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Covid-19: Understanding Vulnerability

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It is often said that a society can be judged by how it treats its most vulnerable. When times are hard, those who have the least power to protect themselves are those we should be helping the most. But what do we mean by vulnerable?

There are groups in society that we instinctively regard as needing special protection- children, the elderly, those with physical or mental disabilities. On the other hand, the archetypal working-age adult is usually seen as being able to fend for themselves. The problem is that society is not organised in neat silos- and Covid has taught us this lesson the hard way. People can become vulnerable overnight, and when this happens it has direct implications for those around them.

There are four classic types of vulnerability- physical, social, economic and attitudinal- each of which makes a community more susceptible to external threats. When Covid struck, at an individual level the first type of vulnerability to be highlighted was physical- it quickly became apparent that the elderly and those with pre-existing medical conditions were more likely to become seriously unwell and had to be shielded. Next came social vulnerability- specific socioeconomic groups, occupations and geographical locations increased susceptibility to contracting the virus and passing it on. After this, and particularly as we entered lockdown, economic vulnerability took the spotlight- those working in industries such as hospitality, with zero hours contracts and with less employment flexibility were hardest hit. Finally, now we have had time to reflect on the first wave (and brace ourselves for the second), it is increasingly clear that attitudes towards Covid are going to play a key role in shaping how we as individuals, communities and, indeed, nations recover from this pandemic. But there is an important point that we need to recognise- these types of vulnerability are neither independent nor sequential- each one intimately affects the others. Let me give you an example.

In a study of working adults aged 25 to 54, the effect of employment status on all-cause mortality was investigated. To take account of possible selection bias (i.e. that those with poor health are more likely to end up unemployed), a statistical technique known as propensity score matching was used. The results were clear- unemployment was associated with a significant increase in all-cause mortality regardless of prior health and socio-demographic characteristics. Furthermore, not only can economic stress affect the individual’s health but it has direct consequences for those around them, be this their children, parents or other dependents. For the elderly, we know that Covid poses a physical threat to health. They are vulnerable in a very direct way. However, the economic vulnerability of those around them, the breakdown of normal social structures, and the pervasive attitudes of the society in which they live also play a key role in determining overall well-being. Health, in its broadest sense, is not just physical but mental, and as we discussed previously this is strongly linked to a sense of social inclusion. Physical, mental, social and economic well-being cannot be separated.

I do not envy those who have to make decisions about balancing the the direct risks of Covid against its indirect effects on health and the economy- and I’m not going to pretend to have the answer. However, I do believe that our response to this virus is teaching us important lessons about the way we interact with others- if we can learn from this, and try to understand the complex vulnerabilities that the virus has exposed, we can emerge as a stronger, more cohesive society.

Please note that the views expressed here are those of the author alone and not necessarily those of any other person or organisation

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