Control measures to overcome the COVID-19 pandemic affect different population sectors in radically different ways. In the current, almost dystopian situation, social determinants of health are more clearly shown.
The coronavirus crisis in Spain continues to have its focus in Madrid, where community transmission remains increasing. We have reached the stage of confinement with movement restrictions. As today, we do not know how long they will last.
We need effective measures for physical distancing. We also need to know how the control measures to overcome the COVID-19 pandemic affect different sections of the population in radically different ways, now and in the near future.
We have experienced many previous examples of how crises exacerbate social inequalities. In the current, almost dystopian situation, social determinants of health are more clearly shown.
The ability to assume physical and social distancing will be greater for those of us in confinement who have certain resources in our homes, neighbourhoods and cities.
It helps us to have distractions: television, movies, books we have not read yet. We want to communicate with good internet connections, mobile phones and tablets. It is important to have a good food stores nearby, a health centre and a hospital where we can get help or our phone calls may be answered. And for everything to go well in the long run, we need a good job, the security of not losing it, a decent pension, good housing and a social network that will listen to us and help if something goes wrong or very wrong.
So, under those favourable conditions, confinement would be bearable for a long time. The remaining and necessary questions are: Can all sectors of our population face this health crisis with the same guarantees? And, are we all equally affected right now and in the near future?
Social inequalities create and perpetuate health inequalities. These social inequalities are nothing else than the processes and phenomena that occur in our societies, countries, cities, districts, neighbourhoods and buildings, and which are directly related to the health and diseases we have. Social determinants are closely related to jobs and educational level, to gender, age and where we live.
The type of work and employment situation we have, will allow us to deal with confinement in very different ways. For example, if I cannot work from home, I will probably have to commute in public transportation, and the crowded situation of trains and subways at rush hour, even after the state of emergency has been established in Madrid, is definitely worrisome.
The possibility of teleworking will also determine how we take care of children, and how we help them continuing their education during confinement.
Picture: Víctor Carreño
There are jobs and jobs. In this situation of crisis and social tension, we applaud the health workers who are carrying out titanic work. It is great that we are doing so and, above all, that we are taking very much into account the fact that the universal health care system, its researchers and technicians need greater support, funding and protection in the future.
However, strangely enough, we remember less about the clerks in the neighbourhood food shops and supermarkets, the Bengalis, Pakistanis, Dominicans, stockists and supermarket cashiers who, with minimum wages and infernal working hours, attend to customers in fear with infinite patience.
Healthcare personnel, pharmacy office staff, food workers and many other workers we need right now are the “indispensable ones” Bertolt Brecht wrote about, those who fight all their lives from their job positions.
And let us not forget about job conditions and security. Although the Spanish government has already launched a package of social measures to alleviate the consequences, the state of emergency is calling into question many jobs with the ERTEs (Temporary Layoffs).
As the most famous sociologist Ángeles Durán has told us, the burdens of paid and unpaid work are very different between men and women in Spain. It is no longer just important who has what kind of job and its different remuneration, but who takes care of whom. There are fundamental jobs in our society done mainly by women. Migrant women take care of our children, our elderly persons, our homes. These weeks or months they will be paid less, or not at all.
We are talking a lot about elderly persons during this crisis. Elderly persons who already have chronic illnesses are those at greatest risk of dying in hospitals according to the first studies already published in Wuhan (China). But elderly persons are not all the same either. There are those who live alone and those who live in families, those who have adequate housing and those who do not, those who still take care of our children and those who are cared for. There are those who live in residences costing 3,000 euros a month and those who live in public nursing homes.
There are elderly persons with maximum level pensions and an enormous number with minimum pensions. In the report on interdisciplinary research of the CSIC “The rhythm of senescence”, in which I participated, we already concluded by highlighting the relevance of redistribution policies that emphasize a crucial intersection: that of gender, age and social class.
For elderly persons, shopping can be the only time of day to socialize and have contact with shopkeepers and neighbours in the neighbourhood / Photographer Jose Luis Carrero
In the moment of preventive confinement we are facing, the quality of our housing is essential. There are spacious, well-lit, ventilated houses, houses with a terrace and garden, as opposed to the small, poorly insulated, elevator-less houses in our neighbourhoods and cities. How can a member of a large family be isolated in a 50-m2 apartment?
Very few resources are still being allocated, compared to other areas of research, to studying social inequalities by neighbourhood and urban health. Now, in the face of the coronavirus crisis, the European Commission has just selected 17 research projects and in Spain we are participating in 6 of them. None of these 6 projects includes aspects on how to face, and how this crisis will affect, the different segments of our populations.
Research that includes interdisciplinary approaches including social science aspects and methodologies will be that which best allows us to understand and design the most effective and equitable actions to face public health problems such as the COVID19 crisis.
We remain blind to the extremely unequal reality of our societies. Today, social inequality translates into 15 or 7 years of difference in life expectancy according to whether one belongs to one social class or another, whether one lives in one neighbourhood or another. And we all understand that many good things can be done in 7 years. These inequalities are unjust and avoidable. Once again, national and local city governments that invest most in social services will be those with the highest levels of health and the fewest inequalities. This has been clearly shown for the US in research conducted by Stanford colleagues.
In the face of the COVID19 crisis, it is necessary to act politically, administratively and scientifically so that it does not become another factor that increases the already alarming inequalities in health.
Manuel Franco is a professor of Epidemiology at the University of Alcalá in Madrid and the Johns Hopkins School of Public Health (USA). He is the main researcher of the European project Heart Healthy Hoods, which studies the influence of the neighbourhood of residence on cardiovascular health in the districts of Madrid.
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