No Natural Disasters Concept
New theoretical frameworks challenge the categorizing of natural events “natural disasters”. See this link for information about the #nonaturaldisasters movement, which is a campaign “to change the terminology to show that whilst some hazards are natural and unavoidable, the resulting disasters almost always have been made by human actions and decisions.” Without agreeing that policy can prevent every vulnerability, I argue the terminology change highlights the role of policy in preventing harm. Addressing the particular vulnerabilities that many people constantly experience would reduce the ability of an event (weather or pandemic) to cause widespread harm. The no natural disasters concept can be the basis for a syndemic framework to analyze COVID-19, weather events, climate change, and can be stretched to inform inner city crime and gun violence in the US. Social, environmental, economic, and political conditions influence outcomes. Under such an approach, the issues could include what legal or policy structures were in place that allowed people (and animals and the environment) to be harmed. Then movement in two analytical directions could ensue. First, was there an issue of political will that influenced vulnerability to contracting COVID-19 (or increased exposure to it)? Second, what ground level protections would help eliminate vulnerability?
For example, one issue worthy of investigation is global poverty. Are there ways in which wealthier countries take advantage of low wage workers that contribute to poverty and made them more vulnerable, less able to afford PPE, or more susceptible to difficult cases of COVID-19 due to pre-existing conditions? Are there political structures within countries with lower average and median wealth per capita that increased vulnerability? Is a global approach or a national approach helpful? Looking at the harms of COVID-19 through the lens of poverty provides important context.
Another issue is poverty in the United States, a wealthy country. In California, workers in these jobs had the highest number of COVID-19 cases: Food and agriculture, transportation or logistics, facilities, and manufacturing. Was there added vulnerability due to a systemic injustice, the absence of protections that people in other jobs enjoy, the inability to stay home, a lack of precautions?
Upstream and Downstream Actions
A broader approach could lead to a solution that involves a broad policy change, even something like an international treaty, accord, or convention that could decrease the pressure on downstream solutions like more PPE or a quick way to make ventilators. Some of the manufacturing and distribution during the COVID-19 pandemic presented or solved ethical problems of scarce resources. Reorganizing on a national and international level could decrease personal vulnerability. Can both approaches be reconciled? A broad framework would best solve both the macro and the downstream issues.
A Healthy Population
Another issue during COVID-19 was preexisting health conditions. In bioethics, the social determinants of health take scientific data (proof that certain things that seem not to be medical or biological influence health significantly) and create a structure to analyze why a person or group is disproportionately harmed by sickness. The social determinants of health reflect research on justice and they reflect actions that at the societal and the workplace level could be beneficent. Moral philosophy underpinning the social determinants stems from early philosophers looking to define the role of government, some trying to expand it and others pushing back to ensure individual liberties. In COVID-19, at various levels (global, federal, state, local), government could have done more, but at what cost? Corporations have a role in ending the pandemic. But, there can be downsides. How should we approach the bioethical issues of the role of patents in vaccination? What is the moral value in maintaining incentive to innovate? Does that moral value compare to an opportunity to have more countries manufacture vaccines, something that arguably arrangement among corporations achieves anyway.
Syndemics & Justice
A syndemics framework addresses those issues by beginning with a macro framework and working toward the policies at state and local levels that may govern individual behaviors. “A syndemics framework examines the health consequences of identifiable disease interactions and the social, environmental, or economic factors that promote such interaction and worsen disease.” https://www.thelancet.com/series/syndemics
To learn from COVID-19, many bioethical and philosophical frameworks can inform the disparate effects of the virus. The justice of equal access framework contributes to a syndemic approach. In the United States, vulnerability mirrored demographics like race, ethnicity, and income. Humanism and sociology frameworks like integrative theory melding micro and macro objective and subjective considerations add to a broad approach as well.
A syndemic framework with the no natural disasters movement in mind would inform evaluation of the pandemic as well as preparation for future events including storms, volcanos, pandemics, epidemics, and environmental disasters.
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Bruce Jennings, The COVIDs of Our Climate, Minding Nature: Spring 2021, Volume 14, Number 1 (Points out similarities in COVID-19 and climate change as public commons, arguing the relationship between humanity and the natural world is broken. Optimistic that social goods are politically within reach. Argues for climate change adaptation and support for public health, reducing impact, and protecting vulnerable.)
Srajana Kaikini, The Necessity of Understanding Disasters in the Language of Suffering | Voices in Bioethics (columbia.edu)
Inês Fronteira, Mohsin Sidat, João Paulo Magalhães, et al., “The SARS-CoV-2 pandemic: A syndemic perspective,” One Health, Volume 12, June 2021, 100228 https://doi.org/10.1016/j.onehlt.2021.100228 (The failure to recognize that COVID-19 is syndemic in nature negatively affected public policy and public health.)
Merrill Singer, Nicola Bulled, Bayla Ostrach, Emily Mendenhall, Syndemics and the biosocial conception of health The Lancet, Volume 389, Issue 10072, 4–10 March 2017, Pages 941-950.
Emily Mendenhall, Brandon A Kohrt, Shane A Norris, David Ndetei, Dorairaj Prabhakaran, “Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations,” The Lancet, Volume 389, Issue 10072, 2017, Pages 951-963, https://doi.org/10.1016/S0140-6736(17)30402-6
Sarah S Willen, Michael Knipper, César E Abadía-Barrero, Nadav Davidovitch,
Syndemic vulnerability and the right to health, The Lancet, Volume 389, Issue 10072, 2017, Pages 964-977 https://doi.org/10.1016/S0140-6736(17)30261-1
https://www.nonaturaldisasters.com/useful-information provides further reading.