COVID-19 is presented as an equal opportunities virus. It does not discriminate and can strike down anyone on an almost random basis. Witness the Insta postings by Madonna speaking from a rose petal filled bath and by David Geffen aboard his luxury yacht entreating their followers to stay safe in the face of a ‘great equalizer’. British Chancellor Rishi Sunak in his jaw-dropping speech that released billions of pounds (could have gone further) into the British economy used the refrain of ‘in it together’ throughout.
That narrative of equal risk requires challenging and contextualisation.
No disease is meritocratic. Decades of research in Britain, and other high-income nations, has demonstrated that mortality and morbidity rates follow distinct patterns. Where we find a social inequality we find a health inequality. Or paraphrasing the language of the pandemic, the more socially distant a group the worse the health.
Persistent and enduring health and wellbeing differences are evident in the intersections of social class, ethnicity and gender. They are amplified by exploitation, racism and patriarchy. These differences are not wholly explicable by reference to the usual risk and lifestyle factors of smoking drinking, diet and exercise. And even if we do find a risk factor, such as smoking, we find that social processes mediate and are involved in constructing that risk
I will make it clear that I am not suggesting that anyone located in the most advantaged sections of society is somehow charmed against COVID-19, and we should be dismissive of people in that group. The hospitalization of Prime Minster Johnson, the self-isolation of Michael Gove and the COVID-19 related death of Lord Bath of Longleat are a case in point. Mortality rates tend however to follow a gradient. We see fewer deaths the further we go up the social scale and the reverse in the opposite direction.
People will die and have died across the social spectrum. Every death is a tragedy. Every life matters. It is just that we see higher levels among groups marginalised by class and ethnicity. As numerous others have expounded that gradient is unnecessary. It is in many ways a choice made by social and economic policies.
What data is available tends to support (though that may change) the speculative comments I am making here. In the United Kingdom, Black and Minority Ethnic people are over-represented in mortality rates.
While in the United States of America disproportionate COVID-19 deaths among African Americans has been reported. In Chicago, 70% of all COVID-19 deaths are African American. As a side point, Black Chicagoans also experienced higher mortality rates in the 1995 Chicago heatwave. Klinenberg’s classic sociological autopsy of the event identified long term poverty and racism as playing a critical role in explaining the excess number of deaths.
I suggest that three possible, and overlapping, pathways exist by which marginalised and socially distanced groups may be more susceptible to COVID-19.
- Bodies weakened by social inequality and racism. People exist amid a set of social relationships as embodied beings. Their emotions, bodies, biological and neurological systems are therefore part of a wider assemblage of social, economic, material and historical relations. Shocks and damages in the social elements of that assemblage are recorded on the body and the mind.That physical, mental and emotional damage becomes the empirical material fact of inequalities. Working-class people age faster. People from ethnic minorities have lower levels of health and wellbeing. Someone from a marginalised group by class or by ethnicity, or more tellingly the intersection of the two, is, therefore, more likely to display the underlying health problems that increase chances of infection and the complications that can become critical.
- Work-related risk of exposure to COVID-19. Many working-class jobs entail close proximity to others. Whether this be care work, nursing, shelf stacking or the transport industry. As we know proximity is the main mode of transmission. So, people who find themselves in proximity to others will be at greater risk. In London, nine bus drivers to date have died from COVID-19.The power relations of work can also mean that working-class people are more at risk. A recent video of a boss at a ready meals production factory shows him implying that people taking time off work for illness and to self-isolate could lose their jobs. In a previous blog post, I noted the precarity of people in the gig economy. While they may not be at risk from exposure of the virus, their wellbeing may be impacted due to loss of work and loss of earnings. The recent government support for workers in secure jobs may not reach them.
- Lack of material and other resources. A moral panic in the United Kingdom has centred on the use of parks. Too many people disobeying the rules. Brockwell Park in Brixton was singled out. Again, we see the hidden injuries of class. It is harder to be socially distant if the material conditions of your life are cramped or overcrowded. Access to greenspace is class-related when sections of the population have no access to gardens of their own to escape the confines of staying indoors.The focus on too many people using parks has echoes of responsibilisation. The blame for deeper structural issues and recent policy turns deflected onto the actions of poorer and socially powerless groups.
To finish. COVID-19 arrives in societies where health is already a complex terrain of inequalities. The spread and effects of the virus will, therefore, interact with pre-existing structures and those inherent health inequalities. I will also speculate that we will see a rise in other health and wellbeing problems that follow in the wake of the pandemic that will also mirror existing health inequalities.
In terms of being in it together, then those inequalities need to be addressed. Perhaps it is too late for this pandemic. But pandemics (SARS, H1N1, Ebola) are regular events. Any lessons have to be as much about preparing for the next one as they are in dealing with the current one.
About the Author: Chris Yuill is a lecturer in sociology in the School of Applied Social Sciences, RGU in Aberdeen. He has published a number of text books both on sociology generally but also on medical sociology. One of which, ‘The Sociology of Health: an Introduction’, published by Sage is now in its fourth edition. In addition to his textbooks, he has published his own research into the relationships between alienation and wellbeing in the workplace. He currently sits on the board of the British Sociological Association.