Why Public Health

"Public health comes first"

The argument that justifies individual crimes

Critical questions:

• Are health care, lifestyle, social and physical environment of the population included in the lockdown policy?
• Did the 9,444 flu deaths from 2017-2018 affect public health?
• Are 250 rescued ICU patients affected by public health?
• Is there really such a thing as mental health?
• Can you doubt the effects of something beyond doubt, such as the ICU?

It could be a nice exam assignment: Argue that the concept of 'well-being' does or does not belong to public health

[EDIT 7 November 2021: I did not yet have a picture of delayed care in April 2020, nor did the malfunctioning vaccinations with an unknown risk profile.]

"Public health"...? In what timeframe?

In the context of 'public health first', every effort is made to postpone death dates slightly. This allows healthcare to continue to do its job, albeit just about the only one. This has saved 600 lives among 600,000 infected people so far, for sure. But what does the calculation on the other side of the balance sheet look like? How many lives do we sacrifice?

'Public health first' seems to be a contradiction between economy and health, but it is not. Economic health is a prerequisite for good public health after the crisis. It is not even necessary to convert everything into amounts.

• With a 1% increase in unemployment, suicides also rise by 1%, I have heard.
• What about life expectancy in the event of a poverty trap?
• If there is no longer a decent budget for healthcare due to the lockdown, what happens to public health?
• What about patients who have been pushed back during lockdown?
• Is QALY's ever expected to reduce the well-being of 17 million Dutch people? Well-being as in: lost businesses, lost houses, can no longer pay mortgages, no more nice holidays, divorces, domestic and other violence, psychological complaints (depression) etc. etc.
• To what extent is excess mortality during an epidemic or flu wave compensated by under-mortality? For example, within six months or a year?
• Can you think in Net longer-term results or do you have to pull everything out of the medicine cabinet at any time of the day without worrying about tonight, let alone tomorrow?

Perhaps none of that falls under "public health", and we need to redefine that term as 'fighting mortality from a new disease'. Because with known diseases, none of this plays a role.

RIVM's own objectives out of the picture

All of the above points and possible critical questions appeal to common sense. In doing so, you can overlook things that only experts know. The policy and advice of the RIVM can therefore also be compared to your own RIVM objectives. With the almost obsessive focus on ICU and care capacity, they really no longer seem to meet their 'public health' objective.

So, Collateral Damage: now or then?

The (post-)corona health effects of the lockdown such as stress, unemployment, bankruptcies, violence, poverty trap and associated reduction in life expectancy do not play a visible role in decision-making.

There is a lot of talk about economics vs health. They seem to be two worlds that are opposed to each other, but of course they are not. In terms of budgets, health care will also have to be put on a ventilator if the economy falls to its knees. The lockdown has already cost tens of billions if we only look at the hard, direct expenses. The financial risks such as the risk of economic depression, losses on the stock market, future support to banks, etc., are NOT included. If that happens, the amounts involved will be many, many times higher than what we are currently thinking of. That means: shortening, cutting back, cutting.

Cut, cut back, cut. Smaller care budgets include lower quality (or less) care, which in turn has an effect on life expectancy, public health and mortality. Don't brush off the 'money' argument too quickly.