By John Vincent C. Sibal
(The author is a BA Community Development-Sociology student of UP Visayas)
The current global pandemic serves as a reminder that the history of cities is intimately tied to the history of infectious diseases. Over the past centuries, humanity has been plagued by pandemics. They have shaped societal relations, health systems, politics, and ultimately urban development (UN-Habitat, 2021). Although the coronavirus disease 2019 (COVID-19) pandemic is affecting populations worldwide, there are numerous reports and studies indicating that it poses serious negative impact on lower socioeconomic groups and minorities (Burström & Tao, 2020). This is particularly true in the case of people living in urban poor communities, specifically that they are confronted with multidimensional problems that exacerbate their current condition. Hence, it calls into question the generally held popular notion that COVID-19, like any other previous contagious diseases, is a ‘socially neutral disease’, which infects the rich and the poor alike (Bambra et al., 2020).
Undeniably, cities play a variety of purposes in all societies. According to the World Bank (2017), they assist businesses and industries in creating jobs, increasing productivity, and raising citizens’ incomes over time. These functions are critical for ending poverty and promoting shared prosperity. However, Kuddus et al. (2020) posited that while cities are at the center of technological advancement and economic growth, they also serve as breeding grounds for poverty, injustices, environmental hazards, and communicable diseases, among others.
Today, approximately 95% of all COVID-19 cases reported occur in urban areas (Mizutori & Sharif, 2020). Their population size and high degree of global and local interconnectivity make them extremely vulnerable to the rapid transmission of the virus. Thus, it is not surprising that they have become the epicenter of the current health crisis. In this regard, the COVID-19 has resurrected research and scholarly interest in the issue of urban vulnerability to pandemics. It offers a significant opportunity to understand how social determinants of health affect urban population health (Sharifi & Khavarian-Garmsir, 2020). Undoubtedly, social epidemiology is beneficial for these investigations as it facilitates the identification of the social characteristics that shape the pattern of disease and health distribution in society (Honjo, 2004).
II. Social Determinants of Health of Urban Poor Communities in the Time of COVID-19
In recent decades, there is a growing consensus among social epidemiologists that social determinants of health (SDH) is a fundamental concept in the field of population and public health (Lucyk & McLaren, 2017). According to the World Health Organization (2019), the SDH are non-medical variables that influence health outcomes. They are the conditions or circumstances under which people are born, grow, work, live, and age, as well as the broader set of forces and systems that shape their everyday living.
Islam (2019) posited that an existing ambiguity is budding in the field of social epidemiology due to the expanding list of SDH – both in peer-reviewed literature and academic textbooks. However, in light of the present COVID-19 pandemic, it is essential to highlight the five important domains of social determinants of health namely: 1) health and health care, 2) education 3) neighborhood and built environment, 4) social and community context, and 5) economic stability (Wilkinson & Marmot, 2003), in order to encapsulate the multifactorial nature of COVID-19 in urban poor communities.
Access to health care, health insurance, and health literacy are all aspects of health and health care (Singu et al., 2020). Kutner et al. (2006) argued that individuals living in urban slums have lower health literacy than those who live in affluent areas. People in urban slums who usually lack health insurance may delay obtaining COVID-19 treatment, potentially leading to more severe disease and mortality (Burström & Tao, 2020). This is empirical evidence that health-seeking behaviors, associated to health literacy as well as access to health care, are greatly influenced by costly user fees in hospitals and health centers.
Aside from the costs of health services, education also plays a critical role in shaping an individual’s health. Since education improves health-seeking behaviors, studies have shown that people who receive quality education throughout their life course are healthier than those who do not. However, given that access to education remains a problem for the poor, low-income households in urban communities tend to have less access to educational resources and opportunities (Singu et al., 2020). Hence, it heavily affects their ability to make decisions concerning their health and capacity to enhance their holistic wellness during the pandemic (Shankar et al., 2013).
The neighborhood and built environment where individuals live considerably impact their health and well-being. Thus, when large numbers of people congregate in one community, several problems might arise, particularly in the context of a pandemic. There is a scientific consensus that one of the keys to flattening the curve and lowering COVID-19 cases is social distancing. However, in neighborhoods that are crowded, it may not be possible. Frumkin (2021) explains that individuals living in crowded neighborhoods, such as urban poor communities, are at a higher risk of acquiring COVID-19. Their safety is heavily compromised given that the virus commonly thrive in densely populated environments.
When it comes to our health, where we live geographically is as important as the social and community context – the social circles we engage and the relationships we build with family, friends, and others. According to Campos (1996), in an urban setting, social networks are typically less dense. Social relationships among urban poor are mainly only based on friendships, jobs, and an appreciation for diverse interests. However, once established, their psychosocial stability is neither lower nor higher than their rural counterparts. In the time of COVID-19, it is important to highlight that individualism in urban poor communities has heightened. With the restrictions set in place, isolation or confinement-related stress has posed detrimental effects on people’s physical and mental health (Prime et al., 2020).
The pandemic has surely redefined the way people manage their financial resources, especially that the issue of economic stability has been underscored more than ever. Undeniably, the pandemic has worsened poverty in urban slums as most urban poor rely in “no work, no pay” arrangements (World Vision, 2020). The established relationship between poverty and health outcomes has been further highlighted during this time to explain how socio-economic status shapes overall health and wellness. Today, people who suffer from financial insecurity are the most vulnerable to hunger or COVID-19 infection as they are the ones who frequently go out of their house to buy what they need.
The five domains of social determinants of health mentioned and plainly elaborated above do not entirely capture the multitude of social factors that shape the pattern of disease and health distribution in society. However, they can recommend ways for medical practitioners, development workers, and policy makers alike to collaborate with one another in order to reduce health inequities and enhance health outcomes for socially disadvantaged populations.
The recognition that health problems, such as the COVID-19 pandemic, are social problems is the first step to approaching health holistically. It is essential to acknowledge that medicine is also a social science discipline as it studies the social determinants of health (SDH) that greatly affect health outcomes. Indeed, SDH are significantly influenced by the political, social and economic factors present in society (Islam, 2019). Hence, a detrimental combination of weak policies and programs, unjust economic structures, and incompetent governance during this pandemic may result to unfavorable conditions, thereby worsening existing health inequities confronted by vulnerable populations. This brings us to the conception that health and illness absolutely follow a social gradient, whereby people with lower socioeconomic status have worse health compared to their wealthier counterparts (WHO, 2019).
The current COVID-19 pandemic is a major impetus for urban planners in designing cities as pandemic resilient as possible. Inclusive urbanization must be further fostered so that everyone can reap the advantages of urban growth and competitive cities (World Bank, 2017), despite facing health exigencies. Apart from focusing on the creation of more economic opportunities, governments must also invest in responding to the felt needs and interests of the urban poor to improve their overall health status. In this time of great uncertainty, it is crucial for them to recognize that the health of the population is more important than any economic losses. After all, a government cannot thrive without its people. Toward healthy, sustainable, and inclusive urban communities we go.
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