The Pandemic Challenge: Reflections on the Social Justice Dynamic.

The outbreak of the 2019 novel coronavirus, or SARS‐CoV‐2, and the disease caused by it, COVID‐19, has disrupted life around the world. Indeed, as a pandemic, COVID‐19 has led to rampant human suffering and deaths, posing threats not only to public health and health security but more generally to societal stability and wellbeing across levels of analysis, whether local, national, or global. The pandemic has impacted virtually all sectors of society and is changing the world, even against the backdrop of other conflicts and competition, within and across countries and populations. However, COVID‐19 has disproportionately impacted certain individuals and groups—identified particularly by factors, such as race, class, gender, disability, age, displacement and homelessness, and migration status, among others—reflecting longstanding disparities and inequalities not only in health and health care but in society more generally. In the same vein, COVID‐19 has further highlighted imbalances in power and resource distributions relative to technology and knowledge divides, supply chain disruptions, and demographic and rural‐urban disparities in health‐care access and capacities and overall resources. Together, these circumstances constitute questions of social justice as a fundamental determinant of health and societal wellbeing.

The concept of social justice is typically understood relative to notions of human rights, with particular emphasis on bettering the lives and life chances of peoples who have been marginalized or treated as the “other” in society relative to various identifying factors, as mentioned above. The uneven impacts of COVID‐19 on such populations have occurred for several reasons, including already existing social, environmental, and health inequities. Limited health‐care capacities and resources in many parts of the world have affected responses to the virus. For example, across countries and communities, health‐care systems have faced problems of surge capacity for hospitalization, treatment, and other essential services during the pandemic. Existing health problems and underlying conditions also add to the likelihood of comorbidities, which, in turn, mean more dire reactions to the virus. Furthermore, consistent exposure to environmental health hazards, such as contaminated water and industrial air and land pollutants and toxins, is linked to more severe COVID‐19 outcomes. The unequal distribution of benefits and burdens in society, as expressed in health inequalities and responses and the disproportionate suffering of disadvantaged and vulnerable groups from the virus and its effects, calls for an examination of how the pandemic plays to, complicates, and intensifies social inequities and problems.

This situation emphasizes the need to attend to social disparities that make society in general more susceptible to the pandemic. The advent of COVID‐19 has served to underscore—and has exacerbated—social, political, economic, and environmental inequalities and inequities, borne especially by already vulnerable and disadvantaged populations. Serious problems in relation to health and health‐care infrastructures and provisions, working and living conditions, access to clean water, and so on, represent serious threats to wellbeing in general. Recognizing specifically disadvantaged populations and communities as particularly vulnerable to the ravages of the pandemic, related threats to public health also are translated and understood within broader struggles for social and environmental justice and human rights. Accordingly, addressing the global challenge posed by the virus calls for investigating its effects on some of the world's most pressing problems, pointing not merely to questions of public health and medical preparedness in isolation but necessarily in relation to social justice as a health determinant and efforts to eliminate resulting gross disparities across countries and populations.

The working and living conditions of many vulnerable and disadvantaged peoples continue to create risks in the larger scheme of pandemic effects, marking situations in which their health is already compromised—for example, lacking clean water and sanitation facilities, and lacking access to quality health care, including inequalities in diagnosis and treatment. Persons of lower social circumstances and statuses—defined especially by relative deprivation in terms of income, wealth, occupation, and education—have been marked by poor health conditions and outcomes. Such groups have been the most impacted by the disease, in terms of health, working, and living conditions, and include those living and working in industries and under conditions that leave them especially vulnerable to pandemic exposure (e.g., migrant farmworkers, health‐care workers, food processing plant workers, etc.). Typically living in medically underserved and impoverished situations, the profoundly disparate health conditions marking these populations have been magnified in the wake of COVID‐19 in keeping with persistent social inequalities and inequities. These things go hand in hand with poor educational capacities, limited employment opportunities, below living wages and earnings, crowded living conditions, reliance on public transportation, food crises, etc. However, having said that, the COVID‐19 crisis is changing the world and affecting people's lives in a variety of ways, not only in direct reference to health disparities but to a range of more general social, economic, and technological divides. The social, political, and economic implications of, for example, how and to whom services are provided during the pandemic can have implications far beyond the individuals and communities directly or immediately involved, affecting possibilities for COVID‐19 transmission across society and overall societal wellbeing.

Public health policies that focus on biomedical and technological interventions without attending to social factors and circumstances are bound to fail. While some efforts aimed at reducing disease transmission, such as personal protective equipment, sanitizing, and physical distancing, can be effective, the fact is that, even with the best of intentions for compliance, the living and working conditions of some individuals and groups and the lack of resources in some locations render it next to impossible to stringently follow recommended practices. While addressing questions of social justice, employment, and vulnerable populations in both direct and indirect relation to COVID‐19 and other relevant health concerns, the geographic distribution of the active virus requires maintaining an integrated perspective that considers the different locations and populations in which the virus has taken hold.

Policy foci in this regard are on the effects of the COVID‐19 pandemic and widespread concerns regarding subsequent societal disruptions. Challenges to humanity in responding to the pandemic have made it clear that further research is needed to illuminate and provide a greater specification of the social and structural factors that determine capacities for dealing with health threats and related preparedness. Basic topics include how COVID‐19—and future health disasters—can affect the individual, group, and place‐specific health and general wellbeing, and how related factors can contribute to or help ameliorate health disparities and inequities, including issues of preparedness and planning, particularly in terms of resource distributions. Research also is needed to inform efforts to recover physically and economically from the pandemic and to improve life conditions, with access to affordable health care, educational opportunities, and economic advancement.

In some ways, the pandemic might be viewed as offering opportunities to “do better,” not to go back to a normal state that was far less than ideal for large swaths of the world's population, but to put programs and policies in place that will address related social problems and improve current societal relations and conditions for all. Although scientific advances are occurring relative to combat the disease, the world still faces uncertain times in relation to the pandemic, and reactions to COVID‐19 constitute an analytical project aimed at challenging social, political, and economic forces that determine observed disparities. A more critical and expansive perspective is required to better understand related morbidity and mortality rates and patterns, especially from the perspective of social justice, and to plan interventions accordingly to engage the global challenge that is the pandemic.