Intended for healthcare professionals

Letters Covid-19: turning the world upside down

Covid-19: planning a future that focuses on sustainability, health, and social value

BMJ 2020; 369 doi: (Published 14 May 2020) Cite this as: BMJ 2020;369:m1919
  1. Ali Mehdi, consultant orthopaedic surgeon
  1. Borders General Hospital, Melrose TD6 9BS, UK
  1. orthopaedix{at}

The need for international solidarity, as discussed by Kickbusch and colleagues, has never been greater.1 Political, economic, social, technological, legal, and environmental factors are key determinants of society, of which healthcare is an integral part. The effects of covid-19 on these factors have been elaborated widely in different ways. Mankind faces many challenges in recovering from the existential threat these pose.

Political gain, financial return, and material acquisition are key barriers towards more sustainable living and protecting our planet effectively—which environmental campaigners have spent decades calling for. Reluctance to suffer economic loss delayed quarantine measures, instead causing unprecedented economic meltdown.

This is the real wake-up call, a time to reflect on how we plan our “new” future in the same way that planners of the welfare state did during the second world war. Crisis can be a time in which we learn and grow.

There is a long held wisdom that if an organisation looks after the interests of people and empowers them, it achieves sustainable financial success through social capital. Now is the time for organisations, including those in healthcare, to ensure that success for people, organisations, and nations is measured using a balance of social value, wellbeing, sustainability, and employee engagement as much as customer or patient care, efficiency, and profit. And governments need to legislate this into action.

World leaders need to put aside the trade wars, military conflict, nationalism, sectarianism, and self-interest that have plagued the 21st century. They must show responsible leadership that serves the interest of all legitimate stakeholders, the environment, and the future.

An urgent international consensus is necessary, like the Bretton Woods Agreement in 1944, which established the financial order after the second world war. Globalisation of sustainability, health, and social value should be the core mission.


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