Health, Economic and Social Challenges in COVID-19 Pandemic: History
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Subjects: Health Policy & Services
Contributor:
Komali Kantamaneni
,
,
LEKHA BHAT
,
Robert Ramesh Babu Pushparaj
,
K Rajasekharan Nayar
,
Lovelina F X
,
Louis Rice

The COVID-19-pandemic-related economic and social crises are leading to huge challenges for all spheres of human life across the globe. Various challenges highlighted by this pandemic include, but are not limited to, the need for global health cooperation and security, better crisis management, coordinated funding in public health emergencies, and access to measures related to prevention, treatment and control. 

  • COVID-19
  • global economy
  • healthcare
  • social development
  • low- and middle-income countries
  • transdisciplinary research

1. Pandemics and Their Impact on Various Population Groups

Pandemics/disasters often leave a significant impact on human health and development. This includes, but is not limited to, loss of human lives, livelihood issues, and psycho-social problems. Pandemics can create long-term imbalances in societies and communities. The challenges confronted by the general public due to the pandemic have revealed inadequacies in the areas of managing health risks, injuries, diseases, disabilities, psychological problems and deaths [1]. The COVID-19 pandemic has affected all aspects of human life and the global economy [2]. The World Trade Organization (WTO) and Organization for Economic Cooperation and Development (OECD) marked the COVID-19 pandemic as the greatest peril to the world economy since the financial emergency of 2008–2009 [3]. Emerging issues related to jobs and income of millions of people, social safety net, future of income support schemes, the burden on women, and the plight of migrants and informal sector workers are some of the main challenges that the world is confronting [4]. Oxfam predicts that the economic crisis due to COVID-19 could push half a billion people into poverty [5]. Due to the lockdown, economic activities and livelihoods were affected in many ways, especially in the fields such as production and distribution, consumption, restriction on trade and business, large-scale uncertainties in the market, lack of access to the resources and sudden disappearance of the more informal sectors of employment/sector [6]. The global outbreak has resulted in developmental impacts on health, education, gender, economy, politics and the environment. The COVID-19 pandemic has exposed huge health inequalities across countries and within countries due to existing social stratification and resource sharing. People from lower socio-economic strata lack access to essential healthcare services during the pandemic time [7]. The economic decline during the pandemic has significantly affected people from the lower socio-economic stratum [6]. This pandemic has marked a significant impact on the lives of many vulnerable sections of society, including women and children. Across countries, the number of cases related to domestic violence has increased [8]. The pandemic has had an extensive impact on the education sector [9][10][11], and all educational institutions have been closed for several months, especially in countries where vaccination proceeded at a slower pace. The pandemic has forced a worldwide lockdown, with a huge number of citizens confined to their homes [12], often resulting in social isolation. Social isolation has led to chronic loneliness and boredom, which has affected mental health, human happiness and wellbeing [8].
The pandemic affected political systems across the globe, causing ideological differences, lack of need-based initiatives, geopolitical cooperation/dysfunctions, misinformation and misleading/false claims. The COVID-19 pandemic has affected religion in many ways, including cutting short pilgrimages and journeys related to religious practices and festivities [13]. People working in the informal sector, including migrant workers, are at a high risk of poverty as their income and livelihood options are limited [14][15]. Vulnerable populations have struggled to cope with the magnitude of problems and the incidence of suicide has increased due to loss of income, livelihood and other factors [16]. Challenges of immunization, nutrition, poverty, hunger, acute undernourishment, and health inequalities, especially amongst vulnerable groups, have posed severe health and economic challenges [14].
The pandemic’s impact on social life, the economy and the financial sector has led millions of people to face an unprecedented situation related to poverty, wherein an average of 3.3 billion of the global workforce are at risk of losing their livelihoods [17][18]. Breadwinners working in the informal economy, particularly marginalized populations in low-income countries, which includes small-scale farmers and indigenous peoples, have been drastically affected [19]. According to a WHO survey, in May 2020, it was found that in 155 countries, the pandemic had severely curtailed people’s ability to avail treatment services for Non-Communicable Diseases (NCDs). This situation is of significant concern because people living with non-communicable diseases tend to be at higher risk of severe COVID-19-related illness and death [20]. While the health systems of various countries are being challenged by the increasing demand for care of COVID-19 patients, it is imperative to maintain preventive and curative health care services, especially for the most vulnerable populations, such as children, women, older persons, people living with chronic conditions, minorities and people living with disabilities [21]. The pandemic has deepened pre-existing inequalities in social, political and economic systems, including access to health services and social protection. Women with care responsibilities, informal workers, low-income families and young people have been most adversely affected by the pandemic. There has also been a significant rise in domestic violence [22]. An increase in violence against women has resulted in a threat to public health and women’s health across the globe. The health impacts of violence, particularly intimate partner or domestic violence, on women and children have significantly increased in various societies. Women who have been displaced, are refugees, and are living in conflict-affected areas are the most vulnerable [23]. Lack of education and economic insecurity has also increased the risk of gender-based violence. Without sufficient economic resources, women cannot escape from abusive partners and hence face a greater threat of sexual exploitation and trafficking [24]. Pandemic-induced poverty has also widened the gender poverty gap, pushing women into extreme poverty, as they earn less and hold less secure jobs than men [5][25]. The economic fallout for women has increased due to more unpaid care work, thereby compelling them to go back to traditional gender roles of more household and care workers [26].
Children are affected due to the pandemic and this is most visible in their health and education in various ways [27]. Children from marginalized sections have been the victims as inequalities in the teaching-learning system widened. Data show that 463 million children did not have access to the internet or digital devices for remote learning during the closure of schools [28]. Closures of schools have severely affected those children who rely on school-based nutrition programmes for their food and survival. Children suffering violence at home, refugee children, migrant children and children affected by conflict face appalling human rights violations and threats to their safety and well-being [29]. The additional stress and stigma that befall families struggling to cope have also impacted their children [29]. In the last two decades, there has been significant progress in the fight against child labour; however, the pandemic could significantly reverse this otherwise positive trend [30]. This reversal is because the crisis has enormously disrupted global education, and the lack of distance-learning solutions in many of the developing and underdeveloped countries has excluded children from online education for a very long duration. Furthermore, this trend has the potential to push millions of children into child labour [31]. Whilst the adverse socio-economic and financial impacts have fallen on the majority of households globally, there is significant inequality with some children impacted more severely, for example marginalized minority groups, disabled, street-connected and homeless populations, single or child-headed households, migrants, refugees, internally displaced persons, or people from conflict or disaster-affected areas, will be more vulnerable to child labour [32].
Beyond poverty and informality, the most explicit references to other vulnerable people and groups include older persons and people living with disabilities [33]. As the world struggles with an incomparable health crisis, older persons have become the topmost victims. The pandemic affected persons of all ages, yet older persons and those with underlying medical conditions tend to be at a higher risk of serious illness and death due to COVID-19 [34]. In the face of a life-threatening pandemic, especially during the first wave, many of the older persons faced challenges in accessing medical treatments and health care services for non-COVID ailments and chronic diseases. In developing countries, the prolonged lockdowns, weak health systems and healthcare facilities requiring out-of-pocket expenditure left millions of older people, especially those in the poorest groups, without access to basic health care, which ultimately increased their vulnerability to COVID-19 as well [35]. While older people often have been invisible in humanitarian action, the pandemic uncovered their exclusion. Older persons usually had to rely on multiple income sources, including paid work, savings, financial support from families and pensions. Additionally, for those older people living alone, isolation combined with other factors such as limited mobility creates greater risks [36]. Individuals living with disabilities represent 15% of the population [37], and their barriers related to accessing mobility, access to health services and appropriate communication have increased tremendously, which further increases their vulnerability [38]. The physical, social, economic and health impacts of COVID 19 on people with disabilities require empirical studies so that severity can be assessed and appropriate policies can be developed [39].

2. Governance Issues

The pandemic also put to test the efficiency and quality of governance and the political will of the leadership in each country. During a public health crisis, people naturally depend on their governments for security and support [40]. COVID-19 brought in a unique set of challenges to governments across the globe, such as a lack of post-crisis reconstruction and recovery, weak legal and institutional mechanisms, weak infrastructural facilities, including communication networks, a lack of systematic, periodic assessment and accounting of potential losses, and poorly managed financial, technical and human resources [41]. Spontaneous behavioural reactions such as generalized panic and rumours regarding the spread of COVID-19 were reported from across the countries and each country dealt with it using different levels of efficiency and effectiveness [42]. For example, in India, the most troubling aspect was the shortage of proper provision of safety nets (e.g., food safety) during the lockdown for the weakest and vulnerable sections of the population, which was tackled by providing free food grains and cash transfer support for three months [43]. The unprecedented pandemic situation has shown the inadequacies in the global governance structure [14]. Moreover, the spread of fake news and misinformation was a major unresolved challenge for many of the democratic governments [44].

3. Strategies for Solving Multiple, Interconnected Problems of COVID-19

The WHO report on global surveillance for human infection with novel coronavirus highlights the importance of research studies to understand the viral transmission from animals and animal handlers, which will serve as evidence to prevent outbreaks similar to COVID 19 in the future [45]. To effectively respond to a public health emergency, the health system of the country must engage and step up preparedness activities with active involvement and leadership of the health department/ministry. Public health systems play a crucial role in planning health responses to respond and recover from the threats and emergencies introduced by pandemics. In various countries, fragmentation of health services has led to limited timely interventions and responses to health crises, which shows the need to have a strong coordination mechanism in place [46]. Public health emergency preparedness requires planning and intervention activities to prevent the spread of the virus, protect against other diseases and environmental hazards, promote and encourage health-seeking behaviours, respond to the crisis, assist communities in recovery, ensure quality and accessibility of the essential health services. Highly active surveillance is needed in all countries using the WHO-recommended surveillance case definition [47]. Furthermore, epidemiologic and surveillance activities would enable the public health systems to choose the most efficient ways to control the pandemic [48]. Non-pharmaceutical interventions based on supported physical distancing have a strong potential to lower the epidemic peak [49]. Priority should be accorded to certain areas, including assessment of the global health landscape; to accepting and recognizing epidemiological, environmental and economic crisis; to ensuring health regulations, such as tobacco control; to upgrading healthcare service delivery systems; and to ensuring innovative infection control, global research collaboration, universal health coverage, and public health surveillance. To support contact tracing, governments must consider expanding the use of information technology and digital initiatives to find high-risk areas [50].
The role of effective public health surveillance is crucial both in the short term and long term because the disease may remain in isolated pockets and regions even if it ceases to be a pandemic anymore. Surveillance informs about reality on the ground and provides insights for policymakers, which is essential [51]. Exploring and using web-based open tools to modernize data reporting can help provide newer, faster insights about COVID-19 controls [52]. COVID-19 surveillance in low/middle-income countries for a longer period is a real challenge due to a lack of resources, expertise, skills, people’s attitude to tackling these issues technology transfer, financial assistance and capacity-building support is to be ensured [53].
The disease load of the pandemic is inequitably distributed among vulnerable populations [54]. People living in low- and middle-income countries have reduced capacity for self-protection (due to poor housing, sanitation and living conditions) [55] a high risk of food insecurity [56], a widened gap in health care access [57], loss of livelihoods, and a decrease in dietary intake and health care consumption [58]. Public policy needs to reorient federal, state and local governments to handle health equity issues sensibly [59]. The relevance of integrating public health efforts with broader public policy and acknowledging the role of social determinants of health is important [60]. Developing universal schemes for food assurance, minimum incomes, reforming unemployment insurance, and investment in community development will help to address health-inequity-related issues in the post-pandemic era [61].

4. Role of Multi-Stakeholders in Controlling the Pandemic and Promoting the Development

COVID-19 presents a set of significant challenges to health care providers worldwide [62]. Given the complexity of the problem and the requirement of inter-sectoral collaboration, formal multidisciplinary working groups are recommended to offer relevant, effective and pragmatic solutions [63]. The pandemic is a complex phenomenon, with multiple determinants and impacts across all spheres of life. The pandemic experience serves as evidence for the need to adopt a comprehensive trans-disciplinary approach, including several experts, not only from medical sciences but also from engineering, political science, economics, humanities, psycho-social and demographic disciplines [64], as well as media that raises public awareness about health promotion and prevention [65]. The care of patients with COVID-19 can be optimized by collaborating with various multi-stakeholders to meet the demands that are required to combat the deadly disease. Multiple stakeholder engagement is critical to address the public health crises resulting from the pandemic, including but not limited to: aid donors [66][67], international aid networks, legislative and regulatory arms of the state, logistics organizations, private health care sectors [68][69], direct suppliers, media, social media [70][71][72], local aid networks, private insurance companies [73], military and para-military forces [74], government and inter-government organizations. Inputs of experts from the field of management, economics, environmental health, disaster management and other specialized disciplines to be incorporated in policy formulation based on inter-sectoral collaboration, which in turn can create programs and policies that are more efficient and feasible [63]. The support of patients, healthcare professionals and the wider community in addition to the government is equally important to address this health crisis [44].

5. COVID-19 and Social Development

The innovative, collaborative and strategic directions proposed to control the pandemic by slowing down transmission and reducing mortality associated with the pandemic are presented in Table 3.
Table 3. Strategies for COVID-19 and beyond.
Strategies
Identify innovative and culturally acceptable measures to prevent similar public health crises which explores and accommodates strategies beyond conventional economic lockdowns [75][76]
Identify easily available, culturally adaptable local technology, which is easily accessible and affordable to everyone [77][78]
Ensure that the most vulnerable populations are consulted and included in planning and response [79][80]
Organise communities to ensure that essentials including alternative livelihood opportunities to cater to needs related to food, clean water, essential healthcare and other basic services [81][82][83][84][85]
Advocate and promote priority-based social welfare services and in a social policy environment that services adapt, remain open and pro-active in supporting communities and vulnerable populations particularly women, children, elderly and persons with special needs [86][87]
Facilitate easily acceptable physical distancing with social solidarity advocating for the advancement and strengthening of social welfare services as an essential protection against the disaster [88]
Identify adaptable or easily doable strategies and remain open and adapt to the conditions based on available successful examples of best practices [89][90][91]
Respond to the pandemic situation with inputs from social and behavioural sciences to develop a vision beyond this crisis and translate fear, sorrow and loss into empowerment and social transformation [92]
Ensure realistic forecast, targets and goals for prevention [93][94] and control using integrated environmental and health management perspective
Promote and ensure community participation and empowerment [95][96]
Promote behavioural modification (build ownership) [97]
Work with public-private partnership modes in research, development and health care delivery [98][99]
Ensure social participation [100], long-term commitment and leadership [101][102][103]
Use and encourage e-reporting [104][105], community-controlled partnerships and intervention [106]
Develop capabilities at all levels for handling emergencies, pandemic prevention and management [107][108]
Ensure responsible and competent state leadership which includes a women’s leadership component [109][110]
Promote greater participation and accountability of local communities and other stakeholders [111][112]
Strengthen inter-organizational coordination and local responsibility with centre’s coordination [113][114][115]

This entry is adapted from the peer-reviewed paper 10.3390/healthcare10050770

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