How worsening inequalities must make us all activists

Abstract

The story of the pandemic is one of inequalities, both national and global. The SARS-CoV-2 virus does not discriminate, we were told. But the reality is that it does discriminate against the poor, the marginalised and the disadvantaged. Whatever inequalities existed before the UK felt the full force of the pandemic – and there is convincing evidence that the effect of inequalities on health outcomes were worsening faster in the UK than in other rich nations¹ – those inequalities have only been exacerbated.

When the UK announced that 19th July would be ‘Freedom Day’ – freedom from government COVID restrictions – the people most likely to be affected were the poor, the marginalised and the disadvantaged. The very people least likely to take up vaccinations for complex reasons, many of which rest with the state and the media. By differentially affecting the most vulnerable in society, the premature ‘end’ of the pandemic called by the UK mirrored the beginning when the outcomes of people in social care were the lowest priority.

Should we seek a society that understands the importance of placing people at the centre of social care by using and being responsive to patient-reported outcomes?² Should we find ways to support and celebrate our colleagues from disadvantaged communities who have played a central role in the pandemic response?³ Should we finally break the inverse care law of those most in need being those most likely to avoid vaccination? Should we remind ourselves that as we celebrate the overall success of the UK’s vaccination programme, the effects of allowing a virus to circulate freely may lead to long-term harm for those unvaccinated in the UK and around the world?

In every scenario, in every pilot or evaluation of an innovative approach,⁴ it is the poor, the marginalised and the disadvantaged who bear the worst outcomes. One response is to shrug your shoulders and say that this is the way of the world, of forces that are beyond the capabilities of most individuals, politicians and societies to resolve. Another is to use that sense of injustice to inspire activism. Not to be a rebel without a cause, but to be an expert with a duty to patients and the public. When we accept that reality, of how making decisions based on evidence can place you at odds with political dogma,⁵ then, as Henry Marshall argues, there is no distinction between expert and activist.⁶

References

Hiam L, Minton, J and McKee M. What can lifespan variation reveal that life expectancy hides? Comparison of five high-income countries. J R Soc Med 2021; 114: 389–399.

Hughes S, Lee Aiyegbusi O, Lasserson D, Collis P, Glasby J and Calvert M. Patient-reported outcome measurement: a bridge between health and social care? J R Soc Med 2021; 114: 381–388.

Johnson HP. If I was minister of health I would prioritise addressing all health inequalities. J R Soc Med; 114: 406–410.

Ashton J. When is a screening test not a screening test? J R Soc Med 2021; 114: 411–413.

Donaldson IML. Reflections on translating passages on ‘empirical’ and ‘dogmatic’ medicine in Celsus’s De medicina. Part 2. J R Soc Med 2021; 114: 400–405.

Marshall H. Where the medical expert ends and the political activist begins. J R Soc Med 2021; 114: 376.