“All animals are equal, but some are more equal than others”
9 minute read
We have heard in countless press briefings that “the virus does not discriminate” – this is true, but its impacts do. At a global level, it has exposed major deficiencies in how public services are delivered and highlighted the structural inequalities that impede people's access to these services. Take the UK lockdown measures as a small example – if you can maintain your full income by working from home, are in good physical and mental health, live in a safe and secure household, have the means to get all the food, medicine and household supplies you need, have access to child care (within 260 miles), a garden and a Netflix account then frankly lockdown probably wasn’t too bad. The problem is that so many people are lacking so many of these things. The fortunate among us were probably able to knuckle down and keep safe during the virus peak. The less fortunate would have had to venture out to work, braving public transport; or go without food, medicine or access to support and counselling services; or be trapped in an abusive relationship; or countless other situations that put them at risk, either directly because of the virus or indirectly.
“The amplification of inequalities the virus creates puts swathes of already vulnerable and discriminated against people at even greater risk.”
As is so often the case, the effects are boosted even further in low-income countries and especially for people living in conflict zones, the internally displaced and refugees. The UN estimates that lockdowns could drive 420 million people into absolute poverty (defined as living on less than $1.90/day), an increase of two-thirds. The WHO has warned of the risks of interrupting vaccination programmes. If the significant disruption continues, in Africa the there could be as many as 140 child deaths for every one COVID death averted by lockdown. 1.4 million deaths could be caused by tuberculosis between 2021-25 if the vaccination programme isn’t back up to full steam by the end of the year. Vaccination rates have fallen in rich countries too, risking outbreaks of other diseases we had previously brought under control. The Institute of Cancer Research has warned that delaying cancer consultations in England by six months would offset 40% of the life-years gained by treating an equivalent number of COVID patients. Similar research from UCL suggests that 18,000 cancer patients could die over the next year due to delayed treatment.
Let’s take a look at how, according to the UN, the pandemic is exacerbating inequalities for four particular groups - children, women, people with disabilities and older people:
Children
Thankfully it would seem that for now, children are escaping the brunt of direct health impacts of the virus but they stand to be disproportionately impacted by the immediate socioeconomic measures deployed to battle the pandemic and the longer-term effects of the delayed implementation of the SGDs. According to the UN policy briefing we mentioned last month, the main impacts on children will include:
Poverty – it’s estimated that an additional 42 to 66 million children could be forced into extreme poverty (adding the estimated 386 million children already suffering in it).
Learning – an estimated 1.5 billion children and young people in 188 countries are impacted by school closures and while roughly two-thirds of these countries have implemented some kind of distance learning, children suffering in poverty and those in low-income countries are more likely to be digitally excluded thus putting their learning and development back even further.
Health and nutrition – hundreds of thousands of additional child deaths could come as a result of the economic hardships of the global downturn. There is also an increased risk to children’s mental health. A rise in malnutrition is forecast as the 369 million children that rely on school meals as their main source of nutrition must source their calories elsewhere.
Safety – lockdown measures put children at greater risk of witnessing or being victims of abuse.
Women
Economic – globally, women earn less, are able to save less and are more likely to have insecure jobs; thus are at greater risk of financial hardships during the downturn than men are.
Health – while it would seem that COVID is killing more men than women, the reallocation of healthcare resources, particularly sexual and reproductive health disproportionally impacts women.
Domestic abuse – it has been widely reported that gender-based violence has skyrocketed; a combination of social and economic stress and women being locked down with their abusers. The lockdowns are also disrupting support services for survivors.
Care – women are more likely to be unpaid carers; the pressure on whom has increased markedly with children out of school and additional needs of older people during lockdowns.
People with Disabilities
Around the world, people with disabilities are less likely to have access to healthcare and education. They are less likely to participate in the workforce and therefore more likely to be economically vulnerable. They are more likely to live in poverty and experience violence, abuse and neglect. An estimated one billion people are living with at least one disability, 80% of which are in developing countries.
It’s not hard to see how pretty much all of the issues we’ve just discussed that women, older people and children face also apply to disabled people and let’s not forget that all these groups can suffer from disabilities too. An estimated one in five women will experience a disability during her lifetime, so will one in ten children and 46% of people over 60.
Disabled people are more likely to catch COVID, more likely to develop severe symptoms and be killed by it. They are at greater risk of suffering discrimination in access to healthcare (both COVID and non-COVID related). They are also likely to be amongst the hardest hit by the socioeconomic downturn and any scaling back of social support safety nets.
Older People
Virus mortality – most obviously. We all know that older people are more likely to be killed by COVID. The mortality rate of over 80s is five times greater than the average rate. It is thought that roughly two-thirds of people over 70 have at least one underlying health condition, which again we all know increases the risks to them further. Older people may also face age discrimination when overwhelmed healthcare systems make decisions on care. We have also seen that residential care homes (not just in the UK) can be epicentres of local outbreaks.
(non-COVID) Healthcare – Some estimates say as many as half of older people do not have access to essential healthcare in developing countries and (similarly to women) the reprioritisation of resources away from some critical services will disproportionally impact them.
Social isolation – the adverse health impacts of loneliness are astonishing. Lockdowns cause some older people to become even more isolated with relatives unable to visit. Older people are also more likely to be digitally excluded.
Physical neglect and mistreatment – there have been troubling reports of neglect and mistreatment in some care settings. Risk of domestic abuse is also heightened for the same reasons as it is for women.
We have talked a lot in previous months about the importance of a green recovery but the recovery must help create a more equal world where vulnerable people are not marginalised or forced to bear the brunt of global hardships. Fiscal stimulus packages must be inclusive of all people in society and ensure appropriate representation of and focus on these (and more) groups if they are to have the impact that is so badly needed; rather than reinforce these inequalities or even exacerbate them.
None of these inequalities are new, none have been caused by COVID. The virus has brought them into stark focus and (probably) sent the SDGs aimed at addressing them back by years, even decades. As you know I’m an optimist and the post-COVID rebuild we need to undertake gives us the perfect opportunity to address inequality and to build a more just and resilient world. It is in everyone’s interests to do so.