Covid-19 pandemic and the social determinants of health

The covid-19 pandemic has exposed the longstanding structural drivers of health inequities, such as precarious and adverse working conditions, growing economic disparities, and anti-democratic political processes and institutions. These important determinants of health have interlinked with class, ethnicity, gender, education level, and other factors during covid-19 to exacerbate existing social vulnerabilities in society.
Numerous warnings of the dangers of inequity have emerged over the past decades. The Alma Ata declaration convincingly argued that “health for all” could be achieved only through a New International Economic Order and people’s participation in decisions affecting their community’s health.1 These principles were affirmed in the report of the Commission on the Social Determinants of Health2 and the 2008 World Health Report.3 The commission proposed “tackling the inequitable distribution of power, money, and resources” that drive systematic inequalities in health outcomes, and improving daily living conditions especially for those in vulnerable circumstances.2 Historically, the social determinants of health agenda has been influential in highlighting and reducing inequities,45 and in relation to covid-19, academics and activists have called for a social determinants of health approach.67
From a social determinants of health perspective, global economic trends create enduring health hazards. These trends include the ballooning debt burden of low and middle income countries (LMICs), interpretations of the Trade-Related Intellectual Property Rights (TRIPs) agreement that undermine equitable access to medical technologies, and the pressure from the International Monetary Fund (IMF) on borrowers to implement austerity policies. These processes entrench the commercialisation of healthcare and constrain implementation of policies to reduce inequalities between and within countries. Additionally, the marginalisation of certain groups because of ethnicity, race, caste, migrant status, gender, class, or nature and conditions of work, for example, continues to undermine health.
Understanding what a post-covid world could look like necessitates an examination of key structural determinants that have contributed to the disproportionate effects of the covid-19 pandemic on marginalised and other groups, beyond the proximate drivers of the current crisis. Interventions to tackle systematically reproduced conditions of vulnerability would contribute towards a fairer and more sustainable world.