There is little about COVID-19 that is clear right now. It has torn through countries, though at varying rates. Death rates have varied, and as time has passed, initial assumptions about who is affected have been shredded, as even young, healthy people have succumbed to the disease. The uncertainty surrounding COVID-19 has been a challenge for everyone, whether a small business owner or public policy expert.
Arguably one thing we do know about COVID-19 is that, within a given population, it is going to affect the most vulnerable people the hardest. Emerging data out of the United States underscores this point most tragically thus far, with black Americans dying at disproportionate rates across the country. As the article just referenced argues, the reasons are somewhat obvious:
“…black Americans are more likely to work in service sector jobs, least likely to own a car and least likely to own their homes. They are therefore more likely to be in close contact with other people, from the ways they travel to the kinds of work they do to the conditions in which they live.”
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This pattern, in which inequality begets disparate public health outcomes, is generally well understood. Public health experts might refer to these rather stubborn trends as the “social determinants of public health outcomes” — social inequalities determine epidemiological outcomes more than the bug itself. I would argue that you might equally call such outcomes the political determinants of public health—as such outcomes are less a function of personal decision making or agency as they are often a legacy of racist housing policies, sometimes legislated, and a function of political clout and thus the flow of scarce resources and responsive government.
As organizations and companies tinker with models to predict where COVID might hit hardest, some are laudably attempting to include ‘vulnerability’ (by including demographics and housing types) alongside more material measures (like hospital beds). But as the virus begins to impact the Global South, as well as the North, it may be time to more seriously consider how the political economy within countries will determine outcomes, and thus who gets battered most by this awful disease.
“Political economy” may sound wonkish, but we witness it every day: President Trump has threatened to cut off funds to the WHO for a perceived lackadaisical response to the pandemic, but equally in line with his disdain for UN organizations and America First “policy.” In India, the ruling Bharatiya Janata party (BJP), has seized on how a gathering of an Islamic missionary group helped spread the disease, to spread false rumors of a Muslim conspiracy.
Policies and their enforcement, in other words, are not always guided by science or rational calculations of cost-benefit, but driven by personal vendettas, historical grievances, or more simply hate. And it can play out at different levels, influencing trade negotiations and lending between countries for example, or how village leadership distributes basic resources between different religious sects. And heightened tensions, alarm over the Coronavirus, and misinformation can exacerbate differences and how officials may respond in a crisis.
This bodes very poorly for immigrant, refugee and IDP populations, marginalized groups including the LGBT community, lower castes, women, and ethnic or religious minorities, especially where such social cleavages have driven conflict or war.
Political Economy to Predict Outcomes
While on the one hand all of this suggests a broad-spectrum response to COVID-19, or more of what international development is already trying to accomplish, there are some specific recommendations for a fast approaching and uncertain COVID-response that flow from a political economy perspective:
- Map and respond to the most vulnerable: That might seem obvious, but it depends on how ‘vulnerable’ is defined. In the context of limited resources and weak governance, this might mean some tough trade-offs, but from a political economy perspective these are the underserved, or worse, the intentionally marginalized or those denied services based on an arbitrary political or social calculus.
- Crowded refugee camps are going to be especially susceptible to a COVID-19 outbreak, as are slum communities. How will the sick be isolated and access care in these environments?
- In some locations, women, a religious minority, a lower caste, ethnic minority or even those affiliated with the wrong political party will either a) be most susceptible to an outbreak, because of their work or living conditions b) the least to be served by a state emergency response or c) both. Identify these communities, and anticipate the needs to come.
- Approach all development as resilience: COVID-19 forces us to think about resilience on different scales, temporal and geographical. Moreover, the local-level foundations of resilience, like robust social networks and within-group bonding and across-group bridging, are to some extent upended by the need for social distancing. But much the rest of what makes for resilience—effective governance and a baseline, equitable health and wellbeing—will distinguish those communities that bounce back from those that suffer most.
- A post-COVID-19 development paradigm should continue to build on what it has learned from resilience programming, to leverage social connections and maximize positive coping mechanisms, but it should also prioritize even more basic investments in access to health and education, targeting especially those groups who have been historically deprived of these most essential services.
- Make governance a cornerstone of development programming: There is no one perfect model of effective governance, but those governments with more authoritarian tendencies have already permitted disinformation and scapegoating, and are more inclined to distribute scarce resources, including urgent medical supplies or money for economic recovery, though webs of political support, patronage or clan or family ties. Even more basically, an effective response to any crisis requires a clear chain-of-command, coordination among responders, and transparency. This is as true of a state response as it is for a village response.
- Donors and implementing partners should continue to understand/learn what local governance mechanisms currently exist (not just on paper but in practice), who is (inadvertently or purposefully) excluded in the process, and thus work with local agencies, and even informal actors where most relevant, to build capacity, transfer technology and augment local systems to more effectively respond to community needs.
Development after COVID-19
As the development community contends with how to respond to COVID-19, it is no doubt attempting to isolate areas that are hardest hit. This can be modeled using sophisticated AI, crunching age, historical travel patterns—whether for trade and commerce or pastoralism—and other factors including incidence of comorbidities like asthma, diabetes or HIV possibly. This will certainly have some instrumental value.
But as with much of development, those places most likely to be hardest hit are those that have always been hardest hit—those communities either targeted for violence and hate because of their religion, language or misinterpreted “origin story.” It will be those communities that have been intentionally deprived of government services for similar reasons, and those shelled and bombed because of their support for an opposition candidate, and those of course who are simply caught in the cross-fire.
This does not dismiss the hard work of development organizations globally, partnering with communities to bring systemic, sustainable change, but to underscore that outcomes do continue to hinge in part on decisions made by those in relative power, based on personalistic and political drivers. These factors will undoubtedly affect a COVID-19 response, and beyond.
It is also to say that, along with PPE, testing kits, and hopefully one day a vaccine; Development writ large must continue to pressure the source of bad policies and health inequities. It must continue to wade into the murky waters of political advocacy for those in informal settlements that cannot access electricity or water, and who continue to lack political representation to change it. Its programs must, in other words, do as much to break down systems of exclusion as they do to treat the after-effects.