By Catherine Trundle
Pandemics and viruses seem deeply democratic. We all have bodies susceptible to disease and infection, and nearly all of us can’t avoid touching card payment machines, escalator handrails, elevator buttons and door handles in our daily life.
But while it’s true that COVID-19, like any infectious disease, can spread to any community, health risk and health outcomes are never evenly shared across a society.
As a medical anthropologist, the global Coronavirus outbreak reinforces to me the importance of keeping the social factors that shape health in plain view and in public debate, and at the forefront of policy decisions.
History shows us that during previous infectious outbreaks around the world, be they HIV, Ebola or Zika, some sections of the population suffered more than others. The Zika virus, for example, was spread in South America by mosquitos that proliferated in places with stagnant water, which were more likely to exist in poorer neighbourhoods that had less access to adequate sanitation. Pregnant women living in poverty bore the brunt of the epidemic.
In other words, we need to take seriously questions about who will have access to the preventative measures they will contain the spread and mortality of any virus, and we need to aim for all of us to have equitable access to healthcare.
At the moment, in these early stages, when COVID-19 cases are largely arriving from overseas, it’s likely those infected will skew towards those who travel for family, work or leisure. The demographic profile will be quite mixed.
But if COVID-19 becomes more established here we’ll need to think carefully about who is vulnerable. It’s clear that at a biological level, certain groups are at higher risk, namely the elderly and those with underlying health conditions. But what about at a social level? How has the way we have organised our society created an unequal landscape of risk?
It’s well established that those living in more crowded conditions are more likely to catch infectious diseases. Moreover, those who can afford to go to the doctor and seek medical support early have better recovery outcomes. Those who can afford to take time off work when ill, and who have access to sick leave, are more able to quarantine themselves as necessary and thus help contain the spread of a disease.
As already noted, those with underlying health conditions, including respiratory illnesses, cardiovascular diseases, cancer and diabetes, will likely have worse mortality and morbidity outcomes in this outbreak. It’s vital to recognise that we have well established evidence that the rates of heart disease, diabetes, respiratory illnesses and cancer are higher among those who live in poverty. And they are also higher for Māori and Pasifika communities.
And there is evidence that these health disparities are not caused by these groups acting ‘less responsibly’ in their lifestyles. Instead, they are the direct result of the stresses and strains of poverty, constrained resources and choices (about exercise, food and leisure, for example), and are further linked to racism, and access to healthcare.
Some of our social spaces could also be more vulnerable than others. Those living and working in nursing homes and in prisons could face elevated risks. Both of these types of institutions in New Zealand face constrained resourcing, and both are partially ‘out of sight’ from public life, making them vulnerable to patterns of neglect or abuse.
In assessing the social dimensions of this disease, we need to also think about the moral panics that coalesce around certain groups and not others. There are reports that Chinese restaurants are suffering from very low customer numbers, and some Chinese New Zealanders have suffered racist abuse connected to COVID-19.
But with outbreaks now established or establishing in Europe, especially in Italy, I’ve not heard the same boycotting of Italian restaurants. In other words, social prejudices shape whether we think non-western migrants are riskier for our health than middle class New Zealanders returning from touring Europe.
All of these factors remind me why it’s vital to keep thinking about how we as a society are not simply combatting a virus. We have also built a social system that makes some of us more vulnerable than others to ill health. And in responding to this outbreak we require a public health response that cares for all New Zealanders, no matter their means, and no matter their marginalization.
