Politics
How COVID, Inequality and Politics Make a Vicious Syndemic – Scientific American
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It is folly to respond to COVID by focusing only on the coronavirus that causes it, because the virus alone did not dictate the catastrophic impact. For instance, in the U.S., the illness initially hit urban populations hard. But the virus has traveled to more rural areas over time, and recently the impact has shifted to Southern states. In those areas, people younger than 70 years old have been dying more frequently from COVID than they have elsewhere. These same states have had fewer people getting vaccinated and protected. The mortality trends are strongly tied to the increased burden of cardiovascular and metabolic illnesses in the American South, which existed before the virus hit but have made its impact worse. Poorer access to health care has also been a factor in these sad Southern numbers because many of these same states refused to expand Medicaid under the Affordable Care Act. Even before the pandemic, states that expanded Medicaid showed improved health; those that refused expansion did not. As COVID took hold, states with Medicaid expansions were better able to ramp up testing and tracing and to provide health care coverage to people who were suddenly out of work.
The larger lesson of COVID is that social and biological risk are deeply entangled. Viruses may cause disease in individuals, but pandemics play out in populations. This disease, like previous pandemics, reflects political, economic and social conditions. One way to understand these dynamics is through the concept of syndemics.
The term syndemic refers to the synergies among epidemics. The idea involves three claims. First, political-economic forces with historical depth lead to entrenched social, economic and power inequities. Second, those inequities shape the distribution of risks and resources for health, leading to the concentration of disease in specific parts of a population. And third, some overlapping diseases make one another worse because of biological interactions.
COVID is not inherently syndemic. Syndemics are not properties of diseases but rather of systems. Syndemics reminds us that, while we can understand viruses in the lab, the distribution of disease depends on complex, real-world interactions among political-economic structures, ecological contexts and human biology. In other words, context matters. Local histories and power structures influence where conditions cluster, how they interact and why some people suffer more.
In the U.S., conditions were ripe for a syndemic to emerge. A deep history of systemic racism and white supremacy in the country had two immediate consequences. First, race-based residential segregation, the racialized structure of the workforce, and racial inequities in the prison system, among other factors, meant that Black and Indigenous people and other people of color were more likely to be exposed to SARS-CoV-2, the virus that causes COVID. In contrast, the accumulated advantages of whiteness meant that white people were more likely to be in professions that allowed them to work from home, reducing exposure. Second, because of the same political-economic and social inequalities, Black and brown people were already suffering disproportionately from poor health conditions such as hypertension and diabetes. There are biological interactions between these conditions and COVID, such as when chronic inflammation from diabetes is augmented by acute inflammation from SARS-CoV-2, leading to an intense immunological reaction that can damage multiple organs.
Such syndemic interactions are likely one reason worldwide excess deaths in 2020 far outpaced the already shocking number of deaths directly attributed to COVID that year. These conditions made the anemic U.S. federal response to the disease in 2020 even more deadly. By continually downplaying the threat and moving to reopen crowded businesses while infections were still accelerating, the Trump administration allowed the virus to spread along the fault lines of society. Syndemic interactions with preexisting inequities in health and the conditions of life meant that the hardest-hit communities were already suffering from concentrated poverty, substandard housing, less access to health care, disproportionate police surveillance and incarceration, greater exposure to air pollution, less access to healthy food and higher rates of cardiometabolic disease. The pandemic made many of these conditions worse. For instance, there were unequal impacts of the economic fallout throughout 2020, and the current economic recovery continues to leave many Black communities and other communities of color behind. And earlier this year, failures to prioritize equity in vaccine distribution allowed glaring inequities to grow.
It didn’t have to be this way. Consider the case of New Zealand. There are many differences between that country and the U.S., but they share a common history of European settler colonialism and enduring social, economic and health inequities among white, Asian, Pacific Islander and Indigenous people. New Zealand had, and has, the background for syndemics. But when COVID brushed its shores, Prime Minister Jacinda Ardern closed down the country. Her “go hard, go early” approach, embodied in the nearly five-week lockdown that she instituted in March 2020, focused on protecting her “team of five million.” She also urged New Zealanders to care for one another, to be compassionate. The nation has been largely successful in keeping COVID under control. Drawing on long-standing pandemic preparedness plans, Ardern employed basic public health principles to stop the disease in this smaller, less dense population.
Many other countries responded with strong public health leadership, implementing swift lockdowns and controlling the disease. For example, Rwanda’s government shut everything down and tightly controlled the spread of COVID in 2020, in part through established trust within the system and what the country’s former minister of health Agnes Binagwaho described as “compassionate leadership” in a 2020 International Journal of Health Policy and Management paper. A national lockdown ensued a week after the first case was confirmed, followed by extensive contact tracing and testing. Today Rwanda is fighting a new spike in cases by pushing to vaccinate as many citizens as possible, but accessing enough vaccines is difficult because of global inequities in immunizations.
Inequality takes lives. Demographer Elizabeth Wrigley-Field recently showed that Black people in the U.S. experience pandemic-scale premature mortality every year. Like the influenza pandemic a century ago, COVID exacted a staggering toll, instantly reducing life expectancy in the U.S. by more than a year. Yet even the reduced life expectancy of white Americans remains higher than it has ever been for Black Americans, and the reductions in life expectancy for Black and Latino populations are expected to be three to four times greater than for white people.
When a novel coronavirus is introduced into that context of inequality and allowed to spread, it is a recipe for disaster—and not only for the targets of racial oppression but for everyone. Another recent study estimated that, if the U.S. government had paid reparations to descendants of enslaved people—an essential step toward liberty and justice for all—then the overall transmission rate of the virus, regardless of ethnic or racial background, would have been between 31 and 68 percent lower than it was. Everyone would have been better off.
If the pandemic begins to recede, we hope the world will not return to a “normal” that was not working for everyone. COVID will not be the last pandemic threat we face. To reduce the suffering from the next one, we must reduce the suffering people experience now. The larger lesson of syndemics is that a more equal society is also a healthier one.
Politics
The Earthquake Shaking BC Politics – TheTyee.ca
Six months from now Kevin Falcon is going to be staggering toward a catastrophic defeat for the remnants of the BC Liberals.
But what that will mean for the province’s political future is still up in the air, with the uncertainty increased by two shocking polls that show the Conservatives far ahead of BC United and only a few percentage points behind the NDP.
BC United is already toast, done in by self-inflicted wounds and the arrival of John Rustad and the Conservative Party of BC.
Falcon’s party has stumbled since the decision to abandon the BC Liberal brand in favour of BC United. The change, promoted by Falcon and approved by party members, took place a year ago this week. It was an immediate disaster.
That was made much worse when Rustad relaunched the B.C. Conservatives after Falcon kicked him out of caucus for doubting the basic science of climate change.
Falcon’s party had fallen from 33 per cent support to 19 per cent, trailing the Conservatives at 25 per cent. (The NDP has 42 per cent support.) That’s despite his repeated assurances that voters would quickly become familiar with the BC United brand.
BC United is left with almost no safe seats in this election based on the current polling.
Take Abbotsford West, where Mike de Jong is quitting after 30 years in the legislature to seek a federal Conservative nomination. It’s been a BC Liberal/United stronghold. In 2020 de Jong captured 46 per cent of the votes to the New Democrats’ 37 per cent and the Conservatives’ nine per cent.
But that was when the Conservatives were at about eight per cent in the polls, not 25 per cent.
Double their vote in this October’s election at the expense of the Liberals — a cautious estimate — and the NDP wins.
United’s prospects are even worse in ridings that were close in the 2020 election, like Skeena. Ellis Ross took it for the BC Liberals in 2020 with 52 per cent of the vote to the NDP’s 45 per cent.
But there was no Conservative candidate. Rustad has committed to running a candidate in every riding and the NDP can count on an easy win in Skeena.
It’s the same story across the province. The Conservatives and BC United will split the centre-right vote, handing the NDP easy wins and a big majority. And BC United will be fighting to avoid being beaten by the Conservatives in the ridings that are in play.
United’s situation became even more dire last week. A Liaison Strategies poll found the NDP at 38 per cent support, Conservatives at 34 per cent, United at 16 per cent and Greens at 11 per cent. That’s similar to a March poll from Mainstreet Research.
If those polls are accurate, BC United could end up with no seats. Voters who don’t want an NDP government will consider strategic voting based on which party has a chance of winning in their ridings.
Based on the Liaison poll, that would be the Conservatives. That’s especially true outside Vancouver and Vancouver Island, where the poll shows the Conservatives at 39 per cent, the NDP at 30 per cent and United lagging at 19 per cent. (The caveat about the polls’ accuracy is important. Curtis Fric and Philippe J. Fournier offer a useful analysis of possible factors affecting the results on Substack.)
And contributors will also be making some hard choices about which party gets their money. Until now BC United was far ahead of the Conservatives, thanks to its strong fundraising structure and the perception that it was the front-runner on the right. That’s under threat.
The polls also mark a big change in the NDP’s situation. This election looked like a cakewalk, with a divided centre-right splitting the vote and a big majority almost guaranteed. Most polls this year gave the New Democrats at least a 17 per cent lead over the Conservatives.
If the two recent polls prove accurate and that gap is much smaller, the NDP faces a tougher campaign challenge than anyone expected a few weeks ago.
Next: What’s behind the B.C. Conservatives’ surge?
Politics
Political longevity of Sunak smoking ban likely to outlast PM – BBC.com
Unless the opinion polls shift and shift quite a bit, Rishi Sunak knows his time left as prime minister might be running out.
But he is the instigator of a smoking plan with substantial, cross-party political support, which looks set to herald a sizeable social change.
And that cross-party support suggests it’s an idea with greater political longevity than he might have, because Labour wouldn’t scrap it if they win the election.
In other words, whatever happens, it is what some in politics call a legacy.
As I wrote here when Mr Sunak first set out his plans last autumn – in what he described at the time as “the biggest public health intervention in a generation” – this is a government seeking to nudge, or elbow, a societal shift along: the near end of smoking.
On Tuesday, Health Secretary Victoria Atkins said she hopes creating a smoke free generation will “spare thousands of young people from addiction and early death as well as saving billions of pounds for our NHS”.
What was once mainstream is already marginal. Now the attempt to near-eradicate it, over time.
This isn’t the end of this discussion: what we have seen so far are the early parliamentary stages. There is more to come before it becomes law.
So that is the big picture, potential social change stuff. What about the politics?
Nearly 60 Conservative MPs voted against Mr Sunak’s idea.
Yes, they had a free vote – they weren’t told how to vote – but they defied him nonetheless. The cabinet minister Kemi Badenoch among them.
Another 100-ish abstained. The cabinet minister Penny Mordaunt among them.
A source close to Ms Mordaunt told me that she abstained because “she was not a supporter of the bill. She has many objections to it. The practicality of it. The implementation and enforcement of it. But being a serving cabinet minister she thought voting against it would look more confrontational and posturing than abstaining would have been.”
Who could that possibly be a dig at? Ah, Kemi Badenoch.
And what do Ms Mordaunt and Ms Badenoch have in common? A splash of ambition.
They are both talked up by some as future Conservative leaders.
Read more about the smoking ban
When you look at the numbers, nearly half of Conservative MPs couldn’t bring themselves to endorse one of their leader’s flagship ideas of the last six months.
Which tells you something about the fractious nature of the Conservative parliamentary party, although not a lot that wasn’t pretty clear to the regular observer already.
Labour are already gleefully talking up that it is a good job they backed the idea or Mr Sunak would have lost.
And they are also publicly pondering what those opponents might do once the chance arises to change the ideas, to bolt on amendments.
But then again they would be defeated if those in favour keep backing the plan as it is.
When governments manage to latch on to a plan which goes with the grain of where a society is already heading, the might of the law can shove it along profoundly and, probably, permanently.
This idea – for now at least – looks like it might be one of those.
And, for all his political troubles, it is Mr Sunak who is its author.
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