“The paradox is that at the same time that risk makes us equal, it also reveals how unequal we are,” writes Spanish philosopher Daniel Innality in his book Pandemocracy: The Philosophy of the Coronavirus. The evidence is clear. The pandemic exposes and amplifies social inequalities. This is what emerges from a report produced by the World Council on Inequality, AIDS and Pandemics.
The first important finding is that high levels of inequality within and between countries make the world more vulnerable to pandemics. Not only are pandemics more deadly and economically destructive, but they last longer. In turn, the pandemic exacerbates inequalities and fosters cyclical and self-reinforcing relationships. Within countries, income inequality and other social conditions are associated with HIV infections, AIDS-related mortality, and COVID-19 infections.
In Brazil, for example, people with less education were 2.6 to 4.7 times more likely to die from COVID-19 than those with a university degree, and the difference between the two groups was larger in the richest regions than in the poorest, according to one study. Even in Sweden, which is considered egalitarian, people with lower levels of education and income were at higher risk of hospitalization and death from COVID-19.
The global financial structure exacerbates inequality between countries. Cuts in official development assistance (ODA), high public debt, and the imposition of austerity measures by international financial institutions have limited fiscal space for social policies to protect against the pandemic and enable an effective response.
Currently, 3.3 billion people live in countries where they spend more on debt payments than on their health. Recent USAID closures and PEPFAR cuts pose major challenges to public health funding in these countries. When a pandemic hits a country, low-income people have fewer resources for vaccines, health care, and family support. During the coronavirus outbreak, low-income countries spent about 2% of their GDP on non-health measures, compared with 8% of their GDP in high-income countries.
The second finding is that acting on the social determinants of health is essential to preparing for and responding to a pandemic. The conditions in which people are born, grow, live, work, and age, as well as inequalities in power, money, and resources, create health inequalities in normal times and in pandemics.
The pandemic also negatively impacts these determinants. This vulnerability arises from socio-economic inequalities in income, education, race/ethnicity, gender, sexuality, and other indicators, predates the introduction of health care systems, and cannot be fully alleviated by medicine or health technology.
Failure to respond to current pandemics such as AIDS and tuberculosis will perpetuate the cycle of pandemics and inequality, but there is evidence that this cycle can be broken. The first step is to remove fiscal barriers in the global structure and create fiscal space. Examples include debt relief and abandoning austerity during the pandemic.
Second, recognize the importance of investing in the social determinants of the pandemic, including social protection. In Bolivia, Renta Dignidad’s assistance contributed to food security. In Brazil, between 2004 and 2018, AIDS incidence decreased by 5%, hospitalization rates by 14%, and mortality by 12% in areas with high Bolsa Familia coverage.
Third, develop local and regional production and new R&D governance to ensure the exchange of technology as a public good and overcome inequalities in access to vaccines. Fourth, strengthen trust, equity and effectiveness through multi-sector initiatives and community-led infrastructure in partnership with government.
In conclusion, we need to move towards a society that prioritizes health and well-being, according to each person’s needs.
Machine translation review by Isabel Lima
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