Case Study E – Covid-19: Non-Pharmaceutical Interventions (Lock Down, School Closures, Face Masks)

Context

In the early stages of the COVID-19 pandemic, with modelling studies predicting a public health emergency and the overrun of already stretched health services, the UK Government announced the first of several non-pharmaceutical measures. They included a lockdown, school closures, face mask orders and social distancing measures. The measures represented a previously difficult to imagine “curtailment of normal life” in order to “contain the rate of infections, thus protecting public health and preserving the National Health Service’s (NHS) capacity to treat the anticipated influx of patients” (Halliday et al., 2022: 386). Compliance with the measures was high (though far from being universal) (Denford et al., 2021; Liam et al., 2022; Smith et al., 2020).

Key Elements of Change

Widespread compliance with these temporary changes to ‘normal life’ are of interest as they suggest normative reasons for alteration of behaviours and practices. A useful distinction exists between instrumental forms of compliance (where people comply in order to avoid detriment or costs) and normative reasons (contributing to a collective goal or good). The latter implies that less coercive forms of compliance are possible (Tyler, 2007).

While the measures were backed by legal frameworks (including some notable and public sanctions for non-compliance), and detriment was associated with loss of peer approval and possible threats to personal health, compliance was also rooted in normative motivations (Halliday et al., 2022). The laws had public legitimacy and social license. For Halliday et al., normative mechanisms relate to: agreement with the effectiveness of the rules; obligations to others; consciousness over rights and their suspension; and a sense of procedural justice.

All arguably diminished as the COVID-19 pandemic progressed through various waves of strains and infections, with a mounting critique of curtailed rights to mobility, social contact, work, education etc., and a sense of injustice as non-compliance of certain groups were publicised. Nevertheless, obligations to others were notable. A critical factor here was the government messaging around ‘staying at home to save the NHS’, introduced in March 2020, relentlessly reinforced by government and health care providers. This galvanised a positive, solidaristic, sense of ‘doing your bit’ to save the NHS and close contacts (including elderly family and friends) as well as a negative, and more instrumental, aspect of peer disapproval for non-compliance.

A key element here was the shared sense of the value of the NHS as a cherished institution (which had recently celebrated a 70-year anniversary). Culturally, this became a symbolic rallying point, with rainbow insignia and weekly ‘giving thanks’ becoming a ritualised form of social engagement (even if this backing and thanks were sometimes regarded as tokenistic). It has been suggested that part of the message’s success was to communicate a message that ‘we are all in this together’.

Lessons for Net Zero

This example demonstrates the importance of normative reasons and collective obligations that can underpin messaging around policy, particularly interventions which curtail routine habits and choices. It is likely that net zero itself, as a goal, is not enough to deliver societal changes. It also highlights the importance of reinforcement and rearticulation of key messages through mid-level actors (in this case, through interaction with different facets of health provision).

Elements of Societal Change

Multi-factor DRIVERS OF CHANGE

• Pandemic infections (health)
• Health service capacity (and welfare state heritage)
• Poor health outcomes in elderly and already compromised patients
• Limited testing capacity
• National emergency
• Repetition of core message through public information media campaigns

Mid-level ACTORS

• Health agencies on the ground (GPs, dentists, care workers, opticians etc.) who would
  have relayed the core ‘Stay Home, Protect the NHS, Save Lives’ message

Galvanising ISSUE

• Saving the National Health Service

JUSTICE Considerations

• These measures had numerous distributional effects, intergenerational unfairness and
  issues of equity. For example Student and Foundational Doctors and professionals,
  those with good internet and multiple devices, did better than inner city groups with
  no access to outdoor space, poor connections, shared devices and so on)
• The success of the ‘stay at home to protect the NHS’ messaging may have had the
  unintended impact of discouraging some people from seeking medical help from the
  NHS for other life-threatening conditions
• Procedural justice in the form of processing of non-compliance and aspects of flagrant
  flouting of rules by elites undermined public confidence

CONTESTATIONS and CONFLICTS

• Individual rights vs. intergenerational and social inequalities
• Livelihoods vs. national institution and health of vulnerable

REFERENCES

• Denford, S., Morton, K. S., Lambert, H., Zhang, J., Smith, L. E., Rubin, G. J., Cai, S., Zhang, T.,
  Robin, C., Lasseter, G., Hickman, M., Oliver, I. & Yardley, L. (2021). Understanding patterns
  of adherence to COVID-19 mitigation measures: a qualitative interview study. J Public Health
  (Oxf) 43 (3) 508-516
• Halliday, S., Finch, N., Meers, J., Tomlinson, J. & Wilberforce, M. (2022). Why the UK
  Complied with COVID-19 Lockdown Law. King’s Law Journal 33 (3) 386-410
• Liam, W., Andrew, S., & Daisy, F. (2022). Patterns of compliance with COVID-19 preventive
  behaviours: a latent class analysis of 20 000 UK adults. Journal of Epidemiology and
  Community Health 76 (3) 247
• Ridsdale, L. (2020). Covid-19: “protecting the NHS” encourages people with symptoms to
  stay at home. BMJ 370
• Smith, L. E., Amlot, R., Lambert, H., Oliver, I., Robin, C., Yardley, L. & Rubin, G. J. (2020).
  Factors associated with adherence to self-isolation and lockdown measures in the UK: a
  cross-sectional survey. Public Health 187 41-52
• Tyler, T. (2007). Why People Obey the Law. Princeton University Press