The Economy as a Determinant of Pandemic Deaths

The strong relationship between socioeconomic contexts and the health of individuals and populations has long been settled science and a core tenet of public health.¹ Measuring effects and examining possible causal pathways, however, is an ongoing challenge for researchers and policymakers alike.^2,3

Brenner’s article (p. 1950) discusses, based on innovative methods, possible effects of the COVID-19–related economic downturn on economic and health indicators in the United States, focusing on excess deaths as a result of economic strife. Putting those effects into perspective, he also analyzes the health repercussions of the long recession that has afflicted the United States through much of the past decades, which also helps to demonstrate that some of the bad repercussions can happen in the short term.

The two accompanying editorials, by Pagán (p. 1947) and Nguyen et al. (p. 1944), both stress key issues raised by Brenner: (1) The pandemic had a clear negative effect on the economy that was responsible for an important amount of excess deaths. (2) The recession disproportionately affected communities of color and was independent of the implementation of social distancing measures. (3) Increases in the health care workforce can attenuate some of the repercussions of the debilitated economy on the population’s health.

The role of health care and prevention in softening the blow of economic hazards has been observed elsewhere; for instance, during one of the worst periods of the Brazilian economy throughout the 1980s, infant mortality, which has always been closely associated with general living conditions, kept steadily declining.⁴ This has been interpreted as a result of the expansion of the country’s immunization program combined with specific measures addressing low-weight infants in the poorer regions. Community health workers tracked children’s development to detect early signs of malnutrition, and oral rehydration therapy was implemented at the onset of cases of diarrhea.

The articles by Brenner, Pagán, and Nguyen et al. correctly point to the need to expand the public health workforce and provide wider access to health care as urgent measures to counter the broad negative repercussions of the pandemic, including its economic consequences. Nguyen et al. further emphasizes the need to incorporate research from other disciplinary fields, such as economics and labor markets, to better understand causal relationships in the economic system as well as its intersections with people’s health and possible pathways to alleviate the impact of economic downturns in socioeconomic inequalities and their repercussions on health.

There is, however, a limit to what public health interventions can achieve without addressing what many social epidemiologists have dubbed “the causes of causes,” that is, the overall structural social and economic issues that push entire populations into heightened vulnerability to poor health.

Economic programs that reduce wages and public spending to restore balanced state budgets⁵ have been shown to slow down economic recovery and further penalize the already fragile segments of the population.⁶ Discrimination based on race, gender, and sexual orientation further compounds the problem.

To achieve the long-sought aim of “health for all,” overarching political, economic, and social change is necessary to address the fundamental drivers of poor health and inequality.⁷ Without ensuring that everyone has adequate housing, good jobs, proper education, food security, and protection against all forms of discrimination—in summary, the bare minimum for a decent life—public health personnel will still be compensating for the damage and not building on fair foundations.