The national lockdown was justifiable to protect the nation's intensive care capacity. But any prolonged lockdown and border closure will cause economic issues that lead to broader, indirect problems for our health and wellbeing, writes Professor Grant Guilford.
In a caring society it is right that we do our utmost to reduce the risks to lives posed by Covid-19. However, in so doing we must be careful not to be lured into an unduly short-term view at the expense of the long-term health and wellbeing of our citizens.
Approximately 33,000 people die in New Zealand each year. The leading causes of death are cancer, heart attacks, strokes and chronic lower respiratory diseases, with cancer deaths making up 30 percent of all deaths. Among these deaths are approximately 550 suicides each year. Reducing these major causes of death requires a first-world health system coupled with wider investments in societal wellbeing (remember the Wellbeing Budget?).
The investment required to enhance health and wellbeing is derived from business activity. New Zealanders in work pay income tax; companies in surplus pay company tax; and spending incurs a goods and services tax. It is this money that provides for sustainable investment in health and other public services. Put simply, public services can only be as strong as the business community that supports them – provided of course that that business community is appropriately regulated to ensure societal and environmental outcomes cannot be neglected.
The lockdown imposed by the Government was a justifiable precaution to reduce the likelihood that the Covid-19 epidemic would overwhelm our intensive care capacity. With the benefit of hindsight, however, it appears that New Zealand’s ‘Covid-19 curve’ began to flatten well before the benefits of the lockdown were expected to occur. This suggests factors pre-dating the lockdown – such as our demographic profile, our outdoor lifestyle, social distancing, self-isolation and contact tracing – were already mitigating the severity of the epidemic here. Nonetheless, on the evidence available to the Government at the time it made its decision, the lockdown was a sensible step and one that aligned with the prevailing public sentiment.
Yet we should not lose sight of the fact the lockdown is creating both short-term and long-term detrimental effects on health and wellbeing. Thousands of elective procedures have been cancelled, jeopardising the health of many patients. The tax dollars needed to invest in the highly trained professionals, pharmaceuticals and facilities required by a high performing health sector are rapidly evaporating.
The resulting impoverishment will compromise our progress in reducing deaths from cancer, heart disease and the other major diseases that afflict our population. The training of new health professionals has been compromised and research into the health priorities of New Zealanders has been curtailed. Unemployment is becoming widespread and with it comes a loss of wellbeing and a significant increase in the risk of suicide, psychosocial disorders such as alcohol abuse, and the diseases of poverty, including meningitis and rheumatic fever – all placing more demand on the health system.
While it has been suggested this short-term lockdown is better for the economy than a less-restrictive approach, it is unclear whether there is any compelling evidence to support that view. Moreover, the Government’s talk of prolonged closure of the borders in order to try and eliminate a virus that is highly likely to become endemic in the rest of the world condemns New Zealand to long-term isolation without a near-term exit strategy. Cross-border trade involves not only the flow of product but also of services, people, investment and ideas. Without such trade, our communities are likely to wither and be at risk of growing insularity and intolerance.
When the New Zealand public looks back on the response to Covid-19 they won’t be judging success by whether we went ‘faster’ or ‘harder’ than other governments. Instead, we will want to know whether the Government’s response was balanced and proportionate.
Specifically, was the response proportionate to the risks posed to the citizenry from the virus? Were the short-term and long-term consequences to health and wellbeing appropriately balanced? Were the impacts on younger members of society who bear the brunt of the financial consequences appropriately weighed against the interests of the elderly members who carry the highest health risks? And were the impacts on low-paid wage earners and disadvantaged communities who will fall deeper into poverty appropriately considered and compensated?
Certainly, extending the lockdown beyond four weeks and prolonging border closures would be the right thing to do only if it saves more lives than it costs.