I am at this moment coming up with a lesson plan to teach my students about how capitalism and globalization created the conditions for the COVID-19 pandemic. I am doing this because the college I teach at has asked me to move my classes online for the remainder of the semester. Because of who I am and what I teach, I have decided that if I am going to ask students to study sociology during a pandemic I have only one choice. I have to teach them about how sociologists think about pandemics.
So I thought about starting the way I start my Sociology of Health and Illness class. The first lesson is to introduce the study of epidemiology — a fancy word that means the study of patterns of health and illness among populations of people. (I learned all this originally from a book called The Sociology of Health and Illness by Rose Weitz, 3rd edition. It’s a great textbook currently in its ninth edition.) I will say a few things about how humans used to live much shorter life spans and we have seen a few periods of increase in those life spans, but the really big change for human life expectancy came between 1900–1930 during the epidemiological transition. Life expectancy for white folks in the US went from 47 to 60 at this time and for black folks it went from 33–48. For a long time we congratulated ourselves that this increase was due to good sanitation and sewer systems, and those were very important. But the biggest factors in the epidemiological transition were better overall nutrition and living conditions — clean air and shelter. Eating well and not being cramped in tiny airless hovels in industrializing cities or peasant villages improved our immune systems and reduced the amount of plague and influenza we spread around between each other.
I tell this story to my students to make the point that the way we organize our social lives has the biggest impact on our life expectancy as human beings. The epidemiological transition in the US and Europe was not brought about by modern sanitation or medicine or vaccines, but by general population access to food and shelter and cleaner air.
In the next part of my introductory lecture I move on to telling my students about how the biggest killers of people are today are heart disease, strokes, and cancers. We think of these as “lifestyle” diseases but we know from medical research that that is not completely true. As individuals we can mitigate risk of these diseases in some ways, but a lot of them are genetic or environmental or a complex combination of factors that we don’t really understand, but they tend to happen in older ages. I won’t go into detail about this in my Covid-19 lecture because it’s not a general course in the sociology of health and illness, but if it was we would talk about the many social factors that produce rates of cardio-vascular disease and cancer in the country.
Anyway, in my hypothetical online conversation with students I will then say something that I have been saying to students of the sociology of health and illness for 20 years. Something huge is missing from the story of global human life expectancy that I just told. Although many of us think (thought) that infectious disease was in the past, epidemiologists have been telling us for years that we are not rid of infectious diseases. Epidemiologists say that since around 1980 we have been in a period called the “new rise in infectious disease.” You have heard about diseases like hantavirus, anthrax, mad cow, SARS and ebola. They seem scary to Americans, but far off and exotic. We may not realize how dangerous these diseases are because for most of us they are just on TV and life is too busy and complicated to be worried about people you don’t know in some far off place who are dying from something you don’t ever expect to come into contact with. It’s too hard and complex, and what can we do about it anyway?
But here’s the thing, I say to my students or will say to my students, there is a very good reason we should be interested in knowing more about the new rise in infectious disease. Because although we think we have vaccines and health systems and better food, air and shelter, actually we do not all have these things. In fact, the majority of humans don’t. We live in a world of great inequality where some of us suffer from overabundance and some of us struggle to find adequate nutrition. Some of us get amazing health care while others go bankrupt or go without health care when they get sick. And if we have been listening carefully to epidemiologists, we know that the history of human life expectancy is the story of human wealth and poverty. We don’t have to be rich to be healthy, BUT if we are poor, undernourished, under-sheltered and do not have access to clean food, water and air we will be sick.
What epidemiologists and sociologists have in common is the empirical understanding that the way people live creates the patterns of health and illness we experience. It’s not magic or luck, it is not political or opinion. Animals, plants and algae and other biological organisms are interconnected around the globe. And how we move around the world influences when we meet other biological organisms that can do us harm, when we are vulnerable to infection, and whether we spread those organisms to other people. Our living conditions dictate our patterns of health and illness as individuals, populations, species and ecosystems.
The way we organize our social lives impacts the biology of our bodies and our planet. This is the central analytical point of the Sociology of Health and Illness. It is the crux of epidemiology. When we overuse and misuse antibiotics we make it harder to stop infectious disease. When we cut down forests and build dams and displace large numbers of people and animals we create poverty and inequality and disrupt stable ecosystems. When we put animals and humans in closer contact than they were before, we increase the likelihood of them sharing disease. When we force people off their land and out of their traditional ways of life to work for low pay in global factories we decrease their health and sanitation. We make them physically vulnerable and give new pathogens a place to mutate and grow and become virulent. When we destroy traditional means of finding and distributing food, some people rely on grocery stores and factory farming while others rely on open air markets to buy what they can afford. When we crowd people together and stress their immune systems we increase the likelihood of transmitting disease. When we fly around the world to make sure the factories keep running and products keep being made and sold, we carry diseases with us. And if we fly to countries with inadequate health care systems or stingy social policies, the poorest people in those countries will suffer the most because they will be the most vulnerable to disease and the least able to access treatment.
The US has a for profit health care system that does not operate as a unified system and does not have public health as a number one priority. This lack of organization makes it very difficult for the US to have a singular, effective plan to deal with new, highly contagious diseases. We are the most vulnerable of all high income nations to the devastation of a global pandemic. The new rise in infectious disease is important not as an intellectual exercise, but because it indicates that a truly educated and rational society with abundant economic resources must have a health system capable of keeping us safe from the rise of new infectious disease.
The US has no such system.
So I will conclude to my students, global capitalism created the conditions for the development of Covid-19 which is now a global pandemic. This is why we are now having class online instead of in-person where we were before Spring Break. I have been teaching about the possibility of this unimaginable situation for 20 years. Epidemiologists have been talking about it for twice as long.
And then I will pause, and I will ask them if they understand what I am saying. Well actually I’m not sure how that will work, whether I will pause or the video will end. Because I don’t really know how to use technology effectively to teach an online class. But somehow I will ask my students if they have any questions, is there anything I can explain or clarify? And I will wonder, do they understand the story I have just told them? Do they realize that the “new” rise in infectious disease coincides with rise in neoliberal economic policies that ended 40 years of centralized social policy making in the US and eliminated the very notion of government is supposed to work in the interests of the general social welfare of its citizens?
Will any of my students dare to call me out on my hypocrisy as I deliver this lecture online? Will they ask me why I didn’t do anything to stop Covid-19? Will they will recognize that the very conditions that led to the pandemic also led to the idea that it is logical and rational to ask students and professors to finish their semesters online while we are experiencing a global pandemic. The same logic that concluded that it was too costly to build a health system that could have protected us from this situation is asking us to have this deep intellectual conversation online for a grade while our friends and family members are sick and maybe dying in the rooms and apartments and buildings next door?
I wonder how many of us, the educated elite have really considered this question. In academia we are so used to fighting for our lives, being under pressure of budget cuts and elimination because we teach arts and humanities and these disciplines don’t make money. We have twisted ourselves into knots to justify our profession by saying we provide something job training does not provide — the ability to think critically about the world we live in. We create good citizens who make society better and are empowered to protect themselves from oppression and injustice.
I am asking myself right now, is this what sociology is for? Is this what intersectional feminism is for? Is this why I studied critical race theory and history and disability rights and queer theory? To teach students how to stay calm and carry on in a post-pandemic global economy?
[This essay does not represent the views of Albertus Magnus College where I teach nor the administrators, board or faculty thereof.]
Karen Kendrick is Professor of Sociology at Albertus Magnus College, New Haven, CT