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.

Capitalism and Disease Vulnerability

Capitalism and Mental Health

by Sofia Falzberger, BA

While the second lockdown will have grave effects on Austria’s economy, it seems to be necessary in order to save lives. The infections need to be stabilized to ensure an intensive care bed for every person needing it. Cutting contacts, staying at home, saving lives- this is what the population is required to do.

What is different in the second lockdown though is that we still need to function. While the first lockdown came to all of us as a surprise and was quite all embracing- this second lockdown is harder to understand, harder to grasp.

“So, we should stay at home but then we should go to work. Within the first lockdown I was like telling myself, okay… It’s gonna be over soon. It’s okay to not do anything. I’m just gonna make this puzzle”, a friend of mine told me.

For her, what makes this second lockdown so hard is not that it is the second one but that within it, you are still expected to be functioning. While the first lockdown meant a halt in our capitalistic economic system, throughout this second lockdown capitalism is supposed to continue.

We don’t only need a healthy body. We also need a healthy mind.

The notion that we can only function within a healthy body is widespread within capitalistic societies. Capitalism’s highest premise is that we are functioning well, as it is this collective functioning that keeps this system alive.

However, it seems to me as if we are missing something in this equation. To function well we do not only need a healthy body. We also need a healthy mind.

And this healthy mind has not only been forgotten in capitalistic societies since the Corona Pandemic hit us. On the contrary, while Capitalism is constantly worsening society’s mental health it is still turning a blind eye on the subject.

The paradox we keep on reproducing

In the article A Mad World: Capitalism and the Rise of Mental Illness the author even dares speaking of mental illness as being the second pandemic we are constantly living in[1]. Another article, Capitalism and mental health states that the WHO estimates that more than three hundred million people suffer from depression worldwide[2].

While there is evidence that genetics and physical biomarkers are causing mental disease, the other important factor is environmental and societal causes. Our society prefers explanations based on genetic reductionism over others. Structural inequalities resulting from an economic system that builds upon capital accumulation and competition only, are widely ignored.

The truth is: the more our lives get turned into commodities, the more we feel alienated within them. Here Marx gave the example of a mother labouring (and it is work to give birth to a child!) her child. As soon as the baby is in this world, it gets turned into something doll-like, into a commodity. By this it is taken further away from the woman it came out of, the parents it was made from and the naturality of things. The market is taking this baby and claiming it for itself, alienating it even further from the parents[3]. This constant shift from things how they are, into a notion of things how they ought to be is driven by forces such as capitalism and advertisements. These forces have already been identified by Freud as the motor of increasing neuroses within a modern society. Psychoanalytic psychotherapist Sue Gerhardt also writes about how capitalism reshapes our brains and our nervous systems, stating that we would often be confusing ‘well-being with psychological well-being’[4]. All these arguments are also subsumed in Erich Fromm’s hypothesis that under capitalism humans become divorced from their own nature[5].

Inequality creates mental illness

Another point that this discussion should not miss is the inequality capitalism generates.  It is common knowledge that mental illness is developing out of inequalities and today we also have a lot of scientific proof for this. According to a report of the Royal College of Psychiatrists in London, “children from households with the lowest 20% of incomes have a three-fold increased risk of mental health problems than children from households with the highest 20% of incomes.[6]” This also comes back to the debate of work. In our modern society work is often portrayed as the individual’s fulfillment, as a sort of self-realization. However this argument only embraces a small minority of people (and even within this small minority one could question how self-fulfilling it really is to persistently have to prove oneself to be the best). What work actually does is, that it contributes to the feeling of alienation. A study conducted in 2018 in Britain states that 47% of the participants are considering looking for a new job[7]. Erich Fromm talks about human beings being active creators. Under capitalism however, we are forced to put all the energy in the labour, never mind a personal sense of connection to the outcome. What we create then, we rather produce. We no longer have a relation with the results of our work.

It is strange enough that we live under these conditions that steadily are bringing us further away from our human nature. But even stranger it is, that we know about it and still do not change a thing.

Even if it feels like it has already been mentioned a thousand times and even if it feels like a hopelessly optimistic approach, I will still say it: Maybe the Covid-19 pandemic can open our eyes and serve as a turning point towards a new, more just system.

For further information, read these articles:

David Matthews: Capitalism and Health (2019) in: Monthly Review, an independent socialist magazine.

Rod Tweety: A Mad World: Capitalism and the Rise of Mental Illness (2020) in: Hampton Institute.

[1]          Rod Tweety: A Mad World: Capitalism and the Rise of Mental Illness (2020) in: Hampton Institute. (last access: 03.12.2020, 14:37).

[2]          David Matthews: Capitalism and Health (2019) in: Monthly Review, an independent socialist magazine. (last access: 03.12.2020, 14:32).

[3]          Rod Tweety: A Mad World: Capitalism and the Rise of Mental Illness (2020) in: Hampton Institute. (last access: 03.12.2020, 16:37).

[4]          Sue Gerhardt The Selfish Society quoted in: ibid.

[5]          Fromm, The Sane Society refered to in: David Matthews: Capitalism and Health (2019) in: Monthly Review, an independent socialist magazine. (last access: 03.12.2020, 14:32).

[6]          Royal College of Psychiatrists London: No health without public mental health- The case for action: Position Statement PS4/2010 (London: Royal College of Psychiatrists, 2010) p.18, (last access: 03.12.2020, 14:28).

[7]          Investors in People: Job Exodus Trends: 2018 Employee Sentiment Poll (London: Investors in People, 2018) in:
David Matthews: Capitalism and Health (2019) in: Monthly Review, an independent socialist magazine. (last access: 03.12.2020, 14:32).

Epidemics and Gender Vulnerability

Violence against women as a shadow pandemic during COVID-19

By Beverly Mtui, BA.

How the world is fighting two pandemics concurrently

During the COVID-19 pandemic, we have been reminded that women are affected differently by health crises and emergencies. Professor of history at the University of Agder in Norway, May-Britt Ohman Nielsen, says that “infectious diseases affect women and men differently, primarily because they have different roles and functions through history. The greatest difference regarding illnesses and pandemics is that women often take on emotional responsibilities” i.e. additional care work.[1]

Women are differently affected by epidemics than men

Interestingly, if we take a closer look at history, it appears that women usually have a higher life expectancy than men during epidemics. In the research article Women live longer than men even during severe famines and epidemics[2], the life expectancy of women and men for seven high-mortality populations during extreme mortality conditions between the years 1773 and 1933 was analyzed. It was revealed that even in the face of adverse conditions such as famines (Swedish famine in 1772–1773, Irish famine in 1845–1849 and Ukrainian famine in 1933), epidemics (Icelandic epidemics in 1846 and 1882) and slavery (Freed Liberian slaves from 1820-1843 and Plantations slaves in Trinidad from 1813-1816), women tended to survive better than men.[3] Furthermore, the research shows even for less extreme famines[4] that the overall impact was greater for men than for women, also in regions where the mortality rate for women was generally higher than for men.[5]

The global numbers of COVID-19 deaths paint a similar picture. According to the rapid risk assessment Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK – eighth update of 8 April 2020, a total of 74 066 deaths have been reported worldwide by 7 April 2020 with 51 059 deaths being reported from the EU/EEA countries and the UK.[6] Despite higher age groups being generally more affected by COVID-19, the risk assessment reports that “for all age groups where the outcome of cases was reported, there were more deaths among males overall”. [7] In fact, the male-to-female ratio for deaths was 2.1.[8]

Good Time Being A Woman?

Taking all of this into account, one would probably agree with North American country artist Emily Reid and think “Good Time Being A Woman.” Unfortunately, not so much: women have been fighting an additional battle. One that existed even before COVID-19 startled the world. Calling it the “Shadow Pandemic”, UN WOMEN highlights the increase of the human rights violation that is violence against women during COVID-19. “Globally, 1 in 3 woman have experienced physical or sexual violence mostly by an intimate partner”. However, UN WOMEN states that “data and reports have shown a rise in all types of violence against women and girls, particularly domestic violence, since the outbreak of COVID-19”.[9]

In order to understand this phenomenon, we must first deconstruct the term violence. In Violence in War and Peace,[10] Philippe Bourgois analyzes the normalization of violence in society and targets the “continuum of violence”: Violence as such is divided in four different layers: political, structural, symbolic and everyday violence. The interplay of structural and symbolic violence strengthens and amplifies everyday violence that conversely allows the continuation of symbolic and structural violence, and effectively leads to political violence. On the other hand, political violence can induce new forms of structural and symbolic violence leading again to different expressions of everyday violence.

Increases of violence on several levels

In addition, it is clear that violence in all its forms intensifies and fortifies in situations of crisis, particularly health crises, as shown by an increase in gender-based violence and intimate partner violence during the earthquake in Haiti in 2007, Hurricane Katrina in 2005, and the eruption of Mount Saint Helens in the 1980s, disasters that led to unemployment, family, and other stressors.[11] Evidently, this is reflected in the current pandemic in the following ways:

Increase of everyday violence: According to UN WOMEN, there has been an increase in reports of domestic violence and calls to women support services, particularly during the COVID-19 lockdown period of March-April 2020. In France, reports of domestic violence rose up to more than 30%, and Singapore as well as Cyprus also experienced a rise in emergency calls to women’s helplines of more than 30%.[12] Why? According to the Council of Europe, particularly during the lockdown i.e. “isolation and confinement leads to higher levels of domestic, sexual and gender-based violence”[13].

Increase of structural and symbolic violence: Economic impacts for women such as earning less, working more, unpaid care work, increased risk of unemployment due to caring for children and people in need, and thus increased risk of poverty.[14]

Increase of political violence: UN WOMEN states that in conflict-affected areas where people depend on humanitarian aid, particularly women and children are at highest immediate-risk for COVID-19. Furthermore, women and girls are more vulnerable to gender-based violence in refugee camps, when practicing hygiene at latrines or water distribution sites.[15]

As May-Britt Ohman Nielsen emphasised: “Pandemics are a magnifying glass that sheds light on social conditions, gender included.[16]Therefore, if we ask who is affected by COVID-19, we must also ask how, as it is clear that COVID-19 has an even severer impact on women worldwide.

“Gender-based violence […] is a profound health problem for women across the globe. Although a significant cause of female morbidity and mortality, gender violence is almost never seen as a public health issue.”[17]

[1], accessed November 28, 2020.

[2] Zarulli V et al., “Women Live Longer than Men Even during Severe Famines and Epidemics,” Yearbook of Paediatric Endocrinology, September 11, 2018.

[3] Zarulli et al. 5.

[4] Dutch Hunger Winter, the famines of Madras and Bombay, five south Asian famines, the Bengal famine, and the famine in the Matlab region.

[5] Ibid.

[6] Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK – eighth update, accessed November 28, 2020.

[7] Coronavirus disease 2019 (COVID-19) in the EU/EEA and the UK – eighth update, 6.

[8] Ibid.

[9] The Shadow Pandemic: Violence against women during COVID-19, UN WOMEN, accessed November 28, 2020.

[10] Philippe Bourgois, “The Power of Violence in War and Peace: Post-Cold War Lessons from El Salvador,” Ethnography 2, no. 1 (2001): 5–34.

[11] Shalini Mittal and Tushar Singh, “Gender-Based Violence During COVID-19 Pandemic: A Mini-Review,” Frontiers in Global Women’s Health 1 (September 8, 2020).

[12], accessed November 28, 2020.

[13], accessed November 28, 2020.

[14] Policy Brief: The Impact of COVID-19 on Women (2020), UNITED NATIONS, accessed November 28, 2020.

[15] UN Secretary-General’s policy brief: The impact of COVID-19 on women; Transcript of the UN Secretary-General’s virtual press encounter on the appeal for global ceasefire, UN, 23 March 2020., accessed November 28, 2020.

[16], accessed November 28, 2020.

[17] Lori Heise, “Gender-Based Abuse: The Global Epidemic,” Cadernos de Saúde Pública 10, no. suppl 1 (1994): 135–45.