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Health and Social Care
Textbooks, monographs and policy-focused books on our Health and Social Care list push forward the boundaries of teaching, theory, policy and practice. The list covers areas including global health, health inequalities and research into policy and practice.
Key series include Transforming Care which provides a crucial platform for scholars researching early childhood care, care for adults with disabilities and long-term care for frail older people, and the Sociology of Health Professions, offering high-quality, original work in the sociology of health professions with an innovative focus on their likely future direction. Our leading journal in the area is the International Journal of Care and Caring.
The hypermobile cities of India stood still with the onset of COVID- 19- induced lockdowns. Public transport services were the first to be suspended, and older adults in particular were instructed not to leave their homes (Press Information Bureau (PIB), 2020). Even with the easing of lockdown and the resumption of limited public transport, older adults were ‘restricted’ from using services as per the pandemic- related advisories issued by the state. Mobility, which is central to active aging, health status, and well- being (World Health Organization (WHO), 2007) of older adults, was affected by this exclusion in the public transport system. The short- and medium- term implications of such lockdown protocols towards the (im)mobility of older adults requires attention. Given the Indian urban transport scenario, the dependence of older adults (particularly those from low- income groups) on public transport and the inadequate public transport infrastructure is relevant to contextualize the pandemic advisories.
This chapter uses the case of Bengaluru city in southern India to highlight how transport protocols issued during the COVID- 19 pandemic impacted older adults’ (im)mobility. Even before the lockdown was rolled out on March 24, 2020, Bengaluru’s public transport system had been struggling to cater to passenger demand. With physical distancing norms in place, which reduced ridership and trip number, it has become more difficult for passengers in general, and older adult passengers in particular, to access public transport. In Bengaluru, a large proportion of older adults are mobile, work in the informal sector, and earn a low income. They cannot afford private transportation and are therefore dependent on public transport (Baindur and Rao, 2016).
The Gauteng city-region (GCR), South Africa’s economic hub and home to over 15 million people, is currently facing two epidemics. One is COVID-19, and the other is HIV/AIDS. With just under 2 million people living with HIV/ AIDS in the GCR (Simbayi et al, 2019) and the largest HIV-positive population of any city in the world (Stuart et al, 2018), HIV/AIDS has substantially impacted the demographics of the GCR, and the structure of families and households. Through these shifts, HIV/AIDS has placed a disproportionate burden of caregiving and financial support on the elderly. Our analysis explores the ways in which the arrival of COVID-19 interacts with Gauteng’s demographic and social fabric to further deepen the burdens of care and support experienced by the province’s elderly (see also Lemanski and De Groot, Volume 1).
Overall, 9.1 percent of South Africa’s population is over 60 years of age, which is higher than most other African countries (Ausubel, 2020). The GCR has a slightly lower proportion of those over 60, at 8.46 percent (StatsSA, 2020). One of the main reasons for this is the legacy of South Africa’s history of apartheid-driven labor migration (Moore and Seekings, 2018). Apartheid legislation restricted Black African residence in urban areas largely to those of working age, resulting in profound divisions of families across rural and urban areas. Although the legislation was repealed in the late 1980s, many older people continue to leave the GCR on retirement. South Africa’s higher proportion of elderly relates to the relative affluence of the country in the African context, but also to the HIV/AIDS epidemic, which, particularly prior to the introduction of treatment in 2004, resulted in the premature death of many younger people (Udjo, 2006).
Older adults represent the fastest-growing population segment in the US and many other cities of the Global North (United Nations, 2019), thanks to longer life spans and advancements in medicine. But along with the longer life expectancy come also challenges. Deteriorating physical health, death of a spouse or partner, and living alone make older adults particularly vulnerable to social isolation and loneliness (Victor and Bowling, 2012; see also Volume 4, Chapter Ten). Indeed, the likelihood of living alone increases with age, and this is particularly true for women (Nies and McEwen, 2015). Social isolation often leads to deteriorating mental and physical health (Luanaigh and Lawlor, 2008), including depression, decreases in cognitive functioning, cardiovascular disease, and even mortality (Courtin and Knapp, 2015).
One aspect of counteracting and lessening social isolation is to have opportunities and neighborhood places to go to, to meet, and communicate with others (see also Chapter Eleven, this volume). Being able to walk to the neighborhood grocery store or park not only helps older adults accomplish activities of daily living (ADLs) but also facilitates their social well-being and social needs (Clarke and Gallagher, 2013). Therefore, the built environment – and in particular its public places and ‘third spaces’ – interacts with the social environment (Kweon et al, 1998) and influences older adults’ health and well-being (World Health Organization, 2015).
But the COVID-19 pandemic has been brutal for older adults. Not only has it decimated their lives, but it has also increased the fear among the living of accessing public spaces, thus furthering their social isolation.
The central Chinese city of Wuhan was the initial epicenter of the COVID-19 pandemic and the first city to experience lockdown. The 11 million residents of Wuhan were locked down for 76 consecutive days, beginning in late January 2020. Fang Fang, a well-known Chinese writer as well as a resident of the city, published her personal accounts of the lockdown experience in the form of diaries on Weibo and WeChat, two of the most popular Chinese social media platforms. At the beginning, the diaries were well-received by Chinese netizens because of their bold critique of social injustice, corruption, abuse of power, and other sensitive issues in China that deterred the efficient government response to the pandemic. However, soon after the diaries were translated into English and German and published with a fast-track process overseas, Chinese public attitudes towards the diaries drastically swung against it. Many initial supporters turned to express their concerns and suspicions of the publication’s intention. The prevailing opinion was that the writing sabotaged China’s efforts to fight the pandemic and fed into conspiracy theories and wider anti-China political sentiment. The author was criticized as an opportunist and traitor who capitalized on the health crisis to enhance her own credentials. In Chinese social media, a polarized reception of the diaries emerged.
This chapter explores how the diaries have provided a rare discursive site for the Chinese public to engage in political deliberations and ideological debate about democratic liberalism and populist patriotism which co-exist in contemporary China. Empirical data include some key commentary articles1 about the diaries from both sides of arguments that circulated on WeChat and the responses these articles attracted. The chapter also explores some of the lived experiences during lockdown, as described in Fang Fang’s diaries.
Since its initial appearance in Wuhan, China, in late 2019, much attention has focused on the disproportionate spread and impact of COVID-19 in metropolitan areas and on patterns and rates of infection and morbidity in cities, neighborhoods, and across different ethnic backgrounds (Hamidi et al, 2020; Mills et al, 2020).1 Across the globe, a key strategy to contain and mitigate the worst effects of the virus has been through halting or limiting mobility through ‘lockdowns’. #Staysafe #stayhome public health messaging appeared across print, social, and broadcast media in many countries. Given the short timeframes to assess impact, less attention has been paid in the academic literature to date on the differential impacts of public health restrictions to contain the virus on particular groups, individuals, and communities. While it is still too early to fully document what the long-term consequences might be, in this chapter we detail the immediate impacts of ‘lockdown’ through the experience of one community – Dublin 8, an inner-city neighborhood in southwest Dublin. We argue that the experience of ‘lockdown’ is contextually dependent and, through interviews with key community workers, social care providers, and residents, elucidate how already-disadvantaged communities were disproportionately impacted, compounding their vulnerabilities.
Over the past 30 years, Dublin (Ireland) has experienced extensive urban regeneration through ‘flagship’ commercial projects but also through social housing estate regeneration programs, many controversially initiated under public-private partnerships. Success has been limited, with developments critiqued for failing to address the specific needs of targeted communities and the city’s general housing accessibility and affordability crises (Hearne, 2011). The longer-term implications of this neglect and policy failure became acutely evident during COVID-19 mobility restrictions, particularly in relation to access to green and other forms of safe outdoor spaces.
Based on research carried out in the city of Porto, Portugal, this chapter presents two case studies in which we analyze the practices of children from different social backgrounds in two urban parks, before and during the pandemic. It is important to highlight that the region of Porto was, at an earlier stage, the epicenter of the pandemic in Portugal, with a 47-day lockdown. Here, we assess the influence of social class and ethnicity on children’s uses of and practices in public spaces, based on our fieldwork in the two parks before the outbreak and post-lockdown.
Public spaces are vitally important ‘place[s] of encounter and exchange’ (Tonucci, 2001: 149) between people of different generations and/or socio-cultural backgrounds.
However, in contemporary societies, increasing traffic, noise, pollution, and lack of green spaces, make cities increasingly harder places to live in. Many residents’ ‘right to the city’ (Lefebvre, 1968) is jeopardized and children are a group specially affected, mostly because their mobility and free use of public spaces encounter progressive restrictions.
Urban childhood is marked by a decrease in children’s independent mobility and use of public spaces (Fyhri et al, 2011; Shaw et al, 2015). Children’s daily lives tend to revolve around three indoor settings: home, school, and recreational institutions (Rasmussen, 2004; Sarmento, 2018). Hence, ‘the playful dimension of the city’ (Farné, 2017: 165) is being lost, and we know that children’s play is an essential activity for their physical, social, and emotional development and well-being (Sarmento, 2018; Russel and Stenning, 2020). Through play, children socialize with peers and adults, develop autonomy, create emotional attachment to places, acquire physical and social skills, and build themselves as citizens.
Other-than-human life in Vancouver’s Stanley Park may have never been more audible to so many people as it was in spring 2020, as COVID-19 transformed Canadian space and society. The renowned urban wilderness park, a colonial idea erected over the traditional territories of Coast Salish First Nations, including the Musqueam, Squamish and Tsleil-Waututh, opened in 1888. Not long thereafter, Stanley Park became inextricably bound to the motor vehicle, its roads, and their ecological ruin.
Then, on the morning of April 8, 2020, came an extraordinary rupture: the car park nearly vanished. For the first time in its colonial history, Stanley Park’s roads excluded automobiles. The Vancouver Park Board took this radical move in order to limit the number of visitors while increasing physical distancing and local access to the outdoors. The car closure was not total. It did not include emergency services, public transit, municipal vehicles, and a highway that slices Stanley Park in two. Nevertheless, partly released from the jaws of motor vehicles – including the car but also the float planes typically roaring over its tree canopy and carbon thirsty passenger jets shaking the skies above – Stanley Park almost seemed to revert back to a more primeval, unadulterated version of itself protected from human pollution.
Stanley Park’s transformation from noisy car park to resurgent nature was a common story after COVID-19, which precipitated both a global surge in cycling and noticing nature (see also Volume 4, Chapter Four). It was a strange, ironic rupture: one ecological catastrophe (COVID-19, a zoonotic disease) pressing pause on another (the system of automobility).
Older adults have been thrown into the spotlight of the COVID-19 pandemic and the bright lights have exposed both societies’ admirable and deplorable traits. We have seen stories of heart-warming compassion and deep-rooted ageism. From the appalling #boomerremover hashtag to the calls for mandatory quarantines for those over 70 years of age, public responses to COVID-19 demonstrate the role of age and (dis)ability in amplifying social and spatial inequalities. Although these reactions are unfounded, unethical, and have not received widespread political support, they do highlight the distressing interrelation of several truths: society at large is aging; older adults are at higher risk for developing more serious complications from COVID-19; and the social and physical infrastructure of cities has not been built to support the needs of older adults. In addition to the risks of COVID-19, the confluence of these three realities has potentially exacerbated a second public health crisis: loneliness. And as in the case of COVID-19, older adults are particularly susceptible. In this chapter we examine the relationship between COVID-19, social distance, social isolation, and loneliness with a focus on the older adult experience in urban and suburban environments. In addition to outlining the risks faced by older adults in times of crisis, we explore opportunities to strengthen social bonds while physically distancing through the development of blended communities or virtual retirement villages. Using the experience of the Oakridge Seniors Association in suburban Calgary, we offer targeted recommendations for community leaders and policy makers on how to minimize risk and maximize social cohesion by embracing communication technology while remembering the importance of human interaction. (Chapters Eleven and Twelve also explore the theme of self-organization in the face of the pandemic, but from the perspective of different national contexts and social categories.)
On October 28, 2020, Canada’s Chief Medical Officer of Health, Dr Theresa Tam, stated that the pandemic was exposing existing inequalities in Canada. In a television address, she said that:
‘The impacts of COVID- 19 in this country have been worsened by systems that stigmatize populations through racism, ageism, sexism, and others, who have been marginalized through structural or social factors such as homelessness … Differences [in infection rates] are not random, but all along the lines of populations that have historically experienced health and social inequities … The impacts have been worse for some groups such as seniors, workers who provide essential services, such as those in health care or agriculture, racialized populations, people living with disabilities, and women. The virus didn’t create new inequities in our society; it exposed them and underscored the impact of our social policies on our health status’.
While this may have been a revelation for some people, for the contributors to this volume, and the others in this series, such a direct and unequivocal statement was not surprising.
Such insights are also nothing new to those with lived experiences of these inequalities and injustices. Throughout the four volumes, one of our aims has been to include chapters that amplify these voices by meaningfully, respectfully, and ethically engaging with marginalized communities in order to center their experiences within planning, policy, and political debates about the impact of the pandemic and, importantly, how to respond to it. The findings, analysis, and reflection found throughout this series of books must be a reminder to planners and policy makers that the divisions, inequities, and injustices rendered visible during the COVID- 19 pandemic long predate the virus.