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How not to do public health policy

After the policy of allowing people to come into the country without requiring a two week quarantine has lead to a wave of new infections, to absolutely no ones surprise, the government decided to finally make masks a requirement in public spaces. Or not. It definitely provided a good example how not to implement public health policy.

First things first, making masks a requirement public spaces has been shown to be an effective policy to combat Covid-19, if anything, this requirement comes late, it wasn't in effect in spring for example. However, even a good policy is only as effective as it's implementation and here it is severely lacking.

So you are a government and you want people to change their behaviour. You need to let them know how and why. It is also best to keep it simple. For example, the slogan to prevent drunk driving (even in Germany, where the legal limit is not 0%) is: "Don't drink and drive". It isn't "Don't drink more than one beer and drive" because that would make the message unnecessary complicated. The spirit of the information campaign is also to encourage healthy behaviour, rather than telling people how to observe the law.
Now let us look at the information regarding requiring masks. We need to wear them in public spaces IF it is not possible to observe the 2m rules. How do we estimate that? Well, guess we show up and find out! Some places, such as buses require masks all the time. But you don't need a mask in Strætó, except when you do. Strætó changes it's mind on that every day. What is it that they want to achieve with this policy? To reduce the risk of infection. So you would think that risking a)" people wearing a mask in a situation where they might not need one" < risking b) "people not wearing a mask where they might need one". The rules how they are communicated to people currently risks a over b. Which is also observable, I have been travelling and gas stations, rest stops, restaurants, camp grounds were pretty full. In theory though, the amount of people allowed were restricted enough to be able to keep 2m away from everyone, in practice that was almost impossible.
So why is the rule communicated and implemented in this really complicated way? I can think of two reasons. First, economic considerations, if a mask would be required in all public spaces, it might prevent people of going to restaurants, shopping and in other ways spending money. Second the government might have implemented a mask requirement, however did not ensure that masks would be available to people. Ups.

Hugs, nudges, shoves and smacks
There are several ways governments can try and encourage healthier behaviour. Hugs (rewarding healthy behaviour, such as giving vouchers for free diapers etc to mothers who stop smoking), nudges (making it easier to make healthy choices than unhealthy ones, such as placing fruits and vegetables at the front of shops or sugar taxes vs subsidies for healthy foods), shoves (requiring the healthy behaviour, such as masks) and smacks (punishment for unhealthy behaviours, such as fines for not wearing a seatbelt).
Hugs have been shown to be really effective, but governments don't like them, because they cost money and a lot of times morality is brought into play (you should stop smoking when your pregnant anyway, why should we reward you for that?). Nudges has been the preferred method, often allowing governments to raise taxes on unhealthy goods (like alcohol, right fellow Icelanders?) or using zoning in cities. They have also been shown to be successful, such spatially limiting sale of alcohol reduces binge drinking. Shoves and smacks are often seen as draconian, before there was the anti-masks movement, there was the anti-seatbelt movement for example. And in a democracy policy makers do have to take into account peoples right to protest measures, even if the protesters are stupid.
Most importantly, if you introduce a shove or a smack you have to actually give people the possibility to comply. And here is where the government failed completely. They introduced a mask requirement and then masks were sold out immediately in all the pharmacies and also it is long weekend now and pharmacies are closed. No one is wearing masks. Most people do not even have masks. On Saturday I asked in a pharmacy along with several other people, no luck.
My big question here is: if you can give everyone with a kennitala 5000kr of travelling money, why can you not give two free reusable masks? I really wonder if the nudge of giving everyone a free mask, together with a clear information campaign that a mask should be worn in all public spaces would have been more efficient than the shove of requiring masks in some very specific places, without actually reducing barriers to acquiring masks.

It is Verslunarmannarhelgi and everyone is travelling, walking in and out of restaurants, rest stops, gas stations, camp grounds all which technically can keep the 2m rule and do not require masks, which most people do not have (not for lack of trying, I heard a lot of people ask). In two weeks infections will spike and we will go back to how it was in March. Fortunately for me I am only half way done with my REM related blog posts, so I am well prepared for another months of sitting around in a closed social centre (my workplace).

Here is a free tip from a public health professional:
  • give clear and simple instructions of desired health behaviour to your target group

  • reduce barriers to the point were complying requires the smallest amount of effort possible

  • don't rely on market forces for distribution, they thrive on scarcity

Posted on - Categories: Politics

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