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HomeBlogHow Covid-19 is showing (again) that illness is a mix of sociology and biology

How Covid-19 is showing (again) that illness is a mix of sociology and biology

By: Medix Team
How Covid-19 is showing (again) that illness is a mix of sociology and biology

The pandemic’s transmission and death rates are highlighting a stark gulf between the rich and poor particularly in a number of high-income countries. It’s heralding renewed calls for change. Will it be different this time?

The German philosopher, Friedrich Nietzsche, famously said that history is circular: we’re all doomed to live through endless cycles of events repeating themselves.


For the past two centuries that’s certainly been the case when it comes to our understanding of the relationship between health and wealth and our fluctuating desire to do something about it.


The link between the two was first forged in the mid-19th century.


In 1848, the Prussian government despatched a doctor and anthropologist called Rudolph Virchow to Upper Silesia to try and determine the cause of a typhoid outbreak. This was 13 years before the French biologist, Louis Pasteur, outlined what became known as germ theory: that bacteria cause disease.


Virchow returned from Silesia unsure where typhoid came from, but convinced that overcrowding, malnutrition, poor sanitation and low wages were contributing to its spread. The trip prompted him to become a social reformer.


As his friend and fellow physician, Salomon Neumann subsequently put it: “medicine is a social science in its bone and marrow”.


However, as living conditions became to improve during early 20th century, germ theory started trumping social science among medical minds. The biological origins of diseases and the development of drugs to combat them became the main focus.


The latter half of the 20th century saw it revert from one to the other and back again. In the 1980s, health inequality rose up the public policy agenda after de-industrialisation across the Western world caused mass unemployment and researchers drew attention to widening life expectancy between society’s richer and poorer members.


In the 1990’s, it dropped back down again as globalisation took hold. Covid-19 has now shot it back to the very top. Perhaps more importantly, the virus is also demonstrating how inequality impacts society as a whole.  


In the UK, one study by Sheffield city council mapped changing transmission patterns between Covid-19’s first wave in the spring of 2020 and the second one in the autumn. Initial cases were tied to affluent areas, as residents returned home from European skiing trips during the February half term school break.


By the autumn, case numbers were concentrated and rising rapidly among the working poor in less affluent areas. The UK government calculated that, overall, those living deprived areas of the country were twice as likely to catch Covid and twice as likely to die from it.


This March, the US Centers for Disease Control and Prevention (CDC) published similar figures for America. It found that a black American is 1.1 times more likely to catch Covid-19 as a white one and 1.9 times more likely to die from it.


The US also grapples with uneven medical insurance. A black American is two times more likely not to have health insurance than a white one.


However, when Covid-19 first hit, most governments in high-income countries were more concerned about whether they’d run out of intensive care beds. Some still are, as a third wave sweeps across Europe.


But one year on, many governments are also concluding that they should have paid far more attention to socio-economic factors above and beyond hospital capacity. A study by German and Swiss academics argued this in more depth.


It highlighted the role that overcrowded housing plays in contributing to Covid-19’s spread. The academics also repeated the phrase coined by the election strategist James Carville during the 1992 US Presidential election: “it’s the economy, stupid”.


The media are also increasingly reporting tales of gig economy workers who feel they cannot afford to self-isolate at home. Instead, they head to the nearest pharmacy looking for medications to mask symptoms before proceeding on to work.


Many of these people are in frontline jobs with a high degree of face-to-face interaction. They could be a driver for a ride-hailing firm, or the person delivering a parcel, for example.


More tragically, the Swiss and German researchers reported how “understaffed, underequipped and underpaid” staff turbocharged death rates at care homes right across the developed world.


This February, a US Department of Health and Human Services paper came to a similar conclusion. It noted how Canada reported the highest ratio of Covid-19 care home cases as a percentage of the country’s overall deaths: 80% (as of October 2020).


Towards the other end of the scale are countries like Denmark where the figure stood at 35% in October.  A report by the International Long Term Care Policy Network (ILPN) suggested why.


It said one reason is because older people are often looked after at home in Denmark, reducing transmission. It also reflected that, “care is provided by formally employed and well-trained staff”.


Denmark doesn’t have a minimum wage, but residents enjoy some of the highest pay for low-skilled work in the world (about $22 per hour) thanks to a model dubbed flexicurity. Employers can hire and fire fairly freely, while workers are able to negotiate good pay through a form of unionised collective bargaining.


Studies show that Covid-19 is propelling support for a living wage among Europeans. The EU also wants to introduce a minimum wage and other legislation requiring that companies selling in to Europe to know what wages are paid right across their global supply chains.


The UN lists decent work and good health as two of its 2030 Sustainable Development Goals. The Lancet’s editor, Richard Horton, concluded that they are intertwined in a recent article.


He said we are living through a syndemic (a mix of biological and socio-economic factors) rather than a pandemic. He called for a “more nuanced approach to protect the health of our communities”.


Differing levels of enthusiasm for a Covid-19 vaccine show that this issue isn’t going away anytime soon. It reminds us all of what living in a society actually means in terms of the way we need to interact with one another for it to function properly.


Last November, Pew Research showed that only 42% of black Americans said they would get a vaccine compared to 51% of white ones (hyperlink 12).


Vaccine roll out statistics among ethnic minority communities are now bearing this out. In early April, CDC figures (where it had available data) showed that the white (non-Hispanic) population accounted for 65.7% of first doses administered, with Hispanic ethnicity accounting for a further 9.7%, black 8.3% and other ethnicities the remaining 16.3%.


Western policy makers are not only analysing why, but also how to overcome a lack of trust in government pronouncements.   


This hopefully bodes well for the short-term. But will governments’ desire to ensure that all of society’s members are invested in it, extend to the long-term as well? If it does, then UN has a far better chance of hitting its SDGs.

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