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 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 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 COVID-19. The UK NHS is a renowned universal health-care system, but years of underfunding and short-term political agendas have led to an unnecessarily poor response to COVID-19. The Lancet Commission on the 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 demographics, 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.

Article Info Publication History Identification DOI: https://doi.org/10.1016/S0140-6736(20)32751-3 Copyright © 2020 Elsevier Ltd. All rights reserved. ScienceDirect Access this article on ScienceDirect