When a succession of strikes hit the London Underground system people had to find new ways to get around the city. Many discovered faster and more pleasant ways to travel, having been misled on the geography of London by the iconic design of the Tube map. For some the new behaviour stuck.
Might the coronavirus panic similarly produce lasting change? It is easy to imagine that it could. One of the most serious problems of the dominance of the NHS in health, is that ‘health’ and the NHS are too often taken to be synonymous. They are not. Health is mostly a product of education, income, and the environment in which we live, through their impact on behaviour and on living standards. We have too readily delegated health almost entirely to the health service, and have institutionalised public health.
Coronavirus is serving as a dramatic reminder that public health is a product of our own behaviour: Exercising responsibility for ourselves, and for the impact of our behaviours on each other. Whilst the NHS may deliver world-class high-tech treatment, it cannot wash our hands for us. Whilst flu vaccination is now available for many through the NHS, the coronavirus outbreak has not only revealed the weakness of a strategy based so heavily on vaccination, but also the high risk we all face from the transfer of pathogens within a very mobile and crowded world.
In these situations a health system is also largely incapable of fulfilling its usual role of managing the consequences of our own poor behaviour. There is no hospital cure for coronavirus, just as there is no cure for the common cold. Prevention really is the best medicine, and it is (literally) in our own hands.
We are herd animals and our own behaviours affect other people’s behaviours. If one person leaves the lavatory without washing their hands, it will be more likely that the next person will follow suit. Actions which we may have thought just affected ourselves, also have extensive third-party and spillover effects. The role of such behavioural norms is shown by the substantial variation in the proportion of users of city public transport with faecal material on their hands; research revealed a national average of 28% contamination, but ranging from 13% in London to 43% in Newcastle. Perhaps the current viral outbreak will change this situation in a way never achieved by formal public health campaigning.
Seasonal flu kills around 4,000 to 14,000 people a year in England and Wales, and generates 10,000 hospitalisations. Globally it kills up to 650,000 people every year. Regular hand washing is the simplest preventative measure. Self-isolation is the best strategy for symptomatic people to prevent onward transmission. If coronavirus can rebuild levels of personal responsibility for health then this novel virus will be a cloud with a very significant silver lining.
Its impact may not be limited to health behaviours, but range much more widely. The sudden change in travel decisions may have profound effects on work patterns. Businesses that have already invested in AI, other technologies, and in flexible working, may find themselves more resilient, and therefore more productive through periods of substantial workforce sickness. On the other hand it has highlighted the vulnerability of the ‘gig economy’, deterrents to the use of public transport, and the risks associated with reliance on imported food and other basic goods. Only time will tell whether we have each learnt essential lessons from this. None of these are readily solved by state action. Their resolution is largely within the simple decisions we all take as individuals on a daily basis. It is in our hands.