For more than 150 years, scholarship and research have revealed how poor and marginalized communities are disproportionately affected by disease. People are more likely to become unwell if they earn low wages, have few employment protections, live in unsafe environments, receive poor-quality education, or are discriminated against. Whether Prussia’s typhus epidemic of 1847–48, tuberculosis outbreaks in the United States in the 1930s or chronic diseases today, researchers conclude that people would live longer, healthier lives if a society’s collective wealth could be shared more equally (M. Marmot Lancet 365, 1099–1104; 2005).
Scholars in disciplines ranging from economics to epidemiology and sociology have proposed ideas for how to share the world’s wealth (R. G. Wilkinson and K. E. Pickett Soc. Sci. Med. 65, 1965–1978; 2007). But their advice has mostly been disregarded by politicians. This is in part because the idea that the public and private sectors need to have a greater role in reducing inequality has been at odds with the thrust of global politics for at least four decades.
During the COVID-19 pandemic, the successes that scientists have scored with drugs, vaccines and other interventions have given researchers a voice in decision-making. They need to use that position to advocate policies that would improve social determinants of better health, such as living wages, employment protections and high-quality educational opportunities. In this way, scientists need to ‘get political’.
That will require, among other things, scientists to consider how they can best achieve political impact and policy engagement. But advice is on hand. A News Feature this week describes how community organizations in one of the poorest regions of the United States, California’s San Joaquin Valley, tried to curb COVID-19 in communities of colour by tackling some of the disease’s underlying determinants, in part through political engagement.
Hundreds of thousands of people in the valley — mainly immigrants — work on farms and in food-processing or meat-packing plants. Compared with California’s more affluent regions, wages in the valley are low and labour protections weak. And neighbourhoods of agricultural workers often have poor-quality schools, insufficient clinics and few markets selling healthy food. Some areas even lack clean, running water. A child born in San Francisco, California, is expected to live for at least ten years longer than children born in many parts of the valley.
State and county public-health officials know this, but are often unable to push local leaders for the necessary policy changes. This is because they are generally hired to carry out the wishes of elected politicians, and their budgets and jurisdictions are therefore determined by those politicians.
But academic scientists are not tied by these constraints. During the pandemic, researchers in the San Joaquin Valley have partnered with grass-roots groups to try to address inequities and push agriculture companies to report COVID-19 outbreaks and protect their employees with face masks and physical distancing. They have also distributed free tests, and provided outreach and financial assistance for under-served communities.
The COVID-19 pandemic has laid bare society’s inequities more starkly than most people today will have witnessed. In the United States, Black, Hispanic and Latinx people are about three times as likely as white Americans to be hospitalized with COVID-19. In the United Kingdom, Bangladeshi-Britons have twice the risk of death from COVID-19 as white British people. In Singapore, most COVID-19 cases have occurred in migrant workers, including those from Malaysia, Bangladesh and India.
And the gap between rich and poor is rising in much of the world. In the United States alone, billionaires have increased their wealth by 44% — to a total of US$4.3 trillion — in the past year, and 1.5 million jobs were created in the top wage bracket. And yet, 7.9 million low-wage workers lost their jobs. The number of families reporting hunger and homelessness climbed in 2020.
In the United States and Europe, funders have responded with grants to explore and address health disparities and their social determinants. Researchers should push themselves to go further than simply collecting data on the social and economic roots of poor health, and perhaps even deeper than devising interventions to address immediate needs, such as programmes to teach communities about nutrition.
But there are few long-term funding opportunities for such work, or even for researchers whose main objective is evidence-based policy — let alone systemic reform — and that, too, needs to change. Funders and research leaders must place a higher value on these types of impact in research-evaluation criteria. Then scientists would have a greater incentive to collaborate with economists and political scientists to devise ways to share wealth and turn around rising inequality. Those who study racism could work with epidemiologists to better understand why economic and political systems have marginalized certain groups of people for decades, and how reparations or other reforms could begin to turn the tide.
Researchers can also work with think tanks to write the short, research-informed reports that are required reading for politicians and policymakers, but are not part of conventional journal publishing. And they could co-design their studies with grass-roots groups who advocate for — and work with — communities in need. Scientists should also consider standing for elected bodies such as local, regional or national legislatures — which often have a dearth of representatives with research expertise.
Scientific discoveries and inventions made during the pandemic have led to progress in diagnostics, therapies and, of course, vaccine production. But the pandemic is far from over, and, combined with economic inequality and climate change, the world is in a precarious era. Now that the pandemic has elevated scientists’ voice in society, more must learn how best to use that voice to advance the cause of economic, racial and social justice. Without such change, the essential research that is scientists’ main focus will ultimately fall short of achieving its goal of building healthier, more resilient, more equal and more just societies.
Nature 592, 660 (2021)