After many rounds of negotiations, the U.S. Congress passed a new COVID-19 relief package last night.
As many Americans enter the ninth month of adjusted life after the arrival of the COVID-19 pandemic, public health remains a central legislative priority for Congress. The CARES Act provided funding for healthcare needs and businesses detrimentally impacted by the pandemic, as well as stimulus checks for American taxpayers. The stimulus checks in both the CARES Act and yesterday’s bill sought to lessen the economic burden of COVID-19 for individuals and families.
While each round of stimulus checks were targeted to improve economic conditions for Americans, I view them through the lens of their effects on public health. Harm reduction is a specific public health strategy which offers a unique way to examine the role of stimulus checks in advancing economic, social, and health-related outcomes. Stimulus checks can serve as an effective harm reduction strategy for improving public health, but we must expand stimulus payments in order to make this strategy truly productive.
A History of Harm Reduction
Harm reduction strategies first emerged in the 1980s as an alternative to abstinence-only interventions for individuals with substance abuse disorders. This public health practice instead accepts a certain level of continued risky behaviors in the short-term, while prioritizing a long-term reduction in negative health consequences. In the case of substance abuse, these strategies permitted individuals to still maintain a level of drug usage, with the goal of improving overall health, social, and economic outcomes.
Although controversial, harm reduction approaches have been shown to greatly reduce morbidity and mortality associated with risky health behaviours. In the nearly 40 year history of the practice, harm reduction strategies have expanded their focus from substance abuse to sexual health, teen pregnancy, and alcohol usage. These strategies adopt a necessary balance between short-term behaviors and long-term outcomes that are especially applicable to public health policies enacted in response to the COVID-19 pandemic.
Stimulus Checks as Harm Reduction
While economic interventions have not yet been described as harm reduction public health practices, I argue that stimulus checks during the pandemic could be a strong example of an effective harm reduction strategy. The CARES Act stimulus payments were created to “provide emergency assistance and health care response” for families and individuals during the pandemic. While stimulus payments may explicitly seek to replace reduced wages or lost job opportunities, I believe they serve as an important public health strategy as well.
Because the U.S. did not mandate any national lockdowns, such as those imposed in the United Kingdom and Italy, it implicitly accepted that people would continue to engage in risky behaviors by going out to work, shop, and even socialize during the pandemic. This acceptance of risk came at a high cost for health, with over 300,000 Americans dying from the pandemic by early December. As an alternative to a national lockdown, the CARES Act and yesterday’s bill reflect an attempt to balance between these continued levels of risk and a longer-term outlook toward economic consequences of the pandemic.
Stimulus checks can help individuals supplement lost income from unemployment, pay for necessary medical services during the pandemic, and stimulate economic activity by returning tax dollars to the American taxpayer. Stimulus payments prioritize short-term economic aid as a way to ensure Americans participate in fewer risky health behaviors, such as going without healthcare needs in an attempt to save money or working more hours in conditions that may spread the virus. From the perspective of harm reduction, stimulus checks and other public health legislation could still result in a reduction of negative outcomes overall while accepting some level of risky behavior in the present.
Limitations of this Approach
Stimulus payments can serve as a harm reduction strategy by minimizing present risky behaviors in favor of maximizing future health, economic, and social outcomes, yet are currently insufficient to deliver on this promise. The U.S. Congress passed the CARES Act in March, which provided $1,200 per adult taxpayer and $500 per dependent child in American households. The current stimulus package drops funding to $600 per taxpayer, and does little to address mounting concerns about a looming eviction crisis amid the worst spike of the pandemic so far.
To serve as an effective harm reduction strategy, stimulus payments should take into account the real situation that many Americans face in the coming weeks. By January, nearly 12 million renters will owe an average of nearly $6,000 in rent and utilities. Around 80 percent of census respondents planned to use the initial stimulus check on food, and around 78 percent on rent, mortgage, or utilities. With economic and health conditions in this country worsening, it is likely that even more Americans would use a second round of stimulus payments for these basic necessities, rather than generating economic activity by reinvigorating businesses hurt by the pandemic.
Lessons for Congress to Learn
From the perspective of public health harm reduction strategies, stimulus payments could help individuals and families achieve stronger overall outcomes at the expense of short-term risky health behaviors. However, the stimulus checks in America so far are insufficient to achieve these goals. Here are some examples of the successful application of stimulus payments in other countries and suggest how Congress could move forward with legislation that engages thoughtfully with stimulus payments as a strategy of harm reduction.
In other countries, these benefits have taken the form of singular monetary payments, recurring monthly stipends, and even proportional payments of individuals’ regular salaries. The Netherlands offered workers up to 90 percent of their monthly pay throughout the pandemic. Denmark and the UK similarly offered to pay a proportion of their workers’ salaries. Spain provided a universal basic income for its lowest income families throughout the duration of the pandemic. Each of these strategies consider the long-term effects of COVID-19 on individuals’ well-being in a much more sensitive way than the United States has offered thus far.
To make stimulus payments an effective and equitable harm reduction strategy, the U.S. should move forward with offering additional monthly stimulus checks in line with the models of many European countries. This will enable individuals to use their checks not only to pay off debt accrued because of the pandemic, but also to promote better economic and health-related outcomes by ensuring individuals and families have access to the resources they need in order to thrive in the long-term.
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