Public health responses are quite blind to the realities of those who are most marginalised.
And what happens is that then this results in a different kind of humanitarian crisis and then further increases and exacerbates injustices,
structural injustices and structural inequalities. Hello, I'm Katrien Devolder.
This is thinking out loud conversations with leading philosophers from around the world on topics that concern us all.
This is a special edition on ethical questions raised by the Corona pandemic.
In this video, I talk to Dr Agomoni Ganguli-Mitra, about the social justice aspects of pandemics.
Thanks very much for taking the time to do this interview,
and so much of your work focuses on ethical issues arising from social injustices and inequalities.
How are these issues relevant to outbreaks of epidemics or pandemics?
Yes, thank you very much for having me.
It has been shown that pandemics will, and epidemics, any kind of global health emergencies, will affect people differently.
And these will exacerbate they will magnify existing social and health inequalities.
Those who are already disadvantaged or marginalised would be hit more severely.
And these crises will then create new inequalities and new vulnerabilities.
And this will in turn, of course affect people's ability to access care.
So they might be more adversely affected within the systems of triage or allocation if somewhere down the line,
we haven't thought about who they are, where they are situated in society before they come to us in terms of health care, health care system.
So can you make that a little bit more concrete? So how would they be affected in triage, for example? If we decide that, decide
for example, that triage is based on first come, first serve serve basis.
If you have somebody with a disability or issues with mobility, for example, this affects your ability to access health care in the first place.
They'll never be the first one to access health care. And therefore, there will be a pattern of discrimination within the triage system.
If we are not attuned to the fact that people with disability or mobility issues,
for example, will have more obstacles to face in terms of accessing health care.
Similarly, in our public health responses and policies, if these are not attuned to the social determinants of health,
to existing structural inequalities and things like racial, gender, path based discrimination,
they'll end up reinforcing those social and structural inequalities.
So how would that work? How would they reinforce these inequalities?
So I can give you some examples maybe from an area, that is, how pandemics or outbreaks are always gendered.
So if we think about the 2014 2016 Ebola outbreak, women were far more susceptible for many reasons.
They were more susceptible in their role as carers. They were closer to people with the illness.
There was an increased vulnerability to sexual and other kinds of violence, especially in context of conflict.
There was also a rise in, for example,
in maternal deaths as resources were deviated and allocated to fighting Ebola rather than to the other broader health care issues
existing there. There was a decrease in childhood vaccination rates, which meant that when these children got ill,
mothers had to stay home to care, take care of them. There are also examples from the Zika outbreak.
Early on in that outbreak, there was a policy response to tell women to access contraception, to avoid pregnancies.
And this was done in a context where women have very little autonomy over their own productive and sexual health and choices.
Some of the most disadvantaged women would not have had access to contraception, and will certainly not have had access to abortion.
And yet the policy really responsibilised them to avoid passing on the infection to their potential children, to avoid congenital zika syndrome.
And so there will be examples from the current COVID crisis as well as we fight against this virus.
So, for example, early on, there are worries about the lockdown,
women not being able to access contraception, not being able to access, importantly, abortions.
There are also worries about women being subjected to increased violence within the home space in the UK, but also worldwide.
And the lockdown, women being forced to live in constrained situations with their abusers and also the
fact that the women's aid sector has been hit quite hard by austerity measures.
He said there are fewer measures of support that we can provide women who will be in these situations.
There will be also worries around the fact that women are in the frontlines of this fight against the virus, not only as nurses in hospitals,
but also as staff in care homes where there is a considerable shortage of protective personal protective equipment.
So these are some examples from the UK. There are also many examples worldwide.
So if I can just take one example from India, the lockdown came on rather suddenly.
So everything, shops, transport, etc were all closed down within hours of the announcement of the lockdown.
This meant that given that a large percentage of the workforce in India are migrant labourers they were then left stranded without livelihood's,
without hope. And within that, women who work in India are also a majority of them work as within the informal sector.
Right. So they will work as day labourers. They'll work as cleaners and cooks in other people's homes.
And of course, all these income sources would then be closed would then be closed for.
And so there'll be much more heavily hit by measures such as lockdowns.
And so what we see, unfortunately.
is that there is the fact that public health responses are quite blind to the realities of those who are most marginalised.
And what happens is that then this results in a different kind of humanitarian crisis and then further increases and exacerbates injustices,
structural injustices and structural inequalities, gender being one of those examples.
But of course, this will apply across race, class, disability and other minorities.
Well. What could be the explanation for why there is so little attention being paid to this major problem?
I think if we look at public health measures, we're quite used to look at looking at demonology as numbers or statistics without
necessarily looking at the differentials between between people and how they're situated.
We think about life saves, life saved,
but we'd think less about which life is being saved and whether there's a pattern of discrimination, for example.
There is not also potentially enough ethical and social justice discourse discussion within
how policy is being made within different models of responses that are being discussed.
We tend to think about ethics quite narrowly in terms of access to health care,
end of life decisions, event access to ventilation and things like that.
But perhaps we're less attuned to thinking about the broader social justice aspects of
how we should think about policies and how we should think about ethics in this context.
So do you have any sort of idea about what ought to be done to address these problems?
What we need to do is to start thinking about this far earlier than we have so far.
So when we start thinking about modelling pandemics, when we start thinking about various scenarios,
whether when we start thinking about pandemic planning, that absolutely has to be a systematic consideration of these aspects,
both in the ways in which the pandemic will affect various parts of the population,
but also how our responses will then affect these individuals, these groups and populations.
These are not just numbers. These are people who are situated differently in society with more or less privilege.
And this has to be taken into account. Also, quite importantly, we need to hear these voices.
There is not enough in terms of representation of marginalised people,
of women or people of various ethnic backgrounds and disabilities and so on, other minorities as well.
We have to do this early on and we have to do it systematically.
So it's not to create further injustice and to exacerbate already existing social and structural disadvantage.
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