Most of us are increasingly aware of the direct and immediate impact of COVID-19, even though it seems to behave differently from place to place and is dependent on so many factors. But we may be less aware of the longer-term implications of COVID, and how it is affecting global health. One reason is that it’s even harder to predict, even by the best scientific minds.
It’s essential that we understand as much as we possibly can how to help us minimise those longer-term impacts in the countries and communities where we are working. I am mentioning a few of the many impacts, with a few possible solutions and, as in my previous blog, emphasising again what a valued position we have, as those who believe in God who are able to enquire from him and pray to him.
Some long-term impacts to be aware of
‘Global health is being dismantled,’ as Richard Horton, editor of The Lancet, expressed it. ‘Global health has entered a period of rapid reversal. De-development is the new norm.’ And from the field an explanatory comment we often hear – this one from a Kenyan leader of the Arukah Network: ‘It’s just COVID, COVID, COVID; other diseases don’t count.’
Here are some crucial ways in which COVID-19 is changing and challenging global health.
Let’s start with immunisations. In July 2020, the Director-General of the World Health Organisation stated: ‘The number of children dying from missed vaccinations is likely to far outpace the numbers of people dying from COVID-19.’ Why? Because immunisations are often not available, parents are reluctant to attend health facilities and the AntiVax lobby is alive and growing. Fear increases conspiracy theories and false information.
COVID is adding to the harmful effects of three killer infectious diseases. The Global Fund to fight AIDS, tuberculosis and malaria estimates that COVID will dislocate health systems and could double the number of deaths from those illnesses within twelve months unless urgent action is taken.
What worries many of us is the massive impact that COVID is having on community livelihoods, and critically, the actual survival of the most vulnerable. In many countries lockdowns, important as they are, probably cause more deaths in the short term than COVID itself. The World Bank estimates that COVID-19 will push another 71 million people into extreme poverty, measured at the international poverty line of $1.90 per day.
We must remember the impact on children. At the height of nation-wide lockdowns in April, according to UNICEF, approximately 91 per cent of the world’s pupils in more than 194 countries were out of school. There was an especially great impact on girls aged 5-14 who already spend 40% more time doing house hold work than boys.
Women too have so often been deprioritised in global health. This is happening with COVID. It is estimated that 47 million women will be prevented from access to contraception. Seven million unintended pregnancies are predicted to occur over six months, some from transactional sex to earn income for the family. Also, sources estimate that an additional 15 million cases of gender based-violence have occurred during every three months of lockdown, a horrifying number.
Non-communicable diseases, including cancer, diabetes, and cardiovascular diseases, account for about seven in ten deaths worldwide. That’s 41 million each year. Even in low- and middle-income countries, they account for more deaths than all other causes. In a survey from 155 countries carried out by WHO, approximately half of all patients with hypertension and diabetes will have their treatments either partially or totally disrupted.
What can communities do to help?
Fortunately, quite a lot! For too long in some parts of the humanitarian aid sector, solutions have been suggested and even dumped on poorer communities, as if those who live in comparative wealth know the answers to the realities and feelings of those they are trying to help! The title of a well-known book describes it well: ‘When Helping Hurts’ . And it doesn’t just hurt. It creates dependence and undermines the agency and creativity of the very people for whom effective solutions mean the difference between flourishing and destitution.
So, one positive outcome that we are beginning to see is the greater role of local leaders, and community-based entrepreneurs, opinion formers and champions.
Moreover, community health is of course closely related if not almost identical to primary health care. Primary health care is a brilliant and effective service and system of healthcare, despite its rather prosaic name.
A quote from the WHO World Health Report in 2008 articulates its essence: ‘Primary health care brings balance back to health care and puts families and communities at the hub of the health system. With an emphasis on local ownership, it makes space for solutions created by communities, owned by them and sustained by them.’
Countries, especially in Africa, are giving primary health care renewed priority during the time of COVID. This includes the training of many new community health workers. Kenya is training 100,000. In Sierra Leone, community health workers already outnumber doctors by 95 to 1 according to a Lancet editorial.
We also need to think of home-grown solutions that don’t need visits to hospitals and health centres. It’s quite easy to take your blood pressure and that of family members, or even measure your blood glucose. And then the use of mobile phones, WhatsApp and other forms of IT are playing an ever-increasing role. As one community member expressed it: ‘Whether I’m deep in Malawi or deep in the Amazon, all I need is a mobile phone and connection that allows me to talk to a clinician.’
What can faith leaders and church members do?
Did you know that estimates suggest about 84% of the world have a religious faith, more in parts of Africa? Nearly every community in the world has one or more religious centre. As one church leader has said: ‘We were here before the disaster, we are here during the disaster, and we will be here after the disaster.’
To which the response should be: why on earth aren’t faith leaders more included in humanitarian responses? Fortunately, Ebola and now COVID are changing perspectives on this, even amongst secular leaders.
I mentioned in my earlier blog that when people have problems, religious leaders are often the most respected go-to people for advice and information, especially during difficult times. What a great opportunity for church leaders and church members to help become part of the great army of COVID helpers.
One valuable task for church leaders is to share, and preach from the front, correct information, underline the truth of science, and help to overcome the ‘infodemic’ of false information which is causing so much hurt, confusion and threat to lives.
And church members can help to provide, food, basic necessities, hope and comfort to those in greatest need including those living with physical or mental disabilities. And not just for fellow church members, but to all who are vulnerable, according to need not creed.
One word of caution. Some faith leaders are not following the science but proclaiming that faith and prayer are all that is needed. As health professionals we have an important job in healing to guide our friends and contacts in church leadership to be guided by ‘true information’ in addition to our essential faith and prayers.
We all need to be aware of the present situation and above all the future impact of COVID-19. And then, guided by true information, inspired by hope and working creatively and collaboratively we can make an important contribution wherever God has placed us on Planet Earth.
Dr Ted Lankester is Director of the Arukah Network (www.arukahnetwork.org)
Watch our recent webinar with Dr Lankester where he describes the longer term impacts that COVID-19 will have on global health.