Covid-19, pandemic risk and inequality: emerging social science insights at 24 months

Abstract

In this editorial, we introduce a special thematic collection of articles published in this current issue, and earlier in 2021, which develop a range of social science approaches to studying and theorising pandemic risk, largely focused on the COVID-19 pandemic. We structure this editorial essay in two parts. First, we consider the challenges of theorising pandemics with an attentiveness to inequality. We consider what different theoretical approaches have brought and can bring to studying risk and inequality, before developing a more in-depth consideration of the work of Mary Douglas for this purpose. We draw out key features of Douglas’s work on ‘centre and periphery’, alongside the related group dynamics and tensions which are configured by, and help reproduce, social inequalities. Second, we then develop a dialogue between these analytical sensibilities around inequality, drawn from Douglas, and various conceptualisations and findings emerging in the eight studies published on pandemics in Health, Risk and Society this year (4 in this issue, 4 appearing earlier in the year). Douglas’s work, which has often been neglected in studies of inequalities and risk, provides valuable insights into institutional dynamics of culture and power. The eight recent studies in the journal include some conducted in contexts, and by researchers, located towards the global economic and academic periphery. This diversification, beyond the usual social and governmental contexts, and alongside the growing involvement of different epistemic communities, introduces and cultivates valuable insights, for the field of risk, inequality and health more generally, and for grasping the global phenomena of the pandemic.

Keywords:

• culture
• COVID-19
• Douglas
• global-north-west
• inequality
• pandemic risk
• theory

Introduction

In writing this editorial, we draw on two recent projects which, combined, have brought together 18 studies from 16 countries. These studies have either recently been published in Health, Risk & Society, including in this current themed issue, or appear as chapters in our forthcoming edited book (Brown & Zinn, 2022). Nine of the 18 studies address country contexts beyond the ‘global-north-west’ - which has dominated studies of risk and uncertainty since their inception (Brown, 2015) - and, moreover, are written by authors from these countries. This diversification, beyond the usual social and governmental contexts, alongside the growing involvement of different epistemic communities, introduces and cultivates valuable insights in the field in general and is, of course, fundamental to grasping the global phenomena of the pandemic. These insights contribute to a quickly growing body of knowledge that could become part of a new sociology of pandemics (Brown & Zinn, 2022; Zinn, 2021a; 2021b).

The insights we share below are drawn from this diverse range of study settings that were chosen based on the quality of the studies themselves, rather than a systematic sampling approach. Nevertheless, the diversity of the social contexts when considering the influence of media spheres on citizens´ lifeworlds – China (Wang & Mao, 2021), Italy (Prati et al., 2021) and Pakistan (Ejaz et al., 2021) – practices of everyday life, health care and professional work, and formats of health systems governance, have provided us with a wide-ranging set of analyses which have helped us to reflect on important emerging analytical insights into the pandemic. Given that risk inequality is one of the most prominent topics across these studies, we begin by reflecting on the (ir)relevance of the classic triumvirate of risk theories – following Douglas, Beck and Foucault – for grasping inequality amid Covid-19 risk, before progressing to examine the recent publications in Health, Risk & Society in more detail.

Social inequalities are addressed in various ways, referring to abroad range of approaches. There is a trend from engaging with classical approaches such as Bourdieu’s work and social class (Crawshaw & Bunton, 2009; Threadgold & Nilan, 2009) to more differentiated accounts of inequality such as detailed analysis of the different dimensions of the unequal experience of risk during the first lockdowns in 2020 (Mancini, 2021). In existing critical approaches to risk and uncertainty, much of the work which examines inequality is informed more or less directly by a Foucauldian orientation. Common lines of inquiry here show how the neoliberal tendencies of modern states lead them, in the pursuit of efficiency, towards modified relationships to citizens via health and welfare systems (see Alaszewski’s editorial in this issue for an interesting example relating to shifts in mental healthcare). The outworking of this threefold reworking – of the state, of its subjects, and of the relationship between them – results in the implicit yet insidious ‘assigning [of] different social destinies in line with their varying capacity to live up to the requirements’ of particular socio-economic contexts, with these requirements chiefly relating to neo-liberal maxims of ‘competitiveness and profitability’ (Castel, 1991, p. 294).

More recent work, while very much engaging with risk theory, has drawn on sources beyond the Douglas-Beck-Foucault risk canon or the class focused analysis of inequalities in the tradition of Bourdieu to seek to do justice to a more intricate set of social processes pertaining to inequality and a more intersectional understanding of the roles of structure and identity (Giritli Nygren et al., 2017; Walby 2021). The influence of gender theory and performativity is especially relevant here, though underlying Foucauldian bases remain in these perspectives in at least two senses. First, in acknowledging ‘the way that risks are perceived and done in everyday life always needs to be read within a frame of prevailing structures of power’ (Giritli Nygren et al., 2017, p. 428), recent work increasingly recognises how these structures are more multiple, diffuse and dynamic. Second, an emphasis on performativity – such as in Giritli Nygren and colleagues’ (2017) attentiveness to how risk is ‘done’ (see also Manca, 2021 in this issue) – is influenced by the work of Butler (2002) who in turn draws importantly on Foucault’s work on subjectification.

Alongside these important insights, we can also look to Beck and Douglas for important understandings of inequality amid the socio-cultural processes of risk. The traditions emerging from these two risk theorists highlight an ambivalence towards the novelty of dimensions of vulnerability and inequality through risk. Beck has provocatively challenged existing sociological understandings of class inequality, with his (in)famous references to the ‘zombie concept’ status of class, or the democratic/universal effects of some forms of pollution. These initial arguments have proved very fruitful in the barrage of critiques these (often misunderstood) claims elicited and in the engaging way in which Beck’s later writings absorbed and reflected the insights from his critics. Mythen (2005) thus encourages us to think with Beck in terms of the way new forms of risk may function to reproduce and in various ways intensify existing matrixes of inequality around socio-economic differences, gender and race. Likewise, new or emerging cultures of consumption, for example, which pertain to risk society side-effects, may also offer new economic investment possibilities which are able to be exploited by the privileged, thus furthering inequality (see Curran & Tyfield’s, 2020 work on low carbon economies) along existing lines.

Both the novel features of Beck’s risk society and the continuing and exacerbating of enduring structural inequalities (Curran & Tyfield, 2020), are apparent in the Corona pandemic. Beck’s attentiveness to environmental destruction, the side-effects of this – zoonotic viruses becoming more common as human trade and settlements delve deeper into rainforests and other remote habitats – and ‘the side-effects of these side-effects’ (Ulrich Beck, 1992, p. 77), help us understand the negative outworkings of responses to the pandemic and the inequalities emerging from other phenomena he describes; including those experienced by those neither unemployed nor in stable employment (Mythen, 2005, p. 131). The adverse economic effects of the pandemic as these have been shaped by containment measures, alongside the heightened health risks faced by those who cannot afford the luxury of following these same measures, are disproportionately born by some groups.

Manca (2021, this issue) describes the separation of mothers from new-born babies as a risk mitigation strategy, which has physical as well as identity-related consequences for both – another side-effect of the pandemic side-effect. Yet Manca emphasises that this broader practice is disproportionately impacting mothers from marginalised sections of Canadian society, not least mothers who are ‘black, indigenous and of colour’ . As we will describe later, and as is to read in this issue, Manca (2021) draws more on the work of Mary Douglas (alongside risk and intersectionality scholars such as Giritli Nygren et al. 2017) in her framework for approaching risk and inequality.

Like Beck, Douglas has often been partially and superficially (mis)understood by risk researchers (see 6 and Richards, 2017). In particular, Douglas is often simplistically pigeon-holed as a relativist, functionalist, and/or where her grid-group cultural framework is understood as of little relevance to questions of inequality (see 6 and Richards, 2017 for a critique of these critiques). What Manca and other recent work in the journal (Anderson, 2021; Moore, 2020) highlight is the way Douglas understands cultural processes of risk as being profoundly shaped by power relations and tensions between the centre and periphery. To this end, Manca (2021) cites Douglas’s essay on ‘Witchcraft and Leprosy’, from her 1992 bundle Risk and Blame, whereby Douglas notes – seemingly in dialogue with Foucauldian themes – the ‘ferocity with which a community constitutes its boundaries and oppresses its marginal members. [Sociologists] recognised at once that accusations of immoral conduct are a technique of control against the weak and powerless’ (Douglas, 1992, p. 99). Coincidentally, Alaszewski (2021a) examines Douglas’s historical comparative approach of different cultural-policy approaches to leprosy risks in his guest editorial in this issue.

Risk researchers often note Douglas’s emphasis on the moral features of risk (such as blaming) while the cultural orientations of her grid-group analytical approach (Ofori-Park, 2020) and her recognition of the importance of rituals have also been used effectively by some (Moore, 2020). In various ways, these threads of Douglas’s work have been woven together to consider gendered patterns of inequality and social control (Moore, 2020) and intersections between gender and race in risk practices (Kahan et al., 2007). But studies of risk referring to Douglas tend not to emphasise that the underlying cultural processes which interest Douglas are chiefly ones of struggle between different groups – some powerful and some not – whereby she uses functionalist insights to argue for a profound societal tendency towards dysfunction, and where institutional settlements are precariously maintained (6 and Richards, 2017) amid tensions and power relations between centre and periphery. Some of these features of Douglas’s work are usefully picked up and reworked by Lupton (2013, pp. 639–640) into a framework focused on ‘Others’ and othering. These mechanisms have important potential applications for considering multiple forms of intersecting inequalities in ways (see Manca, 2021) which would include class, but where it is also important and possible to recognise that the key dimensions between centre and periphery are seldom reducible to class and in some contexts gender and/or racial inequality may be the dominant marker(s) of difference and otherness (see Anderson, 2021; Manca, 2021).

As Brown (2022) points out – in relation to Douglas’s interest in the Lele people’s preoccupation with risks pertaining to childlessness, lightning strikes and bronchitis – we can only understand the central risk concerns of a cultural context by understanding what these concerns do to the relationship between centre and periphery. As noted already, Douglas’s attentiveness to the precarity and instability of multiple overlapping institutional arrangements means this analytical approach is not functionalist (see 6 and Richards, 2017). For Douglas, the Lele had a rather sophisticated and equality-oriented format of political accountability, by which citizens ‘mainly attributed these troubles to specific types of immorality in which the victim would generally be seen as innocent and some powerful leader or village elder would be blamed’ (Douglas & Wildavsky, 1982, p. 7). Alaszewski (2021a) similarly notes Douglas’s account of the (partially) inclusive approach of the Latin Kingdom of Jerusalem towards leprosy. Yet we also see many northern European examples in Douglas’s work where risk considerations reproduce and intensify the marginalised position of minorities. These minority positions may pertain to class but race and ethnicity, or gender and sexuality, were often more central dynamics of inequality, group identification and othering: Jews being blamed for poor quality water (Douglas & Wildavsky, 1982, p. 7), and other forms of xenophobia (Douglas, 1992, p. 39); miasmic dangers associated with HIV/AIDS in Brittany, France (Douglas & Calvez, 1990, p. 457); London’s approach to the great plague, whereby it ‘barred itself against its own poor, for fear of infection’ (Douglas & Calvez, 1990, p. 460). Such processes of othering are manifold and have been observed in many countries during the coronavirus crisis (Joshi & Swarnakar, 2021).

Processes of unequal power and marginalisation thus play out amid which risks are worried about, whereby the preoccupations of the centre often tend to become hegemonic assumptions which naturalise and normalise ‘others’ as risky, accentuating the weak and excluded position of the latter – ‘The middle class believe it is a problem of ‘inner city\ urban poverty: good, it does not concern them, so long as there is a cordon sanitaire’ (Douglas & Calvez, 1990, p. 460). But beyond the risky – who, what or which practices are worried about – questions of who worries and with what costs is also relevant to considering unequal outcomes amid cultural responses (Olofsson & Rashid, 2011), especially amid pandemic ‘contagion’. In the earlier example of approaches to the great plague, Douglas does not only emphasise ‘the savage measures to segregate the poor of London’ (ibid.) but, moreover, the different approaches of particular groups; such as of the Muslim community who adopted ‘a fatalist view, and did not cordon off the infected’ (p. 462). This contrasting approach to risk helps us understand the lack of exclusion within this community. But particular processes of (not) considering risk in more worried, fatalistic, individualised or collective approaches also helps us understand different outcomes across groups (Alaszewski, 2021a). We see this in terms of different COVID-19 vaccination rates and SARS-CoV-2 infection rates but also in the psycho-social effects of living amid a pandemic. Prati and colleagues (2021 – this issue) for example, draw attention to how ‘Previous epidemics have been specific to gender subgroups … [and] that COVID-19 has been experienced and perceived differently by men and women; in particular, women report higher risk perception and concern, as well as compliance with preventive measures’ (Prati et al., 2021). These tendencies have implications for a range of emerging unequal outcomes amid the pandemic which, as we have argued here, the work of Mary Douglas is especially useful at helping us grasp, in terms of who or what is worried about, who is worrying and in what way (Boholm & Corvallec, 2011), and the underlying, constantly evolving, organisational-power relations between central and peripheral groups which configure and work through these risk processes.

Overview of the eight studies published on pandemic risk in 2021

Having introduced some broader dimensions for understanding the relationship between cultural processes of risk and inequality, we now move to introduce to you the eight studies on pandemic risk published in Health, Risk & Society over the course of 2021. Four of these are grouped together in this current issue (7–8), while the others were published earlier in the year. Below we now move to outline each study, drawing out core themes which are pertinent to their contributions as these relate to risk, culture and inequality, as we have discussed these thus far.

This current issue continues, following this more general introductory-overview editorial, with a guest editorial by the founding editor of Health, Risk & Society (Alaszewski, 2021a). Here, Alaszewski draws on his recent exploration of COVID-19 policies and practices in his book (Alaszewski 2021b), as he considers the relevance of the three classic theoretical traditions of critical social science approaches to risk – following Beck, Douglas and Foucault – for grasping the nature and social impacts of the current pandemic. A common theme emerging from Alaszewski’s reflections on all three approaches is that each, albeit in different ways, helps illuminate features of change, but that we often see deep furrows of continuity within which these changes spring up (see above and Mythen, 2005, p. 129).

Alaszewski’s work has often approached risk with a strong historical sensibility and indeed these emphases are apparent within his editorial, especially through the engagement with Douglas’s and Foucault’s work. From Foucault, Alaszewski explores the institutional power of medicine as its role and sphere of influence has expanded and, insidiously, become deeply internalised within cultures and bodies. Amid this understanding of biomedicine as a politico-discursive regime, Alaszewski draws our attention to the institutional power of medicine in the early weeks of 2020, whereby the comparison of the emerging outbreak to ‘pneumonia of unknown origins’, or as a novel form of SARS, was powerful in delineating risk understandings and (non)responses among wider publics, as well as serving the interests of powerful institutions in different ways.

Tying in neatly with our discussion of Mary Douglas’s work above, Alaszewski goes further into Douglas’s (1992) historical assessment of the evolving handling of leprosy containment, as this emerged across different politico-cultural contexts and as this evolved over time amid dynamic and precarious institutional arrangements:

In the 12th century the nature and significance of leprosy changed (Douglas, 1991, p. 732). The development of more centralised institutions, feudal kingdoms and the church and new forms of mercantile wealth created new masses of the poor vagabonds, beggars and heretics. The pattern of leprosy changed with rich and powerful apparently immune and the new leper poor being confined in leper colonies; ‘Landless persons whom no one wanted to know about were tidied away’ (Douglas, 1991, p. 732) Leprosy was now characterised as highly contagious and a sexually transmitted disease. Lepers were not only physically segregated they were also socially excluded. The segregation protected the rest of society from the pollution of lepers (Alaszewski 2021a).

Here, we see yet further evidence and consideration amid Douglas’s work of how centre-periphery dynamics configure risk approaches in ways which follow and compound the marginalisation of particular groups; a phenomenon also explored by scholars following Beck (see Mythen, 2005; and Curran’s, 2018 work on ‘risk-class’).

Alaszewski (2021a) also notes the various ways in which core themes of Ulrich Beck’s work have become more relevant than ever amid the pandemic, and Wang and Mao (2021) extend these considerations through a very detailed quantitative analysis of risk framing in newspaper reporting in China in the early weeks of the pandemic. Wang and Mao are particularly interested in Beck’s assertions that modern risk societies are characterised by the delocalisation, incalculability and non-compensability of risks. Risks develop into catastrophes as they become understood as de-local, incalculable and beyond compensation, with this having huge social consequences, which are radically transformative (Beck, 2009, p. 293).

Wang and Mao (2021) delineate this shift from risk to catastrophe as comprising three phases in the ‘virtualisation of risk’, denoting the crucial role of high status clinicians and scientists in reframing the emerging situation from local to national to global. In this sense, we see both evidence which supports Beck’s thesis, in relation to the emergence of the pandemic as a global risk phenomenon, while at the same time Wang and Mao develop important nuances to Beck’s work where the specific role of the state, the nature of media reporting and the relationship between the two is explored in the specific political and cultural context of China. Such findings follow earlier research published in the journal, which both corroborate and nuance Beck’s work when applied beyond the northern European contexts which initially informed much of Beck’s early work (see Van Voorst, 2015 on flooding risks in Indonesia).

Similar to Van Voorst (2015), Wang and Mao (2021) also address Beck’s natural versus man-made binary. But whereas van Voorst’s consideration of flooding emphasised the blurred interwovenness of natural and man-made, Wang and Mao pay more attention to the methodological importance of separating media frames pertaining to cause from those pertaining to treatment of the problem. This becomes particularly relevant when considering the virtualisation of a risk as more local or global, as

‘ … those who are held responsible are often seen as those who are empowered to control the outcome. However, in the case of a pandemic issue, such as COVID-19, the cause may originate among local people or governments while responsibility for treatment may spread to people and governments on a national or even global level. When the media admit the necessity to delocalise the risk that local treatment is not enough to handle the situation, they transform the risk into a real catastrophe’ (Wang & Mao, 2021: this issue page).

These evolving framings of risk and catastrophe have important implications for citizens and politicians as they respond in differing ways.

Published earlier in 2021 (issue 3–4), Waqas Ejaz and colleagues also explored media spheres but this time more from the perspective of the audience and with a specific attentiveness to belief in conspiracy theories amid the media spheres of Pakistan. Informed by the existing literature, Ejaz and colleagues were particularly interested in the role of trust in traditional media and social media, as predictors of conspiracy-related beliefs, as well as the relationship between these beliefs, risk perceptions and feelings pertaining to national identity. In this way, Ejaz and colleagues build not only upon specific work in the field of (COVID-19) conspiracy theories but their work also speaks to a wider tradition in critical studies of risk and uncertainty which is interested in the relationship between emotions, trust, understandings of risk and how these configure one another amid risk lifeworlds. This line of research has been published in this journal (Zinn, 2008; 2016), (Cottingham & Fisher, 2017; Lupton, 2013) and beyond (Ekholm & Olofsson, 2017; Wong & Jensen, 2020).

As with the findings of Wang and Mao above, Ejaz and colleagues develop important empirical insights which diverge in important, potentially locally specific, ways from some dominant risk theories. In contrast to several other studies, therefore, this study found no association between conspiracy beliefs and either trust in traditional media or national identity; though trust in social media was positively associated with conspiracy beliefs. The authors consider here the relevance of studying risk, emotions and conspiracy beliefs in a national context marked by low trust in state institutions (Ejaz et al., 2021, p. 173). When the state is commonly viewed neither as competent nor with motives in line with the interests of its citizens, then ‘national identity’ may reflect a different set of orientations and commitments towards nationhood than in contexts marked by higher levels of trust in institutions and fellow citizens (Jørgensen et al., 2021; van Bavel et al. 2021). Ejaz and colleagues (2021, p. 173) also highlight the inverse association apparent in their data between belief in conspiracy theory and perceptions of pandemic-related risks. The authors explain that, again, their findings contrasts with many other studies,

‘ … yet it is logical in the context of Pakistan. This difference can be explained by underscoring the general tendency of people in Pakistan who are least worried about the potential consequences of a crisis when they believe in a conspiracy theory that insinuates their government is making money … or perceive it as foreign collusion’. (p. 173)

These latter findings also connect to our earlier Douglasian arguments regarding divergent understandings of COVID-19 risks and their embeddedness within group membership configured by centre – periphery relations. Here we might consider centre and periphery both in terms of institutional dynamics within Pakistan, as well as the historical impact of Pakistan´s position on the periphery of the global economy which, alongside the enduring negative effects of regional colonial legacies, can be understood as weakening state institutions and undermining trust.

Ejaz and colleagues´ data supports an approach which considers how a sense of distance from and distrust of the centre is shaping a particular stance towards the risk priorities of the centre and the policies that accompany these priorities. Distrust in government is a particularly pertinent issue in grasping the public’s response to COVID-19 in many local and regional contexts, for example in Hong Kong, where publics’ precautionary approaches were driven by the slow implementation of pandemic preparedness measures by the government (Chan, 2021).

This leads us to return to the work of Gabriele Prati and colleagues (2021) in this current issue who, as we saw earlier, denote the gendered dimension of who worries about COVID-19 risks and with what consequences. As these authors explain, their findings

‘ … indicate that women reported higher use of words associated with negative feelings, protection measures, and daily life during quarantine and lower use of words associated with the categories of origins, information, spread of the virus, and positive attitudes’ (Prati et al., 2021).

The specific causal mechanisms around these different forms of expressed emotion cannot be deduced from the data collected by these authors. Within risk studies a wider cultural tendency for men to ´judge´ risks as lower has often been observed (Finucane et al., 2000), with this cultural tendency being understood as configured by enduring social structural inequalities and related cultural patterns (Olofsson & Rashid, 2011). Prati and colleagues similarly go on to consider inequality in terms of how:

women provide most of the informal care … within families and because of closure of schools and health and social care services during the outbreak, the lockdown effects on working could be more negative for women. For instance, the use of words associated with the category of negative feelings could reflect this stressful condition … the discrepancy between men and women related to the increasing of unpaid work could accentuate the negative way in which women ‘live’ (experience) the pandemic.

These important insights around the cultural reproduction of inequality formed part of a wider study by which these researchers studied the ‘social representations’ (Moscovici, 1984) pertaining to risk held among Italians in the early phases of the pandemic. While there were important differences in these risk lifeworlds, which associated with gender or age, Prati and colleagues also found common themes, such as a relative absence of othering discourses in these early phases which was different to findings from earlier infectious disease outbreaks. The authors zoom out to consider that this was part of a more general pattern where southern European countries, especially in the earliest phases of the pandemic, were ‘more likely to associate the origin of the virus with the overexploitation of environmental resources rather than performing “othering” processes’.

While Prati and colleagues found more evidence for gender inequalities than for ethnic othering in their data on early social representations of the pandemic, Terra Manca (2021, p. – this issue) describes processes by which inequalities bound up with an enduring, gendered problematisation of the pregnant body intersect with historical-colonial structures of marginalisation, in her study of news media in pandemic Canada and beyond. Manca´s analysis of how pregnant women, new mothers and babies are (not) cared for in order to minimise COVID-19 risk, thus helps us develop a more nuanced, textured understanding of Douglas’s periphery, whereby multiple intersectional inequalities in many instances intensify and complicate one another. To this end, Manca synthesises important contributions from the work of Douglas with feminist theory and intersectional risk theory (including Giritli Nygren & Olofsson, 2020), arguing that ‘cultural approaches are applicable to intersectional analyses of what risk does in terms of social organisation, who is blamed for threats, and how the deployment of risk reproduces inequalities’ (Manca, 2021).

More specifically, Manca shows how socio-economic inequalities, combined with movement restrictions and constraints to public transport amid various configurations of national or local lockdowns, led to impossibilities of accessing midwifery and obstetric care, especially for those who – due to the person-level and/or regional poverty – were not able to transport themselves privately to care facilities. This problem of access has been especially problematic for those living in rural areas.

A further Covid-19 measure was the separation of mothers from their new born babies, with the aim of reducing risk of transmission to the baby. Amid these risk relations, where the baby becomes the ‘object at risk’ (Boholm & Corvallec, 2011) who must be kept away from the risky mother, Manca points to historical and journalist-based evidence of ethnic-profiling which has shaped professionals’ assessments of who was more risky. Professionals’ cultural lifeworlds, structured by historical systemic racism, lead them to act on implicit racially gendered assumptions of what a ‘safe’ parent looks like (Veltkamp and Brown 2017), with these inequalities, combining with a history of policies of separation of children away from non-white parents, manifesting in distrust. In turn, this leads to localised or group-based cultures of distrust which further heightens inequalities in access where class and racial inequalities intersect (Manca, 2021).

These inequalities in access and separation lay the basis for further inequalities as parents, and mothers in particular, are responsibilised for the well-being of their new born or young children via guidelines around parental mental health, nutrition (breast feeding, for example) and other health-related goals. Manca observes how these norms are presented in an individualised, achievable manner, yet pertain to goals which many mothers are systematically obstructed from achieving:

The silence surrounding systemic inequities in these columns creates a fiction that all women can control their mental health without improving material conditions that generate higher levels of stress among oppressed women (including low-income, BIPOC, disabled). Even for privileged women, such a responsibility to manage risks could paradoxically materialise in guilt, blame, and stress due to the impossibility of the task of minimizing their felt responses to living through a global pandemic (Manca, 2021).

As we see here, cultural dynamics and beliefs, themselves rooted in and emerging from systemic and entrenched tensions between centres and peripheries, lead to further inequalities whereby Covid-19 containment policies have tendencies to manifest as technologies of control (Douglas, 1992, p. 99).

In this latter sense, while we noted above that Douglas turns functionalism on its head, by emphasising tendencies towards conflict, flux and disintegration rather than autopoiesis (6 and Richards, 2017), Douglas’s work is important in showing how risk may often work to mediate against social disintegration in ways by which the values and concerns of the centre are often reproduced (Wilkinson, 2010, p. 49). The findings of Melissa Roy and colleagues (2021), though not working with Douglas as such, show a similar process by which collective cultural processes of meaning-making, symbolism and ritual – centring around risk – play a powerful role in maintaining existing structures, yet in ways which may manifest dysfunctionally. This is the one study published in the journal this year which we address in this editorial which does not focus on the SARS-CoV-2 pandemic. Rather, Roy and colleagues’ research focuses on social media responses during the 2013-2016 Ebola epidemic and, in particular, on the portrayal of ‘heroes’ within news media across Côte d’Ivoire, France, Guinea, Liberia, Nigeria, Sénégal and the US. As the authors summarise:

First, this production of ‘everyday heroes’ may encourage the involvement of lay people in the epidemic response, by conveying that anyone can become a health hero. Second, we show that this heroisation process maintains the status quo by encouraging adherence to biomedical discourses, and by individualising the narrative and neglecting the structural changes needed to address the epidemic. Finally, we caution against discourses that seem socially ‘progressive’ but may be used as a smokescreen to hide discriminatory dynamics, and we recommend changes in communication strategies. (Roy et al., 2021, p. 73)

Experience with earlier epidemics and pandemics has vitally informed COVID-19 public health policies and risk governance strategies in useful ways, such as the need for deeper community engagement and working with existing community leaders. While these important lessons still need to be learned by many public health bodies beyond West Africa, Roy and colleagues’ article closes with several useful recommendations regarding what can be done differently. In particular they advocate forms of risk communication and engagement which go beyond using heroes in a superficial, illustrative, dehumanising manner, towards involving prominent community figures as leaders, with input into policy decision-making. Rather than cultural-communicative processes merely reproducing centre-periphery dynamics, this would potentially invert them; with Roy and colleagues (2021, p. 86) arguing that: ‘In the context of Ebola, this inclusion of local everyday heroes in social media communication could have helped mitigate cultural barriers, diminished criticisms directed at health authorities, and counteracted polarising dynamics, thus fostering a much-needed synergy of all parties involved’.

As noted above, Douglas’s work helps us understand the reasons why such approaches may work, in terms of their working across existing tensions and hierarchies, seeking to develop narratives and values which travel right across the divides of a community (6 and Richards, 2017, p. 93). Bonnet and colleagues (2021, p. – this issue) develop an important study which explores how occupational health organisations in France have managed risk policies and risk work for those working on the front-line in roles such as social care work. Alongside the conceptualisation of risk work as originally developed by Tom Horlick-Jones in this journal (2005; see also Brown & Gale, 2018; Gale et al., 2016), Bonnet and colleagues also bring valuable insights from Francophone traditions in risk sociology, including the important concept of ‘prevention work’ (travail de prévention) which help us ‘to describe the collective activities related to the concerted search for solutions to preserve health and safety within the framework of established risk categories’ (Bonnet et al., 2021).

In contrast to the concept of risk work which functions mainly at the level of organisational knowledge frameworks and (often) individual professionals’ interactions with patients/clients, prevention work shifts the analytical lens more towards inter-agency and interprofessional cooperation, whereby group dynamics and colaboration become important lines of investigation. As Bonnet and colleagues (2021) describe:

Although the health crisis forced these [homecare workers] to work in isolation, they drew on their practical knowledge of their work and their local resources (family, friends, neighbours, general physicians) to find the masks and means to equip themselves, to organize themselves, and to draw up the rules that they felt were appropriate to protect themselves from the risks of contamination and, above all, to protect those they were caring for.

Amid this consideration of the plurality of partnerships and cooperation within which risk practices and risk work are embedded, Bonnet and colleagues also describe processes of hierarchy and (in)visibility which impacted unequally on the health and safety of different types of workers. For those providing front-line social care, these homecare workers were required to take risks daily in terms of COVID-19 infections, with limited preventative possibilities. One systematic approach which was adopted was referred to as a preventative fortnight, designed to cut chains of infection, by which these homecare workers saw their working hours reduced by 50 per cent, as they worked their usual hours for 15 days per month, followed by 15 days of not working. In this way, these homecare workers faced financial as well as health risk consequences, which were heightened due to their relatively low, less visible position in relation to the health and social care professions. Hence, these workers had difficulty accessing PPE – ‘The State had designated priority to all the healthcare services, except homecare’ – and were also originally overlooked by the French government when it awarded a financial bonus to health and social care workers. Bonnet and colleagues’ interviews with these workers found experiences of significant stress amid these unequal and unequally (in)visible forms of risk and work.

The kinds of institutional dynamics which shape, reproduce and in some cases intensify existing inequalities – for workers, professionals and publics – are discernable within the final pandemic-oriented study we cover in this editorial by Bert de Graaff and colleagues (2021 – see issue 3–4). While the foci of their study are the organisational decision-making processes rather than the eventual consequences of the decision-making in terms of inequality, de Graaff and colleagues highlight three distinctive features of decision-making, as became apparent in their observations of high-level meetings, which developed the pandemic policies for Dutch hospitals and related health infrastructure. These decision-making processes were shaped by narratives of urgency and related fast-paced decision-making. Organisational responses, driven by such time-orientations, came to focus on particular sources of numerical data which became core guides and logics of decision-making. However, as is well understood in risk studies (see for example, Szmukler, 2003), decision-making amid uncertainty and risk is never driven by numbers alone but also, as de Graaff and colleagues highlight, by values and valuing: ‘With limited empirical evidence available, we found a valuation of the (networked) knowledge of these experts who were tirelessly writing and rewriting protocols and guidelines that mediated risk judgements between different contexts’ (p. 123).

These collective processes of assembling together working understandings for ‘heading into the unknown’ (Zinn, 2008) – out of understandings of time-frames, (un)available numerical data, implicit cooperative processes of valuing and categories (see Heyman et al., 2013) – amid a small committee dominated by older white men with specific scientific backgrounds, tended to follow and reproduce existing organisational tendences. As the authors highlight – ‘This risk work appears innovative, but our analysis stresses how participants’ work happened in interaction with traditional institutional logics and routines’ (p. 111). In this sense, de Graaff and colleagues’ rich ethnographic methods take us to the very heart of ‘how institutions think’ (Douglas, 1986) in relation to pandemic risk. As with all of us, the thinking of the medics and other scientists in the Dutch expert committees studied by de Graaff and colleagues were profoundly shaped by the current institutional dynamics of the time, which in turn have their roots in the institutional backgrounds and lifeworlds of those involved. This directs ‘processes of classifying and recognizing’ (Douglas, 1986: 3) in particular ways and, inevitably, to formats of ‘professional blind spots’ (ibid., p. X). The potential for these institutional dynamics to generate policies which reproduce inequalities, as seen by Bonnet et al. (2021) and many studies reviewed above, would seem to be heightened when the decision-makers are acting with a sense of urgency, amid scarcity of data and resources, and in the absence of diverse backgrounds and time to reflect on blind spots. Here, as in all these studies reviewed above, we see clearly how institutional and cultural processes can contribute to the reproduction of patterns of multiple inequalities.

Concluding thoughts

From the early debates in risk studies regarding the priority of risk or class in the reproduction of social inequalities, the focus has shifted to the complexities and mechanisms by which different forms of disadvantage intersect (Giritli Nygren & Olofsson, 2020). This shift has also opened opportunities to develop and nuance debates in acknowledging the ways by which different theories of risk have engaged with inequalities to capture observable complexities – for example, the huge gains of the rich during the early months of the COVID-19 crisis, while others were struggling for survival. These debates include the overlapping of socio-structural and socio-cultural processes in conflicts involving risk, with the important insight that effective forms of risk management and public engagement require solutions which give voice to all cultures and social communities – centres and peripheries. One important suggestion from Douglas’s cultural theory which remains timely is that regarding how the social groups and the margins of society which feel most alienated by the central communities tend to show the highest levels of vaccine resistance in many countries. Here we see the need to overcome stigmatisation. The discursive production of inequalities, deeply rooted in institutional set-up and practices, manifests in various ways. Recent research reviewed above highlights that not only differences between countries but within countries lead many marginalised people to experience, and be exposed to, harm as part of their everyday ‘doing risk’ deeply engrained in the social fabric.

The COVID-19 crisis is not a risk as other global risks. Pandemic risks have to engage with an active agent, a virus, which is little known and continually changing over time. One of the most surprising experiences for many in the global North was the experience of the erosion of superiority and control of infectious diseases. While it is unlikely that the COVID-19 experience will result in fundamental transformations of the world order or social inequalities, what is likely to change is our awareness of and attitudes towards epidemics and pandemics. The learning curve is currently steepest in the countries of the global North experiencing a kind of vulnerability considered more common for the global South. The world risk society and, moreover, critical science studies of risk and uncertainty, might therefore come together under the growing realisation that we can learn a great deal from each other amid the convergences and divergences of global risk experiences.

This would further justify the development of a sociology of pandemics where critical insights from risk studies play a vital role (Zinn, 2021a; 2021b), particularly studies which themselves are often understood as lying on the global periphery (Brown & Zinn, 2022). As we have explored in this editorial in relation to recent work on pandemics published in 2021 in Health, Risk & Society, the theories of Mary Douglas help illuminate many powerful empirical insights into multiple inequalities, and a number of useful modes of conceptualising the patterning of inequalities as these are configured by global, institutional, professional and local community risk dynamics – which can powerfully be understood in terms of centres and their peripheries. We have argued that Douglas’s less state-centric, bottom-up, group-oriented approach to studying risk (Wilkinson, 2010) helps bring together important insights from around the globe (see Brown & Zinn, 2022), in terms of doing justice to the diverse and complex nature of social inequalities (Manca, 2021), but also in developing theoretical and policy narratives as we seek to develop pandemic responses which undo processes of othering, stigma and the material and cultural inequalities these help perpetuate (6 and Richards, 2017).

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