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Beyond the roadmap

I recently returned from a COVID-secure holiday (as far as is possible) to Scotland. Preventative measures included: a private cabin on a sleeper train from London to Inverness, staying in a ‘pod’ on the Isle of Skye, eating lots of salmon (aids physical distancing), travelling by ferry (on deck) and walking and cycling (huge thanks to Andy Bike) around North Uist (recently made famous by the Channel 4 documentary The Scottish Island that Won the Lottery) which has a world-beating natural ventilation system (the wind) and where you are more likely to come into contact with a lamb or a loch than a human.

International travel is unlikely to take off over the summer months. We all have a unique opportunity to explore Britain’s stunning coastline, countryside and cities in a safe and respectful way. This will provide a lifeline to the tourism and hospitality sectors and remind us of the adventures available closer to home. Enjoy it. 

Of course, it would be naïve to romanticise the Highlands and Islands as simply a playground for urban calm-seekers. These are communities where the normal ups and downs of life and work happen, albeit against the backdrop of breathtaking scenery. Whilst population densities are lower and physical distancing (this term is used more widely than social distancing in Scotland) therefore easier, health infrastructure and capacity is often less resilient, and many people and places are dependent on the parts of economy hardest hit during the pandemic.

It is unsurprising that we have found ourselves experiencing a pause in the roadmap. Many argue, for understandable reasons, that the economy is being hampered by restrictions. They neglect to mention that recovery can only be built from a position of confidence. This is impossible if a virus spreads unchecked through the population. The root of the economic harm is the virus, not the measures.

The end of the roadmap is nonetheless in sight, and we need to cast an eye beyond the horizon. Not because the virus is over but because of the consensus that we have to 'live with' it until we can achieve low or no COVID-19. There is a strong and simplistic political movement to ‘get COVID-19 done’ – we all want to see the back of the illness, death and damage it has caused. However, we should not rush to push aside the lessons we have learnt about our society and economy. 

The picture rural communities and islands paint for us, in primary colours, is of the relationship between our environment and our health outcomes. Some circumstances favour the spread of COVID-19, some make it easier to limit. The conditions around us, and they vary from place to place, shape our health and wellbeing more broadly. Few make the leap from intrepid tourist to putting down a deposit on a derelict croft. There are though public policies we can chose together if we genuinely want to improve our health and wellbeing. We do not have to accept the health harms caused by industries that profit from death and disease. There is no reason why millions of children need to grow up in poverty. Insecure and poorly paid work can be improved. It is possible for everyone to live in decent housing. Treatment services are not the only lens through which to view health. 

We should not wait for the end of the current roadmap to discuss the next one – which must be about how we Build Back Healthier (the subject of a past blog). The government has yet to seriously contest ‘the future’ with potentially era-defining concepts like ‘levelling up’ parked in the realm of rhetoric.  

There are five things to consider when thinking about the future of public health beyond the roadmap – crafting a language that makes sense to the public and politicians, securing effective enablers (a new public health system and long-term investment), developing ambitious policies, ensuring clear measures of success and accountability, and promoting a model of leadership that acts on injustices.

The public health community needs a story that chimes with the times; that satisfies both the desire to go back to normal and forward to something better and fairer.


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