Commentary paper:COVID-19, public health, and the politics of prevention

Reference:

Mykhalovskiy, E., & French, M. (2020). COVID‐19, public health, and the politics of prevention. Sociology of Health & Illness, 42(8), e4-e15.

INTRODUCTION

Like past epidemics, COVID-19 has been characterised by widespread fear and anxiety, social disruption and dramatic inequalities of suffering and death. The incredible speed with which COVID-19 has become a worldwide phenomenon, the dramatic force of public health responses, and the endless cacophony of information about the virus and pandemic strain collective efforts to make sense of what is going on.

In thinking and writing about COVID-19 we have found the notion of the ‘politics of prevention’ a helpful orienting concept. Much sociological writing on public health and on epidemics is coordinated conceptually by trajectories of thought about risk and risk governance (Bunton et al. 2003, Petersen and Bunton 1997, Petersen and Lupton 1996, Polzer and Power 2016). This makes good sense, given the centrality of technologies and discourses of risk within public health. And yet, the established possibilities for critique afforded by risk thinking, including the now characteristic, if belaboured, focus on neoliberal forms of healthy citizenship and governance of the self, seem too limited to fully address the political, social and economic consequences of the public health response to COVID-19. 

In this commentary, we suggest how the politics of prevention can act as a heuristic device for framing reflections on key dimensions of the public health response to the COVID-19 pandemic. (05)

THE POLITICS OF PREVENTION

We recognise that a range of public health measures including physical distancing, isolation, quarantine, handwashing, wearing masks, the temporary closure of public spaces, testing and contact tracing may be necessary to control the COVID-19 pandemic. And yet, we are concerned that these measures and the manner in which they are enforced may aggravate structural inequalities based on intersections of race, gender, class and other dimensions of social differentiation. (O5-O6)

The phrase politics of prevention is used widely in the social science literature to signal a critical disposition towards cross-cutting ideological, political, economic, scientific, technological and cultural developments that support or discourage a range of preventive initiatives related to disease and injury (Mamo and Epstein 2014, Padamsee 2017, Roumeliotis 2015, Stewart 2016).

AIM OF THIS PAPER

We thus explore the politics of prevention as a matter of tensions internal to the project of limiting the reach of infectious disease. Doing so reanimates longstanding social justice traditions associated with public health, while focusing attention on structural inequalities that, at times, are not fully addressed by other modalities of critique. (O6)

CONCLUSION

~Prevention walks a tightrope between action and inaction, between promising and pretending (Freeman 1992: 46).

Historian Charles Rosenberg has famously drawn on dramaturgical metaphors to think about epidemic trajectories. Each pandemic repeats patterns from previous epidemics, while exerting its unique character through a plot line of increasing ‘revelatory tension’, crises ‘of individual and collective character’, and eventual slow closure (Rosenberg 1989:2). (O10)

As we watch the horrible spectre of dramatic increases in COVID-19 across the world, following efforts to ease lockdown, we imagine that the virus will be with us for some time, and that when (or if) a biomedical intervention emerges, questions of access to treatment, which reflect extant inequalities, will continue to hamper the pandemic response.

Indeed, to invest all of our hopes in a biomedical intervention is to remain precariously perched on a prevention tightrope, stuck between promising and pretending. To get out of this dizzying situation, governments can articulate a new politics of prevention, one more active than reactive, which produces knowledge about systemic racism and other structural forms of inequality, and which truly intervenes on the social determinants of health. We do not need to wait for the discovery of a magic molecule; we can take action today to alleviate poverty and improve living conditions and wellbeing. (010)