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Pandemic offers chance to remedy structural ills

Updated: May 10, 2022

The Covid-19 pandemic highlights long-standing social ills, but it also offers an opportunity for government to experiment with actions to correct some of the dynamics that undermine our social structure and threaten our stability as a nation.

Widening income, wealth, education and health care disparities contribute to political polarization, but so far there’s little evidence the political will exists to improve conditions that keep some in society down while enriching others. The influx of Covid-19 stimulus money offers North Carolina an opportunity to address some of these problems. Failure to face them now imposes future fiscal and social costs on everyone.

The pandemic exposes historical social dynamics, according to Jay Pearson of the Sanford Public Policy School at Duke. He researches structural inequality and its influence on health determinants. The dynamics “are playing out exactly the way those of us studying it have been arguing they would for the last 40 years.”

The most at risk include African Americans, Latinx, essential workers, the elderly and people without enough food. This partial Covid-19 worry list demonstrates the crisis at hand: an expected rebound in Covid deaths, post-lockdown; a drop in U.S. spending: and a 14.7 percent unemployment rate.

Frontline, essential workers, earning low wages in person-to-person high-contact jobs, sometimes without sick pay, are among the most vulnerable. Some are even penalized for calling in sick. They face a choice between working, and exposing family to a deadly virus, or not working and going without pay. Either could be life-threatening.

North Carolina could implement public policies that benefit these high-risk workers—janitors, bus drivers, cashiers, and more. Such policies could not only lift the consistently marginalized, but also save taxpayers money down the road. For example, when meat packing firms refuse to pay, and may even penalize workers for sick time, it could be argued that this amounts to a business subsidy for a behavior that endangers others. Such practices cost taxpayers, even absent a pandemic, through lower productivityand higher healthcare costs. Besides helping workers, requiring companies to offer paid sick time, as a number of states do, could go far in preventing the spread of Covid-19 as the state’s economy reopens.

Another option would be to make better use of existing social assistance. Unemployment insurance and Medicaid are designed to support the jobless and uninsured, but North Carolina’s programs have draconian eligibility standards. Almost 11 percent of North Carolinians have no health insurance, the tenth highest rate in the nation. That threatens the health and finances of the uninsured, who may forgo preventive care and accrue medical debt.

Only adults who are elderly, blind, pregnant, or living with the certified-disabled or dependent children are eligible for Medicaid. Even uninsured parents of children who are covered often can’t qualify: the adult threshold is $8,004 of annual income for a family of three, less than half that of the poverty line.

Fewer than 10 percent of unemployed workers receive unemployment benefits, ranking North Carolina fiftieth among all states; the average unemployment check is $277 per week, with an average span of 8.7 weeks, next-to-last in the nation.

In terms of lives saved (‘human capital’ in econ-speak), improving conditions that perpetuate social ills is not only doing good, it saves money. Every dollar spent on air pollution control, for instance, generates $30 in benefits, largely in healthcare and worker productivity, owing to fewer respiratory ailments, especially among children and old people.

The 1.6 billion in Covid-19 relief allocated by the N.C. legislature, in federal CARES funds, allowed for expanded SNAP (food voucher) benefits for the poor. The money has also added to unemployment benefits. But the legislators failed to expand Medicaid eligibility nor did they revise North Carolina’s barriers to unemployment benefits.

These trillions of pandemic dollars could address structural changes in health infrastructure and employment. That could include living wages and paid sick leave that would benefit all North Carolinians.

“People are calling it a stimulus check—it’s a legitimate response to a social service need,” Duke’s Jay Pearson says. “I’m not sure the funds coming from the [federal government] are going to have an impact on the populations bearing the brunt.”

That would be the shame of the pandemic: that we not only lose valuable lives, but fail to reclaim those who are endangered all the time, through chronic poverty and lack of opportunity.

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