- Systemic factors mean those on lower-incomes are being disproportionately affected by the COVID-19 pandemic.
- Tackling this inequity will involve reforming the way we think about, finance and deliver health, beyond solely healthcare.
- Investment in education and workforce development can play a large part in improving health through access to healthcare and healthy environments.
- Here are 3 strategies for delivering this systemic reform.
We have reached a breaking point. COVID-19 has unmasked and amplified systemic inequities and failures in our society.
Before the pandemic, global societal injustices such as structural racism and poverty made populations more vulnerable to disease. Driven by unequal access to education, employment, healthcare, healthy food environments and active living opportunities, lower-income population groups have greater exposure to disease and health risks, and are far more likely to be exposed to diseases such as COVID-19. They are more likely to work essential jobs as delivery drivers, janitors, or gig workers, which precludes them from sheltering in place.
The same population groups also face a pre-existing and disproportionate burden of chronic diseases such as diabetes and heart disease that put them at higher risk from COVID-19 complications. Many live in overcrowded spaces or substandard housing that make social distancing and other precautions more difficult to follow. They have poorer access to health-enabling environments, such as public spaces, and to healthy food environments, which further amplifies their vulnerability through higher exposure to obesogenic environments.
For many, the precarity of their work limits their access to healthcare, either due to an inability to take time off to seek care without financial penalty or fear of job loss, or to the unaffordability of healthcare. This is particularly true in countries like the US, where healthcare access is tied to employment and where most blue-collar jobs fail to provide affordable, quality health insurance.
These interrelated factors and structural racism act synergistically, resulting in significant short and long-term pandemic-related consequences for population groups already facing discrimination and experiencing poorer health outcomes pre-COVID-19. Globally, millions now struggle with the fallout of the pandemic — losing their jobs and incomes, facing health risks at work, and being deprived of basic needs like food, housing, and healthcare. To this end, housing, environments, employment and healthcare can all be considered as part of the systems for health by virtue of their impact on health outcomes.
At this critical moment, we need to evaluate the underlying structural and systemic barriers impacting millions of people, particularly those who are bearing the brunt of the pandemic. To rebuild our society, we cannot treat health as an isolated issue. We need to treat it in the context of entire systems for health; multisectoral action is required to prevent disease and create health equitably.
A vaccine won’t cure these systemic problems
The conditions that have brought us to this breaking point will continue to worsen. The world is racing to find a vaccine; but even after one is developed, these systemic problems will continue to deepen.
Financial insecurity continues to grow as many countries enter a deep recession. Marginalized populations faced financial insecurity long before the pandemic struck. Unemployment, cutbacks to social welfare systems and a widening income gap will continue to exist even after a vaccine is found.
Automation will accelerate job loss. These technologies are being programmed to do routine tasks historically associated with blue-collar labour. This has threatened to put millions of factory workers, retail salespeople, cashiers and others out of work.
Healthcare systems will continue to struggle to meet growing demand. Without concerted efforts to prevent disease by addressing the social determinants of health – the majority of which lie outside the healthcare sector – global healthcare systems will struggle to keep up with the growing demand caused by poor physical and mental health. This is further compounded by financial and job insecurity.