Disease and social precarity – neoliberalism creates social instability that leaves society structurally vulnerable to pandemics, and leads to mass structural violence against the global poor

Matthew Sparke and Owain David Williams, “Neoliberal disease: COVID-19, co-pathogenesis and global health insecurities,” Economy and Space, vol. 54, no. 1, 2022, pp. 19-22, https://journals.sagepub.com/doi/pdf/10.1177/0308518X211048905.

COVID has ripped through the societal fault lines created by neoliberalism across the world. It has thereby brought illness and death disproportionately to communities already deprived and dispossessed by market forces everywhere (Oldekop et al., 2020). Four features of societies colonized by market rule stand out as especially effective vectors of this increased damage due to the pandemic. These are: (i) precarious market supply systems for everything from food and water to housing and education; (ii) economic inequality and its intersection with racial inequalities in intensifying vulnerability; (iii) contingent labor and its exposure of essential workers in the post-Fordist ‘precariat’ to heightened risks of infection; and (iv) social alienation and the biopolitical abandonment of diverse sub-populations to experiences of extreme risk in so-called petri-dish spaces such as prisons, homeless camps, slums, and overcrowded farmworker housing. All four of these features of neoliberalized societies are themselves overshadowed by the disciplinary effects of debt and austerity, a form of financialized and disciplinary neoliberalism that repeatedly elevates the interests of investors over states, labour and state social services such as healthcare (DiMuzio & Robbins, 2020). We address the devastating impacts of this leech-like neoliberal medicine for neoliberal patients of the social state in Section 3 (cf Peck, 2013b). It is the four co-pathogenic features of neoliberalized society that are the immediate focus here.

Direct disruptions due to COVID and the indirect disruptions created by lockdowns have seen a cascade of co-pathogenic effects across the market-based supply systems of neoliberal society globally. With most countries dependent on market-mediated food chains, and with shut-downs especially impacting the informal food markets for the world’s urban poor, the UN’s Food and Agriculture Organization has described the food system implications as ‘a crisis within a crisis’, and the World Food Program stated it represented a ‘hunger pandemic’ from which as many as 30 million people may die because of food precarity (Crush and Si, 2020). Similarly, the informal market systems providing water, toilets, sewers, drainage, and waste collection in much of the neoliberalized global south have made slum-dwellers especially vulnerable (Corburn et al., 2020). UN Habitat has highlighted how informal housing markets themselves exacerbate health risks, threatening mass displacement and further disease spread as the urban poor lose their means of subsistence (UN Habitat, 2020). More generally the informal market networks and movements so often eulogized by neoliberal planners as the urban poor’s own entrepreneurial solution to corrupt market states have accelerated disease spread especially in countries such as India where they are not adequately integrated into public health planning (Patel and Shah, 2020; Raju et al., 2021).

Brazil, Ecuador, and South Africa all illustrate how the vulnerabilities created by precarious market supply systems quickly turned into excess death and increased suffering. In Brazil, poverty and COVID have interacted with the authoritarian neoliberal leadership of Jair Bolsonaro to close down health protections for the working poor in the name of keeping the economy open (Ortega, 2020). Millions in the favelas have had to continue to work in the informal labour market, with as many as 500,000 domestic servants facing choices of working or no pay, all the while bustling markets, queues for charities distributing food, and public transport are packed with people spreading infection, all too many of them heading to the mass graves being dug around Brazil’s cities. In Ecuador, neoliberalism and poverty have also interacted aggressively with the pandemic, with hotspots such as Guayaquil seeing COVID corpses left abandoned in the streets after a government cum IMF decision to disband that country’s pandemic response team in 2019 (Corkery et al., 2020; Iturralde, 2020). And in South Africa, a lack of protections for the unemployed and precarious informal sectors has combined with the legacies of apartheid and the syndemic burdens imposed by other diseases of poverty such as HIV and TB to create killer cascades of co-pathogenic COVID vulnerability and death (Bond, 2020; Bulled and Singer, 2020).

In societies such as the US and UK, where the advance of neoliberalism was once promoted with the promise of wealth bringing health, COVID has instead also indexed interconnections between increasing inequality and mortality (Collins, 2021; Dorling, 2019). These are ties that have come to embody the advance of neoliberalism through the advance of disease among the poor, notably alongside the ongoing consumption of health-related advice by the affluent (such as advice on investing in healthcare and vaccine development, as well as on health-related purchases ranging from exercise equipment and vitamin supplements). Hyper-mobile elites and the oligarchs while profiteering from a crisis, have used private jets, private yachts and luxury enclaves for social distancing, secure in the knowledge that they can still access concierge medicine and get tested first, all the while deprived communities have seen disproportionate COVID death rates. Homeless people have endured the cruel ironies of being told to go into ‘lockdown’ and ‘shelter in place’ when they have no doors to lock. Likewise, while financial markets and investing elites fast regained riches thanks to unprecedented central bank interventions, ordinary working people have been ‘let go’ and furloughed in ways that created an unemployment crisis. In countries such as the US where access to health insurance is largely based on employment, the economic and employment secondary impacts of the pandemic are involving a serious breakdown in access to health services. And in the US especially, where neoliberal norms and policies also mean that quality healthcare is concentrated at the wealthy end of a particularly steep income gradient, COVID has further exposed enormous obstacles to treatment in poor and rural communities facing hospital consolidations and closures– with about half of America’s lowest income communities having no access to ICU beds at all (Kanter et al., 2020).

The class divides of neoliberal societies also point to some of the pathways through which economic inequality has causally contributed to the spread of COVID globally through neoliberal social determinants of health that range from the class-contingent access to information, testing and care, to the insecurities of everyday life in deprived communities and crowded slums, to the layering of acute new stresses on top of pre-existing chronic conditions – untreated hypertension, asthma, obesity and diabetes, as well as HIV and TB – that are closely connected to poverty (Ahmed, 2020). It is critical to note, though, that these are all intersectional causal pathways along which economic inequality has widely compounded racialized inequality in stripping people of health rights. Thus in the UK the government has reported disproportionate death rates and hospitalizations in Black, Asian and Minority Ethnic populations (ONS.GOV.UK, 2021). And in the US the embodiment of inequality in increased risk is especially pronounced in much higher death rates from COVID faced by indigenous, African American and LatinX communities – with hospitalizations being over four times higher than that of white Americans for LatinX and African Americans, and African Americans dying at over double the per capita rate of white Americans, and at still higher rates when deaths of middle-aged cohorts are compared (CDC, 2021; Ford Riley, et al., 2021; Webb et al., 2020).

Due to the intersections of racial dispossession with market forces in neoliberal societies, much of the deadly racialization of risk posed by COVID relates back to the economic imperatives of highly stratified labour markets in which people of color tend to be over-represented in the most acutely exposed ranks of ‘essential’ but contingent workers (Gould and Wilson 2020). Employed in cleaning, driving, meat-packing, cooking, farming, retail and care-work, their inability to work from home during the pandemic has come together with the contingency of their contracts as part of the ‘flexible’ or part-time, post-Fordist neoliberal workforce to exacerbate exposure to the virus (Maxmen, 2021). Unsalaried, un-unionized, and unsupported by pension and workplace health-benefits, they are also menaced by the threat of unemployment or underemployment.

More widely, COVID has been exploiting the societal vulnerabilities created by welfare reform and the rise of a vast global informal sector of wageless life (Peck, 2001). Instead of reliable unemployment insurance and income replacement, and instead of programs designed to help employers keep workers on payroll during downturns, neoliberal workfare states and informal economies have intensified the spread of COVID by systematically removing firewalls protecting workers from precarity. Mass unemployment and the dislocation of the global informal workforce (comprising some 2 billion people) has been felt in all but the world’s least neoliberalized societies. The global precariat has thereby been reduced to searching desperately for work and thus to intensifying viral exposure even as employers benefit in rich countries from government assistance, corporate tax cuts, and the promise of liability protection. Moreover, while corporations have been protected, many have simultaneously cut costs in supplying their contingent workforce – including large numbers of nurses, hospital porters and care-workers – with adequate protective equipment. Instead, the precariat’s protection has been turned in typical neoliberal fashion into a matter of personal responsibility (Foley and Gërxhani, 2020).

The wider lack of welfare and reliable income replacement in more neoliberal societies is closely related to other neoliberal norms that have systematically elevated individualized personal responsibility over collective social responsibility and risk sharing. Nutrition, education and housing are all examples of public sector program areas negatively impacted by the withdrawal of the neoliberal state from social protection. In its place has come widespread social alienation and despair, along with diverse forms of self-blame and self-harm. There are already extensive epidemiological and public health literatures on the ill-effects and ‘deaths of despair’ that have followed in the wake of such extensive social alienation (Case and Deaton, 2020; Dorling, 2019; Pickett and Wilkinson, 2015; Schrecker and Bambra, 2015) In the context of COVID, all of these ill-effects have come together co-pathogenically to intensify the spread of risk, fear and self-blame alongside the virus (Manderson and Levine, 2020).

Homelessness has become a planetary crisis, compounding already extensive problems of finding shelter in neoliberal contexts where land and real estate have become increasingly monopolized by the wealthy, a process that central bank bond-buying has only exacerbated by creating the easy credit conditions in which investor purchases are effectively pushing-up housing prices (Fabian et al., 2020). Socially-isolated individuals have experienced increased isolation, loneliness and depression, especially when they have been deprived of access to social workers and online social networks (Banerjee and Rai, 2020). Women have suffered increased domestic abuse due to being trapped in intimate spaces of violence with abusers (Valera, 2020). And marginalized communities such as refugees and migrants have been widely blamed as super-spreaders and scapegoats for all the political-economic crises converging with COVID (Bozorgmehr et al., 2020).

The net result of these increasing forms of social alienation has been increased social exclusion and exceptionalism too, with diverse sub-populations ranging from migrants, the homeless and slum dwellers, to farm-workers and care-home workers to prisoners all being abandoned to the virus in petri-dish spaces of extreme exposure. Their experience of heightened risk under COVID appears thus to completely capsize the picture of increasing health rights and enfranchisement into ‘biological citizenship’ once depicted by theorists of personalized medicine as the biomedical upside of ‘advanced liberalism’ (Rose and Novas, 2008). Rather, those abandoned to the pandemic have come to embody all too many new examples of the ‘biological sub-citizenship’ that critical scholars have tied to the diminishment of health and human rights by neoliberalism (Sparke, 2017). With an already fragile global economy being thrown further into crisis by the pandemic, and with market fundamentalist projections about wealth and health being degraded into desperate discourses about capitalist liberty necessitating sickness and sacrifice, COVID would seem to have revealed ‘advanced neoliberalism’ in its most degenerative stages and morbid symptoms of decline.