COVID-19 and the wider determinants of wellbeing

Brendan Bonner, Assistant Director at the Public Health Agency, explores the determinants of wellbeing and the protective role they can play against the virus and its effects on communities. To view our complete series of COVID-19 blogs, click here.

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Many reviews of the COVID-19 pandemic will explore individual health and clinical factors, especially with those who were affected by or died from COVID-19. 

Our built environment and the movement of people is a key factor in the spread of COVID-19. The delay between viral infection and the development of easily detectable symptoms has made the spread impossible to control through traditional infection control measures.

Social distancing is an unprecedented strategy by government to stop the spread of COVID-19. In the future, we will see the design of communities, cities and landscapes that enable people to move around much more freely and with reduced risk of disease transmission. Consider active travel and town planning that facilitates it. During a pandemic like COVID-19, we no longer consider our transport system as safe as before, due to passenger proximity and overcrowding, but neither can we revert back to car dependence, without expecting a negative impact upon physical fitness, obesity and diabetes, fossil fuel consumption and carbon emissions.

The concept of sustainable homes has changed already in these early months of COVID-19. Our homes have become very different. They have become multifunctional assets as opposed to places where we ‘just live’.  In future we will want to ensure homes within which we can live, work, play and learn. 

An anticipated outcome from social distancing is the impact on air quality, which may impact on heart attacks, asthma and other conditions potentially affected by air pollution. Indeed social distancing may have unintended but beneficial consequences to those with existing respiratory conditions, leaving them less vulnerable to the clinical effects of COVID-19.

Digital technologies have come to the fore in public health during this pandemic, but there is still much room for development. Real-time health surveillance, digital testing and delivery of support interventions have already been stepped up in the response to COVID-19.  Future proofing public health, and indeed pandemic proofing it, will require significant imagination and much faster development of technology.

Well-publicised scenes of food stockpiling and of empty supermarket shelves are a key challenge we need to explore. On one hand the value of breastfeeding is even more increased than usual, offering a natural source of nutrition for babies that is not at the mercy of the food supply chain. On the other hand, we need to learn about the challenges that supply chain issues present in terms of food poverty, healthy diet, nutrition and obesity. How do we support healthy diet when farm workers in rural areas have not been able to get access to the land and when food production plants have had to close or reduce their output?

Work and education have dramatically changed in a matter of weeks. We have a whole-population opportunity to look at flexible working arrangements that can benefit families, volunteers and the environment. Our houses are currently a testbed for new ways to facilitate our children’s learning and to further develop home-school partnership.

Economic pressures presented early in this pandemic and in its recovery period, the full economic fallout will become clear. There is a risk of widening existing inequalities.  During the global financial crisis of 2008, those who suffered the greatest were those who had already been experiencing inequalities. We have a duty to protect the most vulnerable from any COVID-19 economic downturn or austerity. 

We may see a further shift in demographics. We had been experiencing an ageing population but the virus has been particularly severe on older people. There may also be a baby boom in late 2020/early 2021, creating good news for many families (but not all) and putting a different pressure on health and social care, in particular our maternity and paediatric services.

The good news continues in that we will move out of crisis. We will return to a different sense of community and physical connectedness. We have experienced the positive contribution that digital technology can make in helping us keep connected during social distancing. In line with the 5 ways to wellbeing the importance of connection will remain and we will not rely so much on digital technology, but value its support for those who are physical further away from us. 

Coronavirus has already provided new opportunities and challenges for public health. We have a duty to capitalise on the evolution of our knowledge, applied learning, improved technologies and data sources and to ensure that “Out of adversity comes opportunity” (Benjamin Franklin).

To view our complete series of COVID-19 blogs, click here.

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