During the COVID-19 pandemic, saving lives is the highest priority, followed by limiting economic damage. However, emerging recognition of the global health and social legacy of the pandemic is now manifesting itself. Wang et al (2020) showed that non-communicable diseases (NCDs) are a major risk factor for people with COVID-19. A related concern is that 72% of all global deaths are due to NCDs— major contributors being tobacco and alcohol use, air pollution, unhealthy diets, and inadequate exercise (World Health Organization, 2018). NCD prevention and management are interconnected features of contemporary public health and COVID-19 heightens their significance.
There is emerging evidence of a COVID-19 global economic recession, whereas a ‘social health recession’ is less overtly stated. Enforced quarantine by physical distancing encourages behavioural risk factors for NCDs such as unhealthy eating, reduced physical activity, smoking tobacco, and harmful use of alcohol (Venema, 2020). Stickley and Koyanagi (2016) documented detrimental effects on mental wellbeing after long periods of isolation in quarantine for illness or custodial care. Indeed, lifestyle choices damaging to health are exacerbated by feelings of loneliness and isolation. The spread of COVID-19 and the measures to reduce its impact has encouraged NCDs, social isolation and loneliness to work in synergy.
The idea of a ‘loneliness epidemic’ in developed countries had already been raised before the pandemic (Wood, 2013; Ortos-Orspina, 2019). Feelings of loneliness are a key contributor to mental health problems such as depression and suicide (Stickley and Koyanagi, 2016). In the current pandemic, Banerjee and Rai (2020) view loneliness as a social threat. Holt-Lunstad et al (2010) argued that social connectedness is a primary determinant of health and longevity—the impact of loneliness on mortality is similar to intermittent moderate smoking. Yet, the impact of reduced human interaction enforced by the pandemic affecting overall health, mood, ability to work and learn, and resulting in a reduced sense of community may not be acknowledged for some time. Reducing isolation and loneliness and giving a sense of community belonging can improve people's health. Compassionate Communities UK (2020) gives an example of a combined programme of community development with routine medical care, resulting in reduced emergency admissions to hospital (Abel et al, 2018), and concurs that social connectedness has a bigger impact on health than giving up smoking, reducing excessive alcohol intake, reducing obesity and other preventive interventions.
The economic recession facilitated by COVID-19 increases unemployment, financial insecurity, and poverty, intersecting with the social health recession and the resulting detriments to physical and mental health. All these factors interact synergistically in different and substantial ways, with consequential impacts on the health of individuals and populations. Is it time to reconfigure the convention of understanding diseases as distinct entities, separate from other diseases and independent of their social contexts? Addressing post-COVID-19 health as a multifactorial global response to the social health recession by rebuilding and strengthening human connections may be the starting point to the reformation of a new model of public health.