Throughout the pandemic, the fight against COVID-19 has often been framed in terms of striking a balance between the health of the public and the health of the economy. This leads to the assumption that a trade-off must exist between these two objectives. Countries, therefore, have to decide between lives and livelihoods. However, one year on since lockdowns swept the globe the evidence suggests that the trade-off between sacrificing lives and sacrificing the economy is not necessarily clear cut.
Controlling the virus
Restrictions such as social distancing and lockdowns were introduced in order to minimise the spread of the virus, prevent hospitals from being overwhelmed, and ultimately save lives. However, as these measures are put in place, schools were closed, businesses and factories stopped operating, and economic activity shrank. This would suggest therefore, that society inevitably faces a trade-off between lost lives versus lost livelihoods.
It could be argued, therefore, that in the short run these interventions create a ‘health–wealth trade-off’. The lockdown restrictions save lives by preventing transmission, but they came at the cost of lost output, income and therefore GDP. This would also imply that the trade-off works in reverse when the lockdown restrictions are eased. As measures are relaxed, the economy can begin to recover but at the cost of an increased threat of the virus spreading again.
What are the costs?
In order to work out if a trade-off exists and what costs are involved, there must be a monetary value placed on human life. While this may seem unethical, governments, civil courts, regulatory bodies and companies do it all the time. The very existence of the life insurance industry is testament to the fact that human lives can be measured in monetary terms. One approach to measuring valuing life, commonly used by economists who conduct cost-benefit analyses, is the ‘value of statistical life’. It measures the loss or gain that arises from changes in the incidence of death, by eliciting people’s willingness to pay for small reductions in the probability of death, or their willingness to accept compensation in exchange for tolerating a small increase in the chance of death. (see the blog Lockdown – again. Is it worth it?)
Take the example of a complete lockdown. The potential number of lives saved can be estimated based on infection and fatality rates estimated from epidemiological models. This can then be multiplied by value of statistical life to compute the monetary value of saved lives. If this number exceeds the economic costs of a complete lockdown, then we know that it is desirable.
The trade-off between lost lives versus the economy is often erroneously viewed as an all-or-nothing choice between complete lockdown versus zero restrictions. However, in reality, there is a continuum in stringency of restrictions and it is not an all-or-nothing comparison.
Death rates vs downturns
In order to explore the existence of this trade-off, we can compare the health and economic impacts of the pandemic in different countries. If such a trade-off exists, then countries with lower death rates should have experienced larger economic downturns. However, when comparing the COVID-19 death rates with GDP data, the result is the opposite: countries that have managed to protect their population’s health in the pandemic have generally also protected their economy too. This suggests that there was never a simple binary trade-off between the two factors. Those countries that experienced the biggest first wave of excess deaths, also had the biggest hits to the economy.
The UK was the hardest hit of similar countries on both measures within the G7 group of industrialised countries. The shape of the recession in the UK from the pandemic and lockdowns was extraordinary and historic. However, it was also unique as there was a very sharp fall followed by a rapid rebound. Over 2020, GDP saw the largest hit in three centuries; larger than any single year of the Great Wars or the 1920s Depression.
Studies of the declines in GDP contradict the idea of a trade-off, showing that countries that suffered the most severe economic downturns, such as Peru, Spain and the UK, were generally among the countries with the highest COVID-19 death rates. There are countries that have experienced the reverse too; Taiwan, South Korea, and Lithuania all experienced modest declines in economic output but have also managed to keep the death rate low.
It should also be noted that some countries that had similar falls in GDP experienced very different death rates from each other. When comparing the USA and Sweden with Denmark and Poland, they all saw similar declines in the economy with contractions of around 8–9%. However, the USA and Sweden recorded 5–10 times more deaths per million. This therefore suggests that there is no clear trade-off between the health of the population and the health of the economy.
There will be many different factors that impact on the death rate for each individual country and by how much the economy has been affected. Such factors will even go beyond the policy decisions that have been made throughout the pandemic about how best to suppress the transmission of the virus. However, from the data available, there is no clear evidence to suggest that a trade-off between the health and the economy exists. If anything, it suggests that the relationship works in the opposite direction.
Save the economy by saving lives
Given the arguments against the existence of the trade-off, it could be argued that in order to limit the economic damage caused by the pandemic, the focus needs to start and end with controlling the spread of the virus. Experiments that have been conducted across the world definitively show that no country can prevent the economic damage without first addressing the pandemic that causes it. Those countries that acted swiftly in implementing harsh measures to control the virus, are now reopening in stages and their economies are growing. Countries such as China, Australia, New Zealand, Iceland, and Singapore, which all invested primarily in swift coronavirus suppression, have effectively eliminated the virus and are seeing their economies begin to grow again.
China, in particular, stands out amongst this group of countries. The Chinese authorities acted very quickly, and firmly, but also the levels of compliance of the population have been very high. However, it could be argued that few countries possess the infrastructure that exists in China to facilitate such high compliance. The fact that the lockdown in China was so effective reduced both losses to the economy and the need for stimulus measures. China is also one of the few countries that have achieved a “V-shaped” recovery. Countries such as Korea, Norway and Finland also appear to have responded relatively well.
Most of the countries that prioritised supporting their economies and resisted, limited, or prematurely curtailed interventions to control the pandemic faced runaway rates of infection and further national lockdowns. The examples of the UK, the USA and Brazil are often quoted, with many arguing that these countries responded too late and too haphazardly. Both have experienced high numbers of deaths.
Conclusion
Discussions around the responses to the pandemic and what appropriate action should be taken have predominately been about how countries can strike the balance between protecting people’s health and protecting the economy. However, from observing the GDP data available there is no clear evidence of a definitive trade-off; rather the relationship between the health and economic impacts of the pandemic goes in the opposite direction. As well as saving lives, countries controlling the outbreak effectively may have adopted the best economic strategy too. It is important to recognise that many factors have affected the death rate and the impact on the economy, and the full impacts of the pandemic are yet to be seen. However, it is by no means clear that the trade-off between greater emphasis on sacrificing lives or sacrificing the economy is as real as has been suggested. If such a trade-off does exist, it is, at best, a weak one.
Articles
- In a pandemic it isn’t a case of health v wealth
BBC News, Faisal Islam (17/3/21)
- To Save the Economy, Save People First
Institute for New Economics Thinking, Phillip Alvelda, Thomas Ferguson, and John C. Mallery (18/11/20)
- Covid-19: Is there a trade-off between economic damage and loss of life?
LSE Blogs, Bernard H Casey (18/12/20)
- The COVID-19 dilemma: Public health versus the economy
Asian Development Bank Blogs, Euston Quah, Eik Leong Swee and Donghyun Park (24/11/20)
- Valuating health vs wealth: The effect of information and how this matters for COVID-19 policymaking
VOXEU, Shaun P. Hargreaves Heap, Christel Koop, Konstantinos Matakos, Asli Unan, Nina Weber (6/6/20)
- Which countries have protected both health and the economy in the pandemic?
Our World in Data, Joe Hasell (1/9/20)
Questions
- Define and explain the difference between a substitute and complementary good.
- Using your answer to question 1, describe the existence of a trade-off.
- Discuss the reasons why the trade-off between health and the economy would work in the opposite direction.
Rishi Sunak delivered his 2021 UK Budget on 3 March. It illustrates the delicate balancing act that governments in many countries face as the effects of the coronavirus pandemic persist and public-sector debt soars. He announced that he would continue supporting the economy through various forms of government expenditure and tax relief, but also announced tax rises over the medium term to begin addressing the massively increased public-sector debt.
Key measures of support for people and businesses include:
- An extension of the furlough scheme until the end of September, with employees continuing to be paid 80% of their wages for hours they cannot work, but with employers having to contribute 10% in July and 20% in August and September.
- Support for the self-employed also extended until September, with the scheme being widened to make 600 000 more self-employed people eligible.
- The temporary £20 increase to Universal Credit, introduced in April last year and due to end on 31 March this year, to be extended to the end of September.
- Stamp duty holiday on house purchases in England and Northern Ireland, under which there is no tax liability on sales of less than £500 000, extended from the end of March to the end of June.
- An additional £1.65bn to support the UK’s vaccination rollout.
- VAT rate for hospitality firms to be maintained at the reduced 5% rate until the end of September and then raised to 12.5% (rather than 20%) for a further six months.
- A range of grants for the arts, sport, shops , other businesses and apprenticeships.
- Business rates holiday for hospitality firms in England extended from the end of March to the end of June and then with a discount of 66% until April 2022.
- 130% of investment costs can be offset against tax – a new tax ‘super-deduction’.
- No tax rises on alcohol, tobacco or fuel.
- New UK Infrastructure Bank to be set up in Leeds with £12bn in capital to support £40bn worth of public and private projects.
- Increased grants for devolved nations and grants for 45 English towns.
It has surprised many commentators that there was no announcement of greater investment in the NHS or more money for social care beyond the £3bn for the NHS and £1bn for social care announced in the November Spending Review. The NHS England budget will fall from £148bn in 2020/21 to £139bn in 2021/22.
Effects on borrowing and GDP

The net effect of these measures for the two financial years 2020 to 2022 is forecast by the Treasury to be an additional £37.5bn of government expenditure and a £27.3bn reduction in tax revenue (see Table 2.1 in Budget 2021). This takes the total support since the start of the pandemic to £352bn across the two years.
According to the OBR, this will result in public-sector borrowing being 16.9% of GDP in 2020/21 (the highest since the Second World War) and 10.3% of GDP in 2021/22. Public-sector debt will be 107.4% of GDP in 2021/22, rising to 109.7% in 2023/24 and then falling to 103.8% in 2025/26.
Faced with this big increase in borrowing, the Chancellor also announced some measures to raise tax revenue beginning in two years’ time when, hopefully, the economy will have grown. Indeed, the OBR forecasts that GDP will grow by 4.0% in 2021 and 7.3% in 2022, with the growth rate then settling at around 1.7% from 2023 onwards. He announced that:
- Corporation tax on company profits over £250 000 will rise from 19% to 25% in April 2023. Rates for profits under £50 000 will remain at the current rate of 19%, with the rate rising in stages as profits rise above £50 000.
- Personal income tax thresholds will be frozen from 2022/23 to 2025/26 at £12 570 for the basic 20% marginal rate and at £50 270 for the 40% marginal rate. This will increase the average tax rate as people’s nominal incomes rise.
The policy of a fiscal boost now and a fiscal tightening later might pose political difficulties for the government as this does not fit with the electoral cycle. Normally, politicians like to pursue tighter policies in the early years of the government only to loosen policy with various giveaways as the next election approaches. With Rishi Sunak’s policies, the opposite is the case, with fiscal policy being tightened as the 2024 election approaches.
Another issue is the high degree of uncertainty in the forecasts on which he is basing his policies. If there is another wave of the coronavirus with a new strain resistant to the vaccines or if the scarring effects of the lockdowns are greater, then growth could stall. Or if inflation begins to rise and the Bank of England feels it must raise interest rates, then this would suppress growth. With lower growth, the public-sector deficit would be higher and the government would be faced with the dilemma of whether it should raise taxes, cut government expenditure or accept higher borrowing.
What is more, there are likely to be huge pressures on the government to increase public spending, not cut it by £4bn per year in the medium term as he plans. As Paul Johnson of the IFS states:
In reality, there will be pressures from all sorts of directions. The NHS is perhaps the most obvious. Further top-ups seem near-inevitable. Catching up on lost learning in schools, dealing with the backlog in our courts system, supporting public transport providers, and fixing our system for social care funding would all require additional spending. The Chancellor’s medium-term spending plans simply look implausibly low.
Articles and Briefings
- Budget 2021: Key points at-a-glance
BBC News (3/3/21)
- Budget 2021: Full round-up of what Chancellor Rishi Sunak has announced
MoneySavingExpert, Callum Mason (3/3/21)
- Budget 2021 at a glance: The key points from Chancellor Rishi Sunak’s speech
This is Money, Alex Sebastian (3/3/21)
Budget 2021
IFS (3/3/21)
- Rishi Sunak delivers spend now, tax later Budget to kickstart UK economy
Financial Times, Jim Pickard, Chris Giles and George Parker (3/3/21)
- Swifter and more sustained? What did we learn about the UK’s economic outlook from Rishi Sunak’s Budget?
Independent. Ben Chu (3/3/21)
- Spending fast, taxing slow: Briefing Note
Resolution Foundation, Torsten Bell, Mike Brewer, Nye Cominetti, Karl Handscomb, Kathleen Henehan, Lindsay Judge, Jack Leslie, Charlie McCurdy, Cara Pacitti, Hannah Slaughter, James Smith, Gregory Thwaites & Daniel Tomlinson (4/3/21)
- JRF Spring Budget 2021 analysis and briefing
Joseph Rowntree Foundation, Dave Innes and Katie Schmuecker (4/3/21)
- NHS, social care and most vulnerable ‘betrayed’ by Sunak’s budget
The Guardian, Robert Booth ,Patrick Butler and Denis Campbell (3/3/21)
- Spend now, pay later: Sunak flags major tax rises as Covid bill tops £400bn
The Guardian, Heather Stewart and Larry Elliott (3/3/21)
- Rishi Sunak digs in for battle against financial cost of Covid
The Guardian, Larry Elliott (3/3/21)
- Tax and spending experts say Sunak’s budget doesn’t add up
The Guardian, Larry Elliott and Heather Stewart (4/3/21)
Budget 2021: Prepare for a dramatic rollercoaster ride after chancellor’s give-then-take budget
Sky News, Ed Conway (3/3/21)
Official documents and data
Questions
- Assess the wisdom of the timing of the changes in tax and government expenditure announced in the Budget.
- Universal credit was increased by £20 per week in April 2020 and is now due to fall back to its previous level in October 2021. Have the needs of people on Universal Credit increased during the pandemic and, if so, are they likely to return to their previous level in October?
- In the past, the government argued that reductions in the rate of corporation tax would increase tax revenue. The Chancellor now argues that increasing it from 19% to 25% will increase tax revenue. Examine the justification for this increase and the significance of relative profit tax rates between countries.
- Investigate the effects on the public finances of the pandemic and government fiscal policy in two other countries. How do the effects compare with those in the UK?
- The Joseph Rowntree Foundation looks at poverty in the UK and policies to tackle it. It set five tests for the Budget. Examine its Budget Analysis and consider whether these tests have been met.
In a series of five podcasts, broadcast on BBC Radio 4 in the first week of January 2021, Amol Rajan and guests examine different aspects of inequality and consider the concept of fairness.
As the notes to the programme state:
The pandemic brought renewed focus on how we value those who have kept shelves stacked, transport running and the old and sick cared for. So is now the time to bring about a fundamental shift in how our society and economy work?
The first podcast, linked below, examines the distribution of wealth in the UK and how it has changed over time. It looks at how rising property and share prices and a lightly taxed inheritance system have widened inequality of wealth.
It also examines rising inequality of incomes, a problem made worse by rising wealth inequality, the move to zero-hour contracts, gig working and short-term contracts, the lack of social mobility, austerity following the financial crisis of 2007–9 and the lockdowns and restrictions to contain the coronavirus pandemic, with layoffs, people put on furlough and more and more having to turn to food banks.
Is this rising inequality fair? Should fairness be considered entirely in monetary terms, or should it be considered more broadly in social terms? These are issues discussed by the guests. They also look at what policies can be pursued. If the pay of health and care workers, for example, don’t reflect their value to our society, what can be done to increase their pay? If wealth is very unequally distributed, should it be redistributed and how?
The questions below are based directly on the issues covered in the podcast in the order they are discussed.
Podcast
Questions
- In what ways has Covid-19 been the great ‘unequaliser’?
- What scarring/hysteresis effects are there likely to be from the pandemic?
- To what extent is it true that ‘the more your job benefits other people, the less you get paid’?
- How has the pandemic affected inter-generational inequality?
- How have changes in house prices skewed wealth in the UK over the past decade?
- How have changes in the pension system contributed to inter-generational inequality?
- How has quantitative easing affected the distribution of wealth?
- Why is care work so poorly paid and how can the problem be addressed?
- How desirable is the pursuit of wealth?
- How would you set about defining ‘fairness’?
- Is a mix of taxation and benefits the best means of tackling economic unfairness?
- How would you set about deciding an optimum rate of inheritance tax?
- How do you account for the growth of in-work poverty?
- In what ways could wealth be taxed? What are the advantages and disadvantages of such taxes?
Mid-December saw a rapid rise in coronavirus cases in London and the South East and parts of eastern and central southern England. This was due to a new strain of Covid, which is more infectious. In response, the UK government introduced a new tier 4 level of restrictions for these areas from 20 December. These amount to a complete lockdown. The devolved administrations also announced lockdowns. In addition, the Christmas relaxation of rules was tightened across the UK. Households (up to three) were only allowed to get together on Christmas day and not the days either side (or one day between 23 and 27 December in the case of Northern Ireland). Tier 4 residents were not allowed to visit other households even on Christmas day.
The lockdowns aimed to slow the spread of the virus and reduce deaths. But this comes at a considerable short-term economic cost, especially to the retail and leisure sectors, which are required to close while the lockdowns remain in force. In taking the decision to introduce these tougher measures, the four administrations had to weigh up the benefits of reduced deaths and illness and pressure on the NHS against the short-term economic damage. As far a long-term economic damage is concerned, this might be even greater if lockdowns were not imposed and the virus spread more rapidly.
In a blog back in September, we examined the use of cost–benefit analysis (CBA) to aid decision-making about such decisions. The following is an updated version of that blog.
The use of cost–benefit analysis
It is commonplace to use cost–benefit analysis (CBA) in assessing public policies, such as whether to build a new hospital, road or rail line. Various attempts in the past few months have been made to use CBA in assessing policies to reduce the spread of the coronavirus. These have involved weighing up the costs and benefits of national or local lockdowns or other containment measures. But, as with other areas where CBA is used, there are serious problems of measuring costs and benefits and assessing risks. This is particularly problematic where human life is involved and where a value has to be attached to a life saved or lost.
The first step in a CBA is to identify the benefits and costs of the policy.
Identifying the benefits and costs of the lockdown
The benefits of the lockdown include lives saved and a reduction in suffering, not only for those who otherwise would have caught the virus but also for their family and friends. It also includes lives saved from other diseases whose treatment would have been put (even more) on hold if the pandemic had been allowed to rage and more people were hospitalised with the virus. In material terms, there is the benefit of saving in healthcare and medicines and the saving of labour resources. Then there are the environmental gains from less traffic and polluting activities.
On the cost side, there is the decline in output from businesses being shut and people being furloughed or not being able to find work. There is also a cost if schools have to close and children’s education is thereby compromised. Then there is the personal cost to people of being confined to home, a cost that could be great for those in cramped living conditions or in abusive relationships. Over the longer term, there is a cost from people becoming deskilled and firms not investing – so-called scarring effects. Here there are the direct effects and the multiplier effects on the rest of the economy.
Estimating uncertain outcomes
It is difficult enough identifying all the costs and benefits, but many occur in the future and here there is the problem of estimating the probability of their occurrence and their likely magnitude. Just how many lives will be saved from the policy and just how much will the economy be affected? Epidemiological and economic models can help, but there is a huge degree of uncertainty over predictions made about the spread of the disease, especially with a new strain of the virus, and the economic effects, especially over the longer term.
One estimate of the number of lives saved was made by Miles et al. in the NIESR paper linked below. A figure of 440 000 was calculated by subtracting the 60 000 actual excess deaths over the period of the first lockdown (March to June 2020) from a figure of 500 000 lives lost which, according to predictions, would have been the consequence of no lockdown. However, the authors acknowledge that this is likely to be a considerable overestimate because:
It does not account for changes in behaviour that would have occurred without the government lockdown; it does not count future higher deaths from side effects of the lockdown (extra cancer deaths for example); and it does not allow for the fact that some of those ‘saved’ deaths may just have been postponed because when restrictions are eased, and in the absence of a vaccine or of widespread immunity, deaths may pick up again.
Some help in estimating likely outcomes from locking down or not locking down the economy can be gained by comparing countries which have taken different approaches. The final article in the first list below compares the approaches in the UK and Sweden. Sweden had much lighter control measures than the UK and did not impose a lockdown. Using comparisons of the two approaches, the authors estimate that some 20 000 lives were saved by the lockdown – considerably less than the 440 000 estimate.
Estimating the value of a human life
To assess whether the saving of 20 000 lives was ‘worth it’, a value would have to be put on a life saved. Although putting a monetary value on a human life may be repugnant to many people, such calculations are made whenever a project is assessed which either saves or costs lives. As we say in the 10th edition of Economics (page 381):
Some people argue ‘You can’t put a price on a human life: life is priceless.’ But just what are they saying here? Are they saying that life has an infinite value? If so, the project must be carried out whatever the costs, and even if other benefits are zero! Clearly, when evaluating lives saved from the project, a value less than infinity must be given.
Other people might argue that human life cannot be treated like other costs and benefits and put into mathematical calculations. But what are these people saying? That the question of lives saved should be excluded from the cost–benefit study? If so, the implication is that life has a zero value! Again this is clearly not the case.
In practice, there are two approaches used to measure the value of a human life.
The first uses the value of a statistical life (VSL). This is based on the amount extra the average person would need to be paid to work in a job where there is a known probability of losing their life. So if people on average needed to be paid an extra £10 000 to work in a job with a 1% chance of losing their life, they would be valuing a life at £1 000 000 (£10 000/0.01). To avoid the obvious problem of young people’s lives being valued the same as old people’s ones, even though a 20 year-old on average will live much longer than a 70 year-old, a more common measure is the value of a statistical life year (VSLY).
A problem with VSL or VSLY measures is that they only take into account the quantity of years of life lost or saved, not the quality.
A second measure rectifies this problem. This is the ‘quality of life adjusted year (QALY)’. This involves giving a value to a year of full health and then reducing it according to how much people’s quality of life is reduced by illness, injury or poverty. The problem with this measure is the moral one that a sick or disabled person’s life is being valued less than the life of a healthy person. But it is usual to make such adjustments when considering medical intervention with limited resources.
One adjustment often made to QALYs or VSLYs is to discount years, so that one year gained would be given the full value and each subsequent year would be discounted by a certain percentage from the previous year – say, 3%. This would give a lower weighting to years in the distant future than years in the near future and hence would reduce the gap in predicted gains from a policy between young and old people.
Cost–effectiveness analysis (CEA)
Even using QALYs, there is still the problem of measuring life and health/sickness. A simpler approach is to use cost–effectiveness analysis (CEA). This takes a social goal, such as reducing the virus production rate (R) below 1 (e.g. to 0.9), and then finding the least-cost way of achieving this. As Mark Carney says in his third Reith Lecture:
As advocated by the economists Nick Stern and Tim Besley, the ideal is to define our core purpose first and then determine the most cost-effective interventions to achieve this goal. Such cost–effectiveness analysis explicitly seeks to achieve society’s values.
Cost–effectiveness analysis can take account of various externalities – as many of the costs will be – by giving them a value. For example, the costs of a lockdown to people in the hospitality sector or to the education of the young could be estimated and included in the costs. The analysis can also take into account issues of fairness by identifying the effects on inequality when certain groups suffer particularly badly from Covid or lockdown policies – groups such as the poor, the elderly and children. Achieving the goal of a specific R for the least cost, including external costs and attaching higher weights on the effects on certain groups then becomes the goal. As Carney says:
R brings public health and economics together. Relaxations of restrictions increase R, with economic, health and social consequences. A strategic approach to Covid is the best combination of policies to achieve the desired level of infection control at minimum economic cost with due respect for inequality, mental health and other social consequences, and calculating those costs then provides guidance when considering different containment strategies. That means paying attention to the impact on measures of fairness, the social returns to education, intergenerational equity and economic dynamism.
Conclusion
Given the uncertainties surrounding the measurement of the number of lives saved and the difficulties of assigning a value to them, and given the difficulties of estimating the economic and social effects of lockdowns, it is not surprising that the conclusions of a cost–benefit analysis, or even a cost–effectiveness analysis of a lockdown will be contentious. But, at least such analysis can help to inform discussion and drive future policy decisions. And a cost–effectiveness analysis can be a practical way of helping politicians reach difficult decisions about life and death and the economy.
Articles (original blog)
- When Does the Cure Become Worse Than the Disease? Applying Cost-Benefit Analysis to the Covid-19 Recovery
Journal of Medical Ethics, blog, Derek Soled, Michelle Bayefsky and Rahul Nayak (19/5/20)
- How much did the Covid-19 lockdown really cost the UK?
The Guardian, Larry Elliott (6/9/20)
- The UK lockdown: Balancing costs against benefits
VoxEU, David Miles (13/7/20)
- How Economists Calculate The Costs And Benefits Of COVID-19 Lockdowns
Forbes, Chris Conover (27/3/20)
- Coronavirus Is Giving Cost-Benefit Analysts Fits
Bloomberg, Cass R. Sunstein (12/5/20)
- “Stay at Home, Protect the National Health Service, Save Lives”: a cost benefit analysis of the lockdown in the United Kingdom
Wiley Online Library, David Miles, Mike Stedman and Adrian Heald (13/8/20)
- COVID-19 is Forcing Economists to Rethink the Value of Life
RealClearPolicy, James Broughel (20/8/20)
- A cost–benefit analysis of the COVID-19 disease
Oxford Review of Economic Policy, Robert Rowthorn and Jan Maciejowski (28/8/20)
- Living with Covid-19: Balancing Costs against Benefits in the Face of the Virus
National Institute Economic Review, vol. 253, David Miles, Mike Stedman and Adrian Heald (28/7/20)
- How Many Lives Has Lockdown Saved in the UK?
medRxiv, Rickard Nyman and Paul Ormerod (21/8/20)
Articles (additional)
Questions
- What are the arguments for and against putting a monetary value on a life saved?
- Are QALYs the best way of measuring lives saved from a policy such as a lockdown?
- Compare the relative merits of cost–benefit analysis and cost–effectiveness analysis.
- If the outcomes of a lockdown are highly uncertain, does this strengthen or weaken the case for a lockdown? Explain.
- What specific problems are there in estimating the number of lives saved by a lockdown?
- How might the age distribution of people dying from Covid-19 affect the calculation of the cost of these deaths (or the benefits or avoiding them)?
- How might you estimate the costs to people who suffer long-term health effects from having had Covid-19?
- What are the arguments for and against using discounting in estimating future QALYs?
- The Department of Transport currently uses a figure of £1 958 303 (in 2018 prices) for the value of a life saved from a road safety project. Find out how this is figure derived and comment on it. See Box 12.5 in Economics 10th edition and Accident and casualty costs, Tables RAS60001 and RA60003, (Department of Transport, 2019).
Each year the BBC hosts the Reith Lectures – a series of talks given by an eminent person in their field. This year’s lecturer is Mark Carney, former Governor of the Bank of England. His series of four weekly lectures began on 2 December 2020. Their topic is ‘How we get what we value’. As the BBC site states, the lectures:
chart how we have come to esteem financial value over human value and how we have gone from market economies to market societies. He argues that this has contributed to a trio of crises: of credit, Covid and climate. And the former Bank of England governor will outline how we can turn this around.
In lectures 2, 3 and 4, he looks at three crises and how they have shaped and are shaping what we value. The crises are the financial crisis of 2007–9, the coronavirus pandemic and the climate crisis. They have challenged how we value money, health and the environment respectively and, more broadly, have prompted people to question what is valuable for individuals and society, both today and into the future.
The questions posed by Carney are how can we establish what is valuable to individuals and society, how well are such values met by economies and how can mechanisms be improved to ensure that we make the best use of resources in meeting those values.
Value and the market
In the first lecture he probes the concept of value. He explores how economists and philosophers have tried to value the goods, services and human interactions that we desire.
First there is ‘objective value’ propounded by classical economists, such as Adam smith, David Ricardo and Karl Marx. Here the value of goods and services depends on the amount of resources used to make them and fundamentally on the amount of labour. In other words, value is a supply-side concept.
This he contrasts with ‘subjective value’. Here the value of goods and services depends on how well they satisfy wants – how much utility they give the consumer. For these neoclassical economists, value is in the eye of the beholder; it is a demand-side concept.
The two are reconciled in the market, with market prices reflecting the balance of demand and supply. Market prices provided a solution to the famous diamonds/water paradox (see Box 4.2 in Economics (10th edition) or Case Study 4.3 in Essentials of Economics (8th edition) – the paradox of ‘why water, which is essential for life, is virtually free, but diamonds, which have limited utility beyond their beauty, are so expensive.’ The answer is to do with scarcity and marginal utility. Because diamonds are rare, the marginal utility is high, even though the total utility is low.
And because water is abundant, even though its total utility is high, for most people its marginal utility is low. In other words, the value at the margin depends on the balance of demand and supply. Diamonds are much scarcer than water.
But is the market balance the right balance? Are the values implied by the market the same as those of society? ‘Why do financial markets rate Amazon as one of the world’s most valuable companies, but the value of the vast region of the Amazon appears on no ledger until it’s stripped of its foliage and converted into farmland?’ – another paradox highlighted by Carney.
It has long been recognised that markets fail in a number of ways. They are not perfect, with large firms able to make supernormal profits by charging more and producing less, and consumers often being ill-informed and behaving impulsively or being swayed by clever marketing. And many valuable things that we experience, such as human interaction and the beauty of nature, are not bought and sold and thus do not appear in measures of GDP – one of the main ways of valuing a country.
What is more, many of things that are produced in the market have side-effects which are not reflected in prices. These externalities, whether good or bad, can be substantial: for example, the global warming caused by CO2 emissions from industry, transport and electricity production from fossil fuels.
And markets reflect people’s biases towards the present and hence lead to too little investment for the future, whether in healthcare, the environment or physical and social infrastructure. Markets reflect the scant regard many give to the damage we might be doing to the lives of future generations.
What is particularly corrosive, according to Carney, is the
drift from moral to market sentiments. …Increasingly, the value of something, some act or someone is equated with its monetary value, a monetary value that is determined by the market. The logic of buying and selling no longer applies only to material goods, but increasingly it governs the whole of life from the allocation of healthcare, education, public safety and environmental protection. …Market value is taken to represent intrinsic value, and if a good or activity is not in the market, it is not valued.
The drift from moral to market sentiments accelerated in the Thatcher/Regan era, when governments were portrayed as inefficient allocators, which stifled competition, innovation and the movement of capital. Deregulation and privatisation were the order of the day. This, according to Carney, ‘unleashed a new dynamism’ and ‘with the fall of communism at the end of the 1980s, the spread of the market grew unchecked.’
But this drift failed to recognise market failures. It has taken three crises, the financial crisis, Covid and the climate crisis to bring these failures to the top of the public agenda. They are examined in the other three lectures.
The Reith Lectures
Questions
- Distinguish between objective and subjective value.
- If your income rises, will you necessarily be happier? Explain.
- How is the concept of diminishing marginal utility of income relevant to explaining why ‘A Christmas bonus of £1000 means less to Mark Zuckerberg then £500 does to someone on a minimum wage.’
- Does the use of social cost–benefit analysis enable us to use adjusted prices as a measure of value?
- Listen to lectures 2, 3 and 4 and provide a 500-word summary of each.
- Assess the arguments Mark Carney uses in one of these three lectures.