Our response to COVID-19 and thoughts for the future

Our annual work plan for 2020-21 was approved at the end of March. However, the context in which this plan was produced has changed, and continues to change, rapidly.

The COVID-19 pandemic and its associated mitigation and control measures have had a substantial impact on us all. As the crisis containment phase continues, many are beginning to think about what comes next when the time becomes right for the current restrictions to ease and the process of recovery for our services, communities and society begins.   

As our previous work on resilience has outlined, recovering from a shock or crisis rarely means getting back to an earlier pre-crisis state. Instead, a new set of circumstances are often generated by both the crisis and the response to it.  A period of collective reflection can support us to make sense of the crisis but also assess what new ways of being became possible. This can have implications for how we understand the economy, services and what we value in the relationship between individuals and society. Our learning, both historically and in our current work plan, is led by our headline purpose to support new approaches and inform action to improve the city’s health and tackle inequality.  This ethos will continue to support our partners in services, communities, the statutory and voluntary sector as we navigate the recovery phase of the pandemic.

It is important that we see the world post COVID-19 not as an entirely new set of challenges but more as an altered landscape in which some of the existing challenges to population health are thrown into new relief. For example, before the crisis, we knew poverty and inequality made a significant contribution to the city’s mortality rates. Already intelligence from those working at the front-line, in poverty advocacy and our own partnership, Children’s Neighbourhoods Scotland, is  highlighting the scale of the crisis for individuals, families and services which, although made visible by COVID-19 response measures, were already present as challenges and stressors in our communities. Experiences of poverty, inequality, insecure work, the complex and varied experience of deprivation and discrimination as well as social isolation may well lead us to question the degree to which our existing systems can mitigate the impacts of major crises for many in the city. 

Yet at the same time, our societal response feels unprecedented and not without sources of hope. There has been renewed recognition of the importance of social protection for our collective as well as individual wellbeing, of the value of caring roles both formal and informal as essential to our collective resilience and a focus on the importance of the connections between us for our mental and physical health. We have also seen changes in experiences and practices of how we work and the value of our public services and spaces as incontestable societal goods.

In time, the contribution that existing stressors associated with poverty made to Glasgow’s experience of COVID-19 will become even clearer as more data becomes available.  However, something we can already see is that as we collectively build our post-pandemic reality, a renewed emphasis on commitments to reduce inequalities in income, wealth and power will be necessary.

Planned work

Against this backdrop, much of our planned work will continue, not as normal, but in a radically altered landscape with focus shifted accordingly. For example, planned work on developing a cross-system food plan for the city (that will promote sustainability and health) remains timely and relevant but will respond to the challenges of food insecurity presented in the wake of COVID-19 and highlight promising responses that can be built into recovery.

Developing work in support of Primary Care and mental health services will also continue but will respond to experiences and challenges brought to light by lockdown and social distancing. New possibilities for social prescribing, community link workers and the use of financial referral workers as key components for building individual and community resilience will also become visible and our continuing work in these areas will respond and collate successes and challenges accordingly.  

Our inclusive growth work exploring how economic development and population health can be aligned will respond to the current moment of disruption, where economic growth for its own sake has been suspended as a fundamental principle of economic activity and policy.  Planned work to analyse CCTV imaging and other data to monitor pedestrian movement and active travel will now provide intelligence on the impact of the COVID-19 lockdown, locally and nationally, and the use of public space as the restrictions start to ease.

Population data

Our population health observatory function and Understanding Glasgow resource, will continue to play their vital role in helping policymakers and  service planners understand and respond to emerging trends and need. As will the task of understanding the contribution COVID-19 makes to health outcomes in Glasgow, within the complexity of the prior and existing challenges the city faces in relation to poverty and their associated non-viral disease conditions. As data come available, it will be vital the context of poverty and inequality remains at the fore or the contribution it will continue to make to the city’s health profile will remain as significant as before.  

In this context, our established programmes of work on excess mortality, and national and international mortality analyses, including work on austerity-related trends, and poverty and mortality will continue. We are also conscious of the silence around questions of ethnicity in the Scottish COVID-19 discussion. The current crisis is now a key contextual factor in our planned work to understand racialisation in public health, within data, research priorities and the workforce.

New work and existing connections

New activity is also coming to the fore. A key principle of our way of working is that we proceed in a collaborative manner that recognises the need for organisations, communities and policy to work together to develop a shared commitment to create better underlying conditions to improve health.

To this end, the team are offering expertise in the immediate term to advisory groups and local and national structures which have rapidly come into being as part of wider COVID-19 responses. These include a number of Public Health Scotland’s social mitigation cells, a knowledge collation role within NHSGGC’s COVID-19 poverty response group and working with our partners in the Olympia Research Hub – Policy Scotland and the Robert Owen Centre – to promote the alignment of their academic research investments to need within the wider system. 

In the early stages of the crisis unfolding, our community engagement team identified issues emerging within the rapid first responses from the community and voluntary sector, highlighting and escalating, for example, the challenge of digital inclusion to these structures. Connected to this work we are conducting a rapid review of learning from elsewhere in relation to SARS and MERS responses designed to support recovery and renewal relevant to the process of rebuilding.

In the recovery and renewal stages, our links to community, city, regional and national structures will become more vital and we are making connections with the emerging local authority recovery infrastructure as it takes shape to ensure we can inform and influence continuing work.

Our engagement here will shape our evolving work and will be informed by our key principles of focusing on actions and solutions alongside credible data, community empowered and co-produced, and informed by the principles of social justice and socioeconomic inequalities as underlying drivers of health outcomes.

Past learning

A broad range of our past work, such as that on resilience and power, participation and community empowerment, asset-based approaches, and participatory budgeting are also extremely relevant to the post-pandemic recovery phases. We will communicate the key learning from these aspects of our work in a series of short blogs and briefings. This intention being to provide evidence and insight that can support policymakers, practitioners and communities as they readjust, rebuild and recover.

Reflection to move forward

Although a pandemic of this scale has not been seen within our collective lifetimes, the use of crisis to focus on our core values is familiar. In 2008, we hosted a conversation between Julian Tudor-Hart and David Donnison entitled “What then shall we do?” focused on societal action to reduce health inequality.

One of many insightful moments that evening was when discussion addressed what we could learn from our experience of post-war rebuilding in application to that particular moment. The speakers agreed that the tensions between what they described as the ‘have’s and ‘have nots’ present in post-war society had not been addressed in formation of the welfare state and re-emerged as tensions between the providers and users of public services.  Whereas the attempt to address the material dimensions of inequality through the welfare state was to be lauded, in failing to address societal power imbalances, the project had been left incomplete which left public services vulnerable. This tension culminated sixty years later when the narrative of the 2008 financial crash morphed into that of austerity. 

Our response to this crisis therefore must be multifaceted. It must include action to remove the material vulnerability present before COVID-19 and support the flourishing of the relational aspects that have come to the fore in the COVID-19 emergency response (many of the first responses came from grassroots and voluntary organisations). Ensuring that as wide a variety of citizens and perspectives as possible have a say in the questions we ask and choices we make around what our post COVID-19 reality looks like will also be essential to embed longevity, sustainability and fairness.