One of the key social determinants of health that affected women’s reproductive rights during the Zika virus outbreak was socioeconomic status and poverty. Brazil has one of the highest levels of income inequality in the world where the country’s richest 5% have the same amount of wealth as the rest of the 95%, and almost 25% of people live below the poverty line (Brazil: Extreme Inequality in Numbers). This extreme inequality has serious repercussions on the way medical care is given in the country and especially in the way the Zika virus was dealt with when it first came to Brazil.
Poverty is one of the largest social determinants of health, and it can affect health in multiple ways. There is material deprivation among the poor, materials like dirty water and poor nutrition are two such issues, but there is also a lack of proper policy to take care of those who are most vulnerable (Marmot 2005). There is a severe lack of understanding of the extent that political policy can either help or undermine health care for the most vulnerable in a population and in fact “health issues need to be brought into the political arena to advance population health” (Mackenbach 2014). Living in poverty can also affect people’s stress levels, leading their health issues to be more severe than someone who has higher socioeconomic status and who is not placed in such a high stress situation. Stress affects health in several ways, most notably “diverting energy and resources away from many physiological processes important to long-term health maintenance” (Wilkinson, et al. 2003). Due to this, in Brazil, for women living in poverty, the Zika epidemic most likely affected their health much more simply due to the fact that their body was already under stress due to their poverty.
During the height of the Zika epidemic in Brazil, both the government and media focused on treatment for the problem through “eradicating the mosquito and controlling microcephaly, placing the burden of prevention on women” (Riberio, et al. 2018). However, in shifting their focus to “easier” problems to fix they “masked social and gender inequalities” that highly contributed to the effect of the Zika virus on women and their babies (Riberio, et al. 2018). In studies done after the height of the epidemic, it was actually found that the main group of people suffering from Zika were “socio-economically deprived Brazilians… highlighting the role of social factors, such as basic sanitation, domestic refuse collection services and water distribution in the outbreak of Zika” (Riberio, et al. 2018). There were also “pregnant women from lower-income families and regions who revealed their concerns by criticizing public health institutions for not offering medical support and information” (Riberio, et al. 2018).
This effect of socioeconomic status was especially apparent in Brazil’s urban slums. The Zika virus is transmitted by mosquitos and unfortunately “slum-defining characteristics – poor water and sanitation infrastructure, crowding, and poor structural quality of housing – offer ample opportunities for mosquitos to breed and spread the Zika virus” (Synder, et al. 2017). Unfortunately, all these factors based on social determinants of health, are what lead to low income women being most affected by the Zika virus. If a vaccine is found to prevent pregnant women from getting or transmitting the Zika virus to their children, the chance that the vaccine will be able to be given to those that suffer most is very low.
Unfortunately, if Brazil wants to eradicate the Zika virus and its effects from its population, it cannot only focus on the virus itself but the government and health workers need to focus on the social determinants of health and find a way to reduce them.
“Brazil: Extreme Inequality in Numbers.” Famine and Hunger Crisis | Oxfam International, www.oxfam.org/en/even-it-brazil/brazil-extreme-inequality-numbers.
Mackenbach, Johan P. “Political determinants of health.” (2014): 2-2.
Marmot, Michael. “Social determinants of health inequalities.” The lancet 365.9464 (2005): 1099-1104.
Ribeiro, Barbara, et al. “Media coverage of the Zika crisis in Brazil: The construction of a ‘war’frame that masked social and gender inequalities.” Social Science & Medicine 200 (2018): 137-144.
Snyder, Robert E., et al. “Zika: A scourge in urban slums.” PLoS neglected tropical diseases 11.3 (2017): e0005287.
Wilkinson, Richard G., and Michael Marmot, eds. Social determinants of health: the solid facts. World Health Organization, 2003.