The syndemic pandemic: COVID-19 and social inequality

The rate of COVID-19 infection is six- or seven-times higher in the most deprived areas of the Spanish region of Catalonia. In American cities such as Chicago and New York City, there is a dramatically increased risk of death amongst residents of the most disadvantaged counties. In England, the most deprived neighborhoods have a COVID-19 mortality rate more than twice that of the most affluent and in all countries, COVID-19 deaths are highest amongst Black, Asian, and minority ethnic (BAME) populations. This chapter examines these inequalities in COVID-19 in more detail—contextualizing them within the wider literature on health inequalities. Firstly, it summarizes epidemiological evidence of social inequalities in COVID-19. It then applies insights from the wider health inequalities literature to understand how COVID-19 and inequality have combined to produce a syndemic pandemic. Third, it examines the unequal experience of the policy responses to COVID-19, including the lockdowns and the potential unequal impact that the COVID-19 economic crisis might have on future morbidity and mortality. It concludes by reflecting on the longer-term challenges that the pandemic presents, arguing that this is an important moment for renewing efforts to reduce health inequalities.