An ethical analysis of COVID-19 impacts from a global child lens: It’s time to prioritize children’s rights!

Sydney Campbell, Carlo Cicero Oneto, Manav Preet Singh Saini, Nona Attaran, Nora Makansi, Raissa Passos Dos Santos, Shilni Pukuma, Franco A Carnevale

 

There can be no keener revelation of a society’s soul than the way in which it treats its children.

— President Nelson Mandela, 1995

 

  1. Introduction

The COVID-19 pandemic has led to numerous impacts on individuals, communities, and societies around the world, especially in resource-limited nations[1] where health systems, and economies as a whole, face significant resource constraints . For children and adolescents (henceforth, young people), there is no denying the challenges this pandemic has imposed and the immediate, mid-term, and long-term impacts it threatens. However, while resource-rich and resource-limited nations may have distinctive challenges and priorities, one thing is true for both: the interests of young people are too frequently subordinated to the interests of adults. As such, the aim of this analysis is to highlight some of the ways in which young people in various countries (namely: Brazil, India, Iran, Lebanon, Mexico, Nigeria, and Syria) have been impacted by the current pandemic and to examine these impacts from a child rights and justice-based ethical lens to understand how these impacts have been morally ‘good’ and ‘bad’. We selected these countries as ‘global exemplars’ of the diverse regions where the McGill University VOICE research program (VOICE: Views On Interdisciplinary Childhood Ethics) has active childhood ethics engagements, allowing us to develop a transversal ‘global’ analysis while simultaneously working with team members who have local regional ties and expertise.

 

  1. Outlining Impacts

Through scanning literature on the ways young people have been affected by the pandemic in each of the countries aforementioned, many of the various ways young people have been adversely impacted were revealed. Specifically:

  • Young people have been witnessing or personally experiencing more violence in their homes due to confinement and heightened familial stress (2-11);
  • Pre-existing social, class, and economic disparities have resulted in additional vulnerabilities to immediate and long-term impacts from the pandemic for many young people (7, 12-16), along with distinctive experiences for young people from privileged positions (e.g., being at risk of becoming overweight due to decreased activity and processed foods) compared to young people from less privileged positions (e.g., being at risk for malnutrition) (17). One clear example of this arises from the fact that young people from Indigenous communities in Brazil have been more significantly impacted by the pandemic due to the historical and social disadvantages these communities face (18);
  • Young people have experienced significant mental health impacts, such as stress being passed down by financial worries of parents and physiological health worries about their family (19), more mental health diagnoses and reported fear (20, 21), and impacts from being hospitalized if COVID-19 is contracted and from broadly living in confinement (22);
  • Socialization-related problems and other social challenges have been incurred due to the pandemic and directly impact the well-being of young people (7, 12). For example, in Iranian culture when there is a death in a family, the immediate and close community/social circle usually gathers for a three-day mourning period to support the family and young people who experienced the loss, but this has not been able to happen during the pandemic and parents, who may also be grieving, have had to act as the sole support for their children (23, 24). Also, as illustrated by Anant Kumar et al. (6), children in India (along with other countries) have lost the opportunity to play outdoors and socialize, potentially affecting psychosocial experiences and development;
  • Relatedly, changes in behaviours, including irritability, development issues (21) and an increase in aggression (11) have been experienced by many young people due to the confinement and social isolation;
  • Use of internet as a way to continue socializing has led to excessive internet usage for some young people combined with increased risk of harm and risky actions, such as participating in ‘challenges’ on social media spaces (e.g., drinking boiling water or harmful substances) (25), less time being spent outside, and being more likely to experience cyberbullying due to more time spent in virtual spaces (20);
  • The pandemic has posed numerous constraints to virtually every aspect of education for young people in the countries examined. For one, it has caused a large number of young people to be out of school, perpetuating a pre-existing educational gap present in certain regions, such as Nigeria (26). Additionally, many households in Mexico, Brazil and Lebanon (amongst other countries) lack stable internet connectivity and related resources, making it exceedingly difficult to continue with school and, thereby, widening pre-existing socioeconomic gaps in education (13, 19, 27-29). Moreover, it has contributed to an overarching concern related to school closures resulting in lack of social experiences, activities, and independence for young people;
  • Young people without parents (either those who became ‘orphans’ due to the pandemic or young people who were previously in foster care settings) have had their financial and holistic support (i.e., support related to all interfaces of the person—body, mind, and spirit) withdrawn and have received limited protective support by the government or arms-length institutions/organizations (4, 8). They have also encountered a greater risk of infection from having to live in group settings (14, 16);
  • Some strategies to respond to the pandemic (e.g., physical distancing) have impacted food systems and supply lines for nutritious, affordable foods (including production, transportation, and sales) leading families to face malnutrition or rely on nutrient-poor alternatives (30, 31);
  • Displaced persons in Syria and Nigeria, who are already facing significant disadvantages, harms, and challenges, have experienced additional trauma, fear, and physical and mental health impacts from the pandemic. Additionally, in Syria the majority of displaced persons are women and children (32); in one camp in northeast Syria (namely, the ‘Al Hol’ camp), more than 50% of the 65000 refugees are under the age of five (31). As such, the pandemic has added an additional layer of complexity to already dire humanitarian crises (10, 33);
  • In Mexico, more young people under the age of 14 have died than in the US or Spain, likely due to high rates of childhood obesity, child labour, and informal employment that impacts young people throughout the country (34). Likewise, young people in many regions, such as Iran, also face heightened risk of physiological effects from the virus due to the shortage of necessary resources, vaccination hesitancies, and unregulated and potentially harmful self-treatment (35-37);
  • Boys from families in Nigeria following Almajiri Islamic practices have been exposed to a higher risk of infection, have lost support from the communities they are situated in, have been unable to move freely in the country, and have had to quarantine without their families (38);
  • For young people with cancer in many areas of the world (e.g., Mexico), collateral effects have been experienced due to changes in cancer treatment trajectories (39); and
  • Sufficient and appropriate education about COVID-19 has been missing for young people in some regions (e.g., Iran), thereby contributing to further increases in stress/fear, misunderstandings related to appropriate care regimes, higher risks of infection, and suppressed emotions (35, 40-42).

 

While this list highlights an overview of only some of the complex, problematic impacts young people are facing, there are some positive outcomes that can be associated with the pandemic within these countries too. For one, authorities in some areas (e.g., Mexico and Iran) have developed and utilized ingenious solutions to providing education to students that does not depend on having stable internet connection. These solutions are based on data that indicates most citizens and families in the country have a television or radio in their homes and, as a result, education has been provided to young people through programing delivered on television or on the radio, depending on where in the country the young person is located (27, 43). Though this is certainly not a perfect solution, as it does not entirely account for or serve households with one television/radio and multiple children in distinctive grades (27, 28), it does indicate innovation. Additionally, increased time spent at home has meant that young people in many countries around the world, such as Iran, are able to have increased interaction with their parents and this has been positive for some (though not all) (44). Furthermore, sanitation packages have been distributed by government and non-profit agencies to working and homeless young people in resource-limited countries, like Iran, as a protective and preventive measure (45).

 

  1. Common features across jurisdictions

In conducting an overarching analysis of these findings, we identified several underlying commonalities among these impacts that transverse the geography in which a young person is living and confronting the harms. First, and as aforementioned, literature from each country indicates that young people are experiencing and/or witnessing increased violence or threats of violence. This increased risk of violence indicates that there is inadequate sanctioned protection for vulnerable children, despite decades of research that has shown periods of financial and psychological stress to be associated with an intensification of domestic violence that children experience (46). In relation to the Canadian context, that members of our team initially examined (47), worries about risks of violence seemed more pronounced for young people in resource-limited nations.

 

Second, the literature scans revealed that for these resource-limited countries, less resources have been invested in child health and well-being broadly and, by extension, very few resources in the pandemic response plans have been invested to deal with the impacts of COVID-19 on children specifically. The downstream effects of reduced child welfare budgets has been revealed by the pandemic’s threats on the lives of children, warranting policy action by political leaders in each jurisdiction.

 

Third, in the countries that were examined for this commentary (and in other resource-limited nations), there are large and widening health inequalities that exist as a result of socioeconomic disparities (48). In the context of the COVID-19 pandemic, young people and their families that experience greater social disadvantages and less privilege are prone to experiencing much greater immediate and long-term problems. In addition, implementation of school supports have often not adequately accounted for the most vulnerable or disadvantaged families and children in a society, perpetuating the social disparities even further. In Canada and the US, similar findings have been revealed in this pandemic (49), but these disparities and the implications the poorest people in a country are facing during the pandemic are extreme in resource-limited nations.

 

Fourth, findings from each of these countries emphasize needs for community support in order to assist young people and families with the challenges they are facing. As a result, and not surprisingly based on existing evidence (50), there seems to be a collectivist-lens that is foundational to the ways harms are experienced and redressed from a global child perspective. This was exemplified by the relational nature of various harms, whereby the pandemic has caused an increase in parental economic, physiological, and psychosocial stress that has ripple effects leading many young people to being in more perilous physical, emotional, and mental states. The importance of the collectivism inherent to these countries was also exemplified by the concern for the current lack of community support that young people and families have access to in Iran following a death, that they otherwise would have experienced (through a three-day mourning period).

 

Fifth, our analysis revealed that COVID-19 impacts tend to have an inherent temporal feature, either through being constructed as immediate impacts that require immediate rectification (as has been the case in each country that has employed pandemic plans that aim to reduce mortality rates from the virus) or being constructed as mid- to long-term impacts, which do not require urgent attention or upfront investment in resources. The latter, longer-term timeline has been used in many discussions of how young people are likely to be impacted by COVID-19 and, as such, the needs of young people have been associated with narratives that justify diverting resources towards more immediate impacts first (rather than investing/re-investing resources into areas where young people are being most significantly impacted).  Temporality is, therefore, used as a frame to justify prioritization, while also implicitly regarding young people as ‘human becomings’ such that their lives become valued for what will come later rather than recognizing the young person in the moment—‘here and now’—and acknowledging their experiences as human experiences that warrant urgent attention. In the limited COVID-19 work that has utilized a childhood ethics approach, this temporal focus has been shifted to indicate the necessity of supports for young people that are attentive to where the young person is, ‘here and now’, and to mitigate the harms and impacts as much as possible (47).

 

Finally, the importance of young people’s voices and participation was not accorded significant value or attention within the countries examined, which is especially interesting when compared to analyses within Westernized contexts that have discussed, in depth, the importance of including children in pandemic policy development and the ways to do so (47, 51). There were a couple of instances where young people’s participation was mentioned. For example, in one paper by Brazilian scholars listening to the voices of young people was positioned as a solution to the excessive internet usage concern rather than being viewed an aspect of young people’s worlds that has not been granted adequate consideration (25). Additionally, in a small section of an article pertaining to the Indian context, young people’s participation was discussed only in relation to the mobilization of communities (7). Though additional research would be required to understand why the voices of young people are not recognized as requiring urgent attention in resource-limited countries or from a global perspective, the lack of substantial discussion does demonstrate an important tone and helps illustrate the challenges young people are facing in trying to be heard.

 

  1. Applying an ethical lens

Although these impacts have been studied and discussed, an analysis of the global child impacts using an ethical lens—to understand the ways in which these impacts are good and/or bad—has not been reported to date. Therefore, in what follows we examine the ways in which pandemic plans have been morally sound or ‘good’ and, in contrast and using a children’s rights and justice-based framework, the ways in which pandemic plans have been morally problematic or ‘bad’. First, pandemic response plans have, from a strict consequentialist lens (52), been morally permissible in that quarantine and/or physical distancing efforts have reduced infection, transmission, and death rates compared to what they otherwise would have been (53). This has been the justification generally used by decision-makers to explain why reducing transmission is a priority at all costs—even when young people are silently suffering consequences associated (directly or indirectly) with pandemic precautionary measures. Additionally, positive outcomes associated with these measures (such as the two positive impacts aforementioned) have been celebrated and used as further justification for these approaches.

 

Despite the benevolent aims of pandemic measures, they may also lead to some morally impermissible, albeit inadvertent, outcomes. Most prominently: each country’s response to COVID-19 has failed to acknowledge many rights of young people. Leaders in positions of power have made decisions about the relative importance of particular pandemic impacts with systemic dismissal or under-recognition of what is really at stake for young people. According to the United Nations Convention on the Rights of the Child (henceforth, CRC), young people hold particular rights and responsibilities—as such they have the same general human rights as adults and a specific set of rights that recognizes their special needs as rooted in their best interests (54). The aim of the CRC is to ensure that every young person actualizes their potential, as the CRC safeguards the rights of young people to realize this aim (55). Articles within the CRC that outline rights particularly relevant for this discussion generally fall into three main categories: (a) participation, (b) protection from and prevention of abuse, neglect, discrimination, exploitation, and other harms, and (c) provision of assistance to support basic needs that young people have (56, 57). Essentially, the CRC uses an ‘interests’ conception of rights, such that any action that pertains to a young person must hold the young person’s best interests as a primary consideration (57, 58).

 

Drawing on advances in childhood ethics, a conceptualization of best interests that aligns with a view of young people as human beings with rights involves ‘an authentic recognition of their voices and agency’ (59). Relatedly, one’s agential capacities are understood as relying on the relationships one has and environments one is embedded within, as these orient how one discerns what is meaningful and what matters—illustrating a shift towards relational notions of autonomy and agency (59). Therefore, a focus on the best interests of a young person that aligns with these advances in childhood ethics entails authentically listening to the perspectives, experiences, and interests of young people (whether they have recognized decisional autonomy or not), while also being attentive to the individuals and communities that are involved in their lives. This understanding of best interests also aligns with the inherent community-centeredness of the jurisdictions included in this commentary and, through meaningful consideration of the context one is situated in, also allows for openness to the incorporation of local customs and outlooks into the conceptualization of agency employed (59).

 

Pandemic response plans in the countries examined within this analysis have demonstrated that children’s rights, likely unintentionally, have not been adequately considered within the COVID-19 context. Essentially the ‘three p’ rights categories aforementioned have been largely ignored or violated by pandemic response plans. First, young people have not been able to participate meaningfully in pandemic planning efforts in any of these countries, despite being directly affected by measures themselves. This concern has not appeared to be a primary consideration on the agendas of the countries examined here. Article 12 in the CRC states that young people have a ‘right to express [their] views freely in all matters affecting [them]’ and for their views to be ‘given due weight in accordance with the age and maturity of the child’ (58). As such, lacking public policy space in the COVID-19 context, for these views to be considered, is a direct breach of young people’s rights to participate. Additionally, the lack of transparency to disseminate COVID-19 related information with young people conflicts with the rights that young people are due according to Article 13 of the CRC (58).

 

Second, and as previously highlighted, confinement, school closures, and other pandemic measures have meant that some disadvantaged children are compelled to live in harmful homes and community settings, as young people are inadequately protected because harm is more difficult to prevent behind closed doors. Most clearly, article 19 in the CRC claims that, ‘States Parties shall take all appropriate legislative, administrative, social and educational measures to protect the child from all forms of physical or mental violence, injury or abuse, neglect or negligent treatment, maltreatment or exploitation’ and, in addition, ‘such protective measures should, as appropriate, include effective procedures for the establishment of social programs to provide necessary support for the child and for those who have the care of the child’ (58). In the context of COVID-19, young people continue to face mental health impacts, especially those within marginalized communities and facing social disadvantages, as the implementation of measures to redress these harms have not been adequately prioritized. Depending on the country, other articles associated with ‘protection’ within the CRC also appear to be violated by pandemic responses, as demonstrated by impacts highlighted above, including: article 22 (protection of children with refugee status), article 23 (protection of children with preexisting mental or physical conditions), article 24 (rights of children to be able to access a high standard of health and health care in order to protect against threats to one’s health), article 25 (protection of children in state care, including foster care), article 32 (protection from economic exploitation and performance of child labour that interfere with education, health, or well-being), article 34 (protection from sexual exploitation and sexual abuse), and article 36 (protection against all other forms of exploitation) (58).

 

Finally, the ‘provisional’ articles within the CRC are meant to outline the ways in which state bodies will provide support to young people and the associated rights young people have to receive this support. However, as the summarized impacts above have illustrated, there are numerous ways in which these actions by governments are not being sufficiently actualized, thereby undermining young people’s rights. Specifically, rights that seem to be infringed are associated with: article 17 (provision of information by mass media aimed towards and focused on young people), article 18 (provision of support for parents who are raising children, where necessary), article 26 (providing sufficient social security that takes into account the resources and circumstances of the child), article 28-29 (provision of education to young people that aligns with their capacities), and article 31 (provision of time and space to rest and to engage in play and other recreational activities) (58).

 

While many government responses have certainly been effective for reducing virus transmission, to differing degrees depending on the country, they have remained inadequately attentive to young people’s rights—rights that have, by many ethics, legal, and human rights scholars, been deemed to have strong normative force due to their conceptual indifference from human rights generally (60). Consequently, young people have been silenced in the pandemic by having their social status pushed to the margins of the political backbone in each country. However, given that pandemic responses are, largely, paternalistic in nature for the purpose of promoting public health as a whole, some might still ask why children’s rights matter (or ought to matter) in the context of a global pandemic. This question misses the mark. The restriction of individual and group rights is a significant concern in many countries and requires substantial evidence to indicate why and when it is permissible to override these rights for a ‘greater good’, but the same consideration is often not granted in cases where children’s rights are overridden. As such, why do violations to children’s rights (for collective good) seem to not be granted the same regard?

 

Responding to this question, in a way that aligns with the notion of ‘best interests’ developed above, forces us to return to the initial question and work backwards to understand why rights (in this case, children’s rights) have moral thrust. In doing so, a natural alignment emerges with the Capability Approach (CA) to justice (as constructed by Sen (61), and expanded by Nussbaum (62) and Venkatapuram (63)) and allows an additional layer of ethical rigor to be added to our commentary’s assessment. CA asserts ‘supporting—protecting, providing, expanding, restoring, and so forth—the capabilities of individuals to conceive, pursue, and revise their life plans’ to a minimum threshold (63, pg. 90). The initial premise of this ethical framework is that the ‘opportunity to reach states of proper functioning and well-being are of basic moral significance and that the freedom to reach these states is to be analyzed in the language of “capabilities”’ (64, pg. 259). Capabilities are of primary focus rather than goods (e.g., income) because goods only gain value based on what people can do or be through these goods (63, pg. 90). In Nussbaum’s account of CA, she distinguishes her approach by identifying ten ‘core capabilities’ that all citizens ought to have available to them (64, 65), many of which overlap with the children’s rights outlined in the CRC. These capabilities include:

  1. Being able to live a normal lifespan
  2. Being able to have good bodily health, nutrition, and shelter
  3. Having capacity for bodily integrity (specifically, being able to move freely, be free from violence, and opportunities for reproductive choice)
  4. Being able to use senses, imagination, and thought in an informed way through diverse education
  5. Having capacity for emotions and emotional attachments
  6. Being able to possess practice reasoning to form a conception of the good
  7. Being able to live meaningfully in affiliations with others and with one’s self
  8. Being able to have concern for other species
  9. Being able to play
  10. Having capacity to control environment through being an active citizen and being able to participate politically

According to Nussbaum, all ten of these capabilities, up to the threshold level required for sufficient dignity of the person, form the ‘minimum requirements of justice’ and, as such, justice requires that societies ensure the world (beyond an individual state one resides in) does not interfere with individuals’ development of their core capabilities and political participation (64, pg. 260). It is a demanding approach to justice because it requires us to not obstruct an individual’s attempt at flourishing (a negative requirement), while also supporting efforts made by individuals to flourish (a positive requirement) (64). CA is considered a ‘partial theory of justice’ by Nussbaum, as it does not provide a comprehensive list of the necessary and sufficient requirements of justice, but rather relies on a minimum threshold (63, pg. 90).

 

Nussbaum (at least initially) claimed that the focus on capabilities is more readily applicable to adults based on the dominant belief that we must respect the choices of adults to determine their own lives, while, for young people, our focus ought to be on achieving a minimal state of functioning (63). However, supporting this dichotomy between approaches to justice for adults and young people fails to treat the young person as a moral agent and undermines the societal need to take the choices and preexistent capabilities of all young people seriously. Advances in childhood ethics make the case for there being applicability of CA to young people. Therefore, considering the partial nature of this approach, expansion of CA may focus more particularly on the ways in which young people require relational support to have their needs met, based on the psychological, political, biological, and legal disadvantages they face.

 

In terms of the connection between CA and children’s rights, capabilities have been positioned as ‘a clarification that enhances the connection between human rights (and children’s rights) and human dignity’ as dignity is inherent to the ten capabilities. Since human rights (and children’s rights) safeguard capabilities, they also can also safeguard human dignity (66); this is also true in the case of children’s rights safeguarding the capabilities and, by extension, dignity of young people (67). Capabilities are also granted the status of being affiliated with a basic human right or moral entitlement following global deliberation (68), and this is also true when we examine the ways in which the rights within the CRC were determined.

 

Therefore, when it comes to the question of why we ought to regard children’s rights with the same major consideration that the human rights of adults are afforded, the answer is clear: both human rights (broadly) and children’s rights (specifically) outline the capabilities and dignity we ought to protect. In the context of COVID-19, where various rights of children are not being protected, upheld, or prioritized in the face of mandatory choices about resource allocation, young people are having their capabilities undermined and ignored and, by extension, their dignity threatened. When young people are not able to participate, are not protected despite evidence that indicates increasing psychological, social, physiological, and economic harms (including significant risk of abuse), and not supplied provisions to improve their lives, their capabilities are not sufficiently met to the threshold degree such that dignity is ensured. As a result, this pandemic has exposed the significant injustices that young people are forced to confront, in the resource-rich contexts (like Canada, as identified by members of our team in another commentary (47)), but especially in resource-limited contexts (like the countries examined in this commentary).

 

 

  1. Ways forward/recommendations

Therefore, it is the task of governments, NGOs, and policymakers (in the resource-limited countries that are affected, but also those that exist as allies in resource-rich nations) to redress harms faced by young people and the task of the UN Committee on the Rights of the Child, along with national youth protection advocates and bodies, to hold each country accountable to their commitment to children’s rights outlined by the CRC. With this in mind, we finish with the following broad recommendations and calls to action:

  • Invest government resources to (a) support parents/families/caregivers and educators to improve communication with and resources for young people, (b) improve healthcare infrastructure, and (c) support organizations and centers that aim to improve child well-being;
  • Integrate parental recommendations established by UNICEF regarding the inclusion of young people, transparency of pandemic-related information to engage with young people, avoiding violence, supporting play (in safe ways), and ensuring parents/caregivers are supported to act as calm as possible when discussing COVID-19 with their children (69);
  • Prioritize the needs of young people and families from less privileged positions or settings (e.g., families with lower socioeconomic statuses, homeless children, orphans, families from marginalized communities, etc.) to ensure their capabilities and interests are met and to mitigate impacts of systemic disadvantage within a pandemic context;
  • Engage in and financially support specialized research that is focused on ‘global’ pandemic child ethics, including studies that assess why child participation is often not situated as a priority in a global context;
  • Develop educational (school-based) tools and strategies to teach children that are informed by the actual identified needs of young people and their families from diverse socioeconomic positions;
  • Consider the implementation of free (government/agency funded) mental health support, programs and tools in each country, based on the prominence of concern for the mental health of young people as a result of psychological impacts they have had to experience during and following COVID-19;
  • Learn from compassionate community models to develop more robust community health frameworks that support the collectivist values and needs of the ‘global child’ and family; and
  • As Dr. Kay Tisdall stated on a recent panel hosted by a variety of children’s rights interest groups (70), ‘we need to stop asking whether we involve children and young people, so the question [can] become how we are going to do so’ and, by extension, how to do so as meaningfully and effectively as possible; this is true in the context of the pandemic where young people, especially those from resource-limited nations, face significant injustices.

 

The words of President Nelson Mandela’s included at the outset of this piece were intended to highlight the duties individuals, institutions, governments, and societies have towards young people. Though they face significant impacts and injustices from the pandemic, linked to the ways their capabilities, rights, and dignity have been overlooked (especially in resource-limited nations), we must act to relieve these impacts and find suitable, effective, and young person-guided solutions to avoid future instances of similar harm. There is still time to build a better ‘soul’ (as President Nelson Mandela said) for individual countries and for our world. There is still time to prioritize the young person as they are—‘here and now’.

 

 

[1] We chose this term as it reflects many of the challenges that were identified in the searches conducted for this commentary, pertaining to the limited health care, socioeconomic, political, and welfare resources available for the countries chosen in this analysis. The term was also selected because it departs from the ‘developing nations’ rhetoric that has been said to subsume resource-limited countries under Western nations and to imply a hierarchy.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Economic Inequality Fuels the Spread of COVID-19

By late summer of 2020, as new cases of COVID-19 showed signs of a resurgence, it was evident that Canada’s recovery from the pandemic was years, not months, away. More than that, COVID-19 has put the class divide into a sharp focus.

Consider who has felt the brunt of the pandemic so far. Lower wage and part-time workers in essential services in retail, public transit, and health care who cannot easily practice physical distancing. This group is poorer, more racialized, more female, younger, more likely to live and work in overcrowded conditions, least likely to be unionized, and disproportionately more likely to have been infected. They have not been able to take time off work or advocate for an extension of hazard pay.

Then there are the unemployed and underemployed who were furloughed or laid off, have used up any paid leave or savings they might have had, and see few opportunities to return to work. Canada’s unemployment rate in February 2020 was 5.6%. By May, it was 13.7%.

Consider as well Canadian adults with disabilities, many of whom straddled the poverty line before the pandemic and now have extra expenses, complex health needs, and fewer opportunities to work. Those who received disability benefits did not qualify for more generous programs like CERB and are now accumulating new debt as a result.

Despite the rush of government aid programs that were meant to cushion the blow of the shutdown, these groups are in a more difficult place than they were before COVID-19.

Meanwhile, there is a relatively fortunate a group of high-earners—professionals and highly skilled public employees that maintained steady incomes throughout the pandemic. Some are anxious, tired of Zoom meetings, or bored. Many have continued to work safely from home, paid down debt, and accumulated savings. Most are doing fine.

The economic gaps between these groups have been widening for decades and are unlikely to close in the midst of a national emergency. In fact, they will compound the health and social impacts of COVID-19 and make economic recovery more difficult. Wide social disparities in wealth and opportunity are not what you want when so much depends on mobilising public support for physical distancing policies, masks, handwashing, and prolonged disruptions to travel, commerce, and social and cultural activities.

There are two main reasons for this, both equally depressing. First, looking globally at the distributions of income and economic wealth in different countries, there we find that inequality aligns with biased social policies that benefit the rich through lower taxes, fewer protections for lower-wage workers, and less generous government investments on health, education, and other social services (see for example Daniel Béland’s blog on a Canada-USA comparison). Where inequality reaches extreme heights, and the rich see that they have less to gain from sharing their wealth for the common good, there is reduced support for democratic institutions and public health agencies, increased support for a strong leader to restore social order, and a drift towards plutocracyMasks and MAGA hats are rarely worn together.

Second, countries that are more unequal also have larger health inequalities and tend to have worse health overall and more social problems. The various consequences of inequality on population health are well documented and the data point—more or less— to class anxiety and distrust that flare across class lines. The problem here is not abject poverty in the absolute sense. It is the juxtaposition of poverty alongside extreme wealth. Constantly having your nose rubbed in your poverty reduces feelings of control in life and intensifies its frustrations and stressors.

In countries like Brazil, Russia, South Africa, and the United States, we are witnessing the reciprocal effects of toxic economic inequality, health disparities, and stumbling, inept government responses to COVID-19. A few of the world’s most unequal countries sit at the top of the world league tables of COVID-19 cases and deaths. They will probably stay there.

But Canada has no reason to be smug by these international comparisons. This pandemic has exposed deep-rooted inequalities that needed sustained government action before COVID-19 and may now hold the key to recovery. Come the next national election, Canadians are likely to hear a lot about budget deficits, the national debt, and spending cuts. Now is the right time for a serious discussion about ways to reduce inequality in this country, beginning with a Basic Income Guarantee.

 

For further reading, see: The trouble with trust: Time-series analysis of social capital, income inequality, and COVID-19 deaths in 84 countries

Elgar, F. J., Stefaniak, A., & Wohl, M. J. A. (2020). The trouble with trust: Time-series analysis of social capital, income inequality, and COVID-19 deaths in 84 countries. Social Science and Medicine. https://doi.org/10.1016/j.socscimed.2020.113365

The Return of the Welfare Landscape ? Remaking and Improving the Materiality of Redistributive Justice

We’re in a time of outrage, confusion, great uncertainty, and the ugly spectre of widespread total cynicism. We’re also in a moment of opportunity, if we can get beyond the tear-it-all-down rhetoric spewing relentlessly from the ‘left’ and the ‘right’ of the political spectrum. Now that almost six months have elapsed since the pandemic came to be taken seriously in countries such as Canada, an initial sense of urgency is gradually being complemented by deeper and broader conversations about how policymakers should proceed. This is where—or why—I want to make a broad suggestion, as someone who specialises in design, planning, and policy for everyday infrastructures, both material and institutional, but also as a landscape ethnographer who is fascinated by how we collectively muddle our way through defining the architecture(s) of the human condition.

What we are seeing, with COVID-19 and how the State has reacted quickly, for better or for worse, is potentially a renaissance of so-called ‘welfare landscapes’. These are especially seen in the Nordic countries with what Gøsta Esping-Andersen (1990) described as comprehensive social-democratic forms of welfare capitalism, but also seen in furtive ways in postwar Canada. By this I mean not (just) the metaphorical landscapes of institutions, policies, and programmes, but very much the material landscapes through which those priorities and/or processes take physical form in ways that endure through time, with impacts for who has secure access to continuous opportunities for wellbeing. For several years, I’ve been exploring this question through a project with colleagues in Sweden with funding from the Swedish Research Council on Sustainable Development, and the current pandemic has revealed it to be all the more germane in Canada and elsewhere.

It is hugely important that we seize the COVID-19 moment to make, remake, and enhance various infrastructures of redistributive justice, as discussed by Raphael & Bryant (2015), among others, to improve upon past (incomplete) attempts to collectively create ‘welfare landscapes’. We see this in the many expressions of shame, humility, and/or frustration at how so many people in ‘rich’ countries are suffering the effects of COVID-19—in terms of how readily households can access green space as well as decent housing that enables them to work remotely without major difficulty and neighbourhood services necessary to everyday wellbeing. Attention has also been drawn anew, as it should be, to the general failures of supposedly progressive urban policies and the spatial patterning whereby  neighbourhoods with high levels of ethnocultural diversity tend to have high rates of COVID-19 infection. We can do something more than wring our hands and moan. In effect, the climate emergency requires that we take real action beyond the endless rhetoric (Lister, 2016 ; Moe, 2019).

As Honor Bixby has articulated so well in this series, now is the time for us to collectively redefine priorities and actions so that central government empowers local municipalities and civil-society organisations to ensure proper support for marginalised populations. Her message—asserting the importance of subsidiarity—is one with which I completely agree. Among Bixby’s six priorities, which rightly include mobility for essential travel, education, food security, and mental health, the most vital is how to ensure equitable, secure access to good housing for all members of society. I want to take this further, scaffolding up a set of policy questions that are thoughtfully foreshadowed in another contribution to this series by Annmarie Adams, reflecting on how attitudes toward home and place are shifting in terms of the de-facto continuum of private and public space. My suggestion is that we see housing as indissociable from its context, in terms of broader physical, ecological, institutional, cultural, and economic processes, as a matter of concern for health and wellbeing. I’m fortunate to work with a network of Canadian specialists grappling with this with a view to significant institutional reform, but we need broader coalitions of support.

My premises are hopefully clear and self-evident: first, COVID-19 has slapped us silly, demanding a deep reckoning on how we deploy ourselves in the physical world; second, significant change is already underway, albeit in ways that are messy, brusque, and even violent; third, an opportunity space has opened up for exciting reform by (and with) private-, public-, and third-sector actors, if we are willing to go beyond ad-hoc ‘emergency’ measures. This is dangerous territory for people in my professional fields of architecture and urban planning, since we have a rather dreadful longer-term track record of dramatic interventions of a utopian nature, as roundly critiqued in sometimes-constructive commentaries that no longer count even as contemporary history, including the work of astute individuals such as Jane Jacobs, Kevin Lynch, Jan Gehl, and Françoise Choay. Bold interventions nominally done in the ‘public interest’ and collectively referred to as ‘urban renewal’ have nevertheless been revisited by critical observers ranging from Katherine Bristol (1991) and William Littmann (1998) to Mikkel Høghøj (2019), François Racine (2019), and André Sorensen and Paul Hess (2015), all of whose work reveals how these were complex assemblages including the handiwork of architects, designers, and planners, but done within institutional landscapes marked by path dependency, political contingency, and ideological ruptures.

“So what” you ask? Fair question. My point is that we have made deliberate attempts in the past, for better or for worse, to create ‘welfare landscapes’ in Canada, as in other OECD countries. The COVID-19 moment invites us to have another kick at the proverbial can—and to what extent, for whose benefit, and with what mechanisms in place to assess success or failure vis-à-vis the glaring need for redistributive justice. We should be talking about both why and how ‘rich’ (OECD or G7 or G20) countries can act on flagrant matters of concern around housing quality and affordability that have only been amplified by the COVID-19 pandemic. I especially want to assert that physical space matters. This means that we need to talk not just about housing as houses, but also as the ‘milieu de vie’—configurations of buildings, streets, open space for communal use, and specific sorts of amenities such as swimming pools or ‘islands’ of cooler temperatures for relief in summer heatwaves.

What happens immediately—for instance, before the next round of federal, provincial, and local elections in Canada—should be considered in terms of what we do on the one- to five-year time horizon. This matters both in terms of the inevitable next spikes in COVID-19 but also in terms of other aggressive vector-borne diseases (VBDs) that may emerge for the same reasons that led to the current pandemic such as biodiversity loss and the ample pathways for VBDs to spread because of mobility and settlement patterns. It matters in terms of the climate emergency and the future of humankind.

COVID-19 has a message. It tells us that we must talk about who has access to the spaces that are vital to health and wellbeing. We are now seeing widespread evidence of how housing and neighbourhoods are where this access must literally take place. To ignore this message would be a travesty.

 

 

 

 

Bristol, K. (1991). The Pruitt-Igoe myth. Journal of Architectural Education, 44(3), 163-171.

Esping-Andersen, G. (1990). The three worlds of welfare capitalism. Cambridge: Polity Press.

Høghøj, M. (2019). Planning Aarhus as a welfare geography: urban modernism and the shaping of ‘welfare subjects’ in post-war Denmark. Planning Perspectives (online first : https://www.tandfonline.com/doi/full/10.1080/02665433.2019.1672207).

Lister, N.-M. (2016). Resilience beyond rhetoric in urban landscape planning and design. In F. Steiner, G. Thompson, & A. Carbonell (Eds.), Nature and cities: The ecological imperative in urban planning and design (pp. 296-319). Washington DC: Lincoln Institute of Land Policy.

Littmann, W. (1998). Designing obedience: The architecture and landscape of welfare capitalism, 1880-1930. International Labor and Working-Class History (53), 88-114.

Moe, K. (2019). The architecture of work and the work of architecture today. Journal of Architectural Education, 73(2), 251-253.

Racine, F. (2019). The influence of urban design theories in the transformation of urban morphology: Montreal from 1956 to 2018. Journal of Urban Design, 24(6), 815-839.

Raphael, D., & Bryant, T. (2015). Power, intersectionality and the life-course: Identifying the political and economic structures of welfare states that support or threaten health. Social Theory & Health, 13(3), 245-266.

Sorensen, A., & Hess, P. (2015). Building suburbs, Toronto-style: land development regimes, institutions, critical junctures and path dependence. Town Planning Review, 86(4), 411-436.

 

 

 

 

COVID-19 in Canada and the United States: Comparing the Social Protection Responses

by Daniel Béland (McGill University), Shannon Dinan (Bishop’s University), Philip Rocco (Marquette University), and Alex Waddan (University of Leicester)

COVID-19 did not, at least at first, appear to prefer one side of the 49th parallel. In early March, Canada and the United States had virtually identical daily rates of confirmed deaths from the virus. Nor did the virus seem to discriminate in wreaking economic havoc. In April 2020, unemployment rates in Canada and the US surged dramatically to 13 and 14.7 percent, respectively. Yet the United States’ tepid public-health response has created a stark divide between the two countries. As of late July, the confirmed rate of COVID-19 deaths (1 in 2,814) there is now twice as high as the Canadian rate (1 in 4,185). Such national figures should not hide the existence of sometimes dramatic discrepancies among states/provinces, which have been unevenly affected by COVID-19.

Regarding the social policy responses to the pandemic, there is a sharp contrast between Canada and the United States. As the economic crisis took shape, federal and subnational governments in each country enacted temporary social policy measures to mitigate the dire, unprecedented socio-economic consequences of the global pandemic. While social scientists tend to group Canada and the United States together as examples of the “liberal” welfare state (characterized by weak state provision), a closer look reveals a number of startling differences in how each country used the tools of social policy to ensure health and economic security for their populations during the pandemic.

Put simply, Canada acted both more boldly and more rapidly than the United States. In Canada, the policy response has been more centralized despite provinces having jurisdiction over most social policy issues. The federal government quickly adopted emergency economic responses on March 25 and April 11 and has continued to build on them. These include the easy to access Canada Emergency Response Benefit (CERB), which provides income support to affected workers, and employer subsidies under the Canada Emergency Wage Subsidy (CEWS). Together, the government has spent over $69 billion CAD on these policies by the end of June. The federal government also increased federal transfers and funding for vulnerable populations as well as families and students. The pandemic exerted important pressure on provinces which are responsible for healthcare provision. Contrary to the US, Canadians maintained their healthcare coverage under the country’s universal structure. However, the number of cases and, significantly, deaths was disproportionate in public and private long-term care facilities. The cost of these emergency measures and slowed economic growth have created record deficits in the modern era at the federal and provincial level.

In comparison to Canada, the United States acted more slowly and less boldly to respond to the social protection challenges of COVID-19. There were important and potentially expensive measures put in place, but the impact of some of these actions was slowed by existing institutional fragmentation. The problem did not initially lie in Washington DC as Congress enacted, and President Trump signed into law, measures that both created new policy instruments and significantly expanded existing ones. A one-off payment of $1200 per adult and $500 per dependent child was made to people who earned less than $75,000 in their 2019 tax filing. The Unemployment Insurance (UI) program was temporarily adjusted to cover categories of workers losing their jobs who would have ineligible for UI under the existing rules and the federal government added an extra $600 a week to the standard benefits. For many recipients this meant that they were receiving more in UI benefits than they had previously been earning. One piece of legislation, the CARES Act, had an estimated cost of $2.3 trillion, amounting to 11% of GDP. In addition, were the Paycheck Protection Program, which was costed at $483 billion, and the Families First Coronavirus Response Act at $192 billion. But if this upstream action was decisive by the standards of modern Washington DC, the downstream implementation was more problematic. The huge numbers of newly unemployed stretched many states’ administrative capacity delaying payments. This was especially so in states such as Florida that had deliberately made the UI application process to be opaque. Further, Republican opposition in Washington prevented the inclusion of extra federal funding directly to the states in the relief legislation. This was especially problematic for states, nearly all of which are required to balance their budgets, at a time when their expenditures on programs such as Medicaid were rising.

There are three basic reasons for the divergence between these two so-called liberal welfare states. First, as shown in the cases of unemployment protection and health care, Canada possessed a social policy architecture that enabled a quicker response to rapidly emerging conditions. Canada’s universal single-payer system, for example, meant that massive unemployment did not translate into historic waves of health insurance losses, as it did in the United States. Second, even when Canada had to adapt its policies in response to the emergency, its parliamentary system enabled a faster response than in the US, where checks and balances slow down policymaking, when different parties control the House and the Senate. The immense power of the executive in Canada isn’t without its problems, however, as the Liberal government undergoes an ethics investigation for benefit administration. Ultimately, this slowed down benefit delivery for student volunteers. Third, the intense polarization of American political parties relative to their Canadian peers has accentuated the gridlock caused by the separation of powers, and has further frustrated the development and maintenance of emergency relief programs in the US.

While long-term trends in both countries are difficult to predict, the social policy divide between the two countries is already great. If anything, that means the gap between the two countries on major indicators of income inequality and health disparities is likely to grow.

No place like home: Changing relationships of private and public space during COVID-19

Most of us have been stuck at home for the duration of the COVID-19 pandemic. This has underlined a longstanding image of home as a safe haven and a retreat. While “cocooning” typically brings on a cycle of intense consumption, buying stuff and doing house renovations have been difficult. Instead, we’ve turned to hoarding groceries (Fig. 1), re-arranging the furniture, editing our closets, solving puzzles (Fig. 2), cultivating house plants (Fig. 3) and baking bread (Fig. 4). As the weather improved, we gardened.

Fig. 1: Weekly grocery hauls for our family of four were much larger than usual. When lockdown began, on March 13, there was still snow on the ground.

Many Montrealers live in buildings constructed before World War I. These Victorian and Edwardian houses and apartments are set up well for both sickness and work-from-home. Pre-modern houses typically have discreet rooms arranged around circulation systems like corridors and stairways. Victorian rooms were single purpose and designed for particular family members. The parlour, for example, was for the wife and mother; the dining room, was for the husband and father. The house was an extraordinary ordering system, clearly communicating each person’s place in the universe through design. A key to its magic was its capacity for isolation.

Fig. 2: The Adams-Gossage family fridge scrabble is restricted to terms related to COVID-19.

By contrast, many homes since the 1920s, and especially after World War 2, have open plans. Modern rooms are often multi-purpose, with sight lines into other multi-purpose rooms. The postwar family room is a great example, often connected to a combination kitchen-dining room. It’s not a place where it’s easy to quarantine. The post-war kitchen, for example, was a kind of technological command centre, designed so that a single worker, the wife and mother, could cook, clean, and care for kids simultaneously.

Fig. 3: House plants are our companions, including refugee plants from our university departments.

As more people get sick (knock on wood), will the home become a container for sickness, rather than a retreat from COVID-19? For many of us, our work lives now occupy our bedrooms, dining rooms, family rooms, and basements. My own work space (Fig. 5), for example, is in a corner of our bedroom, a spot that I transform every morning for work; and take down every evening, for sleep. Post pandemic, how will we separate work and life? On Zoom we can use different backdrops to frame our work spaces, but what is the backdrop for real life? Is a new style of home with dedicated and separate spaces for work on the horizon?

Fig. 4: Our bread standards went way up and we even started to experiment.

I’ve been thinking a lot about the Victorian sick room, where family members were nursed back to health without risk to other family members. Another recurring image is the home library/office for the man of the Victorian household, which sometimes had a separate entrance. Similarly, doctors’ offices in houses (this was common in the 20th century) is an interesting precedent for the accommodation of work at home, where pocket doors or changes in décor would indicate a clinical section of the house plan, allowing a separation of medical practice and family life. Will those with the means to renovate adapt their houses in these retro modes?

On the flip side, the pandemic has illuminated “the workplace” as somewhat unnecessary and as a potential source of contagion. If we all work from home, what will happen to our city centres? Where will business-people meet clients, in public parks and squares? Surely not in homes. What is the post COVID-19 “public sphere”? We’ve all seen the images of futuristic offices with separate bubbles for each employee. How one gets to a bubble, however, is unresolved.

Fig. 5: My improvised home-office is a little-used dining room table, moved to a corner of our bedroom, with an ever-changing Zoom backdrop as smokescreen.

The pandemic has illuminated the hospital as a source of contagion, and thus a place to avoid. How will hospitals change after COVID-19? I suspect hospital architects will focus on preparing for the unexpected. I’ve watched with some amusement the return to the so-called “pavilion plan” for emergency hospitals in cities like London. Pavilion-plan hospitals maximized ventilation; its hallmark feature was the Nightingale ward, where 30-36 patients occupied beds interspersed between often-open windows. These spaces resembled barracks. Montrealers may know it from the old Royal Vic, in use until 2015 (Fig. 6). This type of hospital-as-shed, we have learned, is better than nothing, but might it also be better than the purpose-built hospital with its inflexible circulation and single-purpose planning?

Additionally, the pandemic has revealed long-term care institutions as sources of contagion. One might even say that long-term care is our new image of hell. Few speak about the architecture, beyond the need for single rooms. The architectural problem is much larger than density. Long-term care is a very low prestige building type among architects. There is next to no encouragement in schools of architecture to take on buildings that solve social problems, let alone “warehouse” old people. There are few design awards for long-term care; housing in general rarely gets published in the glossy magazines and websites. What incentive is there for innovation? Sometimes I think it should be called Long-term Not-care.

Fig. 6: The now empty Royal Victoria Hospital wards once housed 32-36 patients, separated by open windows. The pavilion-plan hospital maximized ventilation in order to minimize contagion.

My theory about why the long-term care nightmare of COVID-19 has been so shocking is because it de-stabilizes our image of home as a safe haven.

On the bright side, and to conclude, I like the way the pandemic has brought new admiration to older, low-tech systems like the Victorian house, the sick room, and the pavilion-plan hospital.  Relatedly, I embrace all the hand-drawn signs and optimistic, crooked rainbows (Fig. 7). I think they are evidence that what we design post COVID-19 will have a more human touch.

Fig. 7: Delightful, hand-drawn rainbows, with the optimistic message ça va bien aller, decorate windows all over Montreal.

Graphic advice by Anaik Fortier and David Theodore. Photos and bread by Annmarie Adams. Rainbow by Katie Adams-Gossage. Fridge scrabble mostly by Peter Gossage.

Some recommended readings on changing notions of home and work:

Annmarie Adams (and others), “Field notes on pandemic teaching: 5,” Places (April 2020)

Kyla Chayka, “How the Coronavirus will reshape architecture,” New Yorker (17 June 2020)

Harriet Little Fitch, “Will our homes look different after the pandemic?” Financial Times Magazine (6 June 2020)

Edwin Heathcote, “Between dreams and delirium: reflections on illness, Financial Times Magazine (20 June 2020)

Joe Moran, “Out of office: has the homeworking revolution finally arrived?” The Guardian (11 July 2020)

Annalise Varghese, Maram Shaweesh, “Rethinking ‘home’ post pandemic,” Parlour: women, equity, architecture (29 April 2020)

Enabling Cities: Lessening the impacts of Covid-19 on the urban poor.

Reference to Covid-19 as ‘the great leveller’ was short-lived. As critics foresaw, the pandemic has brought societal inequalities into sharp focus. Privileges of the wealthy and middle classes reduce the risk of not only contracting the virus, but also dying as a result of infection and suffering the pandemic’s longer term social and economic effects. This is most evident in cities where the poor and rich live in close proximity and the urban poor and working classes carry a disproportionate burden of the Covid-19 pandemic.

Racial disparities in Covid-19 incidence and outcomes, as seen in the U.S. and U.K., are a reflection of long-standing inequalities acting to exclude Black, Asian, Indigenous and Minority Ethnic people from privileged positions, and place them among those most vulnerable to Covid-19 infection and death.

The pandemic response can and should prioritise equity
The examples that follow demonstrate the capacity to prioritise equity in the pandemic response. As cases continue to rise in some regions and localised outbreaks have seen cities re-shutdown, cities and local governments must use their structures, powers and assets to go further in championing equity and engage with community members to address local needs. Fast and definitive action from decision makers, ‘out-of-the-box’ ideas, and new partnerships between government, private sector, and civil society remain essential to mitigate the pandemic’s impacts on cities’ vulnerable communities.

Secure safe housing. The stay-at-home orders – used around the world to limit spread of the virus at the root of the current pandemic – prioritised the need for universal housing. Emergency legislation to temporarily suspend evictions, freeze rents and ban foreclosures gave residents in countries including Spain, the U.K., the U.S. and Canada some security against the threat of eviction, when incomes declined or stopped amidst business closures and job losses, especially in the gig-economy services. Several cities across Canada temporarily suspended deadlines for municipal property taxes and utility payments.

Cities needed to rapidly and safely house their homeless. The U.K. provided an emergency fund of £3.2 million for accommodation to support self-isolation of people without permanent housing, establishing facilities to separately house and monitor those infected. Overcrowding in homeless shelters led to outbreaks in many places. In response, thousands of homeless people considered most likely to require hospitalisation or die as a result of infection were placed in the vacant hotel rooms of cities, including Los Angeles and Toronto, where social distancing could be more easily practiced.

Maintain urban mobility for essential travel. Major cities, including London and New York, reduced public transport services to minimise non-essential travel. To promote alternatives to mass transit for people needing to access and deliver essential services, road driving charges were suspended during lockdown in London, U.K., and public bicycles were made free to use for healthcare workers. ‘Tactical urbanism’ projects improved walking and cycling infrastructure overnight.

Some regular services were maintained for those without cars needing to travel longer distances. Increased cleaning frequency, reduced station counter services, entrance/exit of buses restricted to doors furthest from drivers and mandatory face covering were among the policies implemented to optimise the safety of riders and providers on operational routes.

Enable continued learning for poor children. In March, 85% of the world’s students were out of school due to pandemic closures. Many schools began distance-learning through online platforms. Many students in low-income households without the necessary resources to participate faced additional hardship. Chromebooks and iPads were distributed to students without devices in cities in the U.S, Canada and Australia. The U.S. government coordinated the ‘Keep America Connected’ pledge among broadband service providers to keep people connected, regardless of payment, and to provide free or low-cost service to low-income homes.

Address growing food insecurity. Demand for foodbank assistance soared, forcing the scale up of existing infrastructure with financing and personnel to meet the growing need. The U.S. national guard was deployed to help cities cope with an up to eightfold increase in food bank demand. Urban charities have set up “drive-through” distribution points for food and essential supplies and organised volunteer meal delivery to elderly and vulnerable populations. Many supermarkets limited essential item purchases to prevent stockpiling by those who could afford to do so. Quito, Venezuela, used a food system map to target assistance to vulnerable neighbourhoods and supported home delivery of produce from local urban and peri-urban gardens.

Over 850 thousand students in England and 30 million students in the U.S. participate in free or discounted school meal programs. Schools in the U.K. were mandated to continue providing meals during closures. Furthermore, a voucher program allowed schools to issue supermarket gift cards to carers of children that qualify for free meals. Cities like Baltimore opened up emergency food distribution sites with grab-&-go breakfasts and lunches for any child.

Support for victims of domestic abuse. Heightened anxiety and home confinement were linked to surges in calls for assistance to Women’s advocacy groups and emergency hotlines in many places. Several governments exempted abuse victims from fines that were in place to enforce stay at home regulations. Paris established a code word alert system for victims’ use in pharmacies. France additionally paid for 20,000 nights of hotel accommodation to relocate people away from abusive situations. Safe-guarding practices in some U.K. schools had teachers make weekly calls to students during school closures.

Support for mental health services. The communities carrying the disproportionate burden of Covid-associated ill-health, loss and uncertainty are most risk of suffering the pandemic’s mental health impacts. To offer free support to those in need, Toronto developed a pandemic support strategy in partnership with local organisations to complement existing services. The London mayor worked with ThriveLDN to coordinate mental health support through healthcare, charity, education and business organisations.

Many cities under lockdown have allowed residents to leave homes for daily exercise and maintained the access to nature provided by local parks, particularly important for families lacking outdoor space at home.

Moving Forward

These strategies have not been without criticism. Some fell short of their stated goals and left needs unmet; for others the implementation timelines left people at risk for lengthy periods. As countries reopen, any short-term policies and programs should be replaced with longer term efforts to address the urban inequalities exasperated by the pandemic. Investment in a green economic recovery, for instance, would reduce urban environmental hazards that are too often concentrated in poor neighbourhoods.
Dealing with the challenge of urban inequalities requires coordinated action across multiple sectors including housing, transport, education, health and wellbeing. It is cities and local government who have learned over-and-over how to deliver services efficiently and can address local needs. It is local government and local organisations that have demonstrated their efficiency in this crisis. It is time that national governments should pass resources and jurisdictions to them in order to better support the urban poor.

CHSLDs in Court: Thoughts on Government’s and Managers’ Liability.

The COVID-19 pandemic is revealing the extreme vulnerability of elderly people. The situation being relayed by the media, the Canadian military, and many other witnesses is grim. Our current understanding will be supplemented by the Quebec Ombudsperson’s upcoming investigation, which will no doubt help to better identify the various factors behind this tragic state of affairs.

Liability lawsuits (including class actions) are one response to the pandemic, and its effects on the elderly, that is currently emerging. At this time, there are two class actions against private care homes in Quebec and seven in Ontario. The affected families’ feelings of helplessness and anger may indeed lead them to blame individual actors within the “CHSLD system”, when it is perhaps the system itself which is failing. To understand everyone’s responsibility for the current tragedy, it is essential to ask ourselves: What system are we referring to? What failures are we talking about? Who is involved?

What system are we referring to?

Three types of long-term care facilities (CHSLDs) exist in Quebec: public, private, and private under agreement. Public CHSLDs are part of the Quebec health and social services network and are operated by Integrated Health and Social Services Centres (CISSS) as well as Integrated University Health and Social Services Centres (CIUSSS), which are both public organizations. Private administrators manage private CHSLDs, as well as private CHSLDs under agreement, which are funded by the government. It is essential to distinguish these categories of CHSLDs because they entail important differences in the extent of the harm experienced by our seniors, the mode of the CHSLD’s administration, and the legal framework for the liability of the CHSLD’s managers.

What failures are we talking about?

The law of civil liability (tort law—or responsabilité civile in Quebec) deals with the allocation of responsibility and the compensation of victims for an injury that has been suffered on a case-by-case basis. It is therefore difficult to generalize about the possible outcomes of legal proceedings instituted in response to the tragedy experienced by our seniors. For example, the chronic underfunding of long-term care homes or the low salaries for employees that have been the subject of discussion for years would not be treated in the same way as the contamination of personal protective equipment during the pandemic. Failures within CHSLDs to respect infection prevention and control guidelines would not be considered similarly to the government’s decision to transfer seniors to CHSLDs in order to open beds in hospitals at the start of the crisis. Some issues are individual, others are organizational; some involve political decisions, others manifest themselves on the ground.

Who is involved?

Finally, the criticisms of CHSLDs target three very different categories of actors: the Minister of Health and Social Services (the government), the entities that operate CHSLDs, and employees of CHSLDs. Can victims demand that the courts hold each of these actors accountable? Let us leave aside the situation of employees and discuss claims against the government and CHSLD managers.

Immunity shields many government decisions from liability lawsuits. The Quebec Public Health Act grants immunity to the government, the Minister of Health or “another person” for acts performed in good faith in the exercise of powers held under a declaration of public health emergency aimed at protecting the health of the population (s. 123 PHA). Bill 61 provides for a similar immunity (s. 51). As for government decisions that precede or fall outside this declaration or the ambit of Bill 61, partial immunity protects those decisions that deal with the allocation of resources and the determination of health priorities, unless they are made in bad faith or are irrational (see e.g., Cilinger v. Quebec (A-G) and Khoury 2016).

What about CHSLD managers? Will the CIUSSS/CISSS operating a public CHSLD be immune from liability proceedings as “another person” exercising powers under a declaration of public health emergency? The answer to this question is far from clear. If not, the CIUSSS/CISSS will be subject to the ordinary rules for liability, just like the managers of private CHSLDs and private CHSLDs under agreement. Their liability will depend on having committed negligence that caused the injury a victim has suffered (art. 1457 CCQ), for example, having failed to put in place reasonable infection prevention and control measures.

When evaluating negligence, judges will have to disentangle the roles and obligations of all the actors involved. They will have to establish how they are going to take account of the exceptional circumstances these actors faced, the lack of resources to which they had access, the urgency with which they were required to make decisions, and the changing and incomplete scientific knowledge that underpinned their pandemic management. Judges will also have to rely on public health experts to define what the reasonable standards are for curtailing a pandemic, given the novelty of the situation, taking into account the uncertainty that existed at the relevant time (see e.g., ter Neuzen v. Korn).

Finally, in addition to the existence of negligence, liability is conditional on the existence of a causal link between this negligence and the injury (the death of residents, for example). Tracing the transmission path of an extremely contagious virus whose carriers are often asymptomatic is not an easy task; assessing the causal link between organizational failures and the deaths of our seniors will be equally difficult (Khoury 2012).

Research funded by the McGill Emergency COVID-19 MI4 Fund / MUHC Found

 

 

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