The Conservative government’s strategy to combat the COVID 19 pandemic includes a range of measures, which have developed over time, culminating in advising the British public to stay at home other than venturing out for food, health reasons, or work.
This paper will use McConnell’s (2010) three dimensions of policy success to critically evaluate the measures: programme success, process success and political success. It will examine the strategy’s impact through the lens of the social determinants of health and their causes (Ratcliff, 2017). It will question whether the government’s approach to rising levels of infection and mortality, which initially aimed to empower people to make choices regarding their safety, ignore the external forces which shape decisions.
Botterill and Hindmoor (2012) argue that facts that were once contested by researchers are undisputed in policies. This was apparent within the government’s initial ‘herd immunity’ strategy. The government adopted a different strategy from the ones its European neighbours followed. Rather than insist on social distancing from the outset, the government continued to keep shops, businesses and schools open believing this would result in a ‘herd immunity’ that would protect vulnerable groups from infection (MIT, 2016). Arguably, they did not want to deliver the seemingly draconian or politically divisive ‘lockdown’ measures that the rest of Europe were delivering in order to avoid the sensationalist headlines in figure 3.
Figure 3 (Russel, 2020)
Boero (2013), argues that media reportage has influenced policy. The population’s knowledge of science is filtered through the media, which selectively report on, and oversimplify, scientific issues. The sensationalist language of such reports, as seen in figure 3, drives government policy.
The ‘herd immunity’ strategy was met with strong criticism with over 100 scientists writing to the government urging them to introduce tougher measures (Financial Times, 2020). Favouring a simplified scientific view over politics can be used to deliver an easier response to difficult political issues.
Response to the pandemic.
Russo (2011) asserts that policies should be causally based rather than specifically founded on evidence. Decisions based on risk factors, such as going out to work or visiting family, don’t examine the causes of such behaviour. In this way, the government’s pandemic policy process, in McConnell’s (2010) terms, is a ‘precarious success’ (McConnell, 2010, p.352). Issues concerning empirical scientific data and the influence of the media in constructing concerns around ‘herd immunity’ damages the legitimacy of the policy.
Helping People Make Safe Choices
As part of its strategy, the government offered advice through daily press briefings and short information films. What the government have not examined is that the people from lower socioeconomic backgrounds are disadvantaged regarding opportunities to work from home or socially distance. Many socially disadvantaged people are employed as keyworkers who provide a vital role in enabling society to function; refuse collectors, shelf stackers, supermarket attendants, cleaners, nurses and care-workers for example. Such roles are vital, never more so than during a state of emergency. Without venturing to work they would lose their incomes. In tackling the pandemic, the government are nudging individuals to make safe choices rather than acting on the structural inequalities in neoliberal societies.
Neoliberalism is an economic policy model that emphasises minimum state intervention. It became a vital part of government policy in the UK when it was placed at the centre of economic policy (Cobo, 2018). Foucault (1991) asserts that neoliberal governments depend on populations accepting their directives voluntarily rather than adopting punitive measures. From a Foucauldian perspective, Lupton (2018) argues that Neoliberal governments use policy documents to normalise their population and make them more productive. Individuals who are positioned as being vulnerable are expected to change their lifestyles. The government’s strategy has placed the population as lacking the right information regarding keeping safe. The government believed that providing correct information would lead to behaviour change. However, such an approach lacks an awareness of the complexity of an individual’s health-related behaviours which are embedded in socioeconomic and cultural perspectives.
The government’s policy presumes that individuals lack knowledge regarding safe practices and therefore don’t take accountability for their own health. It is questionable whether a ‘nudge strategy’ based on personal motivation through guidance can induce mass behaviour change in an inequitable environment where the social-determinants of health impact on the level or risk individuals take regarding their safety.
Policies driven by neoliberal ideologies of individualism are not sufficient to combat structural inequalities that limit safe choices. This strategy is unsustainable as it is focused on the whole of society rather than the barriers to health that affect specific groups and communities. Strategies targeted at society as a whole mean that only those who are economically privileged can make safe choices, thus widening inequalities. Sectors that are economically marginalised become discounted as essential targets for such campaigns.
Using McConnel’s (2010) policy success framework, a judgement of ‘precarious success’ can be applied to the government’s strategy policy programme and politics due to its weak legitimacy in tackling a complex issue (McConnel, 2010, p.358). Laitin and Edelman (1978) observe that words might succeed where policies fail; this argument is relevant to the government’s daily press and information campaigns. The Conservative party’s popularity has been boosted over their handling of the Coronavirus (Malnick, 2020). However, their strategy has targeted the behaviour of the majority of the populace at medium or low risk and had little effect on an individual level. Consequently, this suppresses the validity of the public health message, where the lay public becomes aware of the inconsistency of health communications.
Focusing on individuals diverts attention from the broader factors at work; the vast evidence of structural determinants of health is absent from the strategy. The government uses a basic formula of suggesting the opposite behaviour in order to prevent infection (Kelly and Russo, 2017). Using daily press briefings and information films to educate the public about social distancing is ineffective and unsustainable because knowledge about safety is only one part of the decision to socially distance. Processes used to understand a health concern are not the same as those which prevent risk. Such practise which ignore the inequalities affecting choice and do not take into account structural inequalities are not sufficient to deal with complex issues.
An argument for success would be to uncouple the pandemic strategy from the politics. Successful public policy (such as tobacco control) is far greater than the time between elections (Kelly and Russo, 2017). The government’s initial policy of ‘herd immunity’, in supporting people to make safe choices assumes that health-related behaviour change can be connected in a straightforward process. It has avoided the complexity of the sociological sciences. Affecting individual choices, to change behaviour, is only as good as the choices available. With rising food poverty, austerity measures, and a widening equity gap, such decisions are limited.
Bacon, L. (2010) Health at Every Size: The Surprising Truth About Your Weight, Dallas: Benbella Books.
Baggott, R. (2012). Policy Success and Public Health: The Case of Public Health in England. Journal of Social Policy, [online] 41(2), pp.391-408. Available via ProQuest. [Accessed 31st January 2020]
Boero, N. (2013). Obesity in the media: social science weighs in. Critical Public Health, [online]23(3), pp.371-380. Available via Sage [Accessed 16th December 2019]
Botterill, L. and Hindmoor, A. (2012). Turtles all the way down: bounded rationality in an evidence-based age. Policy Studies, [online] 33(5), pp.367-379. Available via Elsevier. [Accessed 16th December 2019]
Brownwell, K. and Warner, K. (2009). The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food?. Milbank Quarterly, [online] 87(1), pp.259-294. Available via Sage [Accessed 16th December 2019]
Cobo, R (2018) The Political Economy of Prostitution and Women’s Human Rights. Canadian Women’s Studies [online] 33(1-2) p99-106. Available via ProQuest [accessed 16th October 2019]
Drewnowski, A. (2009). Obesity, diets, and social inequalities. Nutrition Reviews, [online] 67, pp.S36-S39. Available via Sage [Accessed 16th December 2019]
Foucault, M. (1991) Governmentality, in G. Burchell, C. Gordon and P. Miller (eds) The Foucault Effect: Studies in Governmentality, Hemel Hempstead: Harvester Wheatsheaf, 87-104.
Jebb, S., Aveyard, P. and Hawkes, C. (2013). The evolution of policy and actions to tackle obesity in England. Obesity Reviews, [online]14, pp.42-59. Available via Sage [Accessed 16th December 2019]
Kelly, M. and Russo, F. (2017). Causal narratives in public health: the difference between mechanisms of aetiology and mechanisms of prevention in non-communicable diseases. Sociology of Health & Illness, [online] 40(1), pp.82-99. Available via ProQuest [Accessed 12th December 2019]
Laitin, D. and Edelman, M. (1978). Political Language: Words that Succeed and Policies that Fail. Contemporary Sociology, [online] 7(5), p.615. Available via Sage [Accessed 16th December 2019]
Russel. G., 2020. ‘A national emergency’: what the papers say about the UK’s coronavirus lockdown. The Guardian [online], 24th March 2020. Available at: https://www.theguardian.com/world/2020/mar/24/a-national-emergency-how-the-uk-papers-covered-the-coronavirus-lockdown
[Accessed 1st April 2020]
Legge, D., Wilson, G., Butler, P., Wright, M., McBride, T. and Attewell, R. (1996) Best practice in primary Health care. Australian Journal of Primary Health [online], 2, 12-26. Available via Sage. [Accessed 2nd February 2020]
Lupton, D. (2018). Fat. 2nd ed. Oxford. Routledge.
Malnick, E., (2020) Public Confidence in Boris Johnson’s handling of Coronavirus epidemic soars after lockdown.The Telegraph [online], 28th March 2020 Available at: https://www.telegraph.co.uk/politics/2020/03/28/public-confidence-boris-johnsons-handling-coronavirus-epidemic/ [accessed 1st April 2020]
McConnell, A. (2010). Policy Success, Policy Failure and Grey Areas In-Between. Journal of Public Policy, [online] 30(3), pp.345-362. Available via: ProQuest Central. [Accessed 7th December 2019]
MIT Technology Review (2020) The UK is scrambling to correct its coronavirus strategy. MIT Technology Review [online]. 16th March 2020. Available at www.technologyreveiw.com/f/615369/uk-dropping-coronavvurys-herd-immunity-strategy-250000-dead/ [accesed 1st April 2020]
Ratcliff, K. (2017). The Social Determinants of Health: Looking Upstream [eBook]. Polity Press. Available via: ProQuest Ebook Central [accessed 2nd January 2020]
Russo, F. (2011). Public health policy, evidence, and causation: lessons from the studies on obesity. Medicine, Health Care and Philosophy, [online]15(2), pp.141-151. Available via Sage [Accessed 16th December 2019]
The Social Determinants of health and health inequalities: a resource book. [online] Available at: https://www.who.int/social_determinants/publications/9789241548625/en/ [accessed 8th February 2020]
Sally Squires is a part-time MA student in Public Health at Nottingham Trent University as well as Assistant Headteacher and Chair of The Mustard Seed Project, Uganda. Sally’s interests lie in development work and gender equality, and how neoliberal economics impact on society. Twitter: @SallyESquires