Editorial
Health as a foundation for society
In 2020, a virus that thrived on chronic disease and
inequality became the great revealer. COVID-19 revealed
the fragility of civilisations built on social injustices,
short-term policies, and a dangerous disregard for the
environment. The need to become more resilient to
crises of all kinds is almost universally agreed on. But to
construct that resilience, a philosophical change in how
we care for each other and our environment must be
made. Health improvement is the guiding principle to lead
a recovery away from regressive policies that harm the
most vulnerable (and will result in future catastrophes)
and point us towards change that supports equity
and sustainability, and reinvigorates the Sustainable
Development Goal agenda.
Societies start and end with the collective security of
the planet. Climate stabilisation must be the cornerstone
of the 2020s and beyond, closely entwined with equity.
Equity for now, but also for future generations. 2020
was supposed to be the year that The Lancet focused on
child and adolescent health, but many of our initiatives
were delayed. 2021 demands renewed activity. The
Lancet Countdown on climate and health and our 2020
WHO–UNICEF–Lancet Commission, A future for the world’s
children?, will continue to investigate the impacts of the
climate crisis on health and the type of environment that
young people can expect to inherit, ahead of COP26.
Countries might justifiably start to look inward to
repair the damage after COVID-19. But equitable access,
whether to a vaccine, food, or finance, will require global
collaboration. The health community should nurture
and encourage multilateral partnerships, in which
countries share responsibility for each other, as the best
way to build strong and just institutions. A complex,
synergistic relationship exists between the environment,
conflict, migration, and equity, in which the desire for
good health is a common denominator. As reported in
a World Report, a record number of people will require
humanitarian assistance in 2021. The Lancet will publish
a Series on women and children living in conflict-affected
areas (representing over half of all women and children),
and a standing Commission on migration and health will
investigate these dynamic relationships.
COVID-19 has proven that the economic and political
success of individual countries is founded on the
health of its population. The disproportionate impact of
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COVID-19 on the USA has made clear where the Trump
administration’s lack of public health response and
espousal of health-harming policies have accelerated
negative outcomes. A forthcoming Lancet Commission
on public policy and health in the Trump era will serve as a
FatCamera/Getty Images
call to action for the new Biden administration to refresh
the way health is valued in the USA. Without health, there
is no productivity, no GDP, no trade, and no education.
The case for universal health coverage has never
been clearer; yet it has not guaranteed success against For more on humanitarian need
in 2021 see World Report
COVID-19. The UK NHS is a renowned universal health- page 12
care system, but years of underfunding and short-term For the Health Policy on global
political agendas have led to an unnecessarily poor health security and universal
health coverage see
response to COVID-19. The Lancet Commission on the Health Policy page 61
NHS will be published in early 2021 and explores how
a system run on efficiency and restricted resources has
resulted in a lag in life expectancy and infant mortality
compared with other high-income countries. Health-care
systems will need to prioritise resilience and sustainability
to overcome the collective challenges of shifting demo­
graphics, climate change, and increased demand.
This week, a Health Policy piece in The Lancet scrutinises
the disparities between a global health security agenda
and fragmented universal health coverage systems. It
indicates that a new understanding of preparedness must
develop—one that appreciates that the baseline level of
health in a population dictates how well a country will
fare in a crisis. New Zealand and Germany are examples
of countries whose sustained investment in the health of
their people has paid off during COVID-19.
In 2020, death featured as a shared human experience.
The Lancet Commission on the value of death argues for
a reanalysis of dying. How populations collectively value
the health of individual lives (and deaths), irrespective of
age or economic activity, prime a society’s overarching
ideology and predicate the humanity and identity of a
state. For a long time, health has been considered by
politicians as secondary to other aspects of governing:
an added bonus that can be moulded, a budget that can
be reallocated, a policy that can be sidelined, instead
of the driving force of a functioning economy. In 2021,
The Lancet will continue to put social justice at the centre
of our work, and we will strengthen our commitment to
argue for health as a foundational value and outcome for
all other aspects of society. n The Lancet