‘Can you lock down in a slum?’ published in Global Epidemiology

Delighted that this paper co-authored with Pieter Streicher has now been published in Global Epidemiology.

Broadbent A, Streicher P. Can you lock down in a slum? And who would benefit if you tried? Difficult questions about epidemiology’s commitment to global health inequalities during Covid-19. Global Epidemiology. 2022;4:100074. doi:10.1016/J.GLOEPI.2022.100074 (https://www.sciencedirect.com/science/article/pii/S2590113322000049)

Was lockdown racist?

Delighted to be giving a new talk this week in Cambridge and Utrecht.

Tuesday 17 May, 2.30pm BST: Cambridge Moral Sciences Club, Newnham College

Friday 20 May, 16.15 CET: Conference, Covid-19 and Public Policy, Utrecht University

Abstract

In 2016, South African learner Zulaikha Patel argued that a school rule requiring hair to be neat was racist. Even though the rule applied equally to everyone, public opinion swung behind Patel: a rule that imposed a disproportionate burden on Black learners could be racist even if it applied equally to all. The school suspended the rule. Basing itself on this case, this paper argues that global lockdowns in the first half of 2020 were racist. The paper focuses on Africa, arguing first that the lockdown strategy of implementing stringent stay-at-home regulations was externally imposed upon Africa, tracing the origins of this policy to the way that modelling results were presented so as to make just one option feasible. The resulting recommendations were promulgated globally by the World Health Organisation, and geopolitical power relations placed huge pressures on African states to comply. Next, the paper argues that locking down placed a disproportionate burden on Africa, whose population is the poorest in the world and for whom no work often means no food. At the same time, the potential benefit of the policy was small. With a median age of 19.7, much of the population was just too young for Covid ever to be a serious public health problem, and by the same token other threats to life compete for attention. Slum-dwellers cannot reduce their social contact by 75%, which is the figure used in the model upon which the recommendations were based. Most states in the region are unable to afford or implement meaningful food or grant schemes to compensate. Many African countries have no ventilators and low access to health care, so protecting the healthcare system was not a meaningful goal. And the strategy of locking down until a vaccine was available could never have been credible in a region where millions of children die annually from diseases treatable by penicillin. Where a policy originates in Europe and has disproportionate negative effect in Africa, it is impossible to ignore racial dynamics. “Black” is a colonial vestige that does not do justice to the ethnic diversity in Africa. Yet it can be legitimately used as Patel used it: for purpose of internal critique, and as an adjunct identity that does not negate other identities. Lockdown had a disproportionate negative effect on a very large number of Black people, and it was externally imposed. Therefore lockdown was racist.

Taking life from the poor to give to the rich?

I’ve given this talk in various places, most recently Durham University (where I’m a Professor of Philosophy of Science). I’m now giving it at the University of Johannesburg (where I’m a Visiting Professor) for the first time, which is great for me because it’s here that I first had the ideas. The event is both in person and online. Details below. It’s a co-hosted event between Durham’s Centre for Humanities Engaging Science and Society, and UJ’s Philosophy Department, supported by the UJ Library and Faculty of Humanities.

Can robots do epidemiology? Preprint available

Delighted that Philosophy and Technology has accepted a paper by Thomas Grote and I on the relationship between machine learning, epidemiology, public health, causal inference, prediction, interventions, and all the other things we could squeeze into one paper. No “salami slicing” of papers for us. Here’s a preprint.

An egalitarian evaluation of lockdown

I’ve started a new job and in the process not posted anything here for months, nor done a whole lot worth sharing. Now I’m dusting off my “lockdown talk” and updating it, with a view to writing it up soon. It’s now called “An egalitarian evaluation of lockdown” and I feel like it’s matured quite a bit. I also now have the benefit of being able to talk about the global vaccination mess as something totally foreseeable, which matters because awaiting a vaccine is an integral part of the strategy I criticise. Here’s the abstract:

“Lockdown” has come to designate a cluster of non-pharmaceutical interventions intended to slow or stop Covid-19. One familiar line of objection to lockdowns is libertarian: lockdowns restrict freedom of movement, association, and so forth. However, the appeal of libertarian arguments is limited to (a) moral contexts globally where individual liberty rights are a primary dimension of policy evaluation and (b) audiences that see such rights as outweighed by the dangers of Covid. Among the latter are some motivated by egalitarian considerations, who claim that Covid hits poorer people including “minorities” harder than richer people. This paper contends that there is a neglected but extremely powerful egalitarian argument against lockdown, based on the fact that most poor people live outside rich countries in circumstances where lockdowns offer no protection, where the risk posed by Covid 19 is lower both absolutely (due to demographics) and relative to other risks to life (due to these being greater), and that lockdowns greatly exacerbate these risks. This includes racial and other majorities who are routinely referred to as “minorities” by authors in rich countries. The paper argues that neglect of these facts is an instance of epistemic injustice, the victims of which are predominately so-called “persons of colour”. The paper argues further that the unfair features of lockdown are not coincidental, but that it was these very features that led to their endorsement by powerful groups, nations and international bodies, and to the persistent positive attitude to lockdowns. From an egalitarian standpoint, their actions can be interpreted as using the commanding heights of the global knowledge economy, not to reduce the global burden of Covid overall, but to transfer as much of the burden of Covid as possible from the global rich to the global poor.

“Lockdown” has come to designate a cluster of non-pharmaceutical interventions intended to slow or stop Covid-19. One familiar line of objection to lockdowns is libertarian: lockdowns restrict freedom of movement, association, and so forth. However, the appeal of libertarian arguments is limited to (a) moral contexts globally where individual liberty rights are a primary dimension of policy evaluation and (b) audiences that see such rights as outweighed by the dangers of Covid. Among the latter are some motivated by egalitarian considerations, who claim that Covid hits poorer people including “minorities” harder than richer people. This paper contends that there is a neglected but extremely powerful egalitarian argument against lockdown, based on the fact that most poor people live outside rich countries in circumstances where lockdowns offer no protection, where the risk posed by Covid 19 is lower both absolutely (due to demographics) and relative to other risks to life (due to these being greater), and that lockdowns greatly exacerbate these risks. This includes racial and other majorities who are routinely referred to as “minorities” by authors in rich countries. The paper argues that neglect of these facts is an instance of epistemic injustice, the victims of which are predominately so-called “persons of colour”. The paper argues further that the unfair features of lockdown are not coincidental, but that it was these very features that led to their endorsement by powerful groups, nations and international bodies, and to the persistent positive attitude to lockdowns. From an egalitarian standpoint, their actions can be interpreted as using the commanding heights of the global knowledge economy, not to reduce the global burden of Covid overall, but to transfer as much of the burden of Covid as possible from the global rich to the global poor.

It’s bound to be a controversial line of argument in one way, because it’s drawing a normative moral conclusion that’s pretty far-reaching. But in another way, I hope that it might prove more appealing to people who are fed up with “lockdown scepticism” based on libertarian arguments that they just don’t accept (as well as showing “lockdown sceptics” that they might have other intellectual avenues to pursue). It breaks with the familiar left/right and public health/libertarian dialectics, which I regard as rather North/West focused, and as missing an important set of points and contexts. Hopefully many can agree about at least the need for an evaluation that is both global and focused on equality, even some who reject my own evaluation.

I’ll be delivering the talk at a conference hosted by the University of Macau titled ‘The Moral Roots of Lockdown: East Meets West.’ The programme looks really interesting (setting aside my own contribution). See below. Email the organisers for a zoom link: mrqconference@gmail.com

Covid Philosophy Week, 10-13 May 2021 – Registration Open

The journal Philosophy of Medicine, the Department of HPS, Cambridge, and the Institute for the Future of Knowledge, U Johannesburg, bring you a multi-day programme of philosophical discussions responding to Covid-19. There are three events:

10-13 May, Conference: Philosophical Perspectives on Covid-19, hosted by Philosophy of Medicine and the Institute for the Future of Knowledge (UJ)

12 May, Workshop: The Individual and the Population, part of the series Rethinking the Ethics of Vaccination organized by Emma Curran and Stephen John (Cambridge HPS)

13 May, Panel: Philosophy of Medicine on Covid-19, hosted by Philosophy of Medicine and the Institute for the Future of Knowledge (UJ)

These events have been timetabled so that they do not clash and are accessible for as broad a range of time zones as possible.

Registration and further info for all three events available here: https://philmed.pitt.edu/philmed/CovidWeek

Warm regards,

The Editors, Philosophy of Medicine

https://philmed.pitt.edu/

Is lockdown right? Bioethics, global health, and COVID-19

I gave a public lecture at Virginia Commonwealth University, and it’s up on YouTube here. Bear in mind it was midnight my time… surreal but enjoyable experience.

In this talk I argue for these five claims:

  1. Several common arguments for lockdowns fail
  2. Many actual lockdowns have been unjustified and wrong: other measures would have been better
  3. Globally, lockdowns shift the burden of disease from the powerful and wealthy to the less powerful and poor
  4. The global preference for lockdowns is due to their favoring the interests of the rich and powerful
  5. Optional extra: the favoring of lockdowns by the “left” and rejection by the “right” has nothing to do with their intrinsic character: they are as much right as left and vice versa

ML in epidemiology: thoughts on Keil and Edwards 2018

Found a great paper (that I should already have known about, of course): Keil, A.P., Edwards, J.K. You are smarter than you think: (super) machine learning in context. Eur J Epidemiol 33, 437–440 (2018). https://doi.org/10.1007/s10654-018-0405-9

Here are some brief thoughts on this really enjoyable article, which I would recommend to philosophers of science, medicine, and epidemiology looking for interesting leads on the interaction between epidemiology and ML – as well as to the target audience, epidemiologists.

Here are some very brief, unfiltered thoughts.

  1. Keil and Edwards discuss an approach, “super learning”, that assembles the results of a bundle of different methods and returns the best (as defined by a user-specified, but objective, measure). In an example, they show how adding a method to that bundle can result in a worse result. Philosophically, this resonates with familiar facts about non-deductive reasoning, namely that as you add information, you can “break” and inference, whereas adding information to the premise set of a deductive argument does not invalidate the inference provided the additional information is consistent with what’s already there. Not sure what to make of the resonance yet, but it reminds me of counterexamples to deductive-nomological explanation – which is like ML in being formal.
  2. They point out that errors like this are reasonably easy for humans to spot, and conclude: “We should be cautious, however, that the billions of years of evolution and experience leading up to current levels of human intelligence is not ignored in the context of advances to computing in the last 30 years.” I suppose my question would be whether all such errors are easy for humans to spot, or whether only the ones we spot are easy to spot. Here, there is a connection with the general intellectual milieu around Kahneman and Tversky’s work on biases. We are indeed honed by evolution, but this leads us to error outside of our specific domain, and statistical reasoning is one well-documented error zone for intuitive reasoning. I’m definitely not disagreeing with their scepticism about formal approaches, but I’m urging some even-handed scepticism about our intuitions. Where the machine and the human disagree, it seems to me a toss-up who, if either, is right.
  3. The assimilation of causal inference to a prediction problem is very useful and one I’ve also explored. It deserves wider appreciation among just about everyone. What would be nice is to see more discussion about prediction under intervention, which, according to some, are categorically different from other kinds. Will machine learning prove capable of making predictions about what will happen under interventions? If so, will this yield causal knowledge as a matter of definition, or could the resulting predictions be generated in a way that is epistemically opaque? Interventionism in philosophy, causal inference in epidemiology, and the “new science of cause and effect” might just see their ideas put to empirical test, if epidemiology picks up ML approaches in coming years. An intervention-supporting predictive algorithm that does not admit of a ready causal interpretation would force a number of books to be rewritten. Of course, according to those books, it should be impossible; but the potency of a priori reasoning about causation is, to say the least, disputed.

How Should We Evaluate Lockdowns? Disentangling Effectiveness, Context, and Politics

Very pleased to share a new blog post I’ve written with Herkulaas Combrink, Benjamin Smart and Damian Walker for the Center for Global Development’s commentary and analysis section.

https://www.cgdev.org/blog/how-should-we-evaluate-lockdowns-disentangling-effectiveness-context-and-politics