The COVID-19 pandemic has come to define 2020 around the world, and perhaps no more so than in the United States. At the time of writing, there have been over 12 million confirmed US COVID-19 cases and almost 260,000 deaths. In parallel, the likely health and equity costs of social distancing measures are in of themselves large and growing. One of the chief pressures facing leadership at local, state and national levels is the nature and timing of ramping up or easing social distancing measures, such as choosing when to open or close schools, for example.
These are not easy decisions for leaders to make. Each is fraught with uncertainty, resource implications and potential liability. Criticism and pressure come from a variety of sources, such as unions, parents, political opposition, trade associations and advocacy groups. And many of the challenges to the decisions that are being made around how to deal with COVID-19 — be they decisions to relax distancing measures or to expand them, to extend additional support measures or not — have been presented as being based on principle or on a pragmatic concern about risk of COVID-19. We acknowledge that it may well be that both principle and concern about risk are informing our collective decision-making. We suggest, however, that an unspoken factor that underlies many such deliberations is privilege.
The dictionary definition of privilege itself includes the term immunity: “Privilege is defined as a right or immunity granted as a peculiar benefit, advantage or favor” (Merriam-Webster). Privilege often means having preferential access to positions, status or resources. Its perpetuation occurs as a result of seeking to retain those (often unearned) advantages. We argue that conservation of privilege has been an unspoken, dominant motivation for our actions during the pandemic, particularly driven by those with privilege who often have fundamentally different experiences of a crisis to those lacking those same privileges.
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The privilege of being able to afford an unexpected $400 bill may seem trivial but was beyond the reach of 39% of the American public before the pandemic began. The ability to homeschool is dependent on several advantages. One is having a good internet connection. This basic privilege is unavailable to just under half of all students with a household income of less than $30,000 per year. Having a partner who can share in childcare duties is another key aspect of homeschooling. Around a quarter of non-Hispanic white children live in single-parent households compared to 65% of African American children. Tied to the ability to home school is being able to work remotely. The privilege to do so is patterned by both income and race/ethnicity (see Figure 1)
We must be cautious that, due to that same privilege, the voices of this minority — which controls most of the levers of power at all levels of society — are not overrepresented in our policy choices. The threat of this happening is substantial.
When President Trump, announcing his departure from the hospital after receiving treatment from COVID-19, tweeted, “Don’t be afraid of COVID. Don’t let it dominate your life,” it is important we understand how varied the “domination” of life has actually been during the pandemic and the extent to which that is mitigated by privilege. His message was written from the position of being able to socially distance, work remotely, have access to healthcare, be insulated from interruptions in employment and income, not required to expose oneself to daily risk as an essential worker, nor bearing responsibility for remotely educating children. These are marks of privilege. And while the President is in a unique position, these privileges are shared by a group much larger than the president. It describes a significant minority, many with college degrees, in the top 20% of earnings, for whom both the risk of COVID-19 itself and the impact of social distancing on their day to day lives, while inevitably changed and affected by this global trauma, have been made relatively easier because of privilege.
We must be cautious that, due to that same privilege, the voices of this minority — which controls most of the levers of power at all levels of society — are not overrepresented in our policy choices. The threat of this happening is substantial. The voices of this minority are often the loudest, even as the risks they face are far from the greatest. This has long been an important but often unacknowledged problem in the context of health, that privilege confers both a lower risk of health harms, and through so, a sense of distance and perhaps unawareness of the greater risks faced by others. For example, a recent paper found that heart disease outcomes in the U.S. had improved significantly in the top 20% of earners in recent years but had stagnated for the poorest 80%. U.S. public health investment, which would improve health disparities, has repeatedly been set aside in favor of funding healthcare innovations that can only be afforded by a minority. This disparity is something that might be imperceivable to the richest 20%, college-educated portion of the population, but a daily reality for the poorest 80%.
The COVID-19 pandemic made this important problem, this privilege gap, an urgent one. When we discuss the benefits and risks to health of policies to address the spread of COVID-19, it is important to recognize the lens of privilege that informs our thinking and to consider how decisions being made affect those with far less privilege who are experiencing the pandemic rather differently.
As we look to the future and the possibility of further lockdown measures, it seems critical that our decision-making takes clear account of how these will affect those who do not have the privilege to move their lives indoors to shelter from the risk of acquiring COVID-19. While working remotely and ordering online may seem an inconvenience, these privileges are a luxury made possible by essential workers who make sure the internet and electricity remain connected, that food and goods can be delivered at homes, and that hospitals remain staffed and clean. Yet even the definitions of essential workers, and the support available to them in spite of their crucial importance, vary by state in the U.S. Those workers who faced the highest risk of COVID-19 received no more pay than those who did not. This is not only detrimental and unjust to these groups but also increasingly likely to hamper efforts to contain the virus, as an inability to meet regular bills is associated with a greater likelihood of reporting to work with a fever.
Importantly, this is directly relevant to the racial and ethnic gaps that have become so apparent in a time of COVID. The overwhelming burden of COVID on minority groups, particularly African Americans, fundamentally reflects long-standing imbalances in power and authority, in other words, positions with less privilege. African Americans had a greater risk of unemployment, were less likely to be able to work remotely, and had far lower levels of household income and assets to weather the pandemic. These same conditions placed them at higher risk of poor health before the pandemic too. Mortality rates among working-age African Americans were 40% higher than their white counterparts pre-pandemic. This reflects the reality of privilege and its impact on health risk long before COVID-19 came along.
Policy solutions that might seem obvious to those of us with the privilege to mitigate them relatively easily may seem like the obvious “low risk” solutions. But these same policies have disproportionately affected those without that same privilege. For these groups, there are significant additional pitfalls both for the pandemic and for the costs of aspects of social distancing, such as loss of income and unemployment, housing and food insecurity, gaps in educational attainment, and poorer mental and physical health.
This analysis matters for what has happened, but also for what might come next. Fundamentally, some of us are experiencing this pandemic very differently from others based on the privileges we have been either afforded or denied. Gaps are opening in educational attainment. Unemployment, which has almost returned to pre-pandemic for the highest earners, remains stubbornly high in those on lower incomes, those same workers who were less able to work remotely from the outset.
As a new administration considers our approach to COVID mitigation therefore, it seems to us imperative that we acknowledge the privilege gap and the impossible situation facing a large population of low income and essential workers onto whom a greater proportion of risk, to their health, wealth and education, is being inevitably shifted. Our current policies fail to take this into account in tangible and avoidable ways.
If we wish to ensure we emerge as a more secure and equal society, or at the very least, prevent further inequalities from emerging as a result of the pandemic, we must also mitigate the unintended consequences our policy choices have for inequity and the distribution of risk and privilege.
Top Image: People wait in line to receive food at a Food Bank distribution for those in need as the coronavirus pandemic continues on April 9, 2020 in Van Nuys, California. | Mario Tama/Getty Images