Three years ago this week, it sank in that this coronavirus thing was serious. I’d just attended a conference in London that, with hindsight, may have been a superspreader event. Hospitals were filling up. Several million deaths from the virus were — correctly — being predicted. Every plan you’d made was being cancelled. On March 11 2020, the World Health Organization declared Covid-19 a pandemic. Many of us spent the next two months indoors.
That spring transported us into a new era that will probably last our lifetimes. It’s an era in which the top priority of rich countries is not consumption or climate or defence but health. Leaving aside the virus, our societies are the oldest in history, and getting older. Overwhelmed health services may never return to the barely manageable levels of demand of 2019. The past three years offer an early glimpse of the health-focused society.
Longer lives are modernity’s best achievement, but also the priciest. More older people means more healthcare, more long-term care and more pensions. Democracies will spend that money, pushed by the ever-growing “grey vote”. That means the post-Covid big-state era will be the new normal. Then add on the costs inflicted by climate change. (We’ll scrimp on preventing it.)
The first rule of this new era: less consumption. The traditional American presumption “that each generation will live better than its parents” is already being buried, an artefact of the growth years of 1946-2007.
Health and social care, which even in 2019 accounted for one in 10 jobs in rich countries, will become the go-to recruiters for anyone made redundant by artificial intelligence. That could help keep a long-term lid on unemployment. Rich countries will train more doctors and nurses, but as young people grow scarce, we will also keep importing immigrants. Immigration-obsessed politics is becoming a relic of the September 2001-February 2020 era (bar the UK government’s preoccupation with small boats).
But the most important factor in keeping people healthy isn’t healthcare. “Restricted access to medical care accounts for about 10 per cent of premature death,” concluded scholars Robert Kaplan and Arnold Milstein in their review of existing research. Diet, smoking and exercise matter more. The extreme case is the US: it outspends everyone else on healthcare, yet Americans now live seven years less than Spaniards.
So the health-focused society must emphasise prevention over cure. That means attacking obesity (and McDonald’s) the way we previously attacked smoking (and Philip Morris). For instance, only 13 per cent of British adults now smoke, following decades of decline, but obesity in England has jumped to 26 per cent. The NHS today spends about one-tenth of its budget on diabetes.
Better to stop people getting type 2 diabetes in the first place. How? In 2020, Dutch academics analysed 51 interventions that aimed to improve public health. They found that the biggest boost came from a tax on junk food, while the most cost-effective policy was “restriction on television commercials with high sugar/high-fat foods and beverages for children”. True, a tax on junk food would hit poorer people, who eat more of it, but we could support them with other payments or tax exemptions. And their health would benefit most. You can deride this as “the nanny state”, but it’s generally the state that has to pay for obesity.
We can also overhaul work to improve workers’ physical and mental health. The four-day week seems to achieve that without hurting business, and also leaves people more time to care for elderly parents. After a big recent British trial, 92 per cent of participating companies decided to stick with four days.
We can remodel cities to favour exercise. A walkable city like Barcelona makes you healthier, whereas car-dominated Dallas makes you sick. One in 10 premature deaths worldwide could be prevented if everyone did just 11 minutes of brisk walking a day, found a University of Cambridge-led review of academic papers covering more than 30 million participants.
We can put public pools in every neighbourhood, hire more tennis coaches and dance teachers and build Spanish-style adult playgrounds. In Madrid recently, I watched an old lady pushing up weights with her ankles as she sat on a park bench. In my neighbourhood park in Paris, a group of local Chinese geriatrics gather every morning for exercise. All this improves community too. Sure, it costs money. But we’re currently scrimping on parks and pools so as to spend more on diabetes.
The society of early March 2020 is gone for ever. That needn’t be all bad.
Follow Simon on Twitter @KuperSimon and email him at simon.kuper@ft.com
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