It might come as a shock to some politicians and policy-makers that public health has a much larger purpose than protecting people from infectious diseases like COVID-19. The essential role that public health plays in society is to maintain or improve the overall health status of the population. A healthy population is the foundation of a prosperous and peaceful society because health is a resource everyone needs to be successful in life: in schools, in occupations, in relationships, and in creating the society we want to live in together. So, anyone interested in economic recovery or a more equal society should be in favour of public health.
Simple ‘stay-at-home’ policies sacrifice essential workers
Public health professionals understand that because there is more to health than simply the absence of disease, successfully maintaining or improving the health status of the population requires addressing all determinants of health—physical, psychological, economic, political and social. But blanket “one-size-fits-all” health policy—in the absence of evidence-informed, targeted interventions for marginalized populations—can worsen existing inequalities. The reason for this impact on inequalities is that accessing the benefits that these blanket health policies are intended to distribute requires you to already have some resources. Case in point: “stay-at-home” policies which are intended to protect people from contracting the COVID-19 virus and spreading it to their family members.
Even though stay-at-home policies are often discussed by politicians as though they apply to everyone, they can only apply to those people who have the kind of job that allows working (and maintaining your source of income) from home. The people who are unable to benefit from this policy are not randomly spread across all socio-economic groups. We can predict up-front which occupational groups will not be able to benefit from this policy. Some of these occupational groups include people who work in manufacturing, food production, caring work or transportation; and people employed in grossly unfair and psychologically unhealthy working conditions which are euphemistically termed “precarious” work.
These are occupational groups in which Black people, Indigenous people, people of colour, new immigrants, people with low levels of education, and people with limited English fluency are known to be over-represented. Demographic data on occupational groups, and other evidence, can easily be accessed by policy-makers, so enacting health policies that are known to be unlikely to benefit identifiable groups of people demonstrates, at the very least, a lack of caring about those people.
Considering this problem from a systems-level perspective reveals something about our society that is even more disturbing than an uncaring attitude toward marginalized groups. The failure to address the health risks associated with working conditions (a social determinant of health) that are more likely to affect people from marginalized social groups in spite of clear evidence of need and when solutions are known, amounts to the conscious selection of these people to quite literally be sacrificed.
No more human sacrifice: legislate paid sick days for all
The harsh reality is that in order to keep essential supply chains intact and maintain as much economic activity as possible, some people will need to go out into public to work. The other harsh reality is that most of those people are likely to be from marginalized social groups. However, is it not a reality that nothing can be done to reduce their risk of exposure to the coronavirus. Targeted policies that address the specific health risks these workers face can reduce their risk of exposure to the coronavirus.
The federal government’s solution is a program that requires an application, possible payment in 4-6 weeks, followed by the chance of income tax implications. But this clearly fails to recognize that the people who need this solution the most are least likely to be able to access and complete the application process, wait 4-6 weeks for money to pay for food, shelter or medicine they need today, or cope with any future requirement to pay back the benefit in whole or in part.
Don’t think for one minute that human sacrifice is a thing of the past, because it is happening in 2021, right in front of your eyes. Speak up and let your political leaders know that public health needs to fulfill its mandate of maintaining or improving the health status of the population by implementing evidence-informed health policy. One of the policy solutions that many public health professionals are advocating for is legislating paid sick days for all, implemented in a way that that workers in precarious employment can automatically and immediately access.
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