The Health State: Bafflement Essay #4

When the historians and political theorists of the future look back on the past two years, they’ll see the emergence of a new social contract in western society.

As the Covid crisis draws to a close, it’s unclear how lasting the effects of this new deal are going to be. Is it going to turn out, as was initially promised, to be a temporary response? Or has it, as some fear and others hope, set a new template for life to come, at least in some places? While recent weeks have seen some countries returning to normality, others such as Canada are still under authoritarian measures, while some governments are introducing new laws to make the emergency pandemic legislation permanent.

The World Health Organisation is in the process of negotiating an international treaty to establish a framework for a global response to future pandemics. The agreement, which the European Union wants to be legally binding, would give the organisation significantly more power and, as these human rights experts point out, ‘could lead to a situation where both the WHO and states instantly spring into ‘emergency mode’ without there being a solid scientific or legal basis for such action, ordering strict public health measures that are likely to excessively limit or even derogate from human rights.’

If these sorts of plans are adopted, there would be a permanent change to the social contract at the heart of liberal democracy, the system that has governed western society for the past couple of hundred years. What would this new deal involve, and what would it be like in the health state?

This Bafflement Essay will explore these questions by way of philosophy and the perceptible, evidential world of public policy. The former, as a domain where ideas are articulated and their implications considered, is one I’ve taught and loved; the latter is a world where words and deeds can be tracked and assessed and one I know well from a former career as a public policy journalist and time as an activist on the left.

Backwards and forwards we’ll go, into the past and onto a possible future.

First, a look at the recent past.

II

How did it all start, the forging of this new contract?

Recently, I was chatting to an Italian postgraduate in Lisbon about his interrupted studies and life under lockdown. Since Italy was the country that pioneered this new approach to infectious disease in the West, I put this question to him.

For years, he said, the Italian government had under-funded the health service. When Covid came, the debate centred on the fact that the health service wouldn’t be able to cope; there weren’t enough beds in the ICUs. ‘But there were only a few to start with, so of course there wouldn’t be enough,’ he shrugged.

The answer, in all its vivid simplicity, gave me an insight into modern society’s contradictory attitudes towards healthcare. On the one hand, it’s unthinkable that the health service should not be able to meet our needs; on the other, its capacity has been reduced in many countries with little, if any, public discussion of the implications. The resulting combination of high expectations and low resources has made western populations suggestible, vulnerable to claims about simple solutions and untried approaches.

When lockdowns were first tried in early 2020, they were new not just to the West but to the world. When the Chinese authorities lockdowned Hubei province on January 23rd 2020, the in-country representative of the World Health Organisation stressed the novelty of the approach: ‘Trying to contain a city of 11 million people is new to science … The lockdown of 11 million people is unprecedented in public health history, so it is certainly not a recommendation the WHO has made.’

Yet only a month later, the WHO had changed its position dramatically: ‘China’s uncompromising and rigorous use of non-pharmaceutical measures to contain transmission of the COVID-19 virus in multiple settings provides vital lessons for the global response,’ read the report of the WHO-China Joint Mission after a visit to China. In a series of developments chronicled by Michael B Senger, it seems that a combination of high level discussions with the Chinese authorities and an extensive social media campaign turned what had previously been unthinkable into the only way to respond to the new disease. The western media heightened the drama of the threat, publishing pictures of people suddenly collapsing dead in the street – see this article in the Sun and this one in the Guardian. (1)

On March 9th, Italy became the first western country to lockdown and, over the next few weeks, the recommendations of the Chinese Center for Disease Control were implemented across the world. In Europe, Sweden held back, as did Britain. On March 13, according to Senger, Boris Johnson’s Twitter account was bombarded with tweets comparing Britain’s approach to genocide. Meanwhile domestically, a populist rhetoric focusing on the evils of ‘herd immunity’ had developed and, driven in part by pressure from trade unions, Britain locked down on March 23rd.

Adopting The Idea from China meant jettisoning all previous pandemic plans and, once embarked on, the new approach took on a momentum that was difficult to stop. What was presented as a few weeks of staying home while the government worked out how to organise healthcare became, in the UK, one of the world’s longest lockdowns. Imposing restrictions on the population’s ability to go about their daily lives had become a habit: in the winter of 2021/2022 new restrictions in England were only narrowly avoided by objections from the Cabinet followed by revelations that, actually, government ministers had never been that worried about Covid at all. Meanwhile restrictions, including fines for going to work, continued in Scotland and Wales and Northern Ireland.

What made Britain – a society defined by its democratic and liberal traditions – so ready to abandon its core principles and way of life?

A full answer would need to deal with a cultural preoccupation with safety, fear of death and the widespread anxiety and social atomisation that I touched on in a previous essay. And, as Laura Dodsworth has documented in A State of Fear, a strategy of behavioural psychology was deliberately used to frighten the population into compliance. (2)

The role of the National Health Service to British society is key to understanding how the bargain was struck. The NHS – ‘almost a god’, some would say – was central to the public’s acceptance of the new deal. A contract is an exchange, a giving of something in return for something else; in this case, the sacrifices of lockdown were made for the body that made Britain caring, civilised and safe: in other words, it represented the nation or society.

It’s worth remembering that the NHS, with a staff of around 1.5 million, is the largest employer in the UK and is thoroughly embedded in the life of the nation. There's an influential infrastructure around it, a network of professional bodies and think-tanks staffed by clever people, specialists able to advocate for the needs of an organisation as big as it is complicated. NHS staff and experts can keep up-to-date with developments by reading the specialist media that reports on it, the chief of which is the Health Service Journal. This by way of background for what follows.

And so it was that, amid rainbows on windows and clapping on doorsteps, the entire population of the British Isles Stayed In To Save The NHS.

Meanwhile, from the health service itself came a kind of rhetoric I had never heard before. Its tone was dramatic as, via broadcast and social media, NHS staff and advocates stressed the scale of the catastrophe, the pressure on the workforce and, above all, the need for the public to follow the rules. At times the injunctions were accompanied by complaints about incomplete compliance, at others by calls for more restrictions. As the weeks rolled into months I started to feel that, whatever the public did, it would never be enough. But what struck me even more forcibly was how fairly and squarely the burden for what went on in the nation’s hospitals had been placed on ordinary people and what they did, down to the tiniest detail.

(The drama wasn't, I should add, shared by my two neighbours who worked for the NHS. One rolled her eyes at 'the world gone mad', saying nobody did social distancing in her department, while the other was having a quiet time on the non-Covid ward where which she worked.)

In late 2021, after the UK had finally come out of lockdown, NHS advocates were calling for new restrictions. At their forefront was Matthew Taylor, chief executive of the NHS Confederation, the body that represents NHS organisations in England. The call for the re-introduction of face masks and limits on indoor gatherings was couched in language that psychologists call ‘minimising’, describing them as ‘inconveniences’ which might be ‘annoying’ to people. In the run-up to Christmas the call was renewed in some curious doublespeak: while NHS leaders were not calling for more restrictions, they felt it important to point out that they were inevitable – ‘when rather than if’.

And here’s the deputy editor of the Health Service Journal tweeting the Prime Minister to point out that more restrictions would lighten the burden on the health service in ways that extended well beyond Covid:

As a journalist whose beat used to include the NHS, I find the arrogation of this new relationship between the health service and citizen utterly baffling.

From the late 1990s to the late 2000s I often spoke to the people in the NHS and its supporting eco-system. I interviewed a chief medical officer or two, the deputy CMO and the head of the NHS. The interviews were long – the complexities of the sector made for a geeky subject aimed at a specialist readership and my interviewees seemed, frankly, delighted to have someone taking so much interest. I interviewed Tessa Jowell as public health minister – then a ministerial appointment so junior that I struggled to find subjects of political substance to ask her about. Back then, government aspirations around public health were modest, focusing on issues such as to how persuade the public to stop smoking and eat more fruit and veg.

I don’t remember the details of what my interviewees said, but I do recall a broad consensus about the issues – health service capacity was a problem to which there wasn’t an easy answer, demands on the service were rising due to high expectations from the public and the growing costs of new treatments. The general view was that expectations had to be managed; a more honest conversation about investment and the rationing of treatments would help. And in a service designed to be run fairly close to capacity, ‘winter pressures’ were to be expected.

Fast forward to 2021 and I might as well have been in another world, one governed by entirely different values. The NHS was still there, as were its surrounding organisations, in some cases staffed by the same people, although sporting different job titles. But the policy landscape and the political rhetoric were unrecognisable. Touring the websites of the think tanks and professional bodies, I found, instead of a policy debate about the big questions facing the health service in the age of Covid, a series of silences and evasions. Where was the assessment of attempts to improve capacity in the twenty months following the first lockdown? Where was the discussion of whether measures known to create new health problems might be adding to the burden on the NHS? And where – the biggest elephant in the room – was the discussion of the costs and trade-offs involved in running what might be a long-running booster programme?

On the vexed question of mandatory vaccination for health service workers and the loss of staff it would bring about, this blog for the Nuffield Trust simply dodged the question: ‘Unpicking such arguments sits within the sphere of expertise of bioethicists and others. So our focus lies in a related question: given the policy, what can be done to mitigate the downsides?’ 

I would love to travel back in time to see the faces of those of the NHS high-ups I used to talk to, to hear their responses to questions about whether the lives of the entire population should be determined, down to the tiniest, most personal detail, by the capacity of the health service and the needs of its workforce. I imagine the more gracious of them would smile and point out that they were public servants; such a thing was not appropriate in a western society. Others might bring the conversation to a speedy conclusion and make a mental note not to speak to that crazy woman again.

III

Let’s take a peep futurewards now. How would the health state differ from western society as we have known it?

Set in the context of human history over the past few thousand years, liberal democracy is a recent thing. You could even say it’s something of an experiment, an attempt to develop a form of self-government that protects people against the ever-present possibility of domination by those seeking to further their own interests through the exploitation of populations and lands, institutions and resources. For most of recorded history, oligarchy and autocracy has been the norm – wealthy and military elites, emperors and pharaohs, tsars and monarchs have been the ones holding the power. And yet, as David Stasavage points out in this excellent piece, democracy has also been around for more or less forever, in different forms, all over the world. Its defining feature is its attempt to keep power in the hands of the people, from which it follows that the rulers depend, for their legitimacy, on consent.

In modern liberal democracy, consent is framed in terms of a social contract: an agreement to exchange the freedoms of the state of nature for the protections of civil society. For Hobbes, the founding autocrat of the contractarian tradition, the trade-offs in giving up a life that would be ‘nasty, brutish and short’ were sufficient to justify rule by a sovereign. Consent was implicit and notional, as in: ‘do you want to be killed by marauding bandits? No? Well, obey your King then.’ But for subsequent social contract theorists such as Locke, consent had to be explicit and ongoing: the legitimacy of government and your obligation to obey its laws only extended as far as it respected your inherent rights.

The idea that autonomy is essential for human flourishing is key to liberalism. As a political tradition that evolved in the West along with the rise of property ownership, liberal democracy is sometimes criticised for its individualism. But the growing power of the middle classes in the nineteenth century led liberal minds to recognise that democracies contained their own conformist forces which, if unchecked, could lead to the oppression of minorities. Mill’s insight into the ‘tyranny of the majority’ created a formulation of liberalism which placed limits on what could be imposed in a free society that applied to both individuals and groups. It laid the ground for a political system in which minority rights were protected, regardless of the majority’s current thinking about sexuality, race or whatever.

And so we get to the western democracies of the late twentieth century, liberal societies predicated on an appreciation of human diversity, an enshrinement of the rights of all in a constitutional framework and a culture of tolerance and freedom.

Of course, these general principles only go so far when confronted with the complexities of decision-making in modern life. There are many competing claims and perspectives, different needs and preferences, depending on peoples’ situations, experiences and alliances, with respect to every area of public life. And here the work of John Rawls comes into its own. The twentieth-century political philosopher sought to reconcile the tensions between liberty and equality (or liberalism and collectivism, right and left) and develop a form of practical reasoning that could produce socially just outcomes.

Rawls came up with a thought experiment: suppose every member of society were to decide which course of action they would like in any given situation from behind a ‘veil of ignorance’ that prevented them from knowing anything about their own circumstances? Rawls called this starting point for reasoning ‘the original position’, but we can also see it as an exercise in impartiality akin to the Golden Rule, a reminder to the thinker to put herself in the place of another.

I’ve often thought, amid all the panicky decision-making and fear-based certainty of the past two years, that a bit of Rawlsian thinking would have come in handy. What if you had no idea how the government policies on Covid would affect you and those closest to you? What if it were your livelihood that would go under in another lockdown, or your adult child rendered suicidal by enforced social isolation? Thinking of a more universalist character would have been an antidote to ‘the argument from me’ – ‘I don’t mind more restrictions, so neither should you’ – that has characterised so much of the reasoning during this crisis.

You might say, with some justice, that ordinary people don’t necessarily have the skills or the need to think in the round, to consider the effects of policies on everyone in society. Indeed. That’s where the politicians come in. Unless, of course, they’re inculcated by a political culture dominated by short term emotionalism or are under the influence of extra-democratic interests.

Anyway, here we are, having entered into a new social contract which, depending on the kind of thinking that prevails in the next crisis, could create very different societies in the West.

It’s impossible to overstate the changes this kind of health-based governance would bring. Citizens would give up the rights that enshrine their ability to meet their basic needs, to a livelihood, education, company and creativity when the government deemed it necessary. Power would shift from the people to the state. The old social contract, based on ongoing consent and the protection of rights, would be no more.

IV

There’s another element to all this, one even closer to home, the lifelong home that is one’s own body. The arrival of the vaccines in 2021 ushered in a second major change to the contract that has lain at the heart of western democracy: the principle of free and informed consent.

Western medical ethics is defined by a principle close to the central idea of liberalism: the principle of autonomy. But to really understand what is meant by the right to make decisions about one’s own healthcare we need a fuller, more embodied sense of what’s involved in medical autonomy. It starts with a recognition of the fact that every medical intervention carries with it consequences and risks, and that if a particular treatment goes wrong, it will be the individual who will experience any resulting pain or physical limitation, potentially for life, in a way that cannot be shared with anyone else. Of equal importance is the sense of psychological control over what happens to your body, something that has long been recognised in our thinking about sexuality and personal space. The difference between something positive and pleasurable and a violation of boundaries is consent.

Decisions about medical treatment are particularly complex as they cross over into all sorts of issues about how we live our lives, intertwining with our attitudes to illness and death. Each individual has, as well as a body with its own distinctive makeup and history, a unique set of experiences and feelings which informs their attitudes to healthcare. Those attitudes are likely to change over the course of a life: a decision about a pregnancy, operation or cancer treatment by the same person may well differ at fifteen, forty-five, and eighty.

Every body is, quite literally, different.

In medicine, the fact that the health professional generally has more knowledge than the patient gives informed consent an extra level of importance. For consent to be meaningful, the patient must have all the relevant information and be in a position to make a genuine choice, one which includes the ability to say ‘no’. The corruption of German healthcare in the middle of the twentieth century, as Aaron Kheriaty points out, precipitated a clear re-statement of the core principle of medical ethics in the Nuremberg Code:

‘The voluntary consent of the human subject is absolutely essential. This means that the person involved should have legal capacity to give consent; should be so situated as to be able to exercise free power of choice, without the intervention of any element of force, fraud, deceit, duress, overreaching, or other ulterior form of constraint or coercion; and should have sufficient knowledge and comprehension of the elements of the subject matter involved as to enable him to make an understanding and enlightened decision.’

Has there been sufficient information about the Covid vaccines to ensure that the conditions for informed consent have been fulfilled? At the time of writing, the publication of the first batch of data about the Pfizer vaccines has just been released. It follows a legal battle in which the pharmaceutical company, with the support of the FDA, wanted the data about adverse reactions to the first wave of vaccinations kept under wraps for the next seventy-five years. Given that it has taken a year and a court order to get the information into the public domain medical professionals such as Dr John Campbell are questioning whether informed consent has been respected.

But what I’m concerned with here is voluntary consent. Over the past year, I’ve seen and heard more indications of the absence of the conditions for full and free consent than I care to think about. First they came in the form of young travellers to Lisbon saying they’d got the Covid vaccine in order ‘to travel’. To me, the reason was eyebrow-raising: I’d never before heard of someone having a medical treatment for a non-medical reason. As the year wore on and governments started imposing vaccine passports as a condition for normal living, I heard more and more non-medical reasons for having a vaccination, from wanting to socialise to ‘having’ to ‘get the jab’ in order to carry on working. It was crystal clear that the conditions for genuine consent were being actively suppressed.

Given their access to the science, it is hard to believe that any politician saw vaccine passports as a useful tool for reducing infection or transmission. A recent Freedom of Information request from the civil liberties organisation Big Brother Watch revealed that Welsh ministers considered they had a 'small, probably unmeasurable’ impact.

On the public level, the move away from voluntary consent was accompanied by a worrying amnesia. Initially I’d put the new trend of people having medical interventions they openly admitted they didn’t want down to youthful ignorance: people in their twenties are used to being to told what to do and are often unaware of their rights. But it seemed that people of all ages were prepared to give up the cornerstone of medical ethics without a second thought. The Great Forgetting had struck again.

This second aspect of the health state raises a fundamental question: who has authority over the body?

The ‘who’ is important.

Defenders of the change to the social contract that has accompanied the Covid vaccines have a ready answer to this question: ‘society’. On this view, the government is simply the enforcer of the benevolently-motivated public will, imposing measures which ‘encourage’ the ‘hesitant’ to do the right thing.

The tyranny of the majority applied to medical matters, you might say. But there’s more to it than that.

In 1961, the outgoing American president Eisenhower warned of the emergence of a new scientific-technological elite that could come to dominate public policy, threatening the freedom and democracy of America. Sixty years and a digital revolution later, it seems that just such an elite has emerged during the Covid crisis. Previously unknown public health figures have been catapulted to positions of authority and democratic processes sidelined by emergency legislation. And the vaccination programme of unprecedented speed and scale that has been rolled out is underpinned by deals between government and industry.

Maybe much of this is inevitable in an emergency. Surely it’s all coming to an end now?

V

At the time of writing, with mandates being lifted in many countries and Denmark giving up on vaccination entirely, it looks as though the age of Covid coercion may be coming to an end.

But look, the new powers it brought into being have given politicians and other public health rulers some rather big ideas.

The head of the Bioethics Commission in Austria envisages a new era of compulsory vaccination to avoid ‘unnecessary diseases’: ‘The Covid-19 vaccine mandates could be the beginning of a new effort to protect people against unnecessary diseases like measles, whooping cough and influenza – also with vaccine mandates,’ said Catherine Druml. ‘Society absolutely has an interest in avoiding unnecessary influenza waves.’

Meanwhile, the UK’s former health minister Jeremy Hunt is mourning a missed opportunity: ‘I was intending to introduce mandatory flu vaccinations in my final year as Health Secretary,’ he tweeted casually in January.

The devolved government of Scotland is currently introducing legislation to make the temporary emergency powers passed in March 2020 permanent. The new Coronavirus Recovery and Reform Bill would allow ministers to impose a full national lockdown and close schools without the need to consult the Scottish Parliament.

Rather than letting its emergency legislation expire, the German government is planning to introduce a new law allowing states to impose measures limiting social contact, mask mandates and vaccination and testing requirements for future outbreaks of Covid which, the Health Minister envisages, will be around for at least a decade. The mere existence of the new laws, Eugyppius points out gloomily, will bring permanent change to German society: ‘These measures don’t even have to be implemented to do their damage; the mere possibility disrupts business models and future plans. The longer these restrictions hang over us, the more deeply they change every aspect of our social and political existence, from music concerns to Oktoberfest to restaurants to schooling to public transport.’

And while the mainstream media report that Belgium is lifting almost all restrictions, this explanation from a resident makes it clear that the country’s adoption of a ‘pandemic barometer’ could easily see their return: ‘They have a coded system that sets the bar quite low for its use. The codes are yellow, orange and red and each colour represents stricter measures to be implemented according to cases and hospitalisations. The bar is so low that our prime minister has said he didn't expect it to go green any time soon. And even if it goes green, the CST will only be in the drawer temporarily, to come out again with every new wave.’

The technical infrastructure for the introduction of vaccine passports on a wide scale is already in development. In February, the WHO signed a contract with a German telecoms company to create a Covid-vaccination verification app: ‘The QR code-based software solution will be used for other vaccinations as well, such as polio or yellow fever, T-Systems said ... adding that the WHO would support its 194 member states in building national and regional verification technology.’

And while the French government is about to lift its comprehensive vaccine passport regime ahead of the presidential elections, it appears to be working on a new, more fraud-secure version that could be re-imposed in future.

In the light of all this, readers will forgive me for seeing this UK government pilot scheme trialling ‘wrist-worn devices’ as a way of motivating health-promoting behaviour as less than utopic. Participants will be awarded vouchers and discounts in exchange for following government guidelines on diet and exercise. (For a short comi-tragic take on life with wristbands, watch this.)

Power is certainly hard to relinquish. But perhaps the biggest surprise is how these sorts of ideas were already waiting in the wings. The EU has had plans for a vaccine passport regime in the works since at least 2018. And as early in the Covid crisis as July 2020, the World Economic Forum announced that it was working on a CovidPass which included ‘mandatory carbon offsetting for each flight passenger’. The language of its more recent proposal for a new system of digital identity – ‘human-centric’ and ‘trust’ – suggests it’s now using communications professionals to allay concerns. (Trust me, I am one.)

So many influential lobbying groups and unelected advisers so very keen to create a post-Covid world of digital control!

It’s important to understand that the changes being promoted by these organisations are intended for the public good. They really are. Their advocates genuinely believe that minimising disease and maximising (a certain conception of) health through greater regulation and cooperation between governments and pan-governmental bodies of experts will create a better world. They are expressing a social planning mindset that has been developing in western society for some time and gaining more traction over the past decade.

The problem, if you quite like democracy, or liberalism, or freedom, or diversity or any of these things we’ve got used to in the West, is that the social planning agenda is inherently unitary and top-down. Enforcing it widely and effectively – globally, as its enthusiasts want – necessarily means giving the authorities a high level of control over people.

So, rather than putting all the blame on China it might be fairer and more accurate to see what’s happening to western society in terms of The Idea from China meets Western Social Planners.

The phenomenon of political perfectionism may help to shed light on what’s going on here. Perfectionism – here’s the political theory again – concerns the fact that every society has a ‘conception of the good’, a particular set of values that underpin its laws and customs, its culture and way of life. And that includes every dictatorship, every totalitarian regime that’s ever been. No leader I’ve ever heard of (outside a bad sci-fi movie) deliberately aimed for the destruction of their own society or the complete elimination of humanity: where they caused harm, they believed they were dealing with something which stood in the way of The Good that was part of their vision, whether in the form of The Nation, Equality or Progress.

The difference between the values of liberal democracies and those of tyrannical regimes is obsession or idealism. The rulers of the latter are driven by a single-minded adherence to a central idea, an idea so supremely valuable that an entire political system must be organised around it, the way of life of an entire population devoted to realising the vision. No sacrifice is too great and no alternative is worth entertaining. Because once we are There, in the society which has fully realised The Idea, everything will be perfect.

The problem is that reality, in its messy, evolving diversity, is always throwing up problems, changes, including other points of view and different ways of doing things. And that’s why leaders possessed by monomaniacal visions feel they need to use control. Their version of perfectionism necessarily involves ‘the coercive promotion of the good’, a form of top-down control applied to whole populations.

House arrest? It’s for your own good!

There’s a fine line between utopia and dystopia.

I’m calling it now. The health state is the latest iteration of this dangerous kind of political perfectionism, one that we’ve seen many times before. It never leads to a good society because it runs counter to the reality of life and to human flourishing.

East, West, Left, Right. Tyranny comes in many forms, and from many directions.

VI

That last bit was rather theoretical. What would the health state be like in practice?

Let’s call in that imaginative handmaid of philosophy the thought experiment. It can also be done on behalf of someone else, in which you imagine how the scenario would feel from their point of view.

You live in Healthtopia. President Power is working with Public Health, Inc. to ensure that a state of collective safety is continuously maintained. A health pass is in place to make sure everyone keeps up to date with their medications – those who fall behind are instantly excluded from all areas of public life.

So far, it’s been okay, more or less. You have to visit your local health centre for regular upjections, but that’s a minor inconvenience. It’s a bit annoying that the over-fives now have to have their own smartphones, but in a technologically-based society they would need them soon anyway. To prevent them losing these costly devices, most parents have fitted their children with digital wristbands and, since QR codes are needed for almost everything, adults are increasingly finding these the most convenient option.

But one day it becomes clear that your partner/parent/child/sibling is at risk of serious adverse effects if they continue taking the medication. Although in Healthtopia exemptions are available in theory, they are rarely granted in practice. The doctor who advised you of the likely side-effects can do nothing – even providing that information has put them at risk of reputational damage.

Is life in Healthtopia still okay?

A while later, you go to the health centre for one of your regular upjections and the health worker tells you that another medication will be administered simultaneously. You haven’t been paying much attention to government announcements lately, and have heard only vague things about the new drug. You’d like some time to think about it, but the medication administrator advises you that refusal will result in your health pass being deactivated on Monday.

How is life in Healthtopia now?

Perhaps even this is still okay, if not with you, with the person you did the thought experiment for. (A British friend recently told me she'd be quite happy to live with a Chinese-style social credit system, so anything’s possible. (3)) But imagine Healthtopia a few years further on, after the government has taken some stringent measures to deal with The Others, those who refuse to have the regular upjections or wear the healthband. The imposition of regular fines dealt with most of them – those who didn’t give in ended up destitute and either died of poverty-related conditions or disappeared into the semi-wild landscape beyond the managed countryside areas. A few remain in the cities, living off an underground economy in the basements of abandoned buildings. It’s also suspected that a tiny number maintain apparently normal lives by dint of fake healthbands, although most of those involved in the fake QR economy that sprang up in Healthtopia’s early months are now in prison. From time to time, there are rumours that the bands of guerrillas who live at the margins of society are planning attacks but the government points out that, because of their lack of upjections, these Unhealthy Ones would be far too weak to manage anything like that.

Last year, while she was walking in one of the managed countryside areas, a cousin of a friend of yours saw a lithe brown form disappear into the bushes on the other side of the border.

For various reasons, some people in Healthtopia don't sleep well at night.

VII

Now for a more positive thought experiment … what would a healthy, flourishing society look like?

For me and many I know, such a society would be rich in community, creativity and contact with nature. It would be possible to earn a living without spending most of one’s time either at work or commuting to and from a workplace. Those living in cities would retain a sense of the local and have a real connection with the people and places around them. And health – understood in broad, holistic terms – would arise naturally out of a way of life rooted in good food, fresh air and fellowship.

If these things sound familiar, it’s because they are. Before the Covid crisis, we already knew we’d lost a lot to modern convenience and were vaguely reaching out for things that were part of daily life for our ancestors: an awareness of the land and the seasons, a more embodied existence and a sense of belonging. While grateful for the benefits of modern sanitation, heating and supply chains, many of us were trying to get some of these aspects of life back through worthy groups and projects. But our attempts at restoration and re-connection were largely confined to odd evenings and Sunday afternoons, exceptional moments that did little to change life in the institutional, corporate society that has grown up around us over the past few decades.

But the greatest problem with these community groups, I now understand in the light of the past two years, was how they caved in the face of Fear and Authority. They lacked internal resilience, a sense of their own legitimacy that would withstand external attempts to render them dispensable. They drew insufficiently on the direct relationship with life central to the conception of freedom articulated by Fromm and Arendt: a spontaneity and creativity inherent in the human condition which, if hijacked and suppressed by external forces, brings only a kind of death-in-life.

I’ll share an odd moment from Britain in the autumn of 2020 by way of illustration. I’d joined a circle of people, part of a community group that hadn’t met since early in the year because of government restrictions. We were meeting in the local park for a walk, divided into two groups to observe the Rule of Six which forbade larger gatherings. As we set off, an edgy caution prevailed; we kept a strict distance from each other and the crossing of the two groups on the same path nearly tipped the organiser into panic. In my group, the talk was of a second wave and hotel quarantine. I had had more fun cleaning the bathroom.

And then someone noticed the strawberry fruit tree, laden with pinky-red globes. And suddenly the uptight little group was gathered around it, plucking the best berries and offering them to each other, enthusing about their delicate flavour, the surprising abundance of nature. It must have crossed minds other than my own that we were no longer Two Metres Apart as prescribed by government. The human impulses to connect spontaneously with nature and with each other had reasserted themselves.

Photo by Alan Harris

With hindsight, the experience contains a lesson about what has gone wrong in societies characterised by top-down control and what it will take for them to start to go right. The change will involve a shift in the locus of authority back to lived experience, a recalibration of what’s considered valid and valuable in terms of individual and collective needs – in short, something more in keeping with the longing to live life on a more human scale.

I suspect that, in the years to come, those of us who have looked the health state in the eye and liked it not one bit will be placing our trust and investing our resources more and more into ways of being that promote this kind of living. We will need to find practical and political ways of creating resilience – especially if, as many predict, some of the established institutions attempt to use the precedents and infrastructure created by the Covid crisis to exert more control, whether in the name of health or other social goods. Where institutions have told us wrong and demanded too much, we’ll be creating new networks more in keeping with the messiness and wonder of life.

And instead of ‘Stay safe’ – the phrase that captures the sacrificial sterility of the social contract at the heart of the health state – our mantra will be: ‘let us be well’.

Notes

1. Eugyppius has written a more comprehensive history of lockdown but the English version is available only to paying subscribers. A free version in German written by a colleague of his can be found online (and could be put through Google Translate).

2. The website of the Behaviour Insights Team boasts: ‘Founded in 2010, the Team has grown from a seven-person unit at the heart of the UK government to a global social purpose company with offices around the world.’

3. Recently I was talking to someone from China and asked him what life was like under the social credit system. 

‘Well,’ he said, ‘I can’t complain.'

This is likely the last Bafflement Essay for a while. Instead, I’m going to be writing shorter, slightly more frequent, pieces for a time.

But I remain baffled by what’s going on with institutions of all kinds – media, cultural and charitable, as well as government, industry and Big Tech – and will be writing about this at some point. If you have any thoughts or information you’d like to share, please comment below. Or get in touch with me directly by email.