Reflecting on equity in the COVID-19 pandemic

But it’s tricky, because we’ve talked about a range of responses as the crisis has unfolded. We’ve been temporarily uplifted by heartfelt video messages from Italian grannies on the importance of not being discriminatory in a time of quarantine. We collectively worried about the growing number of cases in British Columbia. As an office of ‘knowledge workers,’ we can call in to meetings for the foreseeable future. We’ll still receive our salaries. And we recognize that in this, we occupy an extremely privileged position.

The truth is that this pandemic will affect us all very differently, depending on our personal circumstances. Looking across the social determinants of health, we can immediately see how these factors can make huge differences to how serious the impacts of COVID-19 will be.

Employment and Working Conditions, for example, is a social determinant of health which has implications for workers’ ability to protect themselves from COVID-19. Whether we can choose to work remotely or stay home depends on our health benefits and workplace policies.¹ For many Canadians, including those with more than one job, staying home can mean falling behind on rent or bills. Our type of employment also impacts the choices we can make around our levels of exposure to the virus. For some, especially carers, nannies and care home workers, staying home is just not an option. These folks are on the front lines taking care of children, older adults and those with compromised immune systems. They are crucial to keeping people healthy, but are put at extremely high personal risk. This determinant also intersects with Race and Newcomer Status determinants, as these pink-collar jobs are often held by immigrant women. Other newcomer groups who may speak English as second or third language, as well as people with low literacy, will have less access to information that is written rather than visual, potentially limiting the translation of extremely important public health messages.

Likewise, those impacted by Housing determinants including homelessness or precarious housing situations, and who already have poorer health outcomes (Stafford and Wood, 2017), may not even have the option to self-isolate or self-care at home if they become sick, leaving them more susceptible to complications, and more susceptible to a continued lack of housing as their symptoms may make it difficult for them to find shelter. These underlying social and environmental factors and their impact on health will only be compounded as the virus enters more and more communities. Response plans are beginning to surface to protect the street community; Vancouver’s Union Gospel Mission is responding to COVID-19 by implementing their Pandemic Plan, developed following the H1N1 outbreak.

Other serious implications dictated by the social determinants of health may be less obvious but just as dire. Health Services, for example, includes not just those accessing hospitals and primary care clinics, but also those accessing support services such as substance recovery support groups, harm reduction supports, or even grief groups. When group gatherings are cancelled, shifted or otherwise disturbed, folks may lose access to these crucial connections.

Another determinant that will have critical impacts in this time of self-isolation and “social distancing” is Social Exclusion. Intentional social connection has never been more important than during this time when many regular opportunities for connection have been scaled back or cancelled altogether. Progressive organizations such as the Design Studio for Social Intervention have called for a renaming of “social distancing” to “physical distancing,” recognizing that we can still find ways to connect and care for one another without being in close physical proximity.

So, for those of us working in planning and public health who have the privilege of being able to reflect on this pandemic rather than simply react, what should we be considering as we weather this crisis? Here’s what we’ve come up with.

1. Remember that health measures are necessarily not about you; they’re about those around you in your community. Much of what is being encouraged by public health officials over the past several weeks —handwashing, personal hygiene, staying home when sick, etc.—is advice that should be heeded beyond this outbreak. We do this not only to protect ourselves, but also out of moral obligation to those  in our community who are immuno-compromised or for whom a period of illness may have serious consequences.

2. If you have means and are healthy, you have the ability to be helpful to others who don’t. Consider who is being seriously impacted right now, and how you can help. This may mean picking up groceries for someone who is self-distancing, asking your MLAs and local leaders about prevention and intervention measures for those experiencing homelessness, or supporting efforts to ensure paid leave for more workers.

3. Recognize that this crisis will expose inequities in our system, and continue to pay attention to these inequities after this crisis has passed. While we’re considering how we can help those most impacted now, we must also remember that once this challenging time has passed and we begin to return to normal, the work is not done. Our responsibility at that time is to use what we’ve learned for the continuing public good, to help our neighbours and those in our extended communities. And to address systemic inequities to create better health and well-being for all.

References:

1. Benach, J., Muntaner, C., & Santana, V. (2007). Employment conditions and health inequalities: Final report to the WHO commission on social determinants of health (CSDH). Employment Conditions Knowledge Network (EMCONET). Geneva: WHO. http://www.si-whp.eu/resources/employment-conditions-and-health-inequalities.pdf
2.  Stafford, A., & Wood, L. (2017). Tackling health disparities for people who are homeless? Start with social determinants. International journal of environmental research and public health, 14(12), 1535. https://doi.org/10.3390/ijerph14121535