The persistent inequalities

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By HENRI ACSELRAD*

Everything indicates that we are observing the effects of a lasting unequal protection, arranged in time, continuous and capable of drastically marking the social history of the bodies of blacks and the poor.

The first data on the impacts of social and racial inequality on the pandemic came from abroad. The U.S. Centers for Disease Control and Prevention (CDC) reported in April 2020 that 33% of people hospitalized with COVID-19 were African American, while only 13% of the U.S. population are African American.[I]. In France, in the peak months of the epidemic, deaths of immigrants rose at a rate twice as high as that of non-immigrants compared to the same months of the previous year.[ii]. Blacks and ethnic minorities, in England, accounted for, according to the May 2020 report, a number of hospital deaths per capita almost three times higher than that of the white majority[iii].

In Brazil, data on the color of those affected by COVID took some time to register. The Black Coalition for Rights, scientific associations and public defenders insisted, together with the State, that such records be made. In June, the epidemiological bulletins of the Ministry of Health began to publish data on the color of dead and sick with Covid-19 as some units of the federation already did. The hypotheses began to be confirmed. In mid-June, the IBGE announced that the lethality rate was higher among blacks affected by covid-19 than among whites; that income and color inequalities cause black people and low-income groups to be affected by the epidemic in percentages greater than their participation in the population as a whole[iv].

Among the risk factors, we highlight dense and unhealthy housing conditions, located in areas with poor air quality, with low access to adequate health services and lacking basic sanitation; the lower possibility of self-protection due to isolation, the difficulty of accessing emergency assistance and tests. Add to this the weight of underreporting of cases and the information on color and income itself, as well as the action of structural racism that causes black people to be stigmatized when wearing masks[v]. Due to this set of factors, the groups affected more than proportionally by the virus are said to be more vulnerable to epidemic damage. However, under the designation of vulnerable it is necessary to recognize multiple realities that deserve to be better discussed. We will try to make a more detailed examination of this term below.

While the notion of risk designates the probability of occurrence of damage, the notion of vulnerability designates the susceptibility of certain groups to be affected by this damage, considering a set of intercurrent conditions – age group, color, gender, income level, etc. .[vi] The characterization of a group as vulnerable results from the crossing of data on the social distribution of the damage with the said intercurrent conditions, making it possible to perceive the existence of groups affected more than proportionally, that is, in a greater proportion than that of their participation in the population as a whole.

The State, in its current configuration as a public machine, is usually interested in identifying, measuring and locating the so-called “vulnerable” subjects. This is the case of mapping certain social situations configured at a point in time – people below the poverty line and the number of street children, for example. In general, these are surveys that estimate the stock of individuals in need. The authorities, when willing to adopt social policies aimed at these groups, propose to meet these needs, providing a supplement of what would be lacking to bring the “vulnerable” to a condition considered acceptable for existence. It is as if the condition of vulnerability were circumstantial, because when producing a picture of a situation, attention is not paid to the processes of vulnerability that throw these groups into a condition of vulnerability. This only manages to alleviate certain situations of precariousness, without affecting the structures that produce them. It is known, however, that the situation of vulnerability stems from mechanisms that remove – or fail to provide – the conditions that would allow certain groups to adequately defend themselves against risks. An example of this is the veto of the current Brazilian government to the article of Law 14.021/20 (DOU, 8/7/2020) on measures for the protection and prevention of contagion by covid-19 in indigenous territories that obliged the government to provide access to drinking water, hygiene and cleaning materials, internet installation and basic food baskets for the villages . Taking mechanisms of this type into account, it is possible to point to what is due to subjects as a right and to the set of political decisions of a distributive nature that are necessary[vii].

The susceptibility to being affected by environmental damage, for example, such as floods, landslides, windstorms or dam failures, has to do with the relative position of social groups in space, namely, with the preponderant location of the groups' homes. vulnerable on precarious, devalued land located close to sources of risk. Those who live in such situations do so, of course, because they were not given or were deprived of the means that would allow them to live in locations far from sources of risk, equipped with infrastructure and health services. By identifying the processes of vulnerability, one could certainly explain the mechanisms that generate the conditions of vulnerability. By doing so, it would be possible to envisage, through public policies, the interruption of the action of these mechanisms, preventing the most dispossessed groups from being thrown into a condition of vulnerability. Such risks could be faced by housing, urban planning, environmental, health and income policies that would combat socio-spatial segregation and allow everyone to maintain a protective distance in relation to sources of risk. In this way, the creation of so-called situations of environmental inequality, massively observable in our country, would be avoided – situations in which there is proximity or co-location of sources of risk and housing spaces for the black and lower-income population. In the case of the current pandemic, for example, living in precarious areas and the lack of access of such groups to health services radically contrasts with the mobility of high-income families who were able to use air ICUs to move away from places with a network insufficient hospital towards Sao Paulo and Brasilia to get proper treatment[viii].

There are processes of vulnerability, in turn, which, due to their long duration, throw people into socio-spatial situations of existence that end up inscribing vulnerability in their own bodies. In the case of the present pandemic, in addition to the vulnerability resulting from the socio-spatial condition of life of the groups exposed in a way that is more than proportional to the action of the virus, there are indications that the very immunity of these groups would be proving to be diminished. They would not only be more exposed to the risk of contagion, but also more likely to be contaminated in a more serious and lethal way. In the case of viral diseases such as the current pandemic, long-lasting life trajectories in spaces without sanitation, health care, safe housing, etc. would have made the bodies of the black and low-income population more susceptible to contamination and lethality.

It does not matter, therefore, only the moment when someone is in a situation of vulnerability. The time variable matters. And it counts not only because there is a process of vulnerability, but also because of the duration of the subjects' position in precarious situations and, consequently, the stress they tend to suffer in their defense capacities, including, as this case seems to indicate, immune . Researchers in the field of social genomics and psychoneuroimmunology have been working on how social stress, racism, discrimination and precarious living conditions can lead people to a state of increased risk of disease. [ix].

If so, the greater susceptibility of the black population to the pandemic would be projecting in time what had already been verified empirically in space. Until now, the role of the variable “proximity” between subjects made vulnerable and sources of risk had been proven. These subjects tend, in fact, to move in a spatial circuit of precariousness – contaminated land, close to an oil pipeline, transmission line or ditch. Robert Bullard, one of the pioneers of studies on environmental inequalities, reminds us that the lack of guarantee of rights leads to a cumulative impact of deficiencies and co-morbidities on the black and low-income population.[X]. But in the case of the present pandemic, it seems to be worth, in addition, the weight of time, that is, the duration of the experience in a social condition of vulnerability as a stress factor of the immune capacities in the face of health problems. Everything indicates that we are observing the effects of a lasting unequal protection, arranged in time, continued and capable of drastically marking the social history of the bodies of blacks and the poor. The socio-spatial segregation that affects these groups therefore also results in social life time being subtracted from them.

* Henri Acselrad is a professor at the Institute of Research and Urban and Regional Planning at the Federal University of Rio de Janeiro (IPPUR-UFRJ).

Notes

[I] “CDC Data Finds African Americans — 13% Of US Population — Account For 33% of COVID-19 Hospitalizations”, Allison Aubrey and Joe Neel, 8 / 4 / 2020, https://laist.com/2020/04/08/cdc-african-americans-covid-19-hospital-data.php

[ii] “Covid: une hausse des décès deux fois plus forte chez les personnes nées à l'étranger”, Helena Berkaoui, 7/7/2020, https://www.mediapart.fr/journal/france/070720/covid-une-hausse-des-deces-deux-fois-plus-forte-chez-les-personnes-nees-l -estranger?onglet=full

[iii] Lucinda Platt and Ross Warwic, Are some ethnic groups more vulnerable to COVID-19 than others?, The Institute for Fiscal Studies, Nuffield Foundation London, May 2020. https://www.ifs.org.uk/inequality/wp-content/uploads/2020/04/Are-some-ethnic-groups-more-vulnerable-to-COVID-19-than-others-IFS-Briefing-Note.pdf, accessed on 27/7/2020.

[iv] A PNAD Covid-19 from the IBGE showed that the Brazilians most affected by the disease are black, brown, poor and uneducated. Among the 4,2 million Brazilians who showed symptoms of the disease in May 2020, 70% of them were black or brown, while these groups represent 54,8% of the population. https://covid19.ibge.gov.br/pnad-covid/  In July 2020, demographer Eustáquio Diniz estimated that indigenous people were 98% more likely to die than white people, while brown people, 72% more likely and black people, 46%. “Covid-19 Diary: One hundred days of pain and suffering behind the numbers”, https://projetocolabora.com.br/ods3/cem-dias-de-dor-e-sofrimento-por-tras-dos-numeros/. Similar estimates were published in the Lancet journal: “Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study” (Baqui P., Bica I., Marra V., Ercole A, van der Schaar M. .) Lancet Glob Health. 2020; (posted online on July 2, 2020) https://doi.org/10.1016/S2214-109X(20)30285-0

[v] “Black men report cases of racism when wearing masks on the street”, Fabiana Batista,

  https://www.uol.com.br/universa/noticias/redacao/2020/05/08/homens-negros-relatam-casos-de-racismo-por-utilizar-mascaras-na-rua.htm, accessed on 27/07/2020 

[vi] Ayres, JRCM et al. AIDS, vulnerability and prevention. Rio de Janeiro, ABIA/IMS-UERJ, II Seminar on Reproductive Health in Times of AIDS, 1997.

[vii] Vulnerability is a social dynamic and not a passive or inevitable condition awaiting an impact. The most vulnerable people are those whose capacities and freedoms of action are limited or suppressed in multiple ways: the chronically unemployed, the disadvantaged and those excluded from decisions or benefits due to class, racial, gender or religious prejudices. cf. Kenneth Hewitt, Preventable disasters: Addressing social vulnerability, institutional risk, and civil ethics, Geographische Rundschau International Edition Vol. 3, No. 1/2007, p. 49.

[viii] “With a collapsed state, MT millionaires with covid-19 resort to jets to seek treatment in SP”, Vinicius Lemos, BBC News Brasil, São Paulo, in https://noticias.uol.com.br/ultimas-noticias/bbc/2020/07/17; “With a private network without vacancies in Belém and Manaus, the richest flee the air ICU”, Aiuri Rebello, UOL, São Paulo, 06/05/2020, https://noticias.uol.com.br/saude/ultimas-noticias /redacao/2020/05/06/coronavirus-rede-privada-sem-vaga-manaus-belem-mais-ricos-fuga-uti-aerea-sp.htm

[ix] April Thames, “The Chronic Stress of Being Black in the US Makes People More Vulnerable to COVID-19 and Other Diseases”, The Conversation, 9/6/2020.

[X]  “The ´Father of Environmental Justice` on Why He Isn't Surprised by COVID-19 Health Disparities, an interview with Robert Bullard”, Texas Montlhy.174/2020, https://www.texasmonthly.com/news/father-environmental-justice-coronavirus/  

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