Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on Twitter (@joshgans) or subscribe to this email newsletter here.
Last Friday saw another classic article by Zeynep Tufekci, the Sage of the Pandemic; this time about on-going public health messaging mistakes. Her conclusion is simple:
Despite all these good intentions, much of the public-health messaging has been profoundly counterproductive. In five specific ways, the assumptions made by public officials, the choices made by traditional media, the way our digital public sphere operates, and communication patterns between academic communities and the public proved flawed.
The article is damning. You should read it in all its multifaceted glory. I’m going to focus on just one part: what public health experts are trying to do in their messaging.
For context, here is Tufekci:
One of the most important problems undermining the pandemic response has been the mistrust and paternalism that some public-health agencies and experts have exhibited toward the public. A key reason for this stance seems to be that some experts feared that people would respond to something that increased their safety—such as masks, rapid tests, or vaccines—by behaving recklessly. They worried that a heightened sense of safety would lead members of the public to take risks that would not just undermine any gains, but reverse them.
The theory that things that improve our safety might provide a false sense of security and lead to reckless behavior is attractive—it’s contrarian and clever, and fits the “here’s something surprising we smart folks thought about” mold that appeals to, well, people who think of themselves as smart. Unsurprisingly, such fears have greeted efforts to persuade the public to adopt almost every advance in safety, including seat belts, helmets, and condoms.
This is not new. My first experience with this was two decades ago when a famous swim coach decided to tackle toddler drownings in swimming pools head-on by, teaching toddlers to swim. It worked. He would literally through a one-year-old in a swimming pool and they would swim to the edge and hold on. I was impressed. We didn’t have a pool but I thought about this taking my young kids to swimming lessons every Saturday morning for years.
I searched for the original piece but happened upon this report from 2019. Watch it. It is near identical to the one I saw two decades earlier. Nothing has changed.
What really stuck in my memory was the outcry for the medical community. (It is still there in 2019; watch from 4:40). They advised against getting children under the age of 4 swimming lessons of this kind. Why? Because, they argued it would make the parents complacent. If I had this straight, parents, who had pools, should not get their toddlers to learn to swim, so they would always be on the lookout because the consequences would be grave! This seemed crazy to me. It wasn’t that I didn’t believe there was some chance that a parent with a child who could swim would take less care than one who didn’t, that was possible. But, instead, it was likely that the drownings that were actually happening could have been ameliorated if the child involved could have swum. There appeared to be no evidence that learning to swim increased your likelihood, all things told, of drowning. Indeed, to the contrary (thanks Zeynup for the reference).
What is going on here?
Manufactured anxiety
Whether it be watching out for your child or what to do in the face of Covid-19, the public health messaging seems to be doing the same thing: there is a degree of anxiety that is believed to be required so that risks are managed appropriately. What keeps us wearing masks? It isn’t for the fun of it, it is anxiety. What keeps us socially distancing in all of its myriad ways? It isn’t because that is what we want to do, it is anxiety. Anxiety is the way we raise the price of doing things and it is a key instrument the arsenal of public health messaging. When push comes to shove public health people want us to be sufficiently anxious not just about harm to ourselves but about harm to others.
Herein lies the difficulty when we learn good news about the pandemic — for instance, that we have effective vaccines, that transmission doesn’t occur outdoors, or, even worse, you have a test or screen that tells you that you are currently negative. Good news, by definition, relieves anxiety. Thus, the only way to counter its effects is to turn that good news into bad news. Vaccines may not be effective at stopping spreading and so we should treat them as if they are not effective at all. Transmission is less likely outdoors but outdoors is where we really can see you socially distancing. And the fact that you are negative when you take a screen doesn’t mean you should behave as if you have just turned positive five minutes after receiving the results. Don’t let good news alter your anxiety.
Tufekci is right that this leads to pessimism and a “when will it end” mentality. And in this newsletter, I often raise the darker issues from otherwise good news because we economists are trained in being dismal too. But I am not in the business of offering clear rules but instead giving the facts and letting people decide. On balance, I think we should be trying to reduce anxiety rather than maintain or increase it.
The costs of anxiety
Nonetheless, anxiety is a tool of the risk management trade. I do not think anxiety should be at zero and I do not think Tufekci would argue that. But what I think Tufekci doesn’t draw out is that that anxiety has direct personal, and dare I say it, health costs. We need to factor that into account when thinking about just how anxious we want people to be.
Anxiety is not a normal good. When I tell you that other people are dangerous and you should be anxious when being around them, the goal is for you to not pay the price of anxiety but, instead, to not be around other people. If you behave, you get a deal — less anxiety. If you are in a position, therefore, to modify your behaviour, maybe the costs of anxiety are not costs because they aren’t realised.
But what if you are not in that position. What if you are the one third to one half of our workforce who cannot stay at home and avoid others? What then does the public health message promoting anxiety do? Well, it is a pure cost. You are now paying a higher price for something you were doing anyway. In other words, in the language of economics, you are the inframarginal sufferers for a policy to move the margin.
And I don’t have to tell you that there are distributional consequences here. The people who have to work with others are the people who earn the least. So a public health message targeting anxiety has costs that are disproportionately felt by those less well off.
Here is my opinion and I am happy to be proven wrong: public health people using anxiety are not giving any weight to these considerations and, frankly, it is grave neglect. They need to pause and think about them and whether there are better ways.
One of the gratifying initial findings from the CDL Rapid Screening Consortium pilots has been the effect of regular screening on anxiety in the workplace. We have conducted surveys that, one day, I hope to be able to share more details about. But I can give you the top line: when you know you and your co-workers have screened negative for Covid-19 in the last few days, you are less anxious and happier at work. But, moreover, you are less anxious and happier at home because you are more confident you don’t bring the virus home with you. That finding would seemingly alarm public health people. It comforts and gratifies me.