In rich countries, the messages have got out reasonably well on how best to protect oneself from COVID-19. Lockdown and social distancing have been important, as have personal hygiene measures. Learning from public announcements has also been key. The World Health Organization (WHO) has played an important role in getting the message out. It is clear that these nonpharmaceutical measures can help contain the spread of illness.
Virtually all of the WHO recommendations require that a household environment supports the capacity to protect from the virus—what can be called the “home environment for protection” (HEP). The HEP is the result of past wealth-constrained choices, and these are unlikely to change quickly. Dwelling attributes such as its size, construction and location (determining access to treatment) cannot be easily adjusted in response to the immediate virus threat, and nor is health all that people care about when allocating their resources.
Importantly, all of the aspects of the HEP required for compliance with the WHO recommendations are likely to have a wealth effect, meaning that poorer households will have less capacity to protect themselves by following WHO recommendations. This is to be expected between countries as well as within them.
A new paper with Caitlin Brown and Dominique van de Walle asks “Can the World’s Poor Protect Themselves from the New Coronavirus?”? In a nutshell, our answer is “no.” We assemble data on some key attributes of the home environment for one million sampled households from the latest Demographic and Health Surveys. We find that prevailing WHO recommendations for protection make unrealistic assumptions about the home environments of the bulk of the world’s poor. Our calculations indicate that 90% of households have inadequate HEP by one or more of the dimensions considered. Strikingly, the recommendation of having a place to wash hands with soap is not satisfied by the majority of households in the developing world overall, and only satisfied by one-in-five households in sub-Saharan Africa. 40% do not have a formal health-care facility within 5km. Only 6% of the poorest 40% have a home environment that supports full compliance with the WHO recommendations, and the proportion is virtually zero in sub-Saharan Africa.
Our analysis leads us to conclude that the developing world, and especially its poorest half, is ill-prepared to protect itself from this virus. For most households, the recommendations that have been implemented on a massive scale in the rich world must be considered near fiction for the world’s poor.
Given the contagion rate of this virus, the likely degree of exposure to be expected among a large segment of the population of the developing world also points to a serious concern for the entire population.
What can be done? The housing stock cannot be changed rapidly. But there are still things that can be done now, as I discuss further in my paper, “Pandemic Policies in Poor Places.” The current infrastructure for information (particularly cell-phone coverage) holds promise for getting the messages out on public health and access to consumption support. Policies such as distributing or subsidizing soap and improved water access could be feasible in the near term, and justified by both the external benefits and the equity impacts. Home-grown innovative adaptations to the realities of life in the developing world will be crucial.