During the Covid-19 pandemic, individuals have made personal sacrifices for broader public health. However, the UK has suffered one of the highest death tolls in the world, in part due to poor understanding of public needs and the lack of fully integrating citizens into the system.
Under 20% of those asked to self-isolate have done so fully, because of low statutory sick pay- only £95.85- and because of a lack of education in schools about data and scientific relationships, meaning many have a poor understanding of public health so are less likely to follow directives, such as when they are asymptomatic but need to isolate. Over-centralisation has also been an issue, with centrally-run Test and Trace only contacting 67% of close contacts in October 2020 compared to 97% for local council-run teams, showing the need to listen to those on the ground in communities to provide support for public health, such as knocking on the doors of those who have been traced as in Blackburn. Moreover, when Leicester GPs telephoned vaccine refusers, five-eighths decided to take a vaccine, showing the power of local initiatives.
One way of integrating the public into public health is through better education about data analysis, correlation-causation relationships and health itself. Children of secondary-school age should learn in greater depth about how to interpret relationships between two data sets and how to determine if data is reliable, accurate, representative and useful, and teachers could test these skills using materials appropriate to the subject, such as comparing average income with level of education for Geography. Pupils could then produce personal projects on data trends of a subject that interests them in their community, which would allow them to put their skills into practice. At a national level, both GCSE and A-Level papers could place more weight on interpretation than repetition, which would show how well students apply knowledge and respond to data. Funding could also be increased for school clubs that involve exercise or short courses teaching how to cook healthy food on a budget to reduce the chance of becoming overweight, and for earlier education on safe sex to reduce teen pregnancy and STI transmission.
From a public health perspective, this would allow them to recognise false data, such as Andrew Wakefield’s infamous vaccine study, meaning they would take sensible health decisions such as self-isolating or healthy eating. They would also understand public health decisions better and thus be more likely to trust them, as someone who understood asymptomatic transmission relationships would be more willing to self-isolate. Finally, policymakers of the future will take better decisions if they understand data about risks in the event of a future pandemic, meaning the UK will be better prepared and not take decisions contrary to data, such as the Eat Out to Help Out scheme, which the University of Warwick estimates caused 8 to 17% of new infections in summer 2020.
However, education alone will not help involve the public. Another important way to incentivise supporting public health would be an increase in statutory sick pay. Currently this stands at £95.85 per week, the second-lowest in Europe and £425 below the average weekly wage in November 2020, according to the ONS. Lower-paid workers have often not been able to afford self-isolation because of the loss in earnings despite facing triple the risk of higher-paid counterparts, meaning infection rates have been increased by those who cannot afford to do otherwise. An increase in sick pay to the weekly living wage of £326 is needed not just for Covid-19 but permanently, as illness will disproportionately affect those on lower wages who cannot risk taking time off to recover from it. If workers know they will not fall into debt ( as 43% said they would if self-isolating), they will be more willing to recover at home and thus not transmit pathogens to other workers, reducing the likelihood of outbreaks like the one that affected 560 DVLA employees in December 2020.
Sick pay should also be extended to those earning under £120 a week and to the self-employed, which would benefit 6.8m workers. Many “self-employed” workers are in fact on zero-hours contracts earning below minimum wage, such as Amazon warehouse workers and delivery drivers, and are in high-risk environments that put them at even greater risk of illness, meaning greater sick pay is needed to ensure they can survive if sick as their wages are very low. This would require a slight tax increase to fund it, but long-term economic benefits would be derived from workers not underperforming because they were ill and from fewer workers being infected by someone coming in while sick.
Most importantly, local knowledge must be used by public health teams. Test-and-trace teams run at council level have proved better at reaching contacts during the pandemic than outsourced national ones because of their knowledge of factors affecting the area; in Bavaria , local contact tracers pinpointed an outbreak to one worker at a factory canteen, enabling rapid containment. Post-pandemic, we should keeping scaled-back tracing teams to deal with local outbreaks of diseases like flu to prevent unnecessary harm. Advert campaigns could be used to encourage symptomatic people to be tested and they would be urged to take time off work and avoid seeing vulnerable and elderly people. Once traced, councils could then dispatch workers to offer support to those who are seriously ill or at risk of debt while ill. High-risk areas could also have tests offered at workplaces and schools to track spread, helping economically long-term as fewer workers became sick as transmission was lowered. The UK would also be better prepared for a future pandemic, as testing could be built from existing networks.
Local knowledge could also be applied to public health education and strategy. In areas with obesity problems, students could study relationships between obesity and life expectancy, and business grants could be funded for shops selling healthy food or offering exercise, and community figures, like religious leaders, could be used to help propagate messaging.
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