Page - 317 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

317How Should We Allocate Health and Social Resources During a Pandemic? as a good proxy, is distributed along a social gradient in every soci- ety; every socio-economic group is healthier and lives longer than the group below.4 In sum, the way we organize our societies, how we treat and relate to each other, the social choices we make in policies, and the persistent neglect of issues and groups all contribute to creating and distributing health and health inequalities along a social gradi- ent within and across societies. The broad social bases of health and health inequalities make health and its determinants a central con- cern for social equity and justice.5 In the same vein, the broad social bases of the determinants of health and health inequalities that oper- ate across countries puts them squarely at the centre of the scope of deliberations on global equity and justice. Social Bases of Infectious Diseases Given such an understanding of the social bases of health as well as of individual and social group health inequalities, it should be easy to recognize the social bases of infectious disease outbreaks and poten- tial epidemics and pandemics. While the origin of the virus SARS- CoV-2 is still yet to be confirmed, we already know that the conditions that enabled its formation were socially determined. It was not a natural disaster or an act of God, but because of how human-animal inter actions were addressed or neglected, through policy choices and social practices. The spread of the virus from person to person is a social phenomenon, and conditions that enable or restrict those social interactions are socially determined. The spread of the virus across countries, initially carried by persons along busy international flight paths to major global cities, is socially determined. And, to press the point to its conclusion, how infections take root and spread in other countries as well as how they are or are not being controlled are deter- mined by social choices or, indeed, neglect.6 4. Michael Marmot, The  Health  Gap:  The  Challenge  of  an  Unequal  World (New York; London: Bloomsbury Press, 2015). 5. Sridhar Venkatapuram, Health  Justice:  An  Argument  from  the  Capabilities  Approach (Cambridge, U.K. & Malden, MA: Polity, 2011). 6. Isaac Chotiner, “The Interwoven Threads of Inequality and Health”, The New Yorker (14 April 2020), online: <www.newyorker.com/news/q-and-a/the-corona- virus-and-the-interwoven-threads-of-inequality-and-health>; Michael Marmot, “Society and the Slow Burn of Inequality” (2 May 2020) 395:10234 The Lancet 1413.