Poor living conditions seen as vehicle for COVID-19
POOR socio-economic living conditions, which fuel health inequalities, are being touted as the prescription for a greater spread of the novel coronavirus (COVID-19) infections in the population.
“The system, for example, under which people live in Jamaica definitely shows up a lot of the inequalities. For example, when you look at the number of persons who live in very difficult conditions — squatting conditions which have overcrowding — in all the pandemics you can think of, you have a major problem in terms of its outcomes with those persons who are living on the margins of society,” Professor Winston Davidson, professor of public and health technology at the University of Technology, School of Public Health and Health Technology, told the Jamaica Observer in a recent interview.
“In Jamaica, tuberculosis usually preys on persons with poor housing and overcrowding. Cholera also preys on persons with absence of proper disposal of faeces and proper water supply. These two conditions — tuberculosis and cholera — have had major, major impact on Jamaica, as far as pandemics go. Definitely the persons who were in the lower socio-economic group, living in marginalised conditions, had the greatest hit,” Prof Davidson said.
In relation to COVID-19, should the same pattern take effect, the public health expert said it would be no surprise, especially since the living conditions of many people in the lower socio-economic strata of society defy the recommended practices to limit the spread of the virus.
“When you look at the COVID-19 one of the most important conditions for the mitigation of the spread is social and physical distancing. The majority of poor people in this country are not in a position to practise physical distancing, neither at their workplace nor in their homes. And so, we find that the persons who live in conditions where there is no overcrowding and where they have basic amenities of water, light, and proper sewage disposal and proper storage of food, have better outcomes. All of these are conditions which demonstrate the disparity and the inequalities within our society,” Professor Davidson said.
Globally, experts in public health have warned that inequalities in health have worsened since the 2010 Marmot Review, which called for major policy reforms to tackle growing disparities in life expectancy between the rich and poor. The Marmot Review, outlines that health is affected by the environment and the community in which we live. The more deprived the area, the shorter the life expectancy, and the poorer the state of health within these shortened lives.
Further, the outcomes of COVID-19 hinge on matters of equality of access to health services, equality of quality care, and the conditions under which those affected live.
“When we had the cholera outbreak the highest hit were those who had the least resources or the least capacity to survive — people who were living hand-to-mouth basis and didn’t have the resources. When we had the TB epidemic it was the same thing. When we had the HIV epidemic we also had that particular problem especially with low socio-economic groups. The fact is, diseases and conditions will target that section of the population who are least able to afford health and medical interventions. The nutritional state is not up to the same level as the rest of the population who eats three meals a day, while they eat one meal a day or no meals at all. Also, overcrowding has been and continues to be a major factor in the transmission of disease. If one person comes down with the flu in the home with 10 people, it automatically spreads to the rest because of the nature of the transmission of diseases, especially in human-to-human transmission,” Professor Davidson reasoned.
He continued, “If the conditions of the garbage disposal are poor then you are going to get the mosquito-breeding sites and then you get the rapid increase in the persons who have CHIK-V or who have dengue fever or Zika. If the garbage disposal is such where they are near a polluted site because they are living on marginal lands, then it is going to cause the asthma when the fire starts to burn from the garbage dump. It causes the asthma and the respiratory illnesses. All of those things decrease the capacity of the resistance of persons to all of these diseases as they lack of all the facilities necessary to have what we call a harmonious healthy relationship with their environment.
“The environmental conditions are poor. You live in a situation where you do not have many trees. The heat level in those areas are much, much higher. You don’t have any recreational facilities for children and you have overcrowding in these places, it is a prescription for COVID attacking you. It is a socio-economic thing that we know for time immemorial. The health conditions of the people determine exactly the risk of diseases. Those who are better able to live in conditions which decrease these risks will not succumb to these conditions,” Professor Davidson said.
Consider the situation of inner-city residents who constantly defy the stay at home and quarantine orders stipulated by Prime Minister, Andrew Holness. Many have labelled these individuals as the weakest link in the fight against COVID-19, but for one family of six living in a two-bedroom dwelling, their socio-economic conditions makes it difficult for them to obey.
“Miss, we no have any much space. Six of us in my house – my elderly mother and father and me and my three children. To make matters worse is a big yard I live in and bout 10 other families live here. I would love to practise social distancing in my house and ensure the constant washing of hands, but the whole a wi bungle up. Worse thing is we no always have water, so though we have catchment and clean up the place regular, we no have running water pon a regular level, and a dat dem recommend. Mi just a wait it out and expect the worse. Further, me cyaan stock buy as mi get the likkle fortnight pay or the day’s work pay it bun up so daily mi haffi go shop or supermarket and look one, one items,” a woman from Spanish Town who identified herself as Shem told the Sunday Observer, adding that the last time her mother got ill it was pure suffering and scrambling to make ends meet when more technical care was required.
“After she admit and thing, nuff time we couldn’t find it fi the specialist care or the therapies they wanted us to get for her. Is just basic care we were able to afford, and is cause basic care free at the hospital. Now mommy cyaan too walk cause she never get fi do the stroke rehabilitation sessions.”
Many face similar situations as Shem, and apart from low income, factors that also make people more at risk in relation to health inequalities include their education level and employment status, which can further jeopardise their health.
“It puts them in a low socio-economic group, and you usually find that they suffer from the lack of an understanding of the relationship of health and lifestyle. They lack the resources to get access to do the necessary laboratory tests and the yearly check-ups to maintain a good health. Health tests are the last things on their agenda. The largest is surviving basic things – food, clothing. They don’t take health into account and usually have problems and develop the diabetes, hypertension, cardiac disease. They smoke, have high-risk behaviours, have a higher propensity to be engaged in occupations that expose them to conditions that are hazardous. For example, people working in poor occupational health and safety conditions, where there is higher levels of smoking, drinking and other behaviours where the health risk is high. A virus such as one with the nature of COVID-19 will have a greater propensity for infection under these circumstances,” the public health professor said.
Professor Davidson said while it is late to try and deal with the fundamental inequalities of housing and living conditions which increases individuals health risks, going forward, individuals must be given the opportunities to pull themselves out of conditions that create these risks.
Meanwhile, the public health expert encouraged all members of society to put into practice the colloquial term – “Tun yuh hand mek fashion.
“Every Jamaican can prepare a cloth mask for themself. All you have to do is make a three-ply mask. If you have the three-or four-ply cloth mask, it would be enough to protect you. You can wash it and keep it clean to ensure you are doing your part in protecting yourself from the transmission. You must follow proper personal hygiene. The masks do make an immense difference in protecting yourself. The route of transmission is by droplet or aerosol infection. Even if you live in one room with five or 10 people, everyone must have the mask and if the Government doesn’t provide the mask for you then yuh tun yuh han mek fashion and mek the mask,” Professor Davidson said, adding that failure to employ personal protective techniques may result in preventable deaths.
Professor Davidson added that all is not lost, but time has come to throw away the textbooks, look at the conditions of people on the ground, and shape innovations around realities in order to build individuals capacities to resist the virus.
“For the Government to get on top of this it is going to be very difficult and they are going to have to use some innovative measures. Quite frankly, the tests alone in our situation will not be enough. You are going to have to use some other innovative measures using techniques that in fact can help you identify the number of cases you have. We have to use every single means, by any means necessary. Therefore you have to have an open mind and use innovative measures. Measures used in Europe and the USA are very expensive, [and] they are not available. You can’t wait on them, you have to design your own measures. The Jamaican people are innovative, so as long as they put their mind to it, and everybody works together to use every single means necessary, we can put together a good package of locally blended measures that can protect people.”
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