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Virginia Tech, Scholarly Integrity and Research Compliance and Department of Population Health Sciences, North End Center, Suite 4120 (0497), 300 Turner St NW, Blacksburg, VA, 24061, USA.
J Bioeth Inq. 2020 Dec;17(4):649-656. doi: 10.1007/s11673-020-10049-0. Epub 2020 Nov 9.
Public health emergencies expose social injustice and health disparities, resulting in calls to address their structural causes once the acute crisis has passed. The COVID-19 pandemic is highlighting and exacerbating global, national, and regional disparities in relation to the benefits and burdens of undertaking critical basic public health mitigation measures such as physical distancing. In the United States, attempts to address the COVID-19 pandemic are complicated by striking racial, economic, and geographic inequities. These synergistic inequities exist in both urban and rural areas but take on a particular character and impact in areas of rural poverty. Rural areas face a diverse set of structural challenges, including inadequate public health, clinical, and other infrastructure and economic precarity, hampering the ability of communities and individuals to implement mitigation measures. Public health ethics demands that personnel address both the tactical, real-time adjustment of typical mitigation tools to improve their effectiveness among the rural poor as well as the strategic, longer-term structural causes of health and social injustice that continue to disadvantage this population.
公共卫生紧急事件暴露了社会不公正和健康差距，因此一旦急性危机过去，就需要解决其结构性原因。COVID-19 大流行凸显并加剧了全球、国家和区域在采取关键基本公共卫生缓解措施（如保持身体距离）方面的利益和负担方面的差距。在美国，应对 COVID-19 大流行的尝试因明显的种族、经济和地理不平等而变得复杂。这些协同的不平等现象既存在于城市和农村地区，也存在于农村贫困地区，但具有特殊的性质和影响。农村地区面临着一系列不同的结构性挑战，包括公共卫生、临床和其他基础设施不足以及经济不稳定，这阻碍了社区和个人实施缓解措施的能力。公共卫生伦理学要求工作人员既要解决战术上的问题，即实时调整典型的缓解工具，以提高其在农村贫困人口中的有效性，又要解决长期存在的健康和社会不公正的结构性原因，这些原因继续使这部分人口处于不利地位。
