We keep being told that the coronavirus is, in its way, fair. It does not discriminate. Well, up to a point. It is an equal-opportunity infector, certainly, but it grabs the opportunities that societies give it.
The rates of coronavirus infections reflect the patterns of inequality. The virus picks and chooses disproportionately among the people we tend to leave unprotected, ignore or forget.
Take the case of Sweden, as egalitarian a society as you might find in Europe today. Its relatively high death rates (when compared with those of its Scandinavian neighbours) are attracting attention, with the main focus being on Sweden’s softer approach to social isolation – no lockdown; guidelines rather than instructions; gatherings of up to 50 still permitted.
A closer look at the death rate, however, will show that two groups are being affected disproportionately. The elderly in homes account, it’s said, for over 50 per cent of the deaths. People of immigrant background – today, around 25 per cent of Sweden’s population – also figure disproportionately.
Why immigrants? Because Sweden’s pandemic policy overlooked their particularity. The printed guidelines were not distributed in immigrant languages. The policy takes into account the fact that around half of Swedish households have only one person, clearly making a difference to the infection rate. But immigrants tend to live in larger, multi-generational households, which changes the risk.
This oversight almost certainly is a factor in accounting for the mortality in Swedish homes for the elderly. Immigrants are well-represented in the staff at such homes. (It is not the only factor. Swedish care homes are also larger than, say, their Danish counterparts, expanding the potential for infections.)
Inequality is not just a matter of income or opportunity. It is also about how much you matter – how you figure in policymakers’ reckoning. Sweden – an admirable society in many ways, not least for its commitment to equality – has paid a steep price for the invisibility of some.
The price of inequality has been steeper in more dramatically unequal societies, like the US. Some Associated Press data indicates that Afro-Americans account for some 33 per cent of deaths in areas where they form only 14 per cent of the population.
How come? Afro-Americans are more vulnerable to health problems that make COVID-19 more deadly: stress-related conditions, like diabetes and hypertension, as well as respiratory conditions like asthma. A matter of ‘race’? No, racism – its emotional stresses and higher rates of air pollution in areas with concentrations of Afro-Americans. Some men refused to wear masks because they thought they risked being mistaken for hoodlums by the police – a dangerous risk given repeated cases of police brutality.
In general, racial, gender and economic inequalities are correlated with higher rates of infection. But there are other health risks. Victims of domestic violence have been placed at greater risk by self-isolation. They are holed up with their abusers and isolated from social workers who have stopped visiting.
Even creative innovative responses are not innocent of the effects of inequality. Take Italy, where the benefits of e-learning depend to a significant degree on whether a child attends a state or private school.
Private schools have better-equipped teachers. In some places, state school teachers had to photocopy their lessons and leave them for parents to pick up. But the pupils at private schools are more likely to have an iPad, as well as a bedroom (not to say parents) they are not embarrassed to show their friends.
We need to look at more than the comparative infection rates- Ranier Fsadni
Both kinds of schools are struggling, of course, to maintain pupil morale and interest. But the results also reflect – according to reports from the field – the fact that Italy spends significantly less per pupil (in the state education system) than, say, the UK or Germany.
Why does this data matter? Because if it’s true of others, it’s also true of us. We too need a finer-grained understanding of how our patterns of social inequality have overlapped with patterns of infections.
We need to understand better – and not just rely on intuitions – how it came to be that (say) Birżebbuga and St Paul’s Bay have had the top rates of infection. The other demographic patterns of infection may well reveal structural inequality we might not have suspected.
My hunch is that we need to look at more than the comparative infection rates. We also need to work on something that Aaron Farrugia had urged shortly before becoming environment minister: an index of ‘Gross National Well-being’, which includes access to justice, good environment, adequate income guarantees and work-life balance, among other elements.
Farrugia mentioned the indicator as a measure of general progress. I’m recommending it as an index of sectorial vulnerability. If it’s combined with a Human Development Index, we should be able to get, fairly quickly, a good-enough initial picture of the vulnerable groups that need not just immediate help, but longer-term protection as the pandemic lingers.
If Farrugia’s ministry isn’t yet working on developing a well-being index, it deserves all the public backing it needs. Such an index would reveal government shortcomings and so may well meet with institutional resistance.
Let’s not pretend to ourselves that we can see everything already. The Swedish case shows how even governments alive to inequality can have serious blindspots.