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Analysis Covid-19: The Road to Equity and Solidarity

Covid-19 pandemic and the social determinants of health

BMJ 2021; 372 doi: (Published 29 January 2021) Cite this as: BMJ 2021;372:n129

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  1. Lauren Paremoer, senior lecturer1,
  2. Sulakshana Nandi, co-chair of global steering council23,
  3. Hani Serag, director of programmes4,
  4. Fran Baum, director2 5
  1. 1Political Studies, University of Cape Town, Cape Town, South Africa
  2. 2People’s Health Movement, Delhi, India
  3. 3Public Health Resource Network Chhattisgarh, Raipur, India
  4. 4Center for Global and Community Health, University of Texas Medical Branch at Galveston,
  5. Galveston, Texas, USA
  6. 5Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
  1. Correspondence to: S Nandi sulakshana{at}

Lauren Paremoer and colleagues call for action to create a fairer and more sustainable post-covid world

The covid-19 pandemic has exposed the longstanding structural drivers of health inequities, such as precarious and adverse working conditions, growing economic disparities, and anti-democratic political processes and institutions. These important determinants of health have interlinked with class, ethnicity, gender, education level, and other factors during covid-19 to exacerbate existing social vulnerabilities in society.

Numerous warnings of the dangers of inequity have emerged over the past decades. The Alma Ata declaration convincingly argued that “health for all” could be achieved only through a New International Economic Order and people’s participation in decisions affecting their community’s health.1 These principles were affirmed in the report of the Commission on the Social Determinants of Health2 and the 2008 World Health Report.3 The commission proposed “tackling the inequitable distribution of power, money, and resources” that drive systematic inequalities in health outcomes, and improving daily living conditions especially for those in vulnerable circumstances.2 Historically, the social determinants of health agenda has been influential in highlighting and reducing inequities,45 and in relation to covid-19, academics and activists have called for a social determinants of health approach.67

From a social determinants of health perspective, global economic trends create enduring health hazards. These trends include the ballooning debt burden of low and middle income countries (LMICs), interpretations of the Trade-Related Intellectual Property Rights (TRIPs) agreement that undermine equitable access to medical technologies, and the pressure from the International Monetary Fund (IMF) on borrowers to implement austerity policies. These processes entrench the commercialisation of healthcare and constrain implementation of policies to reduce inequalities between and within countries. Additionally, the marginalisation of certain groups because of ethnicity, race, caste, migrant status, gender, class, or nature and …

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