‘A syndemic is a set of closely intertwined and mutual enhancing health problems that significantly affect the overall health status of a population within the context of a perpetuating configuration of noxious social conditions’ (Merril Singer)
Learnings from the COVID-19-pandemic in preparation for future public health crisis
The COVID-19 pandemic does not have the same impact on all groups of the population. Socio-economically disadvantaged people are likely to be more affected in many aspects. This fact is also referred to as the “COVID-19 syndemic” and is highly relevant in terms of health equity. Social protection systems can play an important role in counteracting unequal consequences. The colloquium addressed this issue from an international, national, research and stakeholder perspective. The keynote addressed by an international expert (see detailed programme below) provided a broader contextualisation of the topic from a research perspective. Results of an ongoing Austrian participatory research project were shared, including field reports from co-researchers who are themselves affected by social disadvantage.
Four pathways to an unequal pandemic
The key note by international expert Dr. Claire Welsh highlighted the cumulative disadvantage that people in poor health experienced during the crisis using evidence from the United Kingdom and other countries: For example, the COVID-19 death rate in the lowest income quintile was more than double that of the highest income quintile between March and May 2021 in Scotland. Also, a view back in history showed that already during the 1918 Spanish flu epidemic, higher incidence and mortality rates were recorded amongst the working classes, unemployed and lower occupational groups. Regional inequalities as well as racial inequalities also play a role in compounding the gap between different population groups during a pandemic.
Overall, four main pathways to unequal pandemics may be identified:
- Unequal exposure: Those unable to do home office during the pandemic, and continuing interacting with their community could not shield themselves.
- Unequal transmission: Many people cannot afford to self-isolate effectively, due to perhaps precarious work practices like zero-hours contracts, and jobs that are more likely public facing, or living in overcrowded housing, living in densely populated urban areas makes self-isolation more challenging.
- Unequal susceptibility: The chronic stress of disadvantaged living leads to a weakened immune system, more vulnerable to challenges from novel infections.
- Unequal treatment: Access to and uptake of COVID vaccinations varies greatly between communities.
Social safety nets matter
The experiences reported by co-researchers – a sex worker and a former homeless – clearly highlighted the importance of social safety nets, as well as the important role of NGOs collaborating with public institutions in providing support to potentially marginalised groups. For example, in particular during the early stages, sex workers from abroad faced severe income losses in Austria, combined with a lack of psychosocial support. In addition, it was highlighted that cash benefits provided as income compensation have a meaning also for social life of people with lower income: Going for a coffee or leaving town to be in nature cost money and thus are beyond reach for certain groups during crisis times. People with limited financial possibilities found comfort e.g. by being with their pets or going cycling. Empirical evidence confirms that countries with higher rates of social protection have smaller or no increases in health inequalities during economic recessions.
- Keynote: „The Unequal Pandemic: COVID-19 and Health Inequalitites“
Claire Welsh, Newcastle University
- Social factors of the pandemic – A participatory research project"
Carina Marbler, Austrian National Public Health Institute (GÖG)
- “Personal insights of the pandemic“
Astrid Wenzl and Michael Herzog
Hosting and moderation
Joy Ladurner, Austrian National Public Health Institute (GÖG)
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Claire Welsh is a researcher and epidemiologist working on a number of projects concerning health-related policy, healthy aging, and COVID-19. Since Spring last year Claire has been heavily involved in the local pandemic response in the North of England through analytical support to the NHS, Public Health England and the 12 local authorities. She is a veterinary surgeon by training, but other than the occasional calls for advice and intervention with her extended family's animals, no longer practices, having moved into epidemiology to do a Masters and PhD some years ago.
Carina Marbler is a health expert at GÖG, working in the department of Health, Society and Health Equity. She has a degree in Health Management and joined GÖG in 2017. Carina engages in qualitative and quantiative research, whenever possible applying participatory approaches. She currently works on projects concerning healthy policies and healthy life circumstances, especially for socially disadvantaged people.
Astrid Wenzl and Michael Herzog are co-researchers in a current project on social factors of the pandemic. They are also experts by own experience and gained broader insight in the impact of the pandemic for persons experiencing socioeconomic disadvantages.