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How COVID, Inequality and Politics Make a Vicious Syndemic

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High COVID rates and high poverty overlapped in El Centro, Calif., in 2020. Credit: Mario Tama Getty Images
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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.


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Trump is consistently inconsistent on abortion and reproductive rights

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CHICAGO (AP) — Donald Trump has had a tough time finding a consistent message to questions about abortion and reproductive rights.

The former president has constantly shifted his stances or offered vague, contradictory and at times nonsensical answers to questions on an issue that has become a major vulnerability for Republicans in this year’s election. Trump has been trying to win over voters, especially women, skeptical about his views, especially after he nominated three Supreme Court justices who helped overturn the nationwide right to abortion two years ago.

The latest example came this week when the Republican presidential nominee said some abortion laws are “too tough” and would be “redone.”

“It’s going to be redone,” he said during a Fox News town hall that aired Wednesday. “They’re going to, you’re going to, you end up with a vote of the people. They’re too tough, too tough. And those are going to be redone because already there’s a movement in those states.”

Trump did not specify if he meant he would take some kind of action if he wins in November, and he did not say which states or laws he was talking about. He did not elaborate on what he meant by “redone.”

He also seemed to be contradicting his own stand when referencing the strict abortion bans passed in Republican-controlled states since the Supreme Court overturned Roe v. Wade. Trump recently said he would vote against a constitutional amendment on the Florida ballot that is aimed at overturning the state’s six-week abortion ban. That decision came after he had criticized the law as too harsh.

Trump has shifted between boasting about nominating the justices who helped strike down federal protections for abortion and trying to appear more neutral. It’s been an attempt to thread the divide between his base of anti-abortion supporters and the majority of Americans who support abortion rights.

About 6 in 10 Americans think their state should generally allow a person to obtain a legal abortion if they don’t want to be pregnant for any reason, according to a July poll from The Associated Press-NORC Center for Public Affairs Research. Voters in seven states, including some conservative ones, have either protected abortion rights or defeated attempts to restrict them in statewide votes over the past two years.

Trump also has been repeating the narrative that he returned the question of abortion rights to states, even though voters do not have a direct say on that or any other issue in about half the states. This is particularly true for those living in the South, where Republican-controlled legislatures, many of which have been gerrymandered to give the GOP disproportionate power, have enacted some of the strictest abortion bans since Roe v. Wade was overturned.

Currently, 13 states have banned abortion at all stages of pregnancy, while four more ban it after six weeks — before many women know they’re pregnant.

Meanwhile, anti-abortion groups and their Republican allies in state governments are using an array of strategies to counter proposed ballot initiatives in at least eight states this year.

Here’s a breakdown of Trump’s fluctuating stances on reproductive rights.

Flip-flopping on Florida

On Tuesday, Trump claimed some abortion laws are “too tough” and would be “redone.”

But in August, Trump said he would vote against a state ballot measure that is attempting to repeal the six-week abortion ban passed by the Republican-controlled Legislature and signed by Republican Gov. Ron DeSantis.

That came a day after he seemed to indicate he would vote in favor of the measure. Trump previously called Florida’s six-week ban a “terrible mistake” and too extreme. In an April Time magazine interview, Trump repeated that he “thought six weeks is too severe.”

Trump on vetoing a national ban

Trump’s latest flip-flopping has involved his views on a national abortion ban.

During the Oct. 1 vice presidential debate, Trump posted on his social media platform Truth Social that he would veto a national abortion ban: “Everyone knows I would not support a federal abortion ban, under any circumstances, and would, in fact, veto it.”

This came just weeks after Trump repeatedly declined to say during the presidential debate with Democrat Kamala Harris whether he would veto a national abortion ban if he were elected.

Trump’s running mate, Ohio Sen. JD Vance, said in an interview with NBC News before the presidential debate that Trump would veto a ban. In response to debate moderators prompting him about Vance’s statement, Trump said: “I didn’t discuss it with JD, in all fairness. And I don’t mind if he has a certain view, but I don’t think he was speaking for me.”

‘Pro-choice’ to 15-week ban

Trump’s shifting abortion policy stances began when the former reality TV star and developer started flirting with running for office.

He once called himself “very pro-choice.” But before becoming president, Trump said he “would indeed support a ban,” according to his book “The America We Deserve,” which was published in 2000.

In his first year as president, he said he was “pro-life with exceptions” but also said “there has to be some form of punishment” for women seeking abortions — a position he quickly reversed.

At the 2018 annual March for Life, Trump voiced support for a federal ban on abortion on or after 20 weeks of pregnancy.

More recently, Trump suggested in March that he might support a national ban on abortions around 15 weeks before announcing that he instead would leave the matter to the states.

Views on abortion pills, prosecuting women

In the Time interview, Trump said it should be left up to the states to decide whether to prosecute women for abortions or to monitor women’s pregnancies.

“The states are going to make that decision,” Trump said. “The states are going to have to be comfortable or uncomfortable, not me.”

Democrats have seized on the comments he made in 2016, saying “there has to be some form of punishment” for women who have abortions.

Trump also declined to comment on access to the abortion pill mifepristone, claiming that he has “pretty strong views” on the matter. He said he would make a statement on the issue, but it never came.

Trump responded similarly when asked about his views on the Comstock Act, a 19th century law that has been revived by anti-abortion groups seeking to block the mailing of mifepristone.

IVF and contraception

In May, Trump said during an interview with a Pittsburgh television station that he was open to supporting regulations on contraception and that his campaign would release a policy on the issue “very shortly.” He later said his comments were misinterpreted.

In the KDKA interview, Trump was asked, “Do you support any restrictions on a person’s right to contraception?”

“We’re looking at that and I’m going to have a policy on that very shortly,” Trump responded.

Trump has not since released a policy statement on contraception.

Trump also has offered contradictory statements on in vitro fertilization.

During the Fox News town hall, which was taped Tuesday, Trump declared that he is “the father of IVF,” despite acknowledging during his answer that he needed an explanation of IVF in February after the Alabama Supreme Court ruled that frozen embryos can be considered children under state law.

Trump said he instructed Sen. Katie Britt, R-Ala., to “explain IVF very quickly” to him in the aftermath of the ruling.

As concerns over access to fertility treatments rose, Trump pledged to promote IVF by requiring health insurance companies or the federal government to pay for it. Such a move would be at odds with the actions of much of his own party.

Even as the Republican Party has tried to create a national narrative that it is receptive to IVF, these messaging efforts have been undercut by GOP state lawmakers, Republican-dominated courts and anti-abortion leaders within the party’s ranks, as well as opposition to legislative attempts to protect IVF access.

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The Associated Press receives support from several private foundations to enhance its explanatory coverage of elections and democracy. See more about AP’s democracy initiative here. The AP is solely responsible for all content.

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Saskatchewan Party’s Scott Moe, NDP’s Carla Beck react to debate |

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Saskatchewan‘s two main political party leaders faced off in the only televised debate in the lead up to the provincial election on Oct. 28. Saskatchewan Party Leader Scott Moe and NDP Leader Carla Beck say voters got a chance to see their platforms. (Oct. 17, 2024)

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Saskatchewan political leaders back on campaign trail after election debate

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REGINA – Saskatchewan‘s main political leaders are back on the campaign trail today after hammering each other in a televised debate.

Saskatchewan Party Leader Scott Moe is set to make an announcement in Moose Jaw.

Saskatchewan NDP Leader Carla Beck is to make stops in Regina, Saskatoon and Prince Albert.

During Wednesday night’s debate, Beck emphasized her plan to make life more affordable and said people deserve better than an out-of-touch Saskatchewan Party government.

Moe said his party wants to lower taxes and put money back into people’s pockets.

Election day is Oct. 28.

This report by The Canadian Press was first published Oct. 17, 2024.

The Canadian Press. All rights reserved.

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