COVID-19: Exposing & Exacerbating Global Inequality Health Systems 28/04/2020 • Grace Ren Share this:Click to share on Twitter (Opens in new window)Click to share on LinkedIn (Opens in new window)Click to share on Facebook (Opens in new window)Click to print (Opens in new window) A young boy sits by an open sewer in Kibera slum, Nairobi, Kenya, where COVID-19 prevention recommendations such as social distancing and frequent handwashing are difficult to maintain. “Epidemics, such as this one or any other, by their very nature, feed off existing inequalities and make them worse. And that’s what we see COVID-19 doing to inequalities between countries and within countries.” – Winnie Byanyima, executive director of UNAIDS. As the COVID-19 crisis unfolds and the global economy grinds to a halt, how has this pandemic exposed inequalities in access to medical care, employment, and countries’ abilities to protect their citizens? A panel of global health leaders and international experts tackle this question in the first ‘Global Pandemics in an Unequal World‘ webinar on Tuesday, co-sponsored by The New School and Health Policy Watch. “As this pandemic unfolds, it has made one thing very clear. It’s unprecedented in reach and reinforcing inequality,” said moderator Sakiko Fukuda-Parr, professor and director of the Julien J. Studley Graduate Programs in International Affairs at The New School. “Not only are low income and more marginalized populations more exposed, it’s likely to deepen inequalities between countries.” Global inequality has left entire countries’ health systems exposed to the virus. African countries, saddled by debt, are particularly vulnerable. “30 African countries are paying more towards debt repayments today than to their health sector,” said Winnie Byanyima, executive director of UNAIDS. “That’s the situation African countries have found themselves in. Corona hits at a time when they have very little fiscal space to address a new epidemic, or even to address the existing health needs of their people.” But the inequality can be felt within countries as well. As low-wage essential workers continue to risk exposure to the deadly virus while celebrities and CEOs retreat to private mansions and islands for self-isolation, gaps between the “haves” and the “have-nots” were brought into stark relief by the coronavirus pandemic. “In Italy, we have clearly seen the poisonous combination of two pandemics: the new coronavirus and the pandemic of inequality,” said Nicoletta Dentico, Italian journalist and director of the Global Health Program at the Society for International Development. “The decades of social spending cuts and the very serious problems that we’ve had with austerity measures, since the financial crisis, have devastated completely the health system.” Likewise in New York City, the pandemic has disproportionately hit the poor, immigrant, and other marginalized communities. Over 1 million people have lost their jobs – and health insurance – during the coronavirus lockdown in the city, according to James Parrott, director of Economic and Fiscal Policies at The New School. Additionally, crowded housing in the lowest income neighborhoods in the city have elevated the risk of COVID-19 transmission in those communities. As such, any policy solution to the pandemic must focus on the most vulnerable people at the core, said Mandeep Dhaliwal, director of HIV/AIDS and human rights at the United Nations Development Programme. “Those most vulnerable who don’t have a right to quality basic services, health, education, social protection, social safety nets; who don’t have adequate standards of living living conditions; who don’t have access to medicines or vaccines; who don’t have access to food or don’t have access to water, how can they possibly protect themselves from [COVID-19]?” she asked. Manjari Mahajan, co-director of the India China Institute at The New School, added that solutions must be multi-sectoral. “Health has to really be embedded firmly within larger social, economic, political governance systems,” said Mahajan. “We have to stop thinking about health… as a stand alone sector where the [COVID-19] response has to be determined by health specialists, health experts, health systems and hospitals alone.” (top, left-right) Winnie Byanyima, Sakiko Fukuda-Parr, James Parrott(Bottom, left-right) Manjari Mahajan, Mandeep Dhaliwal, Nicoletta Dentico Here are some more key comments from the panelists, touching on debt relief, tension between the US and WHO, and next steps to address inequality: Winnie Byanyima, executive director of UNAIDS Corona hits Africa at a time when they have the very little fiscal space to address a new epidemic, or even to address the health needs of their people. More than half of the Sub-Saharan African countries have some form of user fees that people have to pay to go to the clinic. So we have a situation where we have user fees that are themselves now an obstacle to diagnosis because people want to offer themselves to be tested. We have a situation where country debt repayments have been deferred by the G20, but not canceled. It’s a good start, but it’s not enough, because you just have a little space now in six months to spend a little more. The World Bank, the Regional Development Banks, they too need to take action. We will win this battle on the ground. We must empower communities, center them in shaping and leading responses. We must be data-driven and evidence-based; we cannot win when we are not focusing on what works. And I add global coordination – strong coordination and sharing of resources. Lastly, we must tackle these inequalities that existed before in order to build a better world afterwards. As Antonio Guterres said, in our interconnected world, we are only as strong as the weakest health systems. Mandeep Dhaliwal, director of HIV/AIDS and Human Rights at the United Nations Development Programme The crisis of COVID-19 also comes crashing into the crisis of inequality and the climate crisis. The policy solutions need to address multiple crises. but not in the way we’ve done them in the past where we trade off a health benefit for an economic benefit, or we trade off an economic benefit for an environmental sustainability benefit. We need solutions that actually address the drivers and the consequences of three profound crises coming together. I imagine in refugee camps, these COVID solutions of ‘shelter in place,’ and ‘wash your hands’ and physical distancing are meaningless in many ways. I think solutions need to really be adaptable to the most vulnerable. And this is not impossible. This is not our first pandemic; the HIV pandemic showed us that global solidarity, led by the people who are most vulnerable and most effective can drive incredible positive change and policy solutions. So I think we need integrated solutions. Nicoletta Dentico, journalist, director of the Global Health Program at the Society for International Development (SID) We are now in the midst of a very delicate and very thorny, complex transition…of exiting the national lockdown. We lost 27,000 people – which is something totally unheard of. The elderly people have been abandoned where the hospitals could not absorb the affected people anymore. There will be a long term effect on the younger generations who have lost their grandmothers and grandfathers without saying goodbye. This is an intergenerational shock that we will have to coexist with. In Italy I think one of the most difficult issues has been that we have a national health system, but it is the regions that are in charge of their people at the regional level. There is a disparity already between those regions that are wealthy enough to maintain a health system and those that cannot. So, the disease has hit the hardest where health was most systematically placed in the hands of the private sector. The fragmentation of the health system has created a lot of inefficiencies, a lot of delays, a lot of problems that finally resulted in losses of lives. Manjari Mahajan, associate professor of International Affairs & Starr professor and co-director of the India China Institute at The New School Emergency discourse around any epidemic makes it seem as though the response has to be about short term measures, whereas what really determines outcomes is the investments in resilient egalitarian health systems, over a long term. The second thing is that we have to stop thinking about health as a standalone sector – health has to really be embedded within larger social, economic, political governance systems. This kind of cross-sectoral response really determines the long term success of various countries. In India for example, a very strict lockdown was announced with four hours notice, without taking into account the wage laborers who need to earn money on a daily basis to buy food, making hunger a big issue. It did not take into account that people live in extremely congested, cramped quarters without access to clean water and sanitation systems, or how populations need to invest in harvest and planting today to ensure their livelihoods tomorrow. James Parrott, director of Economic and Fiscal Policies, Center for New York City Affairs at The New School In the United States we’ve been tremendously affected by the incapable leadership that we’ve had at the national level. What our president has done is inadvertently made the UN a lot more relevant. In a normal period, the United States might be providing international leadership on this or any crisis. It’s just totally not doing that right now, it’s doing the opposite. It’s been very clear that the healthcare system is so inadequate in the United States, despite all of the resources we heaped upon it. The pandemic has played out in very polarizing ways, both in terms of the economy and the health effects. The response of the federal government has not been to assure employers that they should keep their workers fully on the payroll, so that when the public health crisis eases, they can return to work. The response takes the form of laying workers off so they become economically displaced. And the hospitalization impact of this pandemic has been very concentrated in the poorest neighborhoods in under-resourced public hospitals. Hopefully out of this, we will have a spirited national conversation about a sort of health care system we need, as well as a thorough response to the raft of inequities that we’ve seen exposed. New Webinars in the ‘Global Pandemics in an Unequal World’ Series The Tuesday event was the first in a series of four webinars, co-sponsored by The New School and Health Policy Watch, with the Centre for Development and Environment at the University of Oslo joining as a partner. The following webinars will be covering these themes: 27 May – Inequality and access to diagnostics, vaccines, and medicines for COVID-19 24 June – Digital technology and Inequality in the COVID-19 response 22 July – COVID-19 inequalities and the environment Image Credits: Wikimedia Commons. 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