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Health inequalities: death by political means

BMJ 2020; 368 doi: (Published 27 February 2020) Cite this as: BMJ 2020;368:m755

Rapid Response:

Socioeconomic gradient in health and the COVID-19 outbreak

Dear Editor,

Up to the day of this writing, the Coronavirus Disease 2019 (COVID-19), first discovered in Wuhan, Hubei, China, has led to 114,452 confirmed cases and 4,026 deaths(1). While the epidemic has been under better control in China partially due to national mobilization of healthcare resources (including medical professionals and equipment) into Hubei, shortage of medical resources is of grave concern in other, especially those underdeveloped, countries recently affected by the COVID-19, underscoring the implication and potential consequences of health inequalities at a global level.

Many countries are currently employing a household-based prevention model, which usually includes mandatory self-quarantine of people who traveled to high-risk places. However, this model can be very fragile and limited, especially for those socially disadvantaged people who are poor, socially isolated and undereducated. Also, well-being of family members of the patients can be compromised indirectly even if they did not contract the disease. In the rural area of Hubei, a 17-year-old boy with cerebral palsy from a single parent family, whose father was placed in a quarantine facility for possible COVID-19 infection, was found dead after six days of being left alone at home (2).

Moreover, the socioeconomic gradient in health can be observed even among people in relatively higher socioeconomic groups. In Hong Kong, during the earlier stage of the outbreak, there was inadequate government support for healthcare professionals – a specialist claimed that he had been paying out-of-pocket to rent a hotel room in order not to affect his family members; however, healthcare personnel of lower ranking and less earning may not be able to do so (3). We need to be cautious of similar situations happening in other countries where the COVID-19 recently becomes rampant.

In conclusion, the socioeconomic gradient in health extends beyond individuals in relatively lower socioeconomic groups, and applies to their family members and those in higher socioeconomic position. Therefore, attention should not be just focused on high-risk individuals with the disease, but the whole population health prevention strategy that promotes good public hygiene practices and disease-specific health literacy is also essential.

1. Johns Hopkins Center for Systems Science and Engineering. 2019-nCoV Global Cases. (last updated March 10, 2020), accessed March 10, 2020.
2. Disabled teenager in China dies at home alone after relatives quarantined, The Guardian. (Jan 30, 2020), accessed Feb 3, 2020.
3. No Quarantine Arrangement at the Queen Mary Hospital. After Receiving Confirmed Case, Doctor Rented Hotel Room for Self-Quarantine. [瑪麗無隔離安排 醫生昨接確診個案:自租酒店隔離], HK01. (Jan 30, 2020), access Feb 3, 2020.

Competing interests: No competing interests

10 March 2020
Roger Y Chung
Assistant Professor
Dong Dong; Minnie Ming Li
School of Public Health and Primary Care, The Chinese University of Hong Kong
School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT, Hong Kong