictions on individual behaviour for the sake of the health of the public. Beauchamp, the philosopher, explored the reasons in his book, The Health of the Republic, arguing that such laws are needed most for the behaviours that are common and carry small risks. Social distancing for example prevents the spread of COVID-19, thousands of cases/deaths (quite beyond what we have presently) in the population as a whole as against any inconvenience attached to the sit-at-home order which is quite small. This is the truth so hard, and as such yet to be digested by majority of the people. While each individual’s choice to take the risk of going about their daily activities is rational, society’s interest through government policies such as the lockdown order to flatten the curve of the pandemic, and the corresponding deaths (in extreme cases) outweighs all minor inconveniences of obeying the lockdown order, and all other recommendations of concerned bodies.
Beauchamp’s argument in favour of limiting individual liberty for the common good is consistent with his view of Public Health as social justice.
Death and disability are collective problems, he says,and collective action is needed to promote the common welfare. The Nigeria tradition/mentality of supporting private liberty above all is therefore wrong and need to be changed to stop further damages.
•Moral and Religious Concerns certainly would always interfere with scientists studying how to prevent the spread of COVID-19 and other diseases and conditions caused by ‘unhealthy behaviour’. This is so because Public Health is affected by personal and intimate behaviours, which often are embarrassing and even offensive to discuss, thereby raising moral and religious objections. Public Health arouses controversy on moral and religious grounds, most often when it confronts sexual, reproductive, and worship issues. And because Public Health approach to these problems include sex education in schools, and the provision of contraceptive services especially condoms; these measures are often rigorously opposed by members of certain religious groups who believe that such promote immoral behaviour. While there is no question that the safest and healthiest lifestyle is to abstain from sexual activity before marriage and then to be faithful to one’s spouse, experience has long shown that preaching morality has limited efficacy in preventing sexually transmitted diseases (STDs) and unwanted pregnancy. Although there are legitimate differences of opinion on how to weigh competing interests in making Public Health policy, concerns have equally been raised that the government of the day has no moral justifications shutting down places of worship – since the situation at hand has shown to be beyond human solution; places of worship (source of alternative/divine intervention) need not to be locked at all -.
Moralism also enters into discussion of COVID-19. Libertarians argue against regulation of worship/religious activities on the basis that such gatherings are there to help instill the right moral conducts in a time like this, reminding the people to subdue fear and keep to all precautions in place. Above all, the fact that religious gatherings is an opportunity for the religious groups to intercede on behalf of the nations of the world – a proof that religious groups are also on “essential duty” – watching over the immortal souls of men.
In fact, most citizens accept the validity of such regulation; and also kick against the hand washing and use of sanitizer practices in places of worship as an act of faithlessness.
While regulation for the common good is valid, trying to legislate morality associated concerns has often proven to be ineffective, self-defeating, and a threat to liberty, in part because people differ in what they view as morally sound policies.
For instance, when morality is the justification for banning certain gatherings, rational discussion often become impossible. Hence, free speech is repressed, victims are demonized, practitioners of the belief are driven underground, and the ‘pandemic’ spreads even more easily.
This is no argument that Nigeria is a developing country with majority of her citizens surviving as daily income earners with prevalent low and middle economic status. Hence, an endeavour to halt even a day activity could spell a whole lot of damages and difficulty especially for those living on below one dollar a day.
But then, envisage those tender hearts exposed to the dangers of this deadly virus, and afterwards left as orphans; those aged parents left childless, without anyone to properly care for them owing to loss to COVID-19; or a whole family/community turn vulnerable to this pandemic or the like due to the quest of one man to satisfy himself and probably family. Do sit over the judgement yourself…
The inconveniences raised by the lockdown are so obvious and heavy to bear we all can testify but a life infected with disease – such a deadly one at that – I am sure won’t see life as worth living any longer. Not at all once declared a victim by a medical doctor. Just then unannounced, unenforced lockdown commences unknowingly as hospitalization sets in.
To all those still at doubting end, please wake up to reality. COVID-19 is real, even in our country!
The extension of the lockdown is expected to add to the hardship of millions of Nigerians living hand-to-mouth, often on less than a dollar a day. But despite those realities, changing the restrictions can only spell doom for many; unless gradually done with caution. Let us all therefore cope as we pray for God’s mercies and speedy intervention.
With the dead from COVID-19 being buried in their thousands, it is no time to lecture with emphasis on how we should live. It is rather an opportunity to act on the lessons gotten from this crisis as we go forward.
One once wrote, “The Earth is the only world known so far to harbour life, There is no where else…to which our species could migrate… like it or not, for the moment the Earth is where we make our stand”.
And right now, that stand is against a virus of our own making(it is thought that COVID-19 originated in a live animal market in Wuhan, China and such establishments are a fetid mixing bowl for disease, supplied as they are by illegal wide life trade) – a crisis that stopped the human world turning on its axis.
It is indeed a frightening and scarcely credible time in which to be living given to the corona virus induced economic hardship, as well as liberty and religious arguments.
Against all odds, we can only be helping ourselves to end the spread of COVID-19 when we clearly adhere to the necessary precautions/recommendations in place even as the government consider gradual, cautious, informed relaxation.
For ‘our posturings, our imagined self-importance, the delusion that we have some privileged position in the universe, are challenged by this point of pale light. Our planet is a lonely speck in the great enveloping cosmic dark. In our obscurity, in all this vastness, there is no hint that help will come from elsewhere to save us from ourselves’ unless we so wish, wake, and work.
Stay At Home, Safe, & Creative.
Manage As Much As You Can.
Help Someone All You Can.
Light & Love,
IGBOKWE, Daniel O.F
Public Health 4/4, ABSU.