Abstract
At the beginning of 2021, with communities exhausted and shattered, what do we have to look forward to? One scientist, deeply engaged in modelling the pandemic, believes that a vaccine, together with mounting levels of natural immunity, will bring the worst to an end by the summer. I am less confident than him. But I do see an opportunity that is there to be seized. 60 years ago, one of France's leading public intellectuals, Raymond Aron, wrote that “I believe the dawn of universal history is on the point of breaking”. He observed that “the human race is now living through a single history”. The world after two global wars was moving from an era characterised by partition and division to one marked by “the unification of mankind”. The reason for Aron's optimism was the spread of industrial society, meaning that “all sections of mankind have access today...to the same tools”. Aron saw these “reasons for solidarity” as the beginning of “the only worthwhile struggle, the one for mastery over nature and the wellbeing of all humanity”. The evolution of this unity, he predicted, would be initiated through “the unification of the field of diplomacy”, followed by “the worldwide diffusion of certain forms of technical and economic organisation”. His forecast was premature. Partition and division continued, even intensified. But today, in the midst of this coronavirus, perhaps the time is right to invoke once again Aron's notion of a universal era. Every dichotomy in global health has been challenged by this pandemic. Communicable disease versus non-communicable disease. Biological versus social determinants of health. Global health security versus universal health coverage. Developed countries versus developing nations. Democratic governments versus authoritarian regimes. This era is truly one marked by a universal experience, a universal predicament, and the need for universal solutions. One consequence of a universal era, Aron argued, was that “In a humanity on the way to unification, inequality between nations takes on the significance that inequality between classes once had”. Indeed, inequality is one of the most important risks for premature death from COVID-19. Our response to this pandemic, this syndemic, must address inequality as well as the virus itself. There is little sign that governments understand the central significance of inequality to COVID-19. Yet at the end of 2020, an important manifesto for action against inequality was published, one that set out an agenda for renewal which deserves our serious consideration. Build Back Fairer was led by Professor Sir Michael Marmot. The implications of his report are applicable to all countries. The reason why Marmot's recommendations are momentous is because they go well beyond health. The response to COVID-19 should follow the principle of proportionate universalism—universal implementation but with those actions being proportionate to need. Children and young people must be a priority. To give every child the best start in life, focusing attention on early years settings and education should be paramount concerns—eg, by attacking child poverty, prioritising children's mental health, improving access to parenting support programmes, increasing funding for free child care, expanding access to digital technologies, providing catch-up tuition for children in more deprived areas, and increasing opportunities for employment. Creating decent jobs for all is also foundational for building a fairer society. Employment policies should include job retention schemes, enforcing a national living wage, reducing precarious work, and establishing a national goal for everyone to receive a wage that prevents poverty. Marmot made additional recommendations on food poverty, social protection, health equity, environmental sustainability, and good-quality housing. One criticism of his proposals might be that they are simply unaffordable. How can one contemplate investments of this magnitude during the worst economic recession in 300 years? Marmot's answer is direct: how can governments not afford to make these investments? The scale of the threat from inequality is so great, and the opportunity if it is addressed so historic, that the moment offered by entering a universal era must be grasped. Aron concluded his essay by writing about humanity “joined together in one great enterprise”. He predicted that “universal history will be different from the provincial histories of past ages”. Despite the trauma of 2020, now is the time to seize the prize Aron foresaw.
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