What is a death worth? A life? The Moral Economy of COVID-19

Gross national product counts air pollution and cigarette advertising and ambulances to clear our highways of carnage…It counts the destruction of the redwood and the loss of our natural wonder in chaotic sprawl. It counts napalm and counts nuclear warheads…Yet gross national product does not allow for the health of our children, the quality of their education or the joy of their play. It does not include the beauty of our poetry or the strength of our marriages, the intelligence of our public debate or the integrity of our public officials…It measures everything in short, except that which makes life worthwhile. (Robert Kennedy 1968)

On ABC TV’s Q & A on Monday night, April 20, 2020, Professor Gigi Foster, an economist from the University of New South Wales (Sydney) Business School, attempted to quantify, via reference to the concept of traded lives, the relative ‘costs’ (in terms of lives, in terms of dollars, in terms of well-being and mental health) of letting the COVID-19 pandemic run its course without ‘shutting down’ the economy, or ‘shutting down’ the economy in order to save lives.

Her comments provoked significant debate, even outrage. But Professor Foster was echoing, if not supporting, the sentiments of many politicians (Trump and Bolsanaro are prominent examples here), economists, media commentators and far right conspiracy theorists, about the ‘realities’ of COVID-19, and the ‘relative costs’ of the COVID-19 strategies pursued by many governments around the world.

The quote from Robert Kennedy comes from the final of Thomas Keneally’s Plague Journal articles in Melbourne’s The Age on June 13, 2020, that in its print version is titled The economy is a careless god. The quote opens up the space in which I want to pick up on a point made in an earlier post about COVID-19 and the Problem of Generations to suggest that these sorts of debates can be thought about in terms of what I am calling a moral economy of COVID-19.

From this perspective we can ask ‘moral’ questions about the choices that are made, or not made, in the context of the pandemic phase of the current crisis, but also in the coming years when choices will be made, or not made, about so many aspects of the global economy, the national economy, the economies of places, and the lives that are lived in these places.

Trading Lives

A report on Professor Foster’s appearance on Q & A suggested that: ‘economists tried to put a value on something like ‘well-being’ to help them think about multi-faceted problems, such as the consequences of social distancing measures”, and she did not think the lockdown was worth it.

“If you do that kind of calculus you realise very quickly that even with a very, very extreme epidemic in Australia we are still potentially better off not having an economic lockdown in the first place, because of the incredible effects that you see not just in the short run but in many, many years to come”

These comments drew an immediate, and seemingly incredulous response from another panellist on Q & A, Australian Council of Trade Unions (ACTU) secretary Sally McManus:

“How can you say that?”

“We’re avoiding what’s happening in the UK, what’s happening in the US”.

“The idea of having our ICUs overrun and our health workers dying is the most horrible thought.”

In response Professor Foster attempted to defend this sort of calculus:

“It’s horrible either way. The coronavirus has made the world awful, there’s absolutely no doubt about that”.

“But in order to have a proper discussion about trade-offs, you need to think in terms of lives that you’re giving up.”

“I know it’s invisible lives and it’s difficult to imagine that when we aggregate, for example, all of the health effects, all of the mental health effects, all of the effects of people right now who have illnesses other than COVID-19.”

Flattening the curve

In a blogpost on the World Bank www site early in the pandemic Francisco Ferreira asked Is there a trade-off between lives and incomes in the response to Covid-19?

The post is framed by one of the phrases which have become part of our everyday language in a COVID-19 world – ‘flatten the curve’:

All over the world, policymakers considering how to respond to the Covid-19 pandemic appear to face a stark trade-off between saving lives and preserving jobs and incomes… The trade-off originates from the interaction between the epidemiological dynamics of the outbreak and the limited capacity of health systems. This is best illustrated by the “flatten the curve” diagram that has become ubiquitous over the last few weeks. An example, drawn from this blog from Michigan Medicine, is reproduced as Figure 1 below.

Simplifying things, the trade-off is essentially that under Strategy 1 (no containment), there is a period where the number of sick people vastly exceeds the capacity of the health system to treat them, and lots of people die: think of it as the blue area above the horizontal dashed line. However, this is soon over: by the rightmost point of the blue curve the epidemic has run its course and people can get back to their jobs, markets and travel plans. Comparatively fewer people will have lost their jobs or fallen into poverty.

Under Strategy 2 (containment), people are locked in at home for a much longer period (to the rightmost point in the yellow curve). Hospitals can handle the daily inflow of patients, so fewer die. But avoidance behaviours last so long that firms fire their workers or go bankrupt, people have no earnings, and poverty rises dramatically.

Ferreira’s post acknowledges the debates about the apparent willingness of economists to try to quantify the value of a human life, of human lives, and to make calculations about different options, different trade-offs in relation to these lives: 

There have been (at least) two kinds of reactions to this postulated trade-off. Most human beings tend to be shocked that one could even think of a trade-off between incomes and human lives. Surely, they argue, human lives should take absolute priority. A smaller subset of human beings, consisting of most economists (and a few prominent politicians), nod their heads gravely and try to look for an optimal choice somewhere in between.

The post presents a number of graphical representations of the sorts of calculations that economists make in this context, and which are used to inform the differing policy decisions that have been made in various countries around the world in the last 3 months of the pandemic. As Ferreira notes:

The bottom line is that, even if the mechanics of how the epidemic interacts with health system capacity do imply a trade-off between lives and jobs/incomes, the terms of that trade-off are not fixed in stone. On the preferences side, the “rate” at which societies are prepared to sacrifice human lives to save jobs and incomes is a normative matter. In a democracy, policymakers – and the economists advising them – would do well to listen to the people. 

It is in this context that some of the complexities of these sorts of calculations and trade offs start to become more apparent – and start to point to why some people can make arguments against a shutdown to save lives.

Some of these complexities include the ways in which countries have different policies to support those who lose their jobs, or different types and levels of payments to support people who become sick and can’t work, or have systems that provide lifesaving healthcare to all the population – or just to a privileged few: 

shifting out the blue curve as far and as quickly as possible – is the fundamental challenge facing all countries responding to the Covid-19 pandemic. Preserving jobs or providing income support to those who lose their jobs – particularly for the poorest and most vulnerable in society – can considerably reduce the economic pain caused by the containment needed to save lives. Thereby helping society to make the choice to save more lives.

The Moral Economy of Covid-19

In the context of these decisions, these choices – and the debates, arguments and protests in relation to these choices – I have found it useful to think that there is a moral economy of COVID-19.

The concept of moral economy has a particular history in social science. I have been involved in a number of writing projects that have introduced this concept into the field of Youth Studies and Education Studies.

In the first book The Moral Geographies of Children, Young People and Food: Beyond Jamie’s School Dinners,we used the concept of moral geographies to identify and engage with the elements of choice that relate to what it is that we should feed ourselves, our families, our children. We suggested that these questions of choice, and what we should imagine as ‘healthy’ food, extended to the various, often complex and ambiguous, processes and practices of food production, processing, transportation and preparation. As well as to the array of personal and cultural practices that structure often idealised, always morally inflected, ideas about children, parenting and food, the family meal, the issues of young people’s nutrition, health and well-being, public health ‘crises’ such as obesity, and the array of possible responses and interventions in relation to these issues, these crises.

In Neo-Liberalism and Austerity: The Moral Economies of Young People’s Health and Well-being, in building on our work on moral geographies, we found Andrew Sayer’s (2000, 2004 a & b) discussions of moral economies to be useful in framing a discussion of Neo-Liberalism and Austerity, and young people’s health and well-being in the aftermath of the GFC. 

For Sayer (2004b), ‘moral economy’ is a concept that suggests a:

kind of inquiry focussing on how economic activities of all kinds are influenced and structured by moral dispositions, values and norms, and how in turn these are reinforced, shaped, compromised or overridden by economic pressures.

It is in this sense, Sayer (2004b) argues, that ‘moral’ and ‘economy’ are ‘best defined broadly’. The ‘moral’ here includes an interest in:

lay norms (informal and formal), conventions, values, dispositions and commitments regarding what is just and what constitutes good behaviour in relation to others, and implies certain broader conceptions of the good or well-being.

Sayer (2004a, p.2) suggests that it can be useful to argue that ‘all economies – not merely pre- or non-capitalist ones – are moral economies’. In doing so he recognises that:

Of course, just what counts as moral, as opposed to immoral, behaviour is contestable; some forms of moral economy, for example, that of the patriarchal household, might be deemed immoral, or as domination disguised as benevolence and fairness.

In his work on moral economies Sayer (2004a, p.2) explores the:

ways in which markets and associated economic phenomena both depend on and influence moral/ethical sentiments, norms and behaviours and have ethical implications.

Importantly, given our interests in that book in the array of choices made and not made about young people, their education, training and work, their health and well-being in a post-GFC period of ongoing crises for neo-Liberal capitalism, this broad view of the moral creates a:

space not only for assessing moral aspects of economic practices, and economic influences on morality, but also for the assessment of how economic organisation affects human well-being (Sayers 2004b).

So, in talking about the moral economy of COVID-19, my concerns are not just about the immediate costs and benefits of making calculations about saving lives – about the value that might attach to a life – at whatever stage that life is at. For economists such as Ferreira, making such calculations:

necessarily requires us to think of a dollar value for a human life and, of course, agreeing on this “marginal rate of substitution” (as economists call it) is not trivial. Economists tend to start from the technical literature on the valuation of life. There are many approaches, but an influential one typically uses forgone lifetime earnings as a starting point to value a human life.

It is also about the choices that come after – in the immediate future, and in the more medium- and longer-term futures – that will shape young people’s well-being, education, training and employment trajectories through the 2020s.

As the evidence indicates, the virus might not make distinctions about infections based on a person’s class or ethnic background, their gender or religion, where they live. But a person’s class or ethnic background, their gender or religion, where they live, can be overwhelming determinants of when and how they might become infected, and what are the health consequences and outcomes of becoming infected, of being able to access healthcare or economic protection and support.

These are profoundly moral challenges and outcomes.

References

Sayer, A. 2000. Moral economy and political economy. Studies in Political Economy 61(1): 79–103.

Sayer, A. 2004a. Moral Economy. Available from http://www.comp.lancs.ac.uk/sociology/papers/sayer-moral-economy.pdf . Accessed 20 Jan 2016.

Sayer, A. 2004b. Agendas for Moral Economy. Moral Economy: Agendas for the Future. Workshop held on July 6th 2004, at the Department of Sociology, Lancaster University, Lancaster LA1 4YD, UK.