The Deadly Intersections of COVID‐19: Race, States, Inequalities and Global Society edited by SuneraThobani, Bristol University Press, 2022, 176 pp., $83.95 (hardback).

Abstract

Soon reconceived as the “great un-equalizer,” the COVID-19 pandemic uncovered pre-existing inequalities that exacerbated poor health outcomes for racially marginalized communities across the globe (Koch, 2021). Aptly titled, The Deadly Intersections of COVID-19 (2022) provides a deep analysis of the social, political, cultural, and economic forces that drive these inequalities. The book's authors and Editor Sunera Thobani, who are all scholars of color, unpack the depth of these inequalities, outlining the racialization of the COVID-19 pandemic, and identifying global shortcomings in caring for the most vulnerable populations. Through eight distinct examples across the globe, this book dissects government responses, policies, and measures that were driven by political agendas (e.g., the timing of Brexit and the U.S. withdrawal from the World Health Organization) and differentially adopted due to contextual factors (e.g., economic constraints on choice). It maintains the premise that the pandemic could have been prevented, and criticizes neoliberal restructuring, environmental destruction, nationalism, and institutionalized marginalization for further entrenching racial and global inequities. The book is comprised of 11 chapters, eight of which are written by different authors and presented in different settings. It is organized more as an anthology where each chapter is treated as a standalone essay. The chapters are divided into three overarching parts: I) The Racial Political Economy of COVID-19; II) The Violence of Under/De-Development; and III) Lives Under Lockdown. Two of the chapters follow the traditional research study model, one of which is mixed-methods while the other is quantitative. The other chapters are presented as essays, case studies, or journal entries. Major themes in the book include the constraint of economic livelihood following pandemic measures, “sacrificial logic” (i.e., where the sacrifice of a life or group—usually minorities, migrants, noncitizens, and Indigenous people—is necessary for the life of another or survival of another, in this case, a nation's majority), and the lack of accountability by the nation-state. The thesis of the book illustrates the conditions that segued into the pandemic and the gaps in public health measures that continue to fail marginalized populations. Part I of the book unpacks the racial and political economic inequalities, as well as the cultural politics, of COVID-19. The chapters explore a range of topics from sacrificial treatments of Indigenous populations and anti-Chinese racism to barriers to research participation and the choice between life and livelihood presented to minoritized and migrant communities. It dives deeply into the policies, theories, cultural practices, and media portrayals that have amplified the impacts of the marginalization of communities in various global contexts. This section underscores the parallels between the role of disease in historical colonialism and COVID-19 in modern society. Part II explores the contextual limitations of pandemic response measures in three settings marked by varied forms of injustice: the Israeli occupation of the Gaza Strip, the lack of economic security for garment workers and farmers in Bangladesh, and the exploitation of domestic workers in India. These settings of under/de-development are connected by seemingly-irrelevant pandemic measures that exacerbated economic hardship, reflecting “the importance of contextualizing a health response that considers the political and historical reality of the people, as well as the demand for a just resolution to the root cause of such disparity” (p. 100). Inequitable testing and vaccine access, lack of fair labor laws and unionization, and failure of state responsibility to regulate industries supplied by the most vulnerable all depict the willingness to sacrifice certain lives over others (i.e., the sacrificial logic). The personal stories and case studies provided in this section add meaning to the quantitative facts and enrich the overall narrative in support of greater human connection. Part III highlights the lived experiences of marginalized populations under lockdown and the impact of the violence that they incur due to historically racially motivated practices. The book uses examples such as the Black Lives Matter movement and Anti-Asian xenophobia, along with a chapter dedicated to the impacts of COVID-19 in a unique setting: cruise ships offshore in Western Australia. A common theme in these examples is the obfuscation of accountability and responsibility by governing bodies, especially when confronted with social and racial justice issues. This section describes the value of resilience, resistance, and social care in the collective survival of communities. The book concludes with concrete solutions for ameliorating the conditions raised in the various chapters, as well as how to fund these proposals. The solutions are grounded in three main principles: justice, reparations, and reconstruction. Examples include a proposal for equitable global distribution of vaccines, publicly funded mass testing, and health education campaigns led by grassroots leadership. It emphasizes that COVID-19 vaccines are effective but are also unevenly distributed; therefore, combatting the virus needs to adopt a multipronged approach that addresses the social determinants of health to ensure health equity. The authors conclude by recognizing that their proposals are reformist in nature but argue that they are vital in effectively curbing the COVID-19 pandemic. The book boasts many strengths. First, the inclusion of only authors of color speaks to the parallelism between the subject matter of racial inequality and the lack of racial diversity in academia. The editor's intention behind this choice is not unnoticed and fits well within this representative body of work. There were larger themes interwoven throughout the chapters, adding the element of cohesiveness that is necessary when there are multiple authors with different writing styles and subject expertise. Despite the organization of the chapters, the audience is able to read one chapter without having to read prior ones chronologically. This allows for flexibility to select topics or geographic regions of interest to the individual reader. Another major strength of The Deadly Intersections of COVID-19 is the vast and varied global settings for each chapter analysis. Many nontraditional case studies are provided that are not often portrayed in Western media. For example, the Gaza Strip is rarely studied in academic health journals as there have been documented cases of political censorship upon mention of Palestine and critique of Israeli military occupation (Alkhaldi et al., 2022). The contributing authors also provide an appropriate level of historical and economic context that helps situate readers to the specific setting at hand; this is an important foundation to lay regarding pre-pandemic life before tying in the post-pandemic reality. This book tackles difficult topics in full force. While some of the language and criticism may be considered sensationalized, there are merits to such frankness and the equity-oriented lens adopted by the authors. They showcase how race-blind pandemic measures harmed people of color and Indigenous communities the most—ultimately exposing a sacrificial logic and form of covert, de facto racism despite the “post-racial” societies of today. The book's emphasis on anti-racism aligns with Dr. Camara Jones's communication tools for confronting racism, wherein naming racism, asking how it operates, and organizing collective action to combat it are part of a sequential, looping process (Mount Sinai Health System, 2022). Fittingly, the concluding chapter provides examples of policy reform and socioeconomic change that end the largely problem-focused book in a strong, action-oriented manner. The weaknesses of this book are less explicit than its strengths. The book does not appear to include anything on the intersectionality of COVID-19 and the LGBTQ+ community. The title of one of the chapters implies that it has an LGBTQ+ focus, however, the focus is largely on the relationship of the virus with race, systemic limitations, policing, and quarantine precautions. It also appeared that the chapters were written assuming the audience possesses an advanced knowledge of certain terminology and economic concepts, which, if not true, could take away from the larger message that the authors seek to communicate in their chapters. Additionally, there are occasions where the flow of the topics and writing styles are not cohesive, largely due to the text comprising multiple authors and essay styles. It is also worth noting that the book's language may be polarizing, even within the public health community. This may not necessarily be a negative attribute, as it brings attention to lesser-addressed topics in public health, political science, and scientific literature. However, there could be a portion of the audience that may dismiss the contents because the material may not align with their personal, political, or professional values. This book appeals to anyone invested in health equity. The target audience would be educators, policymakers, public health professionals, and transdisciplinary leaders and advocates. The data, anecdotes, and findings of this book can inform policy reform and future research efforts. In particular, social epidemiologists and population health researchers focused on minority health would benefit from studying the featured underlying causal structures that lead to inequalities. The book could be relevant for educators teaching courses on health equity, policy development, global health, and public health governance. Certain chapters could be assigned in higher education curricula to inform future generations of the depth of disparities post-pandemic and motivate action to improve those disparities. Policymakers could analyze the proposed solutions as potential levers in shaping legislative and advocacy efforts in a more equitable direction. As a whole, the book takes a pedagogical lens that is geared towards an audience more familiar with technical terms related to economics, public policy, and critical race theory. It challenges the discourse beyond a superficial discussion of social determinants of health and depicts the role of preexisting structures in directing how the pandemic unfolded. Since a global pandemic requires a global response, The Deadly Intersections of COVID-19 is relevant to a wide audience of professionals, practitioners, and public-private partnerships. This body of work provides a glimpse into the depth of inequities that exist in global populations. The authors’ proposed solutions seek to uplift populations that are lacking in social, political, and economic capital while addressing larger issues of widening inequality. Despite being mostly problem-focused, the book ends with a message of hope, calling for transformative movements to ensure “sustainable, even miraculous, futures” (p. 194). A follow-up book that expands on the concluding recommendations and provides a detailed blueprint from a practitioner's standpoint would be welcome. As of now, proposed solutions addressing COVID-19-related inequities exist in the literature as white papers and policy briefs released from think tanks and nonprofits with a focus primarily at the policy level. A resource is needed to accurately capture the breadth and depth of the impacts of COVID-19 that elaborates on solutions, not only at the policy level, but at the community and grassroots level as well. This proposed two-part series would be even more comprehensive and relevant to researchers, policymakers, global leaders, and public health professionals alike in their efforts to advance health equity. MALIHA A. HUSSAIN is a Doctor of Public Health student at Claremont Graduate University (email: maliha.hussain@cgu.edu). AMAY V. SINGH is a Doctor of Public Health candidate at Claremont Graduate University (email: amay.singh@cgu.edu).