• Paul McGovern

Recovering from COVID – building back better

Updated: Mar 27

Public Health England’s online COVID tracker has been a triumph. It must be developed further to help the UK build back better.

Google UK’s third most-asked question of 2020 was “How many cases of coronavirus in UK?.” Two things came to mind when I learned this – first, how was this beaten by second-placed “Where does vanilla flavouring come from?” and second, how much people want factual health information. None of Google’s top ten questions saw people asking for opinion, analysis or conjecture. They wanted facts about health, and they wanted them presented with clarity.

Unfortunately, clarity is something that doctors and scientists often do badly, even though we think we’re great at it. We talk about prevalence and incidence and all-cause mortality, and people go to sleep. Virtually no-one cares that 15% of cancer in the UK is caused by smoking, or 3 million deaths every year are caused by alcohol worldwide. Anyone can tell that these numbers are bad, but they’re also sterile. They are difficult to comprehend in a way which impacts any individual, and they don’t stop people smoking and drinking. Accuracy isn’t the same as clarity because if you’re right and boring, no-one is listening. You may as well not be talking at all.

Public Health England’s COVID dashboard is a brilliant example of clear, factual health communication. It holds a staggering amount of up-to-date information, yet displays it in a way anyone can understand. You can see the percentage of the adult population that’s been vaccinated, and how the overall progress of the vaccination programme is going over time.

You can look back in time - in May 2021, when infection rates were low across the country, the dashboard showed an uptick in infections in North West England, giving early indications of the impending third wave as it progressed through June.

It can also show us that at end of July 2021, London’s COVID vaccination rate was not as good as it was for the surrounding regions.

The graphs you see on the TV news and in the papers use information from this website, as the raw data can be downloaded and analysed by anyone. The examples above barely scratch the surface of what it can show. Even the underlying technology is open source.

There are a multitude of benefits to this, but two are especially pertinent to public health. First, people can see up-to-date health information and discredit for themselves some of the nonsense they see on Facebook. It may seem as though anti-vaxxers are everywhere, but seeing that nearly 90% of the population has already had a COVID jab, it becomes reassuringly clear the noise comes from a fairly ineffective and very small minority.

Second, it has democratised decision-making and given scientists, the media, and the public an opportunity to challenge health policy and help steer it. Braying about U-turns may be tasty political fodder and a treat for the tabloids, but science is about critically appraising information and being prepared to change your mind if evidence supports it. Groups of experts who challenge political decisions may sometimes feel like they’ve been shouting into the void, but their voices have been heard and they have helped focus and modulate the approach of decision-makers.

Health maps have been done in the past – this is a map of smoking in the USA taken from this interactive service.

It’s a good start, but it lacks clarity and usefulness – the data only goes up to 2012, and you have to do a bit of work to get to interesting information that anyone would understand. The COVID dashboard is streets ahead in terms of usability, understandability, and accessibility.

The potential benefits of extending this approach are huge, and must be a priority for the newly-established Office for Health Promotion. Imagine being able to see the smoking rate for your county, for your town, for your postcode. You could overlay data for unemployment on that for smoking, or alcohol consumption, and see how everything correlates, without even being certain what ‘correlate’ means. You could look at the number of betting shops in a town and see whether that had any links to loan defaults, or you could see whether the number of fast-food restaurants had anything to do with childhood obesity rates. Studies show that there are links between many of these factors, but studies are in inaccessible journals and often took place in another region or country. A levelled-up COVID dashboard would be like a health version of Google Maps – it’s great looking at your own house from space when you discover you can, but curiosity often leads to further discovery.

Researchers and academics may know the answers to questions about gambling and obesity and fast food and poverty, but because they speak in scientific tongues, no-one listens to them. By putting the data in a form which lets people explore and understand for themselves, it makes the conversation more accessible, which in turn gives more people a chance to ask, ‘why don’t we do things another way?’

Don’t underestimate what a lay audience can do with data. If it’s presented in an interesting way, people are likely to get interested. NASA actively recruits enthusiastic amateurs to help them discover planets by assisting with data analysis. It is entirely possible that health insights missed by experts could be highlighted by someone in a call centre killing time in their lunch break.

Much of the data to feed this system is already there. GPs know people’s blood pressure, how much they smoke, how much they drink, and what they weigh. Councils collect information on air pollution and traffic levels. Pharmacists know how many prescriptions are issued for asthma medication. The Job Centre knows how many people are on different types of benefits. Concerns about data security are completely valid and must be thought through, but well-designed systems preserve anonymity and maintain public trust, as the COVID dashboard has already shown.

Local authorities would be better able to understand the health priorities in their area, and see other areas in the country where things have improved. They’d be able to learn from each other and share best practice based on data, without needing to hunt for information in long complex technical reports that no-one has read. There are thousands of health charities in the UK; harnessing their knowledge and insight to learn from the information in the system – while adding new data themselves – would help charities, health services and local authorities understand where collaboration could reap the biggest rewards.

A further-developed version of the COVID dashboard would be a critical piece of national infrastructure. Setting standards for who feeds data into it and how it is supplied would ensure accuracy and quality. Health information that already sits in the UK’s digital attic would become accessible and useful. It would empower local authorities, community organisations, health providers, employers and individuals to take action on health issues in their own areas, and highlight inequalities in a way that would make the people who suffer from them much harder to ignore. It would be a key part of a foundation upon which health, wellbeing and ultimately economic productivity will rise, and would add immense value in helping Britain build back better.

Screenshots from the COVID dashboard were collected on 31 July 2021.

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