Covid-19 will more severely affect society’s vulnerable groups

While the Covid-19 outbreak will have a major impact on practically all people, it will more severely affect people with vulnerabilities, say Monique Jackson and Simone Schulz from Nous Group. “Policy makers should now be grappling with the question how to minimise the risk of growing social and economic inequalities.”

Both Jackson and Simone Schulz have over a decade of experience working with public sector institutions, on among others the topic of social inequality. Based on their experiences, and having studied how other crises have impacted people from different tiers of society, they have put forward a number of reasons why the current coronavirus outbreak may lead to inequality of suffering in Australia.

Impact on vulnerable groups

Income and job security
During a pandemic, low-income workers and those with low job security may have limited financial resources or economic safety net, which can influence their health-seeking behaviours. People and families experiencing poverty may have greater impacts if they need to miss work.

Interruptions in income can impact food security and make treating existing health conditions even harder, with families having less means to pay for health services at a time when the system is under significant pressure.

Low literacy and education
People with low literacy or education levels need to understand public health communication and act on recommendations to reduce their exposure. They can disproportionately experience respiratory disease due to not being able to adequately receive public health messages.

Indigeneity
Inadequate housing, remoteness, lower socio-economic status and food insecurity can exacerbate health and social risks for some Aboriginal and Torres Strait Islander people. Previous pandemics such as the 2009 H1N1 influenza disproportionately impacted Aboriginal and Torres Strait Islander people, with higher rates of notifications, hospital and ICU admissions than the general population.

Pre-existing chronic conditions
People with chronic health conditions need to be able to access their regular medication and health and social services during a pandemic. Disruption to medications or supports can exacerbate illness and increase risk of exposure.

Mental illness or problematic drug / alcohol use
People with mental illness or problematic drug and alcohol use are more susceptible to infections due to low discernment for social responsibility (such as hygiene practices), poor access to timely healthcare and risk of relapse or worsening of mental health conditions due to stress and instability.

Location and living conditions
People living in crowded housing or with an inability to socially isolate or quarantine, such as people experiencing homelessness or in social housing, are more susceptible to exposure and may be unable to work remotely. People living in regional and remote areas face greater barriers to healthcare should they become infected.

Cultural and linguistical diversity
Lack of knowledge about risks, mistrust of health services, language and cultural barriers and lower healthcare-seeking behaviours can increase risk of illness in culturally and linguistically diverse families and communities. Some people may experience discrimination and stigma, such as toward Asian populations in the early stages of the Covid-19 outbreak.

Age
During public health emergencies, children can be at heightened risk of abuse, neglect, exploitation and violence. UNICEF reports that hundreds of millions of children will likely face increasing threats to their safety and wellbeing because of Covid-19 pandemic control measures. This may include mistreatment, gender-based violence, exploitation, social exclusion and separation from caregivers.

The elderly, particularly those in aged care facilities, are at more risk during pandemics due to biological factors. They can also lose access to transport or other supports due to staff illness or social distancing.

Disability
People with a disability who require supports may experience adverse health effects if service availability is impacted due to increased demand, reallocation of health workers or staff illness. Social distancing can be difficult or impossible for those with high care needs or who live in residential facilities.

Gender
Women and girls can experience worse health and social outcomes during a pandemic. Women are more likely to be victims of domestic and family violence (DFV). Given abuse is often about power, an abuser may exploit an already stressful situation to gain more control. Early evidence from Covid-19 in several countries points to a significant rise in DFV and teenage pregnancies. Women are often the primary caregivers in homes, communities and health facilities, increasing their likelihood of infection.

Moving into action

So, policymakers should according to Jackson and Schulz from Nous Group move into action mode. “They right now should be grappling with two big questions: How do you identify those most at risk? And what risk mitigation, communication and response interventions best meet their needs?”

The first step is to provide a lifeline to vulnerable groups, through for instance cash transfers, sick leave, food security, medical supplies, accommodation and continuity of primary services such as energy utilities and essential transport.

In parallel, policy makers should undertake rapid analysis to identify who is at higher risk, understand their characteristics and anticipate potential demand hot spots. Here, a data-driven approach will be key, need just to ensure the analysis on vulnerable groups is accurate, but also for speed given the urgent action needed.

Then, targeted, tailored communications can be sent out to vulnerable groups that inform them of risks, the support they can receive and motivates protective behaviours. To this end, collaboration with local non-government and community services and civil society is recommended as they have valuable insights, networks and trusted relationships that can be tapped.

Meanwhile, federal and local government agencies should be prepared for how they can adequately address the needs of people with vulnerabilities. This includes the use of remote methods to deliver non-emergency health and social care, and engaging with vulnerable groups as part of planning for the future.