By Hayley Evans
The international response to COVID-19 has paid insufficient attention to the realities in the Global South, making the response Eurocentric in several ways.
This series of blog posts looks at three aspects of the COVID-19 response that underscore this Eurocentrism. The first post in this series scrutinized the technification of the international response to COVID-19. This second post looks at how the international pandemic response reflects primarily Western ideas of health, which in turn exacerbates negative health outcomes in the Global South.
This series draws on primary research conducted remotely with diverse actors on the ground in Colombia, Nigeria, and the United Kingdom, as well as secondary research gathered through periodicals, webinars, an online course in contact tracing, and membership in the Ecological Rights Working Group of the Global Pandemic Network. I have written about previous findings from this work here.
Western Conceptualization of Health
In concentrating on largely Western conceptions of health — ideas that are focused on individual life expectancy and the prevention of diseases — the international pandemic response paid insufficient attention to realities in the Global South.
Conceptions of health in the Global North primarily concentrate on specific diseases. Though the European Committee of Social Rights has stated that “health care is a prerequisite for the preservation of human dignity,” the European Human Rights System predominantly categorizes the right to health through the vectors of causes of ill-health, advisory and educational facilities, and prevention of disease and accidents. This framing has resulted in European jurisprudence employing a fairly narrowly-construed definition of “the right to health” that generally focuses on respect for physical and psychological integrity.
Even in its “Statement of interpretation on the right to protection of health in times of pandemic” the European Committee of Social Rights did not interpret the enjoyment of the right to health sufficiently broadly. The United States construes the concept even more narrowly, with some arguing the right to health cannot be enjoyed there.
By contrast, conceptions of health in the Global South are far more holistic in their analysis of which determinants — including social, political, and economic factors — affect the enjoyment of the right to health. This characteristic is possibly in reaction to the realities of climate change, poverty, and armed conflict. This holistic approach engenders more salient policy responses that adequately respond to the needs of marginalized or vulnerable populations.
As evidenced through jurisprudence, non-Western approaches to health include considerations of environmental contamination and degradation; physical and economic determinants of health care access; inequality in health care access; physical and psychological harm; poverty; availability of potable water, foodstuffs, crops, and livestock during armed conflict; and lack of drinking water, electricity, and medicines.
Despite having the institutional competence to do so, the WHO failed to address the holistic determinants of health affecting the enjoyment of the right to health during the pandemic, predominantly determinants affecting those in the Global South.
Although these determinants are varied and many, I will focus on two in the context of the pandemic: violence and hunger.
In Colombia, multiple sources spoke of facing two pandemics: coronavirus and armed conflict. Priscyll Anctil Avoine, PhD candidate in Political Science and Feminist Studies at Université du Québec à Montréal and the director of the Colombian feminist and antiracist collection, Fundación Lüvo, wrote in an email:
COVID-19 is just another layer to the social and political crisis that has ravaged the country for more than 60 years. … For example, last week, armed groups shut down the entry to the city of Arauca, forcing people to stay in their house until the “día de abastecimiento” [supply replenishment day]. … It was also easier to target social leaders because of lockdown measures. Femicide and armed violence have reached new peaks.
While there has been a slight global decline in violence targeting civilians since the start of the pandemic — driven largely by declines in Latin America and the Middle East — most other regions — including Africa, South Asia, Central Asia, the Caucasus, and East Asia — saw an increase in violence against civilians. It is also generally accepted that gender-based violence has increased during the pandemic — though this trend also greatly affects Europe, Asia, and the Pacific.
In Nigeria, rhetoric was similar, but the secondary foe different: hunger. And Nigeria was not alone in facing COVID-related increases in hunger. The COVID-19 pandemic has reduced access to food and adequate nutrition across the globe. New causes of food insecurity have emerged, and preexisting causes have been exacerbated. Pandemic-related furloughs and unemployment, limitation of hours and services at supermarkets, and restriction of economic activity to formal, “essential” services have caused food demand and prices to skyrocket.
At a higher level, pandemic responses have limited worker mobility, which has in turn contributed to labor shortages and disruptions in transport and logistics services. For example, transportation of food has been disrupted due to air cargo declined capacity as well as new border requirements such as the necessity for drivers to get tested or to quarantine, thus delaying farm labor, food processing, food availability, and access to food across the globe. In April 2020, the UN Food Programme Executive Director warned the Security Council that, in addition to the 135 million people facing crisis levels of hunger at that time, COVID-19 could increase those figures by another 130 million before the end of 2020.
The world does not lack sufficient food; rather, it is distributed unequally. In the United States, COVID-19-led market disruptions have left farmers with no choice but to euthanize livestock. OXFAM identified ten countries and regions where the food crisis is the most severe, and further exacerbated by the pandemic — all of which are in the Global South.
Yet the global response paid insufficient attention to these determinants affecting the enjoyment of the right to health during the pandemic. The WHO only published three policy documents relating to COVID-19 and violence, an April 2020 policy brief entitled “COVID-19 and violence against women,” a similar June 2020 brief, “Addressing violence against children, women and older people during the covid-19 pandemic: Key actions,” and a related June 2020 brief titled, “Violence Against Women and Girls Data: Collection during COVID-19.” Similarly, while the WHO jointly published the report, “The State of Food Security and Nutrition in the World,” it focused more on the potential trajectory of food insecurity and food affordability as related to the pandemic, but did not provide concrete policy recommendations, coordinate data sharing among vulnerable groups, or suggest any constraints on State action.
Of course, not all international institutions were silent. For example, the Office of the High Commissioner for Human Rights provided guidance across a myriad of human rights issues including social and economic impacts, the UN Secretary-General delivered a policy brief on COVID-19 and human rights, and the Office for the Coordination of Humanitarian Affairs published a “Global Humanitarian Response Plan.” However, the WHO did not do nearly enough in coordinating data sharing and framing State action in response to these two major pandemic-related trends.
By focusing on Western conceptions of health, the international pandemic response was not actually “international,” but instead disproportionately protected the quarter of the world population that lives in the Global North.
Hayley Evans is a Research Fellow at the Max Planck Foundation for International Peace and the Rule of Law.