Back to normal? Building community resilience after COVID-19
Authors: Michael Penkler, Ruth Müller, Martha Kenney, Mark Hanson
Journal: The Lancet Diabetes & Endocrinology (2020)

Although the COVID-19 pandemic is far from over, many countries are resuming economic and social activities, with the aim of returning to some semblance of normality. But what should the new normal be? The pandemic has exposed how the status quo produced uneven vulnerability to COVID-19, with the most disadvantaged groups bearing the greatest health, social, and economic burden. Globally, population groups with higher prevalence of non-communicable diseases (NCDs), such as type 2 diabetes or hypertension, have had higher hospitalisation and death rates.1Fang L Karakiulakis G Roth M Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection?.Lancet Respir Med. 2020; 8: e21Summary Full Text Full Text PDF PubMed Scopus (2104) Google Scholar These pre-existing conditions are often framed as the result of individual lifestyle choices. However, viewing variation in risk at an individual level diverts attention from the deeper causes of susceptibility, particularly how socioeconomic inequalities shape health risks. In the USA, for example, rates of diabetes are highest among Indigenous, Latino, and Black people who are subject to economic and social discrimination.2Spanakis EK Golden SH Race/ethnic difference in diabetes and diabetic complications.Curr Diab Rep. 2013; 13: 814-823Crossref PubMed Scopus (412) Google Scholar Research in the fields of developmental origins of health and disease and environmental epigenetics has revealed how adverse social and material conditions during early life increase later risk of NCDs.3Penkler M Hanson M Biesma R Müller R DOHaD in science and society: emergent opportunities and novel responsibilities.J Dev Orig Health Dis. 2019; 10: 268-273Crossref PubMed Scopus (41) Google Scholar This association accords with insights from the social sciences showing how social structures like racism or socioeconomic deprivation become embodied, shaping health throughout the life course and across generations.4Krieger N Embodiment: a conceptual glossary for epidemiology.J Epidemiol Community Health. 2005; 59: 350-355Crossref PubMed Scopus (580) Google Scholar Therefore, social justice is fundamental to promoting health in society—greater resilience to health emergencies requires systemic rather than individual change. The post-pandemic recovery phase offers opportunities for devising social and public health policies that channel resources to marginalised communities and support community resilience. The Hawaii State Commission on the Status of Women,5Hawai'i State Commission on the Status of WomenBuilding bridges, not walking on backs: a feminist economic recovery plan for COVID-19.https://humanservices.hawaii.gov/wp-content/uploads/2020/04/4.13.20-Final-Cover-D2-Feminist-Economic-Recovery-D1.pdfDate: April 14, 2020Date accessed: June 16, 2020Google Scholar for example, has proposed a post-pandemic recovery plan that advocates adopting universal basic income and single-payer health care, improving maternal and neonatal health care, addressing gender-based violence, and supporting Native, Black, and immigrant women. The Commission argues: "Rather than rush to rebuild the status quo of inequality, we should encourage a deep structural transition to an economy that better values the work we know is essential to sustaining us. We should also address the crises in health care, social, ecological, and economic policies laid bare by the epidemic." Drawing on literature regarding the developmental origins of health and disease, we argue that recovery plans should also pay attention to groups who are not showing high COVID-19 morbidity and mortality rates now, but whose experiences and exposures substantially affect community health in the long term, especially mothers and children. Disinvesting in maternal and child health during the period of economic recession following the pandemic will sow the seeds of later health inequality and NCD risk, which will undermine community resilience to future health emergencies. Although the rallying cry that "we're all in this together" might encourage members of society to help reduce the spread of the virus, it also hides the fact that some groups are affected much more than others. We argue for community-led and state-supported initiatives for building resilience that focus on the most vulnerable among us, and allow individuals, families, and communities to support each other in times of crisis and beyond. Any ethical new normal must encompass substantial systemic change that focuses on social, reproductive, and health justice and redefines the socioeconomic conditions we consider acceptable. We declare no competing interests.