On March 11 2020 the World Health Organization declared COVID-19 a global pandemic. In the days that followed, schools across the country closed, businesses declared non-essential shut their doors, and Americans were told to stay at home. American citizens met the challenge, altering their entire way of life within days and continuing to uphold these changes 10 weeks and counting. Collectively, citizens changed their behavior for the good of the nation’s health. In remarkably short order, Americans were asked to change their behavior, and we did so, quickly and effectively flattening the curve.
Anyone who has made a New Year resolution knows that changing one’s behavior to improve one’s health is difficult at best. Public health slogans focused on individual behavior change such as “eat less, move more” have not bent the curve for obesity, heart disease, or diabetes. The dramatic declines in motor vehicle-related mortality over the past several decades have not been attributed to better driving behavior, but to seatbelt use, airbags, shatterproof glass, and laws monitoring driving while under the influence of alcohol. In other words, when we have improved health, it has seldom been because we chose to behave differently. This moment is, therefore, particularly important because so many in the past months have changed their behaviors.
As social epidemiologists, our work focuses on the determinants of determinants: that is how social context and conditions are critical to enabling people to alter lifestyles to improve health. We find ourselves then awe-struck by the way individual Americans have been able to change their behavior so quickly and for so long now in the absence of national (and in some cases local) leadership, conflicting information, and the lack of systemic support. From teachers moving all curricula online within a few days, grocery store clerks continuing to work despite threats to their health, parents with children adapting to juggling childcare with professional responsibilities, and we can change quite a bit when we felt our health depended on it. And we can do it quickly, and largely without complaint or protest.
Let us take face masks as an example. Within weeks, Americans were told to wear masks when physical distancing is not possible. In nearly all cases, individual citizens have had to fend for themselves in securing face masks, whether making their own or purchasing home-made masks from various pop businesses. And Americans have, by and large, done just this, buying or making their own masks, with polls estimating that more than half of Americans are now wearing masks outside essentially all the time.
As is perhaps always the case, this behavior change has been hardest for already vulnerable communities, those that are under-resourced, impoverished, and mostly include people of color. Infection, death rates and the economic impact are disproportionately felt in such communities. And yet, these communities have been even more likely to adopt behavior change in the face of this epidemic, bearing more of the burden of adapting to this moment, but also doing so, rising to the challenge.
We recognize that despite this massive behavior change, the nation and the world have a long way to go to defeat COVID-19. Success will require ongoing commitment of citizens, wide-spread policy changes, and scientific advances in treatment, and ultimately a vaccine. However, the pandemic has shown us what people can do. By and large, people, despite chaotic leadership at best and misinformation at worst, have done the right thing and risen to the challenge. This is a moment to pause and celebrate collective action of individual Americans who have shown us how we can change our homes, communities, and country in short order. And it suggests that we can do that and do even more once we set our minds to it. Is this then not a moment to say, let us together change the things that should also be changed? Should we not also demand a healthier world?
Can this prosocial behavior not be a lesson to all leaders that people will act positively and for the common good, even when it requires personal sacrifice? Imagine how much more we could, as a people, accomplish with effective leadership that puts our health above all else, consistently, not only in a moment of a pandemic. Our citizens have shown through their sacrifices that we want health. We have shown we want health. And yet we know that the US far lags behind other high-income countries on health.
Is it then not time for us collectively to demand health at all times? What does that look like?
That means investing in a health system instead of our current sick-care system. It means fostering the preventive conditions of health—like safe housing, good schools, livable wages, gender equity, clean air, drinkable water, a fair economy—all conditions that keep us healthy to begin with. It would require citizen engagement yes, and some change in how we do things. But we have now shown that we can do that when we recognize that our health is on the line. Isn’t now the time to learn from how we as a people have spoken to do right by our health and to create a world that generates health always, even when the pandemic is over?