As the story of the coronavirus pandemic unfolds, global data is revealing a clear over-representation of black people and women, both in rates of infection, prognosis, and mortality from Covid-19, and the importance of systemic inequality. The topic of inequalities has always been central to social justice, sociology and related fields such as social policy, gender studies, critical race studies and human geography.

Most recently, digital inequality has emerged as a major topic. Rightly so, as Covid-19 spreads across the world, cross-cultural comparisons are at the forefront of people’s minds. Race and ethnicity, as well as religion and faith, continue to be powerful forces in demarcating social divisions and inequalities in contemporary societies, despite the ever-growing diversity of our global cities.

On 31 December 2019, the World Health Organisation (WHO) reported a cluster of pneumonia cases in Wuhan City, China. “Severe Acute Respiratory Syndrome Coronavirus 2” (SARS-CoV-2) was confirmed as the causative agent of what we now know as “Coronavirus Disease 2019” (Covid-19). Since then, the unprecedented, unrelenting and uncertain virus has spread to more than 193 countries, including South Africa.

Picking up from where Minister of Health, Dr Zwelini Mkhize, left off in his 19 June 2020 address to the University of the Western Cape community on “Social Solidarity and Equitable Health Care for all in a time of Covid and Beyond Webinar”, where he opined that “we have a double whammy of non-communicable and communicable epidemics — the main ones being hypertension, diabetes, cardiovascular disease, trauma, TB and HIV. It was everyone’s well-expressed fear that, after the virus was imported by generally affluent members of society, a spillover into vulnerable sectors of society was inevitable and there would be no telling what would happen to the poor, the malnourished, the elderly and those living with co-morbidities, including the world’s largest population of people living with HIV”.

Our worst nightmare is about to be realised as this pandemic cuts a swathe across our townships and densely populated and impoverished areas that are characterised by a lack of viable and scalable factories, industries and commerce. Covid-19 has not obliterated these from our environment. If anything, it has initially exposed, not created, our long-standing vulnerabilities if we do not effectively deal with the scourge.

Black people are more likely to contract Covid-19, less likely to be tested and treated, and more likely to die, if they contract the virus, due mainly to the history of systemic racism in the world.

South Africa’s deficiency in outsourcing our supply chain and manufacturing of, among others, medical devices such as personal protective equipment (PPE), ventilators as well as medicines and lack of ownership of active pharmaceutical ingredients was severely exposed. As of Sunday, 26 July, just four months since South Africa’s index Covid-19 patient, of the 434,200 confirmed positive cases, 249,015 were females. This is 57.8% when you exclude the 2,820 that the Department of Health classifies as “unknown cases”.

According to the Office of National Statistics, globally black people are more than four times more likely to die from Covid-19 than white people, exposing a stark and dramatic divergence in the impact of the coronavirus pandemic. This virus has sadly appeared to have a disproportionate effect on people from poor backgrounds. We are now number five in the world, after the US, Brazil, India and Russia respectively, in terms of total cases. In the end, however, health disparities are fundamentally a political problem. This is the direct result of an inequality of power over 426 years between the employed and unemployed, rich and poor, black and white, private and public, the haves and the have-nots, urban and rural, male and female, etc. The proof point is the fact that not everyone is affected equally by Covid-19 and that the pandemic most definitely worsens inequality.

This has come at a time when the nation is contemplating the National Health Insurance Bill, which is anchored in the tenets of the Presidential Health Compact and Quality Improvement Plan, the United Nations Political Declaration on Universal Health Coverage, signed only in September 2019, whereby we joined all nations of the world as we committed to the full attainment of Universal Health Coverage by 2030, and the Health Market Inquiry published by the Competition Commission in November 2019 which highlighted the gross inequity in health care, driven by fundamentally anti-competitive activity in the private sector and the flaws in legislation that allowed for the environment to thrive.

…The inequalities that predate Covid-19 did not suddenly appear, putting this country’s most vulnerable people on the frontline and, similarly, the solutions needed are bigger than just addressing Covid-19. The raw disparities are easy enough to document.

Black people are more likely to contract Covid-19, less likely to be tested and treated, and more likely to die, if they contract the virus, due mainly to the history of systemic racism in the world. Researchers say we must not only look at race, but also the disparate conditions that come from living in poverty. They are calling for research that explores social differences in health and the social determinants that play a major role in health outcomes. The data available show that racial disparities in health reveal the lack of health resources for black people and vulnerable communities, including health insurance and access to healthcare, including the provision of health products and services.

But they also point to living conditions, employment, education and even the impact of the environment. A lack of credible and solid information and even misinformation within black communities can and has played a role in our response to Covid-19 and guidelines to mitigate the disease. The inequalities that predate Covid-19 did not suddenly appear, putting this country’s most vulnerable people on the frontline and, similarly, the solutions needed are bigger than just addressing Covid-19. The raw disparities are easy enough to document.

The root cause of these disparities is not biological, but is the result of the bone-deep and pervasive impacts of systemic racism and still prevalent apartheid spatial planning. We must all collectively call it what it is and to explicitly name systemic racism as a direct threat to public health, long before Covid-19 visited and was subsequently allowed to inhabit our shores. Black people are more infected because we are more exposed and less protected. Once infected, we are more likely to die because we carry a greater burden of chronic diseases from living in totally neglected, underinvested and disinvested poor communities with equally poor food options, coal stoves and dust-poisoned air quality and because we have less access to healthcare.

We must also look at the way vulnerable communities live, often in smaller, cramped informal settlements and, for a lucky few, four-roomed houses and in some cases, with no access to water to wash our hands with soap for at least 20 seconds. There is inherently no social distancing and zero self-quarantine in informal settlements: Alexandra (located less than 4km from the richest square mile in Africa, Sandton, is a prime example of an informal settlement that suffers from issues caused by stormwater runoff and flooding. 

With a population estimate of 180,000 to 750,000 people, it is severely overpopulated, in an area equal to 6.91km²) and Soweto (the largest black city in South Africa, but until 1976 its people could have status only as temporary residents, bordering the city’s mining belt in the south). Its name is an English syllabic abbreviation for South Western Townships inhabited by over two million people – an official population estimate of about 1.3 million people and about 356,000 formal households (in an area of about 200km²), with families of five on average, from a member who is a frontline worker when they are all living in a shack, one and two-bedroom four-roomed houses! The chances of working from home are nil with only 10.4% of households with direct access to the internet and many homes with only a single device – old fashioned, not a smart cellular telephone.

… The majority of testing centres are placed in more affluent areas. Other challenges such as not having a car or not having a doctor’s letter to get a test still make mitigating the virus in black communities, especially the 34% who live in rural areas, nearly impossible. By the time symptoms drive people to emergency rooms of often broken and dysfunctional health facilities, it is too late.

With 13.5 million of us currently totally dependent on not-so-safe, not-so-accessible and not-so-affordable taxis filled 100%, ferrying us the average of 40 minutes to and from work, that is about 40km away and gobbling up at least 40% of our wages, we have a perfect concoction in which the virus has no option but to thrive. Many of us have no places to exercise safely and we live in unhealthier places, often next to toxic dump sites, by design and not by choice. 

All of these things go into communities that have been comprehensively disempowered. That is why we have more diseases, not because we do not want to be healthy, we very much do. It is because of the burdens that systemic racism has put on our societies, bodies and our lungs. Because of the kinds of jobs that black women and men do, we are on the front line of exposure to Covid-19. Due to the grinding, self-perpetuating and vicious cycle of abject poverty, many do not have the option of working from home and waiting out the virus. Many are almost exclusively underground miners, factory workers, domestic workers, warehouse workers, hospital workers, mall workers, supermarket workers, etc. The headlines have shown us that so many black frontline workers have been left without the PPE that we need when we work in malls, nursing homes, hospitals and other areas that have high infection rates.

The disparities show in the numbers, and the rampant unemployment brought about as a result of Covid-19 is exacerbating this issue day by day. Even today, there are still challenges that black people have in even getting a Covid-19 diagnostic test. The majority of testing centres are placed in more affluent areas. Other challenges such as not having a car or not having a doctor’s letter to get a test still make mitigating the virus in black communities, especially the 34% who live in rural areas, nearly impossible. By the time symptoms drive people to emergency rooms of often broken and dysfunctional health facilities, it is too late.

The history of over-representation in jails and prisons among black people has also reared its ugly head in infecting us disproportionately with Covid-19. Everywhere in the world, the black population almost always comprises a vast majority of all incarcerated people. The known infection rate in jails and prisons is about two-and-a-half times higher than in the general population and some of the largest outbreaks in the country have been at correctional facilities.

In the meantime, what we can do is to take personal responsibility to be safe, comply and respect our neighbour! We can’t give up, we can’t give in and we must keep hope alive. The past is where we learnt the lesson and the future is where we apply the lesson. DM