A Return to Normalcy?

Population health

At last, some good news! According to the International Energy Agency (IEA), this year has witnessed a 25% decrease in energy demand in a large number of countries. Globally, energy demand has been reduced by 3.8% and oil demand by 5%. In several countries, electricity has seen a 20% demand reduction and coal an 8% reduction. Additionally, CO2 emissions went down globally.  The coming months are even brighter: the IEA expects oil demand to be down by 9%; coal, 8%; and electricity, 5%, with some areas seeing a 10% drop. Demand for nuclear energy and gas are also expected to drop significantly. Recent, if temporary, improvements in air quality seems unmistakable. And the American Geophysical Union confirms that “two major air pollutants have been drastically reduced,” while similar declines in smog and pollution can be observed from space across the United States.

But before we get too excited, there’s a catch, actually more than one, and they’re big ones: the first is that the decline in energy use and in CO2 and other greenhouse gas emissions, is due to the lockdown of much of the industrial world, creating an economic disaster. Massive layoffs have resulted in millions of people in the United States alone losing private insurance along with their livelihoods. Not surprisingly, the most affected are Black and Hispanic American frontline workers who have historically been the last hired and the first fired, in jobs that pay little and have few, if any, benefits.

A second major catch is that even with a quick economic recovery, the same health and environmental inequalities that existed in November 2019 will continue. After all, if we return to the pre-pandemic world without some major changes, most of us will still live in homes dependent on oil or natural gas, ride in cars mostly powered by gasoline, and depend, at least in part, on coal-powered power plants for electricity.  We will still consume fossil fuels, plastics, and chlorinated hydrocarbons in huge amounts.

And, of course, if we return to that ravenous world of consumption based on petrochemicals, the burden once again will fall most heavily on Black Americans. The Environmental Protection Agency (EPA) reports that Black Americans of every income group are exposed to higher levels of air pollutants than are white Americans, and they suffer disproportionately from the resulting asthma, heart conditions, and environmental cancers. The EPA study confirms what has long been known to Robert Bullard, the eminent sociologist of environmental racism: Race is the “strongest predictor of exposure” to life-threatening pollutants, amplifying the always devastating impacts of poverty. And poorer children will be exposed to higher levels of heavy metals in their homes and chemical contaminants from plastics, pesticides, and even cosmetics. The American Lung Association is more muted, reaffirming in the midst of the pandemic, that “the burden of air pollution is not evenly shared.

Recent studies also indicate that pollution has had a dire impact on Black Americans whose children are disproportionately born premature, underweight, or stillborn.  Another study has given “A Clarion Warning about Pregnancy Outcomes and the Climate Crisis,” indicating that “without mitigating efforts the climate crisis” will have devastating impacts on poor communities around the world and specifically, pregnant women.  “Pregnant women are particularly at risk … at all gestational ages.”

The pandemic has unfortunately provided us with a natural experiment showing that reductions in hydrocarbon consumption can result in substantial reductions in CO2 and other atmospheric pollutants. But, if we return to pre-pandemic “normalcy” we will return to a grossly unfair world marked by massive inequalities in income, suffering, and lifespans. The New York Times notes that “in 2017, more than 17 million workers—disproportionately minorities and women—labored for wages too meager to lift their households above the federal poverty line.”

There are alternatives, and we need to seriously consider them. The social protests following the death of George Floyd have focused our attention on the systemic inequalities that plague the country and, at the moment, are spurring changes in the social landscape unimaginable only a few months ago. For health policymakers, the coincidence of the pandemic and the powerful social movements developing around race and racism may engender a political environment that public health experts have only dreamed of: seriously addressing the inequalities in health brought on by the ever-widening gaps in wealth, education, and environments. A return to “normalcy” should not mean a return to wide inequalities in incomes, opportunities, and health. A return to that world will only fuel the schisms in our society over race that have deepened during the past four years.

Perhaps we can use this time to reimagine a world in which we had a more robust economy, free of dependence on fossil fuels, willing to provide health insurance untethered to a job, providing a social safety net responsive to economic downturns, with security for all. Perhaps, we can imagine a world in which federal subsidies might relieve students of crushing personal debt? The joint crises of a pandemic and demands for equality–aided by the possible change in administration in Washington—may provide a moment of opportunity, if we don’t blow it by limiting our vision to the depressing “normalcy” of 2019.

Even the mainstream New York Times is asking these questions: What might the world look like if we could emerge from the pandemic smarter and less dependent on fossil fuels? What if we emerged from the crisis thinking that everyone deserved a world safe from the greed that exemplifies so much of our modern culture? What if we made use of this epidemic and what it reveals about our national character to truly change the world? These questions are worth asking at this unique moment in history, a moment brought to us by pandemic and social protest.


Rosner D. A Return to Normalcy? Milbank Quarterly Opinion. July 8, 2020. https://doi.org/10.1599/mqop.2020.0708.

About the Author

David Rosner is the Ronald H. Lauterstein Professor of Sociomedical Sciences and professor of history at Columbia University and codirector of the Center for the History of Public Health at Columbia’s Mailman School of Public Health. He is also an elected member of the National Academy of Medicine. In addition to numerous grants, he has been a Guggenheim Fellow, a recipient of a Robert Wood Johnson Investigator Award, a National Endowment for the Humanities Fellow, and a Josiah Macy Fellow. He and Gerald Markowitz are coauthors on ten books, including Deceit and Denial: The Deadly Politics of Industrial Pollution (University of California Press/Milbank, 2002; 2013) and Lead Wars: The Politics of Science and the Fate of America’s Children (University of California Press/Milbank, 2013). He also testifies for plaintiffs in lawsuits on industrial pollution and occupational disease.

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