Loewenson R, Accoe K, Bajpai N, et al, Reclaiming comprehensive public health, BMJ Global Health 2020; 5:e003886.
Over the past 6 months, we have witnessed diversity in the spread and severity of the COVID-19 and in the nature and timing of responses to it in different countries and contexts. Acute emergencies often mobilise a short spurt of attention and resources. COVID-19 is, however, a protracted pandemic that spreads through and exacerbates socioeconomic inequalities and stresses health and democratic systems in a way that calls for sustained responses from local to global levels.
The ways that different governments have responded to COVID-19 highlight the long-standing tensions between different frameworks and approaches to public health. Broadly characterised, one approach views people as rights holders who should actively be engaged in proactive interventions that address the social determinants of health, in a way that is respectful of rights and of collective human security. In contrast, the second approach sees people as the objects of reactive technical, biomedical ‘command-and-control’ interventions, with biosecurity measures to protect populations against harmful pathogens rapidly implemented alongside authoritarian and militarised approaches when epidemics are seen to threaten socioeconomic and political interests and security. Both approaches integrate knowledge and technology, but do so in different ways and to different ends. While these two frameworks have coexisted, contested and been applied, sometimes together, for over two centuries, COVID-19 has exacerbated the tension between them. This has longer term implications for how public health is understood and health challenges effectively addressed.
In this piece, the authors highlight deficiencies and harms of a dominant biosecurity, authoritarian framing of public health. They argue for a comprehensive, participatory, inclusive public health approach that integrates rights, social dimensions and diverse sources of knowledge, evidence and innovation and that maintains equity as a critical goal.