Regardless of geographical location, level of individual income and political system, gaps in state systems to prevent and control cases of infectious disease are strikingly similar. Addressing these gaps is essential to fighting the "Covid-19" disease caused by the emerging coronavirus - which appears to be a recurring challenge - and provides an opportunity for investment that simultaneously promotes greater equality and well-being.
Dr. Michel Khan, a health expert specializing in epidemiology, says access to health care, free of charge and at the time of need, has proven to be a challenge to countries ’ability to contain outbreaks of infectious diseases. The lack of universal health coverage prevents some people - such as those who cannot pay for services, or who do not have insurance coverage by employers, or unregistered immigrants - get rapid testing and treatment services.
"This results in a potentially preventable spread of infection and death among these groups, and in the country more broadly," Khan said in a report published by the website of the British Chatham House Institute, officially known as the Royal Institute of International Affairs. Such manifestations of inequality in health care are evident in high-income countries such as the United States, and in low-income countries such as Kenya.
Likewise, structural inequalities in living and working conditions mean that those who spend long periods of time in extremely crowded places, where social spacing or optimal hygiene behaviors cannot be applied, are more at risk. Singapore is a clear example of this, as an effective strategy adopted by it to control Covid-19 has been hampered by the conditions of overcrowding and lack of hygiene in some dormitories of migrant workers.
Another gap is the lack of financial safety nets for large sectors of the population such as informal workers, which means that they do not receive income from employers or the state if they are unable to work due to illness, or due to the responsibility of caring for the family, or the requirements for social separation.
Khan stresses that the impact of the lack of safe income on controlling Covid-19 disease cannot be underestimated. Millions of people migrated from the cities of India to rural areas, after they became without a source of income once the closure was announced; This was considered a cause of transmission of the virus to rural areas. Ensuring income in the event of illness is essential for people to stop working if they feel symptoms of the disease or are exposed to the virus because of a sick person in the family, in order to prevent the spread of infection in the workplace.
There is also an issue regarding the number of citizens who trust their governments, and this is affected by effective government communication during emergencies. Confidence and communication are important to adhere to public health directives, such as social estrangement.
For example, it is believed that the commitment of UK citizens to bodily social divergences no longer exists when confidence in the Prime Minister and advisers is shaken. Other countries, including the United States, Nigeria, and Pakistan, have made a great effort to persuade groups of citizens to avoid gathering in places of worship, because they have greater confidence in the clerics who tell them that their presence is safe.
Khan says it is clear that everyone, poor or wealthy, now has some interest in filling these gaps. Covid-19 has shown that addressing structural inequalities not only benefits marginalized groups, but also protects the entire country from the consequences of infectious diseases.
Monitoring, accountability and enforcement
Khan argues that cracks at the very foundation of all policies and rules - a robust system of oversight, accountability and enforcement - are becoming evident around the world. The power dynamics and corruption allowed "influential" people to avoid the rules of social estrangement and self-isolation after travel. This type of non-compliance can result in increased disease spread and weak confidence in the authorities.
Those who spend long periods in extremely crowded places are more vulnerable.
The importance of not having a safe income to control Covid-19 can not be underestimated.