"Inequality Virus": COVID-19 and Structured Disparities
Would the pandemic change existing perceptions and practices about vulnerabilities?
This is now understood how the unprecedented coronavirus disease 2019 (COVID-19) has overwhelmed the entire world. Yet its implications are severe for the “at-risk group.” The virus can infect anyone; however, its effects can be overwhelming for some and minimal. As we have seen, in the case of several celebrities who contracted the virus yet remained in “good health.” In contrast, the pandemic has proved devastating for people belonging to low-income social groups and societies. Drawing on this argument, this paper briefly revisits the existing inequalities and triggers the debate, whether this pandemic—which has caused several changes in human imaginaries and practices—would affect perceptions and practices concerning these inequalities and inequities.
Keywords: COVID-19; pandemic; infectious diseases; inequalities; Pakistan
Introduction
The title raises a crucial but complex question; thus, fetching a straightforward answer is not possible. Since it requires illumination of different perspectives, I present some ethnographic findings.
A 25-years-old Haleema, who is a homeworker, and in her last trimester when the virus was spreading in Pakistan. She is with no formal education and lives in a joint family consisting of 12 members in a small village of Sindh province. His husband is a daily wage laborer and earns US$2 a day. She has a history of miscarriage and delivers a baby through cesarean at a charity hospital. Nonetheless, since there is a rapid escalation of COVID-19 infection in Pakistan, and the charity hospital is among the hotspots of the virus, thus she is hugely under stress for primarily two main reasons: (a) To find an accompaniment because the doctors will keep her for a few days and that person should be a female because males cannot stay inside the hospital. Due to the socio-cultural system, a young woman or girl cannot accompany her, thus, the lady should be old. However, an older woman is in an at-risk group to be infected by COVID-19. (b) To find a volunteer to donate blood during the pandemic.
Halema’s case history illuminates how the current pandemic has affected socio-culturally, economically, and politically poor, marginalized, and disempowered. How various forms of disparities substantially shape the effects and response strategies during outbreaks of microorganisms (Bambra et al., 2020). Historical evidence reveal that inequalities and inequities have not only contributed to the spreading of infections but also in health outcomes in terms of providing fertile living as well as working conditions that result in susceptible hosts and “hot spots” for microorganisms to turn in outbreaks, epidemics and pandemics (Farmer, 1996; Eikemo et al., 2009; Castro and Farmer, 2005; Ali and Ali, 2020)
Likewise, thus far, the evidence demonstrate that COVID-19 has affected disproportionally, therefore, it has been considered as an “inequality virus” (Team and Manderson, 2020; Blundell et al., 2020). Although the virus can infect anyone, it has cataclysmic effects that may multiply for a specific group— “at-risk group,” such as economically poor, marginalized, and frontline workers. That means various institutionalized forms of vulnerability are at play that significantly exposes poor and marginalized people to any critical situation, which can be related to socio-cultural and politico-economic backdrops. In contrast, another exposure is related to a job as healthcare workers have been highly vulnerable to the virus. Among healthcare workers, women have been seen facing different forms of inequality, such as PPE size being man-centric.
Moreover, studies have revealed that people older in age have remained at a higher risk of the virus in terms of infection and severe complications, including death (Wu and McGoogan, 2020).
Yet, one can ask why the virus has not caused perilous implications for several celebrities older in age, who were being tested positive with COVID-19, but otherwise, they were in good health.
Solely the UK Prime Minister, Boris Johnson, shown severe symptoms and was shifted to the Intensive Care Unit (ICU). The statement “tested positive with COVID-19, but otherwise remaining in good health” supports the argument and leads to another subquestion:
Do viruses discriminate in actuality, or do specific situations or contexts significantly matter that can increase or reduce the critical effects of viruses?
Structured Vulnerabilities
Undoubtedly, as noted above, that viruses can infect anyone, yet they affect “disproportionately”. These are the specific circumstances that make people invulnerable or most vulnerable— “at-risk group.”
Convincing evidence define this “at-risk” group as people with a weaker immune system, preexisting health conditions, homelessness, marginalized, and those who are dealing with the infection at the frontline, mainly healthcare providers. An immune system in its robust state functions as a defense mechanism and a weaker state cultivates enough ground to contract a contagion. Several factors affect its state. This system is directly related to what we consume: food. Although our immune system gets weaker with age, food still plays a considerable role in shaping it. Food, however, highly depends on our socio-economic and political systems.
For example, in many low-income countries, many women suffer from malnutrition. Due to several socio-cultural patterns, women eat left-over after serving entire families. Economically, some countries encompass millions of people living below the poverty line, such as Pakistan or Papua New Guinea.
Given that a woman or a poor person, due to socio-economic factors, lacks the required resources to have an enough portion of nutritious food.
Thus, both end up eating whatever is available to fill the stomach. This inability to buy and eat nutrient-rich food is significantly linked to these various structures. Those who are socioeconomically and politically weak cannot afford nutritious food to develop a robust immune system. Gender inequalities vary within and between societies (Snipp and Cheung, 2016). These intricately interconnected structures result from an unequal distribution of resources at (and due to entanglement of) local, national, and global levels.
Moreover, other forms of economic and political systems create those structures which make some people vulnerable, especially during any critical event. For instance, lack of required education and awareness, a dearth of an effective and proper healthcare system, insufficient employment, and ineffective economic policies that keep poverty growing. Taking Pakistan as an example, it's around 25 percent of the population that should be around 6 million lives their life below the poverty line (Ali and Ali, 2020). The literacy rate of formal education is around 60 percent, which again significantly differs when compared to rural vs. urban areas and women vs. men. Likewise, healthcare facilities are insufficient as well as infective that again substantially differ geographically and gender-wise.
Interestingly, these are the same populations who are economically poor with low literacy rates and an ineffective healthcare system. These inequalities and inequities further have an interrelationship to generate and influence each other. For instance, during the current pandemic, one survey from the UK showed that low-income households were six times more likely not to be able to work from home, and three times more likely not to be able to self-isolate, perhaps due to dense and multigeneration housing conditions (Atchison et al., 2021).
These national-level inequalities further differ at a local level and often take the form of inequity, as socio-cultural patterns make some individuals more vulnerable than others. As stated earlier, most women face a considerable amount of discrimination in low-income countries as compared to men (Ali and Ali, 2020). Due to lack of economic resources, people prefer to send their sons to school, give sufficient food and attention while considering them (sons) as future heirs and essential members of the society (ibid. ).
Moreover, these forms of structured vulnerabilities resulting—for instance, in an unequal awareness of risks and consequences—create conducive grounds for various rumors and conspiracy theories to question the (re)-emergence as well as the effects of and solutions to a phenomenon. During the ongoing pandemic, people belonging to low-income quantiles and countries have been prone and active participants of various narratives that contain either a possible cure to COVID-19 and a cause of it. For example, in rural areas of Pakistan, many people followed a rumor that brewing and drinking a miraculous tea is an effective cure of the novel coronavirus, and this virus is a “conspiracy” of some powerful stakeholders (Ali, 2020). Furthermore, these national and local level inequalities and inequities are significantly shaped by the global level disparities.
Highlighting a sharp and distinctive difference in world inequalities, the United Nation’s (UN) in its report demonstrated a lucid difference that exists between countries at the global level (UN, 2005). Out of six billion people in the world, one billion people living in high-income countries own 80 percent of the gross domestic product (GDP), while 5 billion people own the remaining 20 percent of the GDP.
Yet in another report, “Inequality Matters,” the UN revealed the absolute gap in mean per capita income between these two categories has increased from US$18,525 in 1980 to US$32,000 in 2010 (UN, 2013). This report further explicated that high-income countries, with 16 percent of the global population, produced approximately 55 percent of the global income. In comparison, low-income countries inhabiting 72 percent of the world’s population produced merely one percent of the global income. In addition to these global level disparities between countries, significant disparities prevail between individuals within each country. Consequently, low-income countries depend crucially on foreign aid, primarily from the International Monetary Fund (IMF) and the World Bank.
Owing to these inequalities, numerous diseases prevail in low-income countries: Six “poverty-related diseases” like Tuberculosis (TB), malaria, HIV/AIDS, measles, pneumonia, and diarrheal are widespread. More than 95 percent of the total cases of the first three diseases are reported in the said countries (Singh and Singh, 2008). Other health-related issues such as malnutrition, anemia, vitamin deficiency, iodine deficiency, marasmus, kwashiorkor, goiter, perinatal deaths, infant mortality rates, and maternal mortality rates are also high in the stated countries than the high-income countries (Iqbal and Ali, 2021).
This global economic disparity considerably affects other aspects of life—socio-cultural and political (Van Dorn et al., 2020; Blundell et al., 2020). The disparity results in inappropriately put in-place institutions required for the advancement of, for instance, education, health, roads, and electricity. The net result is a high illiteracy rate, gender differences, inappropriate and insufficient healthcare system, and persistent corruption. These factors function as a vicious circle that considerably shapes each other: The relationship among them is significantly intricate, which needs further detailed investigation.
These characteristics, results of various forms of inequality, define the “at-risk” group, standing on the verge to get severely affected during a challenging situation, including the current viral infection during the pandemic in progress.
A Way of Conclusion
About measles, an Arabic expression holds that “count your children when the measles has passed” (Morley, 1969). The same expression can be applied to any outbreak, epidemic, and pandemic, including the one in the process; however, with a slight modification:
Count those who are poor, marginalized, and disempowered, socio-culturally, economically, and politically once the pandemic winds down.
After this plausible inference, will this pandemic affect our focus and projects to eliminate the existing inequalities that result in a weaker immune system and appropriate institutional structure? Would the questions be surrounding a crucial debate: why are socio-cultural, economic conditions, health outcomes, and political power distribution so unequal? Concerning these questions, we can probe further that what should be the global community's responsibility and what a specific government has to do for addressing and overcoming these inequalities?
These inquiry lines are highly essential because, despite scientific and technological advancements, microorganisms can still break out. These investigations are not merely supportive to deal with an outbreak effectively and appropriately. However, they also have a pivotal role in several other emergencies and our daily lives. Studying the origins and underlying mechanisms of various forms of inequality is essential for policies aiming to properly control and minimize the impacts of a challenging situation at the local, national, and global levels.
Some Suggestions
It is necessary to formulate equality and equity-based pandemic plan that equally considers the intersectional needs of people who are poor, marginalized, and disempowered, socio-culturally, economically, and politically at a local, national, and global level.
Governments, as well as global stakeholders, consider and address the effects and experiences of the stated people to formulate and implement their short-term and long-term planning and policies.
For such planning and policy, these stakeholders should draw the past, present, and future information and knowledge.
They should focus on the earlier pandemics to learn relevant lessons, specifically to collect the data of poor, marginalized, and disempowered people.
They should study and analyze the effects of the current COVID-19 pandemic to view and deal with the virus's disproportionate consequences. They can fund specific projects to study the pandemic from these perspectives to generate evidence.
In the future, attention should be paid to the effects of a pandemic while bringing inequalities and inequities at the center stage to devise and deal with the longer-term effects.
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