What the COVID-19 pandemic reveals about the equity implications of our choices

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by Dr. Katrina Plamondon

Johnny Nash is playing on the radio, with its irresistible invitation to sing along, “I can see clearly now, the rain is gone… I can see all obstacles in my way…” Apropos at a time satellite images showing skies clearing of air pollution in patterns directly reflecting the spread of the COVID-19 pandemic, first over China, then Europe, North America and India. Song still playing in my mind, I step outside with gratitude for my freedom to enjoy a morning walk around the pond by my home. In this early morning moment, the sounds of the pond remind me that Earth is alive, and will be, whether I take my walk or not.

My freedom to take a walk hangs on many choices made by many people, all grappling with the impacts of a tiny virus that exposed our collective fragility. Public health systems, eroded by years of under-investment, are suddenly understood as critical to the basic sustainability of societies. Political economy and its constituents of globalization (i.e., spread of ideas, things, and people), social policy, trade, infrastructure, and even our supply chains, reveal themselves as revolving in constant relationship with the health of individuals, communities, countries, and even our species. Scholars across disciplines have produced evidence of these relationships for many years, establishing an irrefutable role of socioeconomic and political inequities in shaping the health of populations. COVID-19 brings these relationships sharply into focus.

The health of the economy depends on populations healthy enough to keep it afloat. In the face of a tenacious, non-living, miniscule ball of ribonucleic acid (RNA) encased in fat, our socially constructed monetary systems are exposed for being as infinitely fragile as they are imagined to contain infinite growth. But this is a house of cards. When the backs of people holding up the house collapse, the economy falls. Our current economy relies on mass production of goods, largely by populations already experiencing poorer health and shorter lives than those enjoyed by the populations consuming what they produce.

Canadians tend to place a high value on equity in policy, bringing equity considerations forward to the global stage. With equity ideals well integrated in international declarations, it seems this is a value that is—at least on paper—widely upheld. Re-examining our socially constructed institutions requires careful, critical analysis of the equity implications informing and flowing from the choices used to construct them. How do we pay attention to the equity choices available to us? There is an urgent need to critically examine issues of equity in our policy and systems responses to the COVID-19 pandemic. Some good examples are emerging in Canada over the last week, with announcements of federal supports for targeted populations. Because societies are marked by inequities, though, there is always a risk to miss critical equity considerations amid the noise of so many competing interests. Canadian equity-centred principles guide consideration of how action and inaction evoke equity implications, guiding us to: strive for authentic partnering, foster inclusion, create shared benefits, plan with a commitment to the future, respond to causes of inequity, and practice humility.

These principles would generally guide us to examine the pandemic as a shared health issue wherein responses are designed around the equity needs of a global population. Globally, the equity implications of actions in response to COVID-19 are profound. If robust and well-resourced healthcare systems, such as we enjoy in Canada, are at risk of collapse under the weight of this virus, then we can imagine the insurmountable weight in settings without such systems.

More specifically, practicing humility would guide us to question how we are approaching our work, and choices, encouraging us to practice from a position of learning rather than knowing. If we adopted a practice of humility in the consideration of the news emerging from Wuhan in January, China’s response would have been considered from a position of deep curiosity. Rather than judging social isolation measures as excessive, ‘undemocratic’, or guided by the non-democratic political persuasion of the Chinese government, the world might have deemed them swift and necessary. Indeed, most of the world’s governments—regardless of political persuasion—are now taking the same actions. We might have recognized our tremendous reliance on the productivity of China in the supply chains of essential medicines and supplies. Humility could have mitigated the scale of this pandemic.

Canada’s chief public health officer, Dr. Theresa Tam, compared COVID-19 testing to the light of stars because test results reveal something that happened in the past. Similarly, whenever the intensity of this pandemic has passed, records of who lived and who died will reveal choices made in the past. As almost invariably demonstrated with any health issue, retrospective analysis of incidence and fatality rates will reflect the degree of equity, and inequities, within and between countries. We will cannot examine the equity implications of decisions made today if we do not engage in the dialogue. If those already in positions of power and privilege are alone in their dialogue, equity implications will be overlooked. We see the immediate evidence of the impacts of our choices on our climate and on our global well-being. Actions (and inactions) made in self-interest, however logical it may seem in a moment, endanger many—regardless of whether they are carried out at individual, neighborhood, city, region, province, country, or global levels.

Amid the chaos and uncertainty provoked by this pandemic, we bear witness to the power of our choices and the capacity we have to do something better. Every choice to do or not something carries implications that will be experienced differently by different populations because the world is marked by vast inequities. This means that different groups will experience differential consequences of any given decision. COVID-19 is a window through which we can see the limits of our current economic model. These choices are far more complex than it may seem right now, with the majority of public health dialogue focusing on compliance with physical distancing measures; rather, they always were absolutely and completely about the relationship between the distribution of power, resources, and wealth within and between societies. In the first months of 2020, the economy has been forced to submit to its limits. Today, oil became worthless. Millions of people are unemployed, with hunger and desperation growing. Today, we can fall into fear or we can lean opportunity and deeply, thoughtfully re-examine what kind of fabric we weave for our shared human existence.

Pond-Okanagan-2Skies have cleared and obstacles made obvious amid the tremendous and ever-changing efforts to protect human health and our socially-constructed economic institutions from COVID-19. As awful as it has been for so many, I am grateful that this virus is not any more lethal. It is a canary. A reset button. An opportunity to examine how we organize ourselves and take care of each other on this shared planet. We have the opportunity to restructure, to intervene in economic relationships in ways that reduce inequities. How we uphold the imaginaries of country borders, how we posture toward each other—all of these are choices. They can be part of advancing equity or entrenching inequity. Doing so requires careful, critical, and thoughtful examination of the equity implications of everything we do and do not do.

Earth is alive, and will be, whether humanity remains a guest on her surface or not.

 

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Katrina Plamondon is a Canadian woman, mother, and artist of Cree, Irish, Quebecois, and German-Jewish ancestry. She is an Assistant Professor at the University of British Columbia’s School of Nursing, in the beautiful territory of the Sylix (Okanagan) Nation. As a qualitative researcher, her work focuses on how to advance health equity. A long-time Coalition member, she co-chairs the CCGHR University Advisory Council with Susan Elliott (University of Waterloo).