by Dr Vicki Xafis
Senior Research Fellow, Centre for Biomedical Ethics
The COVID-19 pandemic has had a significant impact globally. Most affected, however, are those individuals and groups routinely disadvantaged by the social injustice created by the misdistribution of power, money, and resources. Simple measures that prevent the spread of COVID-19, such as frequent hand washing and social distancing, are unavailable to millions of people in the wealthiest of nations and in the poorest of nations. Disadvantaged groups are impacted more directly and in disproportionately higher numbers due to existing poor health, and the disruption of services central to securing an income and an education will have lasting consequences for their futures. The unintended effect of exclusionary government policies is that privileged citizens and healthcare systems are also at greater risk.
This paper explores ways in which certain groups who already experience disadvantage are being affected by COVID-19 through a brief examination of some of the social determinants of health that impact health outcomes in both affluent and poorer nations. The areas considered in this paper include income and wealth, employment and access to health services, housing, food environment, education, and safety. Examples are given to highlight the way health inequities play out for different groups but it should be remembered throughout that one form of disadvantage often leads to being impacted by other forms. For example, inability to access education will most often impact on health, and life more broadly, in numerous direct and indirect ways at various stages of a person’s life.
DEEP INSIGHT AND A NEW OPPORTUNITY
This pandemic has already brought about a new awareness. For example, it is only now that low paid workers have finally been recognised for the vital contributions they make to keeping cities and countries functional. People we have previously walked past as if they were invisible have suddenly come into sharp focus; the supermarket worker stacking the shelves has become our hero because he not only replenishes stocks but, in doing so, also unwittingly provides psychological relief; the homeless person lying in the entrance of a building has suddenly become the subject of our concern…or of our fear; the factory worker who works tirelessly to make the mask which may save our life is another such hero.
The COVID-19 pandemic has demonstrated, in profound ways, that all sectors of society and all members of society are interlinked and interdependent. The risks disadvantaged members of societies are exposed to have impacted the whole of society with devastating consequences on mortality and on healthcare systems which, in many parts of the world, have struggled to cope with the rapid rates of infection. Despite the global turmoil COVID-19 has created, governments around the world are now presented with an opportunity to correct the health inequity course we have been on for decades.
Had governments of wealthy nations invested with commitment in programmes and policies that aim to reduce health inequity, thousands of lives may have been spared and billions of dollars may have been saved.
In the months ahead, governments will need to reflect on what has become the greatest challenge of our lifetime. Had governments of wealthy nations invested with commitment in programmes and policies aimed at reducing health inequity, thousands of lives may have been spared and billions of dollars may have been saved. The reduction of health inequities is an ethical imperative but is also prudent from an economic sense, as it ultimately leads to greater productivity, less strain on healthcare systems, and fewer welfare programmes.
It will never be possible to fully eradicate health inequity. However, the multidisciplinary approach that needs to be taken from the start of a child’s life has been articulated multiple times for multiple groups by world renowned experts and focuses on ‘early child development; education and skills development; employment and working conditions; minimum income for healthy living; sustainable communities; and a social-determinants approach to prevention.’ (Marmot 2011). Closing the health inequity gap will entail many years of dedicated efforts but governments around the world now have a rare opportunity to achieve this.
Finally, it has emerged that the character traits of our leaders have played a decisive role in responding to this pandemic. Likewise, during the recovery efforts, leaders around the world will either guide us prudently through this lengthy phase or contribute to widening the health inequity gaps locally and worldwide.
This is an extract of an article published in Springer Nature, 16 May 2020. https://link.springer.com/article/10.1007/s41649-020-00119-1