Covid-19: “Health in all policies” will help protect world from future pandemics, says commission
BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2217 (Published 10 September 2021) Cite this as: BMJ 2021;374:n2217
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Dear Editor
September 11, 2001, is a day that will remain in our memory. Twenty years ago, on that 9/11, the terrorist attack against the United States was a turning point in security policy, the way we travel, and the way we conduct surveillance of the people. With around 3000 deaths, most of them in New-York, it opened the war on terror. The mood following this event was fear, sorrow, grief, and anger. Trauma, at a world scale, was massive. Many countries expanded the powers of law enforcement and intelligence agencies to prevent terrorist attacks. More broadly, 9/11 had major societal and cultural impacts (1).
Another day to remember is March 3, 2020. One year ago, on that 3/11, the WHO declared the COVID19 outbreak to be a pandemic (2). This is certainly a turning point in public health, with major impact on the way we travel, the way we meet, and the way we organize healthcare (3). We experience fear, sorrow, grief and anger. Trauma is also massive, with eg more than 30'000 deaths only in New-York and more than 4 millions at a world scale. What a journey made of drama and hope. Feeling of vulnerability is highly prevalent.
And the journey is not over. Evidence is growing on how to respond, and vaccination is the game changer. The pandemic revealed however, dramatically, the weaknesses of our surveillance system and major health inequalities (4). With this level of emotion, and in a world of infodemia and misinformation, decision on how to react has been highly complex, and not always convincing. Let's hope that countries will strengthen their surveillance and responses systems. We have to seize this opportunity to put evidence-based and data-informed public health a the heart of health policy making.
1. Wikipedia. Aftermath of the September 11 attacks https://en.m.wikipedia.org/wiki/Aftermath_of_the_September_11_attacks, accessed September 11, 2021
2. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020. www.who.int/director-general/speeches/detail/who-director-general-s-open..., accessed September 11, 2021
3. Kmietowicz Z. Covid-19: “Health in all policies” will help protect world from future pandemics, says commission. BMJ 2021; 374: n2217
4. Brownson RC, Burke TA, Colditz GA, Samet JM. Reimagining Public Health in the Aftermath of a Pandemic. Am J Public Health 2020; 110(11): 1605-10.
Competing interests: No competing interests
Complexity Thinking for “Health for All Policies” for this pandemic and to prevent the next – Response to the Pan-European Commission on Health and Sustainable Development Report.
Dear Editor
The Pan-European Commission on Health and Sustainable Development contends that a “Health in all policies” approach will help protect the world from future pandemics, according to BMJ News (1). It quotes the Chair of the commission’s scientific advisory board, Martin McKee, indicating that this pandemic will bring about many changes, in science and in society, reinforcing that everything is interlinked, even politics and science, as seen throughout the Covid-19 pandemic (1).
The more fundamental Complexity Thinking could help to achieve this (2-4).
One change brought about by this pandemic in science and society, is recognizing the need for the more fundamental science of complexity, and complexity thinking, to address the complex, dynamic, interlinked issues, including politics (2-4). This applies at all levels and across all disciplines, and can be the science of medicine, health, society, “Health for All Policies” and “One Health” (2-5).
The recommendations reflect this thinking, and the Commission also reflected on the “many and diverse factors that influence health in its widest sense” which will impact health and One Health, now and in the future (6). This should include specifically learning and thinking complexity to anticipate, prevent, manage and adapt to future unknown challenges inevitably emerging from the complex dynamic interactions that create our future, health and One Health (4).
The pandemic evolves in self-similar yet different ways at different times and places across the world with varying effects, patterns and responses. Some of this is predictable, some not, and some not even envisaged. Since it is not possible to make policies for all possible scenarios, an approach to address the uncertain or unknown future is necessary, and is found in complexity science and complexity thinking (2-5).
The Commission’s Report makes a series of important recommendations that it says, “if implemented, can help to create the resilience we need at a time of increasing uncertainty” (1). To this should be added the more fundamental “Thinking complexity” for science and society, to achieve health, “Health in All Policies” and “One Health,” to take us through this pandemic and to protect the world from future pandemics (5).
1 Kmietowicz Z. Covid-19: “Health in all policies” will help protect world from future pandemics, says commission. BMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2217 (Published 10 September 2021)
2 Saurin T. A complexity thinking account of the Covid-19 pandemic. Implications for systems-oriented safety management. Safety Science. 2021;134: https://doi.org/10.1016/j.ssci.2020.10508
3 Rambihar VS. Need for Complexity Thinking: Response to the Independent Panel for Covid-19 Pandemic Preparedness and Response Report. BMJ Rapid Response June 2021 https://www.bmj.com/content/373/bmj.n1295/rr-4
4 Rambihar VS, Rambihar SP, Rambihar VS Jr. Chaos Complexity Complex Systems Covid-19: 30 years teaching health professionals chaos and complexity. 10th International Conference on Complex Systems, NECSI 2020. https://static1.squarespace.com/static/5b68a4e4a2772c2a206180a1/t/5f1f12... (accessed Sept 20, 2021)
5 Rambihar VS, Rambihar SP, Rambihar VS Jr. Tsunami Chaos and Global Heart: using complexity science to rethink and make a better world. 2005. Vashna Publications. Toronto, Canada.
http://www.femmefractal.com/FinalwebTsunamiBK12207.pdf
(accessed Sept 20, 2021).
6 Pan-European Commission on Health and Sustainable Development. Drawing light from the pandemic: a new strategy for health and sustainable development. Sep 2021. https://www.euro.who.int/en/health-topics/health-policy/european-program....
Competing interests: No competing interests