The illness in Porto Velho reflects what we already know about disease in the Brazilian Amazon: the poorest are most at risk. When we cross-check mobility data provided by Google; data from the state’s Health Department; and social indicators such as the United Nations Human Development Index (HDI) on access to sanitation, education and employment, it becomes clear that areas in Porto Velho where compliance with self-isolation falls below 30 percent are also the poorest ones and those in which there is a greater number of confirmed COVID-19 confirmed cases.
In short, the poorest people are the sickest. We may understand these data in two ways. The first interpretation, advanced by public administrators at the state level, is that it’s their own fault that the poorest people are seeing the most illness. But poor housing, malnutrition and lack of formal employment are clearly not their fault. These conditions mean that the poor are unable to isolate themselves socially, wash their hands or buy protective masks. They have little access to public health resources and social assistance.
The challenge becomes to understand the structural factors that maintain these inequalities and their consequences for people’s health, and to begin to remedy them. Only then will these communities no longer have to choose between working and putting themselves and their families at risk on one hand, versus self-isolating and starving.