Get the poor vaccinated first
Why do poor people die more from covid in the UK, Brazil and in the world?
Commonly pointed out causes have been lack of access to good health services, the existence of comorbidities, such as diabetes, associated with lower quality nutrition, inadequate housing and the need to circulate more to ensure livelihood.
However, there is another possible reason that has escaped analysis and that says a lot about our inability to see the layers of causality behind complex social phenomena.
A text that marked me a lot, a few years ago, was a book chapter written by researchers Clancy Blair and Alexandra Ursache. In it, they argued that poverty gets under the skin of children very early.
The scientific evidence, in fact, is plentiful. During the critical period from pregnancy to the first 3 years of life, essential biological circuits are formed, in particular the ones related to stress management and self-regulation.
Environmental conditions of adversity and unpredictability, typically present in contexts of poverty, disorganize the development of such circuits, especially when parental support (usually from the mother) is deficient or inconsistent. The consequences are for life.
It is like inflicting an invisible scar, which never stops aching. I like to compare it to the activation of an inner sensor that signals the world is capriciously cruel and unpredictable. Life is crazy and hostile, the environment screams, and the sensor is set in the ‘on’ position forever.
This is what Life History Theory, a thriving stream of research within evolutionary science, calls a rapid life strategy, marked by a focus on the present and a predisposition to assume more risk in everyday life.
The result is that children socialized in dire poverty have a disproportionately higher chance of becoming not only poor adults, who will replicate the cycle of deprivation, but also sicker individuals, who will have shorter lifespans.
It is as if our biological defense mechanisms, which include the cytokines that became so well known in the current pandemic, were permanently alert for a world full of pathogens and other threats. Consistent with this view, high baseline levels of cytokines have been associated with an increased likelihood of dying from covid.
Moreover, a recent article published in Nature shows that this pro-inflammatory state predicts decisions consistent with a fast life strategy — impulsive, focused on the here and now and conductive to risky behaviors (such as smoking and alcoholism) which, in turn, reinforce internal inflammation even more. It is one among several vicious circles that keeps propagating poverty across generations.
Research also shows that the scar of early deprivation becomes the seed of problems such as diabetes, obesity (especially the dangerous visceral fat), cardiovascular disease, cancer and psychiatric disorders. Incredibly, this seems to happen even when people manage to overcome the barriers of social ascension later in life.
Should it be surprising, then, that the mortality of the poor due to coronavirus (which causes an exaggerated inflammatory reaction in the body) is higher even in countries that have good health systems, such as Canada and those that integrate the United Kingdom?
It has been known for a long time, thanks to innovative work of the epidemiologist Michael Marmot, that the more socially deprived an area, the lower the life expectancy of its inhabitants — and the lower the expectation of a healthy life.
Marmot also identified that the causes behind covid deaths in the UK are similar to the ones influencing deaths in general. It is a gradient: deprivation kills and the more lasting and intense it is, the worse its effects.
With all this in mind, I see the need to prioritize vaccination in areas with lower human development levels. In countries where there is scarcity of vaccines, such as Brazil, this seems to be a very cost-effective (and equitable) policy to mitigate the ongoing collapse in hospitals.