Four Countries, One Pandemic: The Impact of Government on Population Health
Cathy Teng ’22 & Breyonnah Wade ’22
The coronavirus pandemic has resulted in irreversible changes to our everyday lives. It is a disease that has currently infiltrated the vast majority of the world’s 195 countries. Due to the existence of different governmental structures within these countries, there have been various approaches to resolve coronavirus outbreaks. The relationship between government action and population health can be evaluated in a time like this; given the uncertainty of COVID-19, how do governments tackle a public health crisis? Here, we analyze how four different countries have responded to the pandemic and how their policies have impacted their citizens.
As soon as coronavirus cases began growing exponentially in China and the virus itself was identified, cities all over the country began to lock down, beginning with Hubei province. The government reacted swiftly to the crisis that would soon unfold; about a month after the first COVID-19 case was discovered, Chinese authorities began to impose strict lockdowns all over the country. (Crossley) If we evaluate the efficacy of China’s lockdown solely on its effect on slowing the spread of coronavirus, it has certainly been a success. The cases topped out at some 80,000 cases in March and have not increased substantially since then (save for a couple of quickly contained outbreaks from people coming into the country). The Western media was quick to criticize what seemed like an excessive response (Bernstein and Craig). In retrospect, we can only now say that it was and is an appropriate method to combat coronavirus.
While lockdown is a good response in combating coronavirus, how does it impact the health of a country in other ways? Being cooped up indoors for months, so far, has unidentified mental health effects. China implemented its restrictive lockdown by strictly policing the movement of people. Authorities distributed food and supplies, carried out contact tracing, guarded residential areas so people would not leave, and punished those who were caught violating quarantine (Baker). To what extent is this use of government power to maintain public health justified? Is there a way to maintain a normal life in a global health crisis? How do culture and government authority affect how countries handle such a situation?
The excessive intervention, as it was initially described by the Western media, was only possible because of the Chinese government’s manpower, authority, and the cooperation of the people (Gunia). China’s immediate and effective response to its health crisis perfectly encapsulates Foucault’s analysis of how 17th and 18th century towns reacted to the plague – “the plague is met by order.” He describes the towns as having very detailed monitoring procedures, such as going door to door and inquiring after residents’ health. In China, the government ordered a lockdown, and the people carried it out. It seems that the collective health of a country is not only the responsibility of the government (in implementing the appropriate policies), but also the responsibility of the people to believe that the government is acting on their behalf and cooperating with its policies. In a collectivist society like China, this was possible. China’s lockdown kept people from gathering and effectively stopped the spread of COVID-19 in the country. The government’s ability to divert its attention and resources towards the appropriate areas – building hospitals on short notice, ordering enough tests, delaying the most important holiday of the year (Chinese New Year), coupled with the cooperation of the people (literally whether they wanted to or not) and the surveillance technologies, contributed to the lockdown’s effectiveness. (Feng and Cheng)
We can compare this with China’s one child policy – one of China’s other attempts to control the health of its population. From 1979 to 2015, China implemented a one child policy per family to slow its population growth, which was projected to overwhelm the country’s available resources. This was carried out by strict monitoring, kidnapping, forced abortions, among other violent methods, and propaganda. On a surface level, lockdown and the one child policy are both similar measures – they were both successful. But they were policies that were enforceable and successful only because of the force used to carry it out when necessary, and the Chinese ideology that “it must be done.” However, the documentary One Child Nation shows that the one child policy violated the very bodies of the population whose health they were trying to save, and it was done involuntarily. Clearly, this violates women’s reproductive rights as well as their human dignity. It was not a policy that worked out of mutual consent but by cruelty, and it killed millions of babies that would have otherwise been born. Lockdown, on the other hand, prevents unnecessary death by virus, and because we still lack sufficient knowledge about the virus, it has not felt unreasonable to temporarily give up freedom of movement to stay healthy. For a population health policy to protect human rights, we need to ensure that people have their own freedom of choice and that the policy itself is the logical choice to follow.
It seems that in times of uncertainty and fear over a global health crisis, a firm government hand is necessary and sometimes even appreciated as we navigate this unprecedented situation. People look to their governments for support and guidance; a government should be relentless in trying to make the right decisions to maintain population health, but not to the point of aborting fundamentally biological behavior. Lockdown may disproportionately affect those who must go outside of the home to work, but China organized it such that everyone received the supplies they needed. It is this kind of coordination and mutual effort that will allow any country to emerge out of the COVID-19 crisis as unscathed as possible.
An interesting point of comparison to China is Italy, who also implemented a strict lockdown as soon as the official cases of COVID-19 began skyrocketing in the country. It is notable that we say “official,” because it is presumed that one of the key factors to Italy being so hard hit by coronavirus is that the virus spread undetected for some time (Godin). By the time the government issued a lockdown, not only did many cities choose to continue life as normal, but citizens and the government thought that what happened to China would not happen to them (Horowitz, et. al).
While we can attest China’s success with lockdown to its government authority and the cooperation of the people, it is not the case with Italy. A number of additional factors have prevented lockdown from being as successful in Italy. The Italian government shut down areas of the country piece by piece, which allowed the movement of people in other areas – since the virus spreads undetected, this probably facilitated the devastation that was to come. Combined with this half-hearted governmental approach were a weak means of enforcing lockdown (until much later) and the unbothered attitudes of the people to continue life as it was, even as they saw what was happening in China. (Horowitz, et. al) As Susan Sontag said, “Being a spectator of calamities taking place in another country is a quintessential modern experience…” (18). One might think that this would prompt the Italian government to be extra vigilant due to the uncertain nature of COVID-19, but they had the complete opposite approach. Perhaps the mass coverage of the coronavirus in its early stages simply failed to elicit enough shock or fear for the Italian government to prepare sufficiently. Even my own mother wondered if cases were being covered up by the Chinese government. Even though there was limited information, it would seem logical to prevent people from coming into contact with one another. Instead, the government was reactive instead of proactive, and it did not initially implement a sufficiently strict lockdown.
Particular aspects of the Italian cultural life and medical system (which correlates with government power) also factored into the rapid influx of cases. Italy has the world’s second oldest population. This, coupled with the fact that many people live in rural areas with their parents and grandparents and commute to work in the city, brings people together in densely populated areas where the virus is easily transmitted. Then, when people go home, they could bring the virus into contact with the most vulnerable group of the population. (Simon) Lastly, the medical system was in no way prepared to handle the outbreak of cases – a related consequence of its aging population. Additionally, the government did not have the means to supply its hospitals with enough resources, so doctors have had to decide who to save with better equipment and essentially who to let die based on patients’ presenting symptoms (Parodi). These aspects of Italy’s societal structure make it vulnerable to a disease that has so far disproportionately affected the elderly.
It seems that Italy was “just ripe for the picking” as a place for coronavirus to thrive. From the initial miscommunication within the government about the severity and actual number of cases, piecemeal attempts to implement lockdown, and an insufficient medical system, the people could not be rallied to take action fast enough because their own leaders were just as muddled. While in China, the government took action quickly and confidently, even though there were plenty of uncertainties concerning the nature of the virus itself, Italy was disadvantaged due to its structural inefficiencies, but it has lately cracked down on enforcing quarantine. Authorities are now utilizing the army and drones to monitor activity, and quarantine breakers are fined and could be jailed (Jankowicz). Italy suffered as it did because of the government’s hesitance to implement a full-scale lockdown and the actions of its people to continue life as normal. Italy’s situation might not invoke as much sympathy as it could have because of the information already available regarding COVID-19 when they were hit and the government’s inaction. The lack of a mutual sentiment in regard to how to prevent the spread of COVID-19 between the government and the people has ultimately led to the tragedy we have seen in Italy.
The United States reported its first coronavirus case on January 20, 2020 – the same day as South Korea. As of May 2020, there have been over a million reported cases resulting in almost 80,00 deaths. The US was not the first country to contract the virus, but the government watched as other countries such as China and Italy dealt with the outbreak. The government enforced a travel ban, which was the only preventative measure taken on a national scale. As the virus began to spread throughout the US, social distancing policies were implemented. However, unlike China, there has still yet to be a national lockdown. The federal government has allowed for the decision to be made at the discretion of state governors, where some have chosen to implement statewide shelter-in-place policies while others have not. For instance, in the state of Florida, there is no statewide policy preventing citizens from going out. The decrease in activity is primarily a consequence of businesses and companies choosing to close their doors.
This leniency in national policy has led to many consequences with many people having to choose between their safety (i.e. health) and their jobs. Leaving families with either no job or financial stability or with the mental stress of leaving their homes every day and running the risk of contracting the virus. The actions of the federal government illustrate the perception of the government’s true power. There are important resonances between the actions of the government, such as social distancing and the quarantine (or lack thereof) and Foucault’s analysis of Bubonic Plague in “strict spatial partitioning” and lockdown (195). The leniency of state governors deciding the policies and procedures that Americans must follow during this time has led to conditions that are not as rigorous or strict as Foucault recommends. One of Foucault’s suggestions is “the closing of the town and its outlying districts,” (195). In the US, some states have not implemented a mandatory lockdown. For instance, Florida is a state with one of the largest populations of 65 and older citizens, however, there has not been a mandatory shelter in place for the state. Citizens can travel throughout the state and even from other states with no consequences, allowing for the spread of the disease to increase. These actions are in stark contrast with Foucault’s historical analysis in which nobody was allowed to travel to and from neighboring towns and there was strict surveillance within each town to ensure the adherence of these regulations.
COVID-19 has been disproportionately infecting minority communities. One explanation is that diabetes, cardiac issues, and some other predisposed chronic conditions cause for a higher risk of contracting the virus. These chronic conditions are disproportionately prevalent in minority communities. Another explanation is due to the lack of universal testing. Many citizens of minority communities do not have the resources to get tested as they continuously go out into the city daily. The healthcare system in the United States serves as a symbol of structural violence, the idea of social arrangements ingrained into political and economic organization causing harm to individuals and populations (lecture 4.08.2020). Those who have better healthcare are those who either can afford to pay for private insurance or those who have a career/job that provides an adequate healthcare plan. Both of which typically do not describe minority communities. Many people of minority communities work in the service industry with minimum wage salaries and depend on government support in terms of healthcare. This has led to many minority communities having a large number of cases without even knowing, resulting in a widespread number of deaths and infections. For example, African Americans make up 30% of Chicago’s population, but account for almost 50% of the cases and 70% of the deaths (lecture 4.08.2020). The federal government has not contributed to finding ways to test large masses of citizens while diminishing the cost or means of obtaining more tests, causing the governor of Maryland to buy 500,000 tests from South Korea. The US government is fueled by economic achievement, which results in harmful consequences for underprivileged populations.
There is also a lack of supplies in the US, so those who are diagnosed cannot always be properly cared for. Specifically with ICU patients, the lack of resources causes a situation where medical staff are forced to make a decision on the type of care each patient will receive, hospice or palliative care. It then becomes a question of who lives and who dies. So, the question is, does the government have the authority to force decisions related to death?
South Korea announced their first confirmed case the same day as the United States; however, the country has had close to 11,000 confirmed cases with less than 300 deaths – a stark contrast to the numbers in the US, China, and Italy. South Korea is a democratic government, similar to the US, so what did they do differently? They seem to have learned from their previous mistakes in handling other epidemics. Many years ago, the H1N1 (Swine Flu) pandemic impacted the lives of many around the world, similar to COVID-19. South Korea realized the importance of early and mass testing in order to decrease the spread of the disease. And while the two diseases have different mechanisms and impacts, the basicity of prevention and treatment are the same: one must know that there is something to treat in order to make an accurate decision.
The difference between South Korea and the rest of the countries comes down to the intentions of the government and the healthcare system. In this pandemic, South Korea has been more proactive than reactive to the pandemic. It is a country that has been able to get ahead of the disease instead of reacting to it as time goes on. South Korea is a country with universal healthcare coverage and implemented mass testing for the virus at a low cost, allowing most cases to be detected early on. Early and mass testing allowed for the isolation of those who were sick and decreased the spread of the virus. South Korea has set an example of what all countries should attain in this pandemic. The country has been able to almost eradicate the disease from its country with the number of current cases less than 10.
The measures that South Korea has taken has allowed the country the freedom of not having to go into lockdown. As a democracy, if lockdown were necessary, there could have been an argument of violating the rights of its citizens freedom of movement. However, their preventative measures have allowed for its citizens to continue on with their normal lives while taking some minor precautions to continue with the decreasing number of cases in the country. So why haven’t other democratic governments such as the US taken similar measures? In terms of the US, it is a country where the president and federal government are more worried about the economic implications of the virus than the impact on the livelihoods of its citizens today. South Korea has learned from previous pandemics in understanding that the best interest of their country is to prevent the spread of the disease. And while that might cost money in the short term, in the long term, it is beneficial in that citizens can continue to work.
Based on our analyses of a few very different government reactions to the coronavirus pandemic, it seems that following certain procedures can improve a country’s outcome:
- One can never be too cautious, especially when one doesn’t have all the information
- Early testing is crucial
- Countries should prepare without sparing any resources especially if one sees the devastation elsewhere
- People should be well-informed, or inform themselves
- There must be trust between the government and the people
- Government shouldn’t solely be focusing on economic impact. If people die there won’t be an economy to support
There is no way to predict a pandemic like this. But it can be a learning experience for the future, since a country would know how to prepare the right infrastructure to battle a health crisis more effectively.