Health, the foundation on which to rethink the economy?

The current health crisis is demonstrating how closely interwoven ethical, medical and political issues are.

Florence Caeymaex is a Senior FNRS Research Fellow within the ULiège Political Philosophy Research Unit, and will take over the presidency of the Bioethics Advisory Committee in May. In this interview, she questions our health system in terms of ethical issues.

How do you view the crisis we are currently going through?

The current health crisis reveals how ethical, medical and political issues are completely interwoven. Everything is interrelated. Let's take the example of "patient triage" at the hospital. This modus operandi - the prioritisation of patients - applies in crisis situations all over the world when resources are scarce. Early on, the Belgian Society of Intensive Care Medicine (SIZ) issued an ethical opinion on this practice, recommending that access to intensive care units be reserved as a priority for those for whom it is medically relevant - listing a series of criteria for this purpose. This is known as "proportionality of care". The ethics committee of KUL also published a text on this subject, which the ethics committee of the Liège CHU used as a reference.

To sum up, elderly people who are very frail, i.e. who are highly dependent and have significant comorbidities (chronic diseases, cognitive disorders), should not be given priority care in intensive care units because treatments may not be successful, or may even prove fatal. Indeed, this procedure is frequently used and is generally seen as "common sense".

Consequently, in the current circumstances, elderly residents in nursing homes are no longer transported to hospital, even if their condition requires it. However, hospitals do not only offer heavy or invasive intensive care, indeed, many elderly patients are now being deprived of adequate treatment, especially palliative care. And it is probably the care home staff who were unwittingly a vector for the Covid-19 contamination, since they lacked the necessary protective equipment. That is the scandal! The question then becomes an eminently social one: what fate do we reserve for the elderly in our societies? Therefore, after starting with medical ethics, we have now arrived at a social and political question.

To give another example, we now know that there has been a virulent outbreak of infection in Seine-Saint-Denis in the suburbs of Paris, and another in a suburb of Lyon. Furthermore, it seems clear that in the United States, the black American population is particularly affected by the coronavirus. It is still suspected that obesity is an aggravating risk factor in the event of contamination because the virus causes an inflammatory reaction, which is stronger in overweight people, who also frequently suffer from respiratory problems, high blood pressure, etc. We also know that obesity is a factor in what are referred to as social inequalities in health. There is, therefore, an intimate relationship between social conditions and the level of risk posed by the virus; social precariousness exposes people to greater risk.

Consequently, the aforementioned "proportionality of care" indirectly favours people who have few or no co-morbidities, i.e. those who belong to the wealthy classes. This, therefore, raises serious questions about our health system, as well as about the structural inequalities that affect our social life.

With this in mind, what does the future hold?

Let us be clear, this pandemic will not be the last. Disasters which have brought serious health consequences have already occurred in the past - heat waves, hurricanes, as well as HIV, SARS in 2003, and other viruses whose links with the environmental crisis are now well established. How can we accept the fact that the "economic recovery" our leaders are talking about is, once again, based on over-production, which is destroying not only our environment but also our health?

In the future, how can we tolerate the excesses of the food industry, which are often denounced and which cause diabetes and obesity? Doctors have hypothesised that antihypertension drugs may have indirectly activated the cellular receptors of the virus in some people. Shouldn't this make us question our very conception of health? There is an urgent need to rethink the way economic activity will resume, and to re-examine how it should be transformed.

The crisis we are experiencing is revealing the major importance of health, both that of humans and that of the Earth. I hope that health, in its broader sense, will be the basis for rethinking the economy.