COVID-19: A mirror to existing health inequity
Health inequity are potentially avoidable and unfair differences in health status between groups of people who are more and less advantaged socially which pushes discriminated groups at further disadvantage on health. Pandemics, throughout the history have affected different people in different ways and Covid-19 pandemic doesn’t shy away from it. Rather it has pulled the curtain back on existing health inequity in our surrounding.
Covid-19 has plunged itself into a society with existing health inequities which contributes to the very conditions that make people more susceptible to the infection and its complication. Poor population lacking access and affordability to quality health services in normal circumstances are left most vulnerable during these times of crisis. Lack of information and misinformation on these populations can have drastic impacts on the quality of their health. These populations are more likely to have poor sanitation and hand hygiene practices, occupation that exposes them to higher risk of infection and chronic conditions which are not resolved. They also tend to ignore government warnings on health. This puts them at a higher risk of Covid-19 related morbidity and mortality.
In the context of our country itself, during the nationwide lockdown, people who can afford the luxury of their homes are staying in while the underprivileged migrant workers are walking hundreds of kilometers back home. Furthermore, Government of Nepal has allowed private hospitals to carryout testing of Covid-19. This might increase the testing rates, but if government is not expanding its testing to reach the susceptible population, this decision of the government results in inequity in the phase of diagnosis itself; someone who is not exposed to the infection but rich will have access to the test kit but someone susceptible but poor has to wait for the government to conduct the test. Everyone even in quarantine is not yet tested and a person died of Covid-19 related complication but was tested only after his death.
We have seen that the rate of infection is significantly higher in the young males residing in the districts bordering India. They are mostly those people who work in the neighboring country not emphasizing on the preventive measures. This brings our attention to the occupational disparities. There have been instances where health workers are not provided with essential protective gears and they have exposed themselves to the risk of infection which in turn is a very big danger to the community itself, whereas non health workers ,who are not exposed to the risk are seen wearing them. It also raises the question about the people who are doing the food services, deliveries, cleaning and maintenance in the hospitals concerning the degree of exposure and protection they are receiving.
Though low and middle income countries like ours have less resources to combat this pandemic lacking basic infrastructures of health and sanitation, social protection and safety at work, social dialogue and strong institutions, Covid-19 as unfortunate as it is can be an opportunity to formulate public health policies and programs that not only concerns about health and economy but also on mitigating the disproportionate distribution of resources. Since everything is connected, it would be wise to have a health equity related perspective while assessing the needs of the society, developing policies and assuring the programs to help people thrive. Scholarly research and strong evidences are required to tackle the outbreaks of health inequity in the midst of Covid-19 pandemic. This is a call to include health equity perspective in our health departments so that a more robust infrastructure could be developed which could strengthen the health system of our country in order to manage the dynamics of public health care not just immediately but also in future.
Swostika Thapaliya, First year-Bachelor of Public health, Central Department of Public Health, Institute of Medicine-Tribhuwan University
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