EXTENDED SUMMARY

Purpose and Significance of the Study

This article examines the relationship between persistent social inequalities inherent in capitalism and the disproportionate impact of pandemics, focusing on the COVID-19 pandemic (2019-2023) and the Spanish Flu (1918-1920). The study aims to highlight how capitalist production relations exacerbate social inequalities during crises, transforming health—a public good—into a commodified service. By analyzing the class-based effects of pandemics, the article critiques capitalism as a mode of production and underscores the systemic nature of health disparities. The significance of this work lies in its historical and contemporary comparison, revealing how pandemics amplify pre-existing inequalities and serve as critical junctures for understanding structural socio-economic issues.

Methodology

The study employs a historical approach, combining qualitative and quantitative data to explore the social determinants of health. It draws on empirical research, official statistics, and scholarly literature to compare the socio-economic impacts of the Spanish Flu and COVID-19. Key sources include studies from the United Kingdom, the United States, and Türkiye, as well as reports from organizations like the World Health Organization (WHO) and the International Labour Organization (ILO). The analysis focuses on variables such as income inequality, working conditions, housing, and access to healthcare, demonstrating their role in shaping pandemic outcomes.

Key Findings

1. Historical Continuity of Inequalities: Both the Spanish Flu and COVID-19 disproportionately affected marginalized and working-class populations. In 1918, lower-income individuals in the U.S. faced higher mortality rates due to poor living and working conditions. Similarly, during COVID-19, essential workers (e.g., factory employees, cleaners, and security personnel) experienced higher infection and death rates compared to managerial classes. This continuity underscores how systemic inequalities persist across centuries.

2.Capitalism and Health: The commodification of healthcare under capitalism restricts access for disadvantaged groups. The article highlights the concept of surplus value, where workers’ unpaid labor enriches capitalists while leaving them vulnerable to health crises. Examples from the UK and U.S. show that regions with higher poverty rates (e.g., Glasgow’s Possilpark) had significantly lower life expectancies and higher pandemic mortality rates than affluent areas.

3.Social Determinants of Health: Factors like income, education, and housing directly influence health outcomes. For instance, in England, COVID-19 death rates were three times higher in the poorest 20% of neighborhoods compared to the wealthiest. Ethnic minorities, such as Black and Latino communities in the U.S., also faced elevated risks due to structural inequities.

4.Case Study: Türkiye: Official COVID-19 mortality data in Türkiye underreported deaths, with excess mortality estimates suggesting nearly 200,000 unaccounted fatalities. Industrial cities like Kocaeli and Zonguldak, with dense working-class populations, recorded higher death rates. Reports from trade unions (e.g., DİSK) revealed that workers were forced to continue laboring under unsafe conditions, increasing exposure to the virus.

5.Education and Inequality: Remote learning during COVID-19 exacerbated educational disparities. Children from low-income families lacked access to digital tools and stable internet, while the loss of school meal programs left millions food-insecure. The World Food Programme estimated that 354 million children globally lost access to nutritious meals during lockdowns.

Conclusion

Structural Inequities and the Path Forward

The COVID-19 and Spanish Flu pandemics serve as stark reminders that health crises are never neutral; they act as mirrors reflecting and amplifying pre-existing social inequalities. This study reveals how capitalist structures—rooted in profit maximization, privatization of public goods, and class exploitation—systematically predispose marginalized groups to higher morbidity and mortality during pandemics. The parallels between 1918 and 2020 are undeniable: in both eras, impoverished communities, racial minorities, and essential workers bore the brunt of viral devastation, while elites insulated themselves from the worst outcomes.

Key Insights

• The Myth of “We’re All in the Same Boat”: Political rhetoric during crises often obscures structural disparities. Data from the UK and U.S. show that COVID-19 death rates among low-wage workers were up to three times higher than among white-collar professionals. Similarly, the Spanish Flu ravaged industrial cities and colonies, with mortality rates in India’s impoverished regions eclipsing those of colonizing nations. These outcomes are not incidental but engineered by systems that prioritize capital over lives.
• Sindemics: The Collision of Inequities: Pandemics function as syndemics—where biological and social crises intersect. Chronic diseases (e.g., diabetes, COPD), prevalent in low-income communities due to environmental stressors and inadequate healthcare, compounded COVID-19’s lethality. In Türkiye, underreported deaths and overcrowded industrial zones like Kocaeli exemplified how capitalism’s “sacrifice zones” absorb disproportionate harm.
• The Failure of Market-Based Health Systems: The commodification of healthcare under capitalism exacerbates disparities. In the U.S., uninsured populations faced delayed testing and treatment, while in Türkiye, informal laborers lacked access to social safety nets.
• Education as a Battleground: Remote learning during COVID-19 laid bare the digital divide. In Türkiye, students without devices or internet access were excluded from education, perpetuating intergenerational poverty. Globally, the loss of school meal programs pushed millions into food insecurity, revealing how schools serve as lifelines for marginalized children.