By Joseph Harris
Sociology offers powerful lens for understanding the destructive consequences of epidemics, which often magnify existing health disparities and run along the lines of class, race, and gender in distinctive ways. While the vulnerabilities of black and brown communities in the US have been laid bare alongside those of the poor, the elderly, those with disabilities, the undocumented, and the incarcerated, COVID-19 has also challenged us to think about the impacts this disease has had in relation to the Global South and how some of those experiences not only align with theoretical expectations but actually buck them.
The rapid widespread adoption of innovations aimed at fighting COVID-19 presses us to reconsider much of what we know related to the dynamics of diffusion. First, the speed with which masks and social distancing practices have become a widespread feature of life in societies unaccustomed to them is unprecedented. Few such changes have so fundamentally affected how we live and been adopted so quickly. The fact that the disease is airborne and sometimes lethal, with death often happening in isolation, are factors that have no doubt been a major factor prompting such rapid adoption. However, in the days before anti-retroviral treatment, the death rate from AIDS was 100% but took place over a long period of time. More research is needed to understand how social psychological factors interface with macro-social ones. Further research in this area would deepen our knowledge of the mechanisms of diffusion, which has classically involved learning, coercion, competition, and social construction (Dobbin et al 2007).
The fact that evidence for the efficacy of masks was developed in and diffused from the Global South cuts against the grain of existing theories. Classically, world culture theory has imagined policy models as emanating from the West to the global periphery (Meyer et al 1997). Other important work has explored dynamics of diffusion regionally within the Global South (Weyland 2005). Yet, innovations to fight COVID-19 have spread from Global South to North. These dynamics build on recent work by network analysts (Centola 2018) and also prompt us to think about how diffusion dynamics might be different for innovations adopted by people in societies versus governments.
While the HIV/AIDS epidemic hit the world’s poorest region – sub-Saharan Africa – hardest, it remains to be seen what effects COVID-19 will have in that part of the world. While we know socio-economic status to be a “fundamental cause” of mortality (Link and Phelan 1995), which might give us cause to think that the region will be hard-hit once again, a number of issues may mitigate coronavirus’ effects in the region. Understanding these different factors in relation to one another may reshape our broader understanding of theory.
Many governments in the region have responded swiftly, intervening early with strong measures. Nations in the region also have the experience of fighting HIV and TB to draw on, with some transferrable lessons to use in the fight against COVID-19. While crowded housing conditions may facilitate epidemiological spread among poor urban dwellers, the disease may spread less among more spatially diffuse rural populations. Careful investigation of the dynamics of transmission will tell us a lot about the dynamics of transmission for an airborne disease like COVID-19 differs from other airborne diseases, like TB, and how they further differ from the spread of non-airborne pathogens, like HIV/AIDS.
The impact of cultural customs on the spread of the disease – both positive and negative – is yet unknown. Important work by sociologists has trained our attention on the role of cultural objects and practices in global health (Tavory and Swidler 2009; McDonnell 2016). The practice of clasping hands together and bowing, rather than shaking hands, may have slowed the spread of disease in countries like Thailand. We also know from recent struggles in Africa with Ebola that familial desires to visit and bury the dead contributed to spread of that disease. Heartbreaking stories have pointed to isolation of the seriously ill with coronavirus in hospitals, often dying alone without family around. How such tragic social disconnection plays into the dynamics of transmission in parts of the world where healthcare facilities themselves are non-existent or few in number is an open question.
Understanding social dynamics related to COVID-19 may have broader implications for our understanding of the world, reshaping long-held theories and generating new ones. The discipline of sociology stands to contribute a great deal to that new understanding. But a great deal of work lies ahead of us to get there. Thinking about COVID-19’s unique features in relation to distinct local realities will play an important role in that process.
Joseph Harris is Assistant Professor of Sociology at Boston University and author of Achieving Access: Professional Movements and the Politics of Health Universalism.
Centola, D. 2018. How behavior spreads: The science of complex contagions. Princeton: Princeton University Press.
Dobbin, F., Simmons, B., & Garrett, G. 2007. The global diffusion of public policies: Social construction, coercion, competition, or learning?. Annu. Rev. Sociol., 33, 449-472.
Link, B. G., & Phelan, J. C. 1995. Social conditions as fundamental causes of disease. Journal of Health and Social Behavior (extra issue), 80–94.
McDonnell, T. E. 2016. Best laid plans: Cultural entropy and the unraveling of AIDS media campaigns. University of Chicago Press.
Meyer, J. W., Boli, J., Thomas, G. M., & Ramirez, F. O. 1997. World society and the nation-state. American Journal of sociology, 103(1), 144-181.
Tavory, I., & Swidler, A. 2009. Condom semiotics: meaning and condom use in rural Malawi. American Sociological Review, 74(2), 171-189.
Weyland, K. 2005. Theories of policy diffusion les-sons from Latin American pension reform. World politics, 57(2), 262-295.