“The paradox is that the danger that equals us and at the same time reveals how unequal we are,” says Spanish philosopher Daniel Inerariti’s book, “Inclusive Democracy: The Philosophy of the Coronavirus.” The evidence is clear: pandemics expose and amplify social inequalities. This emerges from the report prepared by the Global Council on Inequality, AIDS and Epidemics.
The first important finding is that high levels of inequality, both within and between countries, make the world more vulnerable to pandemics, which are more deadly and economically disruptive, as well as prolonging their duration. In contrast, pandemics exacerbate inequality, fueling a self-reinforcing cyclical relationship. Within countries, income inequality and other social conditions are associated with the incidence of HIV and AIDS-related deaths and COVID-19.
In Brazil, for example, deaths from Covid-19 were 2.6 to 4.7 times higher among people with no education than among those with a college degree, and the difference between the two groups was greater in richer regions than in poorer regions, according to one study. Even in Sweden – considered an egalitarian country – people with lower levels of education and lower income faced a greater risk of being hospitalized or dying from Covid-19.
The global financial architecture exacerbates inequality between countries: declining official development assistance, rising public debt and the imposition of austerity policies by international financial institutions have restricted fiscal space for social policies that protect against pandemics and allow effective responses.
Today, 3.3 billion people live in countries that spend more on debt payments than on health. The recent closure of USAID and cuts to PEPFAR pose a major challenge to public health financing in these countries. When a pandemic hits a country, low-income people have fewer resources for vaccines, health care, and family support. During the COVID-19 crisis, low-income countries spent about 2% of GDP on non-health measures, compared to about 8% of GDP in high-income countries.
The second implication is that work on social determinants of health is essential for preparing for and responding to pandemics. Inequalities in the conditions in which people are born, grow, live, work and age, as well as in power, money and resources, lead to health inequalities in normal times and during pandemics.
Epidemics also negatively affect these determinants. This vulnerability, arising from socioeconomic inequalities in income, education, race/ethnicity, gender, sexuality, and other indicators, existed before entering the health care system and cannot be fully mitigated by health care or medical technologies.
Failure to respond to current epidemics, such as AIDS and tuberculosis, perpetuates the cycle of pandemic inequality, but evidence suggests that this cycle can be interrupted. First, by removing financial barriers in the global architecture to create fiscal space – for example, debt relief during the pandemic and abandoning austerity.
Second, recognize the importance of investing in the social determinants of epidemics, including social protection. In Bolivia, Renta Dignidad’s aid has helped achieve food security. In Brazil, sites with greater Bolsa Familia coverage saw a 5% reduction in HIV infections, 14% in hospitalizations, and 12% in deaths between 2004 and 2018.
Third, develop local and regional production and new governance of research and development to ensure technology exchange as public goods, and overcome inequalities in access to vaccines. Fourth, enhance trust, equity and effectiveness through community-led multi-sectoral and infrastructure initiatives in partnership with governments.
In conclusion, we must move towards a society that prioritizes health and well-being, tailored to each person’s needs.
Machine translation reviewed by Isabel Lima
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