The social gradient of COVID-19

by Andrew Reid and Siggi Zapart

While COVID-19 does not discriminate, the impacts of the virus will not be equitably distributed. Vulnerable populations living in low socioeconomic disadvantaged communities will feel its health and educational impacts far more strongly than those living in more affluent areas.

 Health impacts
 Reduced access to essential healthcare

Some health experts suggest the COVID-19 pandemic could infect up to 70% of Australians. Based on estimates of current infection, more than 45,000 Australians will have COVID-19 by 10 April, 2020. At least 2,254 people would require ICU beds, (more than the current Australian capacity of 2,229). People in lower socioeconomic disadvantaged communities generally have poorer health and higher rates of heart and respiratory disease, and chronic illnesses. This means they could make up a large proportion of people likely to need ICU beds, and/or find it a lot harder to receive critical healthcare for their other illnesses in their local hospitals.

Furthermore, the Australian Government’s plan to implement a ‘whole-of-population telehealth’ approach will disadvantage vulnerable populations who do not have access to smartphones or computer technology due to lower income or education levels. The ‘whole-of-population telehealth’ includes phone and video mental health, allied health, and primary health consultations. Moreover, even those with internet access will be disadvantaged due to inferior NBN service types(see graph below). Research conducted in 2016 showed only 29% the most disadvantaged areas across Australia (SEIFA decile of 1) had fibre-to-the-premise (FTTP) – considered the best broadband technology solution available – or fibre-to-the-node (FTTN) connections. In the least disadvantaged(SEIFA decile of 10), 93 % had FTTP or FTTN. This is clear evidence that optimal NBN service increases as the SEIFA decile increases. Hence, even though telehealth is covered by Medicare, people living in disadvantaged suburbs are likely to miss out on the much needed essential services.

Impact on mental health

The continuing upward trend in the number of confirmed COVID-19 cases across Australia is causing increased anxiety and stress among disadvantaged communities. This is due to multiple and simultaneously occurring factors including, risk and uncertainty associated with the virus; feeling of powerlessness in the current situation; inconsistent messaging and confusion about social distancing measures; separation from loved ones due to quarantine or self-isolation; loss of freedom, and increased boredom; low income reducing to no income; and the type and condition of housing many people in these areas reside in. Most residents in these communities live in low-cost private rentals, social housing, and for some (many with disability, health or mental health issues, victims of domestic violence, people recently released from prison etc.) and social housing bedsits. The pandemic can potentially raise the Australian adult rates of poor mental health(currently 20%) and high or very high psychological distress (13%).

Educational impact

Across Australia, some states have closed schools, commencing school holidays early. Others like NSW have kept them open but encouraged parents to keep children at home. All schools are preparing for online learning, though at this stage, options for school attendance will be available for those that need it in some states.  However, given the low attendance rates (20-30% last week), it seems many parents think it safer to keep their children at home. For students in vulnerable communities, online learning could lead to increased barriers to education. Not all will have access to computers, the internet, or quality technology, such as wireless networks at home or quality NBN service. Many students might have mobile phones, but these may not be enough to engage with the curriculum or complete required tasks. Shools could send home lessons and resources for parents to use, but many parents in these communities would struggle, or not feel confident to teach their children at home.

In addition, the Federal Government’s closure of public libraries and community centres will hurt the educational outcomes of children in disadvantaged communities as these facilities provide a safe environment to facilitate lifelong learning. Public libraries offer free or affordable access to the internet, computers, printers, photocopiers, and a wide range of educational resources. Several community centres host Learning Clubs, i.e., after school programs designed to provide extra assistance to primary and secondary students in developing academic skills, such as homework, numeracy, and literacy. Not having access to these facilities and programs will prevent a large number of children in these disadvantaged communities from participating in learning, completing online school assignments, and having the right to a high-quality education experience.

So, a final note, although COVID-19 is impacting the entire population, those doing it tough already are and will continue to experience even more severe consequences as a result of the pandemic.

If Putin can do it, why can’t public health (but with good intentions)?

Hacking social media to advance health equity

Social media channels have fundamentally changed the ways in which people interact with each other, consume news, and seek out health information. Users can harness these platforms to voice solidarity, raise awareness, and even hijack elections. But can metadata be hacked for good? What can public health learn from influencers? How can something like getting the annual flu shot “go viral”?

Tanja Cappell
Public Health’s Current Use of Social Media

Between extensive geotags, hashtags, and search functionality, social media platforms lend themselves to a variety of public health research and programmatic work. Hashtags and geotags, which allow users to categorize content they post, are searchable. These often publicly-available pieces of metadata have been used by public health professionals for a variety of purposes including surveillancecharacterising neighbourhood features; understanding public sentiment around public health initiatives or campaigns; verifying knowledge of preventive principles; classifying misinformation; and disseminating information in emergencies. Despite the variation in quantity and quality of their use among researchers and practitioners, social media are key in public health work.

 

The Intersection of Social Media, Equity, and Social Determinants of Health

Individuals use social media in a diverse array of ways that have direct and indirect relationships to individual health, population health, equity, and social determinants of health. Not only are people of all ages using social media for health information, they are also sharing their own health-related experiences.

Activism has taken on a new form in the age of social media. Individuals become involved in causes through simply tweeting, or otherwise adding their voice to the conversation digitally. This phenomenon has been termed “slacktivism.” Despite a name that suggests apathy, it should not be discounted, as slacktivism has become an important way in which individuals interact with their networks and the broader social media community. Most recently, millions of women and men around the world shared experiences of sexual harassment and assault using the hashtag #MeToo.

 

There seems to be contradictory evidence related to whether social media can provide a channel through which to engage “hard-to-reach” groups. While some research suggests social media are under-utilised, powerful tools for engaging these groups in conversations and initiatives that could promote health or address social determinants, other literature points out that a digital divide persists, including less access by location, income or age.

 

Future Directions

Social media could be essential tools in advancing health equity. Oppressed, marginalised and low socioeconomic status populations can be reached and more importantly empowered via social media. They allow for direct, real-time connection and interaction. Virtual communities within these networks such as Black Twitter create further opportunities for direct, meaningful engagement. This potential isn’t lost on experts, as international publications call for work that goes beyond behaviourist angle when incorporating social media in health promotion. Social media are imperfect in terms of measurement to be sure, but they might prove (almost) as valuable as survey or data analysis software that are staples of public health research and practice.

The questions of how and the extent to which social media can be effectively used to advance health equity remain unclear. More critically, what might it mean for users and social media if public health is able to successfully exploit algorithms, even in the interest of equity?

 

Melissa Bernstein is a Research Officer at the CHETRE and a Twitter newbie. Follow her: @theMelBern