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Inequality to Illness

April 23, 2020  · 3 min read

The relationship between structural inequalities and negative health outcomes has long been established. However, the most vulnerable populations remain unprotected by policies and unaccounted for in national strategies and plans. It is only at times of a global pandemic, when morbidity and mortality rates for older people reach unprecedented numbers,[1] that the consequences of poor social policies and structural barriers become inadmissible.


In societies with higher rates of inequality, the lack of affordable housing and increased costs for living means that those on limited, fixed or no income sometimes have to make the difficult decision between eating healthy or having a safe space for the night. In a recent New York Times article, the feedback loop between social inequality and risk for infections was explored.  Max Fisher and Emma Bubola, argue that inequalities exacerbate the risk for infections such as COVID-19, which in turn widens social and economic divisions.



In many countries the lack of recognition of the needs and rights of older people in economic policies means that older people are often left financially vulnerable. In Ghana, for example, a contributory pension scheme that was introduced to promote financial security in later life, remains inaccessible for the many adults who have never worked in formal employment.[2][3] Even stakeholder pension systems, as seen in India, that allow people to make regular payments over the span of several years, does not account for the economic reality of so many older adults who experienced life-time poverty.[4][5]


The impacts of poverty can accelerate the physiological and psychological decline experienced with age, placing older people who are economically vulnerable at disproportionately higher risk for infectious diseases.During the COVID-19 pandemic- where death rates are highest among those with poor immunity and underlying chronic conditions - immediate short-term interventions are necessary to stave off the worst of the negative health impacts.  



IFA Regional Vice President, Dr Vinod Shah, recently reported on the strategies currently in place to protect older people in Maharashtra, India, amidst the COVID crisis.  The state of Maharashtra has the highest reported cases of COVID in the country (162), and as such is taking the appropriate preventative measures to protect those at greatest risk. While the State has issued curfews for the population, food and other provisions are being distributed to older persons living by themselves. To protect older homeless people, state authorities and local ageing organizations such as the Janaseva Foundations are working together to coordinate volunteers from the social sectors to distribute food and health supplies, provide shelter for those still on the streets, and secure resources to ensure medical needs are met for all those infected.


Older people who experience poverty are not often considered high priority in many nations, however, the disproportionate impacts of large-scale pandemics such as COVID-19 should draw attention to the cumulative effects of inequalities experienced across the life course. Policies that focus on strengthening preventative health measures throughout life are key to building healthier societies and provide the greatest protection against larger-scale pandemics.


[1] Lloyd-Sherlock, P., Ebrahim, S., Geffen, L., & McKee, M. (2020). Bearing the brunt of covid-19: older people in low and middle income countries.
[2] Schmitt, C. (2020). The coverage of social protection in the Global South. International Journal of Social Wefare,29(1)6-19
[3] Kpessa, M. W. (2011). A comparative analysis of pension reforms and challenges in Ghana and Nigeria.International Social Security Review 64(2),91-109
[4] Siefert, S. (2018). Chinese and Indian Public Pension Systems and Universal Oldage Security in Times of Rapid Demographic Changes. Contemporary Chinese Political Economy and Strategic Relations, 4(3), 941-XIII.
[5] Gorman, M., & Heslop, A. (2002). Poverty, policy, reciprocity and older people in the South. The Journal of the Development Studies Association, 14(8), 1143-1151.




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