Class Ethnicity Health Medicine United States Vulnerability

Social vulnerabilities and determinants of health

By Victoria Frohnhofer, BA

“Drawing attention to the central role of human freedoms in health is a statement of philosophical position and a call to social action. ”[1](Marmot)

Ethnic minorities, socially vulnerable people or marginalized groups are terms, which are often associated with struggle. The struggle to find housing, the struggle to vote (if the possibility exists) or the struggle to receive appropriate health care to name a few of these. This struggle has continued into the global COVID-19 pandemic, making it more threatening to certain groups of people than others. 75% of people who died of COVID-19 in Washington D.C. up until June 2020 were of African American descent.[2] This reality within the capital shows just how different realities can be, depending on how much melanin your skin contains. Different reasons have led to this palpable scenario. However, these reasons have been apparent long before the year 2020.

The Crux of Health and Wealth

One may think that health is solely determined by wealth, however this conclusion is a bit too linear. The complexity behind linkage of health and wealth comes with the addition of political or socio-economic progress as well as inequities. Because progress is not produced homogeneously, inequities are a side effect of it. Inequity is therefore what determines health perhaps even to a much greater extent than just wealth does,[3] even though wealth is one of the biggest forms in which inequity can be seen. For this reason, the gaps of health within even wealthy countries can be seen in crisis much more clearly. It is the amount of inequity within a country, which determines the health of its citizens, not how large its GDP (gross domestic product) is. Crisis such as the Covid-19 Pandemic have made this painfully apparent.           

Nevertheless, the GDP is important for tracking the growth and development of wealth of a country. The GDP is able to show the income of a nation as well as the proportion of its productivity within one year[4]. It is certainly a limited form of measurement for a country’s wealth since many factors are left out of the calculation or are up for interpretation. The reason for this is that wealth is defined within the GDP only in an economic way. However, other factors such as the environmental wealth of a nation, the wealth of education, health or diversity within a nation are neglected. As explained below, this is especially interesting when observing the United States of America for the reason of its ethnic diversity. However, by using the GDP, it is possible to examine the relationship between wealth and health to a certain degree and enable us to analyze how and were these two aspects of life seem to relate.

Disparity in Diversity

Socioeconomic differences and the social gradient in health[5] are, amongst other things, determining health in most countries. The social gradient in health is a concept which recognizes the correlation between inequities between social classes and population health.[6] The United States makes for a compelling example because of its ethnic diversity and its use of statistical measurements on the basis of these multiple ethnic groups. It is in this country with the highest GDP globally[7] in 2019, that ethnicity still plays perhaps the largest role in one’s health. Being of African American descent in the United States automatically places your life expectancy on the lowest scale[8] compared to other ethnicities. With ethnicity as the major determinants of health within this exceedingly wealthy nation, it is clear that the overall economic wealth of a nation does not automatically produce health in all of its citizens.                                       

It must be said that ethnicity, economic wealth and therefore health are nevertheless interconnected. Even though the economic wealth of a nation may not automatically produce health in its citizens, the lack of personal financial wealth can very well be the cause of a lack in health. An example is the African American community, for whom the poverty rate was more than 10% higher in 2010 than for other US Americans.[9] Reasons for this high amount of African Americans living below the poverty line are that many African Americans work in the low wage sector and in general, earn lower wages than Americans of other ethnicities, regardless of their workplace.[10] This increases the chance of falling below the poverty line. Thus, by understanding that there is an interconnection between low income and low health,[11] it becomes clear that the African American community faces a much greater struggle in obtaining and preserving their health. The most recent health crisis in the United States, the COVID-19 Pandemic, has made this inequity once more exceedingly visible through a death toll that was different for specific ethnic groups.

Feasibility vs. Possibility 

Considering the knowledge we have in todays global world regarding the correlation between health, wealth as well as ethnicity, the inequity within a nation such as the United States of America is logical and at the same time disheartening. Therefore, it is necessary to view the possibilities that a nation with the largest GDP has to implement political and economic changes in order to produce a shift in this inequity. The fact that this inequity has been a known issue for decades, makes it even more confounding as to why this predicament has not yet been tackled in a sustainable way. One may even hypothesize that it has suited successive governments not to eliminate the factor of ethnicity as a determinant of health. As a result, the possibilities of advancement in health for African Americans are limited, making social vulnerability a continued determinant of health.


Bloom, David E. “The Health and Wealth of Nations” American Society for the Advancement of Science, vol. 336 (18th February 2000), pp. 1207-1209.

Deaton, Angus “The Great Escape – Health, Wealth, and the Origins of Inequality”. Princeton: Princeton University Press, 2013.

Kosteniuk, Julie G, and Harley D. Dickinson. “Tracing the social gradient in the health of Canadians: primary and secondary determinants. Social Science & Medicine vol. 57;2 (July 2003), pp. 263-276.

Marmot, Michael “Health in an unequal world: social circumstances, biology, and disease”. The Lancet, vol. 336 (9th December 2006), pp. 2081-94.

Websites:             (5.12.2020) (2.1.2021)

[1] Michael Marmot “Health in an unequal world: social circumstances, biology, and disease” The Lancet, vol. 336 (9th December 2006), 2081-94.

[2] (5.12.2020).

[3] Angus Deaton The Great Escape – Health, Wealth, and the Origins of Inequality. Princeton, Universtiy Press, 2013.

[4] Ibid.

[5] Marmot, 2006.

[6] Julie Kosteniuk and Harley D. Dickinson “Tracing the social gradient in the health of Canadians: primary and secondary determinants” Social Science & Medicine vol. 57;2 (July 2003), 263-276.

[7] (2.1.2021)

[8] Deaton, 2013.

[9] Ibid. (see Figure on p.180)

[10] Ibid.

[11] David E. Bloom “The Health and Wealth of Nations”. American Society for the Advancement of Science, vol. 336 (18th Febuary 2000), 1207-1209

Class Epidemics and Gender Racism Vulnerability

The virus comes by car: the social construction of asymptomatic carriers

By Pamela Kultscher, BA

An international pandemic bears enormous challenges for all governments and health officials. One of those challenges is not to give way to the temptation to name scapegoats within the population, especially if a disease is transmitted by asymptomatic carriers, i.e. people with no symptoms but enough pathogen count to transmit the disease. On December 3rd, 2020, Austrian Chancellor Sebastian Kurz got caught in this communication trap when he put the blame for the rising COVID-19 infections in his country since the summer on the population with roots in Turkey and the Balkans. His reasoning was that they had travelled to their countries of origin for the summer holidays and therefore had imported infections to a supposedly healthy and virus-free Austria. By doing so, Kurz labelled people with migration background as others and constructed the image of a disproportionate number of infections tied to this population group.

There’s something about Mary: a historical perspective

Looking back onto the history of pandemics, it becomes quite clear that this was not the first time that government officials practiced othering and thus constructed an image of certain groups as the culprits in a pandemic. The most prominent single case, especially because it found its way into the English language as an everyday expression, is that of Mary Mallon, referred to by the media as “Typhoid Mary”. Foss explains that the term is used to indicate a person who is “an extreme carrier of disease, a burden on society, a scourge of contagion”. [1]

Mary Mallon was an Irish immigrant to the United States who famously was arrested and put in quarantine in 1906 because health officials of the city of New York were convinced that she was an asymptomatic carrier of Typhoid fever and had caused, in her function as a (somewhat renowned) cook to wealthy New York families, an outbreak of the disease resulting in several deaths. The concept of asymptomatic carriers was new at the time, and when Mary Mallon was labelled as such by sanitation engineer George Soper, she was the perfect person to be made an example of.

Class, race and gender as determinants of health & accountability

Mary Mallon was quarantined for the first time from 1907 to 1910 and after she was set free under the condition to never work as a cook again, was arrested again in 1915. She had not been able to finance her life with a job other than cooking and had thus infected 25 people working in the kitchen of a maternity hospital. As with the first quarantine, she was sent to Riverside Hospital on North Brother Island and lived in a small cottage on the hospital grounds until her death in 1938. She had been detained, without a court conviction for any crime and solely in the name of public health, for a total of 26 years.

Why was Mary Mallon singled out? The literature agrees on three socio-economic traits that predestined her for othering: class, race and gender. [2 3 4] Mary Mallon might have worked at New York’s finest addresses but as a cook, she was part of the working class. And even though she could write and read well, New York’s health officials denied her the capability to understand her health status. [5]

Furthermore, Mary Mallon was Irish and the Irish weren’t necessarily perceived as white at that time. [6] Health officials often blamed epidemics on non-white “races” and did not hesitate to act. In 1900, tens of thousands of Chinese immigrants to San Francisco found themselves confined to Chinatown, which had been closed off by health officials over night because of a supposed outbreak of the bubonic plague. [7] Another characteristic that was ascribed to the Irish at the time was stubbornness. This was perceived as the reason why Mary refused to receive potentially life-threatening treatment as a cure for the Typhoid bacillii roaming her intestines. [8]

And last but not least, Mary Mallon was a woman, albeit not an ordinary woman for her time. Mary was unmarried, (physically) strong and did not have children. She was perceived as somewhat masculine and did not fit into the idea people had of respectable women at the time.[9 10] The fact that she had no husband to support her, no children that needed her and that she was not perceived as how a woman should be, made it possible for her to be detained for a lifetime without a prison sentence.[11 12]  This hypothesis is supported by the fact that while there were more than four hundred other asymptomatic carriers of the disease during her lifetime, none of them faced the same fate as her.[13] Foss argues that Mallon has been continually dehumanized by being reduced to her health status, be it by the media or health officials.[14]

Applause is not enough

Sebastian Kurz has made use of the same kind of dehumanization when he blamed immigrants who are members of certain ethnic groups and the working class, and due to their professions very often women, for rising infection numbers. He omitted to mention that these are exactly the people who have been applauded for continuing to do their work during the beginning of the pandemic: the nursing staff, the supermarket cashiers, the gas station salespeople and so many more who build the backbone of Austria’s economy. Most likely, they did not import their infections from their summer holiday destinations but got infected doing essential work in Austria. This is not how they should be thanked.

Recommended sources:

Rund Abdelfatah; Ramtin Arablouei; Julie Caine; N’Jeri Eaton; Laine Kaplan Levenson; Kia Miakka Natisse; Laurence Wu; Jamie York (Producer) (2020): There’s Something About Mary [Throughline]. Retrieved from [21.12.2020]

Bourdain, Anthony (2005): Typhoid Mary. London: Bloomsberg Publishing.

Fitzgerald & Rimini (2019): Typhus Mary. 50 Hertz. Bern: Der gesunde Menschenversand. Retrieved from [10.01.2021]


[1] Foss, Katherine A. (2020): Constructing the Outbreak: Epidemics in Media and Collective Memory. Amherst & Boston: University of Massachusetts Press, p. 99.

[2] ibid, p. 119.

[3] Hasian, Marouf A. (2007): Macht, medizinisches Wissen und die rhetorische Erfindung der “Typhoid Mary”. In: Philipp Sarasin; Silvia Berger; Hänseler Marianne; Spürri Myriam (Eds.), Bakteriologie und Moderne: Studien zur Biopolitik des Unsichtbaren. Frankfurt am Main: Suhrkamp, 496-521, pp. 506-517.

[4] Leavitt, Judith Walzer (1996): Typhoid Mary: Captive to the Public’s Health. Boston, Massachusetts: Beacon Press, pp. 96-125.

[5] Hasian (2007), p. 508.

[6] Ignatiev, Noel (1995): How the Irish became White. New York, London: Routledge; pp. 2-3.

[7] Hasian (2007), p. 507.

[8] ibid, p. 508.

[9] ibid.

[10] Foss (2020), p. 107.

[11] ibid, p. 119.

[12] Leavitt (1996), p. 97.

[13] Marineli, Filio; Gregory Tsoucalas; Marianna Karamanou; George Androutsos (2013): Mary Mallon (1869-1938) and the history of typhoid fever. Annals of Gastroenterology, 26(2): 132-134, p. 134.

[14] Foss (2020), p. 106.