The social determinants of health are the structural determinants and conditions in which people are born, grow, live, work, and age, and includes one’s neighborhood and built environment, economic stability, social and community context, health and healthcare, and education. The social determinants of COVID-19 are on full display here in the United States and the implications on those at the margins of society are apparent.
As K-12 schools have closed, business employees are working from home, colleges have shut down their campuses, churches are streaming worship, restaurants have suspended dine-in services, and gatherings of more than 10 people are discouraged — mail must still be delivered. Trash still has to be collected. 911 still has to be answered. And grocery store shelves have to be restocked.
Most of these preventative measures need(ed) to happen. None of it comes without consequence. All of it is compounded by massive social disparity across race, class, ability, gender, and generation.
- Viruses don’t discriminate. The way in which we respond to viruses discriminates.
- Telecommuting is a privilege of white collar work. So is paid sick leave.
- School is the safest 8 hours of the day for some kids.
- Social distancing (isolation) is a liability for some people struggling with mental wellness.
- Home is the most dangerous place for some women and children.
- College is not just a place of higher learning — it’s also stable housing, a meal plan, health insurance, and safety for some students.
- Online worship isn’t an option for most of the church-going-aged folks. Neither is online giving.
- You can’t beat a public health crisis without 100% public access to healthcare.
- Grandma’s house probably isn’t the best place to send kids for childcare during a pandemic where the 50+ population is most vulnerable, but it’s the only place for a lot of people who don’t enjoy #2.
- People have been conditioned to avoid healthcare because of costs; that won’t change just because we’re in the midst of a pandemic.
- School is the only way some kids eat at all during the day.
- If you can’t test everybody (because #8 and #10), you can’t treat everybody.
- Service workers and 1st responders can’t afford a work stoppage and we can’t afford for them to stop working.
- Church is the only time some people experience positive touch all week.
- E-learning isn’t an option for the family whose only access to the internet is a cell phone with a 3g connection (if that).
Many of us will be exposed to COVID-19 over the next 18 months. Most of us will make a full recovery. Many of us will not fully recover from the mental, emotional, and socioeconomic consequences of COVID-19 as a result of the extreme social inequities that existed before the pandemic.
If we gain nothing else from this moment, I hope it’s the understanding that the real dis-ease killing us is inequality – and until we deal with that, infectious diseases like COVID-19 will be the least of our worries (which seems pretty scary right now).
“Of all the forms of inequality, injustice in health is the most shocking and inhuman.” – Rev. Dr. Martin Luther King Jr.