Learning lessons on prevention the hard way. The COVID-19 inquiry highlights the importance of creating healthy places
TRUUD’s Director for Research Impact, Professor Gabriel Scally, explores the links between what we are learning from the COVID-19 inquiry and our mission to reduce non-communicable disease through healthier place-making.
The COVID-19 inquiry has delivered some fascinating insights into how government can function, or misfunction, at a critical time. As the inquiry goes on, hopefully, there will be some consideration of how the way we live our lives contributed to our well-being or our ill health during the pandemic. It also highlights areas very relevant to the TRUUD project coordinated by the University of Bristol.
The pandemic struck when it was starting to become clear that the UK was experiencing a massive public health crisis that was invisible to most of the population and many of our political and community leaders. For the first time in more than a century, the population’s life expectancy has ceased to grow steadily. Instead, the lengthening of the UK population’s lifespan was coming to a screeching halt. For some groups in society, notably women living in the most deprived communities, life expectancy was falling.
There are helpful analyses of our health status that show where the opportunity to prevent premature deaths lies. About one-third of the deaths can potentially be prevented by medical interventions and two-thirds by actions that are real primary prevention and have their effect by altering the determinants of health or ill health. The COVID-19 pandemic, in its early stages, showed just how vital these broader determinants of health are. The avoidance of catching the potentially lethal virus depended on avoiding breathing in air contaminated by virus particles. This avoidance of illness was determined to some extent by individual mask-wearing but also by the ability of people to live their lives in work, educational, social, and home environments where they could be safe and sure of breathing fresh or purified air.
Reluctance, or failure, to control the spread of COVID-19 at critical moments made it necessary to put in place legal restrictions that turned people’s lives upside down. Restrictions on movement placed a premium on people in urban areas, having places near them where they could exercise and shop for the necessities of life. Parks and other public spaces became overcrowded in some locations, and access had to be restricted. The urban parks created in the Victorian era, and sometimes even earlier, were of enormous importance during the worst of the pandemic. But their inadequacy raises the question of who is constructing the new public open places of today and for future generations. Similarly, the absence of fresh or purified on much of the transport network (and in workplaces) restricted the choices of those, such as the clinically vulnerable, who were determined to avoid becoming infected. Walking and cycling in our towns and cities became vital for many people trying to live their daily lives.
Another infectious disease pandemic will happen, which is highly likely to be due to an airborne pathogen. The excellent news for preventing this from causing another huge death toll is that the lessons for prevention are apparent. Clean air, active travel and bountiful open green spaces are also the correct responses to a range of non-communicable diseases. A double-winner health improvement and protection approach is within our grasp. The TRUUD project delivers the transdisciplinary knowledge, expertise and new tools created with industry and government partners, that can enable us to make the changes that would keep us all safe.