At times, the argument about lockdown has been described as a choice between saving lives or saving money. But this is a false equivalence. A weak economy leads to weakened citizens: it means less tax revenue, less money for the NHS, and poorer families — wealth and health are all too-closely linked. Just look at the difference in height between Koreans, depending on which side of the 38th parallel their grandparents happened to be caught on.
It’s easy to measure money, but it’s far harder to measure the indirect results of a richer or poorer economy. It’s also hard to work out how much money you should spend to save a life. Ban cars, and you’ll end road deaths. But you’d also hit the economy. So a balance has to be struck somewhere.
This balance has been researched extensively at the University of Bristol, where we have developed the ‘J-value’ (‘J’ stands for ‘judgement’). It’s intended as an objective answer to the safety questions that arise from nuclear plants, railways and the infrastructure that improves our material lives — including in the NHS. How much should a nuclear power plant spend on protecting its workers? Is it cost-effective to install a new safety system for railway signalling? Should the government be spending more to prevent road deaths? In short, the J-value balances the amount of life expectancy that a safety measure restores against its cost. And, it takes the ethical stance that each day of life has the same value for everyone — whether an individual is rich or poor, young or old.
The J-value is especially useful when looking at our response to coronavirus — and particularly whether the cost of locking down is too high. It does this by calculating the ‘years’ lost from a prolonged recession caused by locking down, which we can then compare to the number of years we would lose to the disease itself.
How long someone has left to live at any given point is not, of course, something we can ever know with certainty. For example, any one of us could die in an accident tomorrow. But ONS life tables tell us that a newly born infant in Britain will, on average, live to 81; the average 50-year-old will live to 83 (having already survived risks in earlier decades); and the typical centenarian can expect another two years of life. Averaging the life expectancies of everyone in the UK shows that an average life in this country will last for another 42 years.
When it comes to the ‘years’ lost by lockdown, the link between money and health is clear enough — the richer a country, the longer its people live. Indeed, the J-value can explain 80 per cent of the variation in life expectancy amongst 162 of the 193 nations in the UN. It also explains the year-on-year rise in life expectancy at birth observed in Britain as GDP per head grew over the decades preceding the 2008 financial crash, when GDP per head fell by 6 per cent. The J-value accounts for the stalling in UK life expectancy growth a couple of years later.
Chart one: Showing how life expectancy grows as GDP per head rises
The government’s response to the Covid-19 epidemic is driving the UK into a deep and prolonged recession. The economy was 25 per cent down during the depths of lockdown in April and May, compared with its performance in February. An incomplete recovery began when restrictions were relaxed, but the IMF was predicting that UK GDP would fall 10 per cent this year, even before the Prime Minister imposed a new, month-long lockdown on England. What effect will this new lockdown have on the economy — and what will be the effect on UK life expectancy?
The Prime Minister has declared his intention to ‘reduce the R-rate below one’ and keep it there, until the epidemic gradually fades away. In August, we were nearly there: the R-rate averaged 1.02 for the UK and 1.0 for England. The effect of the restrictions, however, kept economic activity depressed by 9.2 per cent below pre-coronavirus levels.
Keeping the R-rate below 1 now would lock the UK economy into the same, low level we saw in August. This means we would have a long drawn out, flat slump, with between 9 and 10 per cent below normal levels of economic activity.
The J-value tells us that the population-average life expectancy lost from a prolonged trough caused by a continuing 9 per cent reduction of output would be about a third of a year per person. This is deduced from the average life expectancy as seen in chart one. Now, this might not sound a great deal on first hearing, but when it is multiplied by Britain’s population of 67 million (because Wales, Northern Ireland and Scotland are following similar medical and epidemiological advice), the number of average lives lost comes to 560,000 — rather greater than the UK's military and civilian losses in the second world war. That might sound jarring, so how have we got to such a stark figure? It is arrived at by multiplying the average loss faced by a citizen by the number of people in the nation and dividing that by 42 years, the average life to come in the UK.
We have, unfortunately, lost about 50,000 people to Covid-19, and, without the prolonged lockdown that the government wants, we can expect a second and third wave, both of which will have peaks that may be twice what was seen in early April. Better therapies mean that the fatality rate has halved, so the number of deaths should be similar to what we saw in the first spike.
But let us take no benefit from that and assume that we stand to lose 250,000 people to Covid-19 in a worst-case scenario. So far, the average Covid victim is 79 years old, according to Office for National Statistics data. A typical 79-year-old would lose about ten years of life if he or she contracted a fatal dose of the disease. But the average person who succumbs to Covid-19 suffers from more than two pre-existing, serious medical conditions already. As a result, he or she generally only has seven and a half years of life to lose.
If 250,000 people die — who have a mean age of 79 and who have two or more existing serious medical conditions — then this would be equivalent to 45,000 average lives being lost. There is no doubt that this would be a very bad outcome. However, it is less than 10 per cent of the loss of life the nation will incur by subjecting itself to a prolonged lockdown of the sort currently envisaged by the government. There is, besides, no guarantee that a second lockdown for England will work.
Of course we should strive very hard to preserve the seven and a half years of life that the average Covid-19 victim loses — or at least reduce the number of people who are fatally affected by this deeply unpleasant disease. But we should not be tempted to apply remedies that make the situation worse. Imagine if, for a treatment such as chemotherapy to work, it had to be applied to the population as a whole. Perhaps it would prolong the lives of many suffering from a deadly disease. But chemotherapy would be an awful thing to administer to patients who did not need it and bring life limiting effects to the otherwise healthy. Doctors would rightly reject the treatment as unethical. Today, unfortunately, the government does not seem to understand the point. The societal and health costs, when tallied in years to come, will be far worse than anyone in Parliament seems to realise. It is not too late to change tack.