Pandemic has shown that we are not all in this together equally
Significant investment needed for promoting health, reducing inequalities for vulnerable
It is those on the lowest wages who have to travel to work, whether it is to clean, to provide health and social care, to work in food processing factories, or to work in supermarkets. Their work, by its very nature, brings them into close contact with others, making them most likely to be at risk from transmission. Photograph: Bloomberg
The Government instituted appropriate public health measures during the initial phase of the Covid-19 public health emergency, as well as providing short term welfare payments of €350 a week to those who found themselves out of work.
However, the Government also needs to focus on addressing longer term inequalities that have been produced, or made significantly worse, by the crisis.
Infectious disease outbreaks typically affect the poorest first. Paradoxically, this was not the case with Covid-19. In the UK and in Ireland, the first cases followed typically better-off families returning from skiing holidays in the affected areas of Austria and Northern Italy.
Poorer households will be more vulnerable to loss of income to the point of not being able to meet basic needs such as rental costs and buying food
Nevertheless, it is far from being the great leveller that some commentators have suggested. Patterns of subsequent cases, effects on employment, mental health and the increase in domestic violence suggest that Covid-19 may actually be a great amplifier of inequality.
Those in more comfortable economic circumstances can somewhat shield themselves from exposure to the virus. Having the luxury of staying safely at home to work is much more likely for those in long-term employment who can continue to work from their living rooms.
It is those on the lowest wages who have to travel to work, whether it is to clean, to provide health and social care, to work in food processing factories, or to work in supermarkets. Their work, by its very nature, brings them into close contact with others, making them most likely to be at risk from transmission.
The health risk for lower paid workers is compounded by the fact that there is a clear relationship between poverty and many risk factors that make Covid-19 prognosis more deadly. This includes obesity, diabetes, and lung and heart conditions. It therefore seems likely that the least well off in Ireland will be the group hit hardest by the fallout from the virus.
The lowest paid in the “gig economy” are more likely to be employed on short-term or temporary contracts, and many will have been one week’s wage away from the poverty line with no protected job to return to after the lockdown.
Poorer households will be more vulnerable to loss of income to the point of not being able to meet basic needs such as rental costs and buying food.
In contrast, many better-off households may be saving money following a fall in their outgoings, including from the cost of commuting.
Those with family homes and gardens will be experiencing lockdown very differently from those living in small flats.
For some of us, the virus represents a significant inconvenience. For others, it represents an abrupt descent into poverty and an ongoing struggle for survival with associated threats to mental health.
As we move into a phased exit strategy, there needs to be a coherent health and welfare strategy to address these inequalities effectively in the months to come.
Many other groups are no doubt experiencing mental health challenges as a result of grief, stress and isolation, which suggests that an approach that focuses only on the most marginalised will not be sufficient.
We need to make longer-term investments in those most vulnerable and most at risk to benefit the population as a whole
There now needs to be significant investment in promoting health and reducing inequalities for vulnerable groups.
Moving forward with elements of Sláintecare that increase homecare provision for the elderly within a more integrated service model would ensure that senior citizens are assured of high quality care.
This approach could incorporate a national community health worker programme to support the elderly (and other vulnerable groups) in their own homes. The role would ensure basic needs are met and provide the first step on a career path into the caring professions for young people.
In the short-term, this would be a relatively inexpensive way of continuing to support the elderly, and it could also offer a longer-term solution by enabling the most vulnerable to stay in their own homes, reducing pressure on hospitals and residential care, a setting which has proved to be one of the most challenging during this pandemic
The HSE, the Dublin Region Homeless Executive and public health teams and charities have been working tirelessly to ensure that there is extra capacity in emergency accommodation for the homeless, and other vulnerable groups with considerable success.
More recently however, there have been reports of more rough sleepers on the streets of Dublin than at any time since the pandemic began, with charities citing difficulties in accessing available beds and concerns about lack of social distancing within homeless services facilities.
Efforts and resources need to be redoubled to address the issue for the benefit of rough sleepers, which will reduce population spread in Dublin – already the epicentre of the virus.
In the long-term, a more coherent approach to service delivery needs to be developed, with reduced reliance on the charitable sector for basic services, particularly given the financial challenges faced by charities in the current climate.
This crisis represents a real opportunity to develop a national strategy to address the inequalities that Ireland is likely to experience as a result of the impact of Covid-19.
However, Ireland is particularly exposed in this regard as it has no health inequalities strategy and public health has a medical focus, as opposed to a multi-disciplinary approach to improving population health.
The Covid-19 National Action Plan is comprehensive and brings together community, health care, social care and voluntary organisations to address health and welfare issues for those most at risk.
Measures put in place during a crisis are often an opportunity to shape the order that eventually follows.
This may prove to be an ideal time to build on the plan and create a taskforce focused on reducing health inequalities led by public health, while incorporating the expertise of local authority staff, the wider health sector, policymakers and academics with expertise in the field.
This pandemic has shown that we are not all in this together equally. We need to make longer-term investments in those most vulnerable and most at risk to benefit the population as a whole and emerge from this crisis a fairer and more inclusive society. Dr Debbi Stanistreet is interim head of public health and epidemiology, RCSI University of Medicine and Health Sciences