Jub wrote: ↑2020-03-28 02:52am
loomer wrote: ↑2020-03-28 02:16am
That's not what a vulnerable population means. Again, you wish to argue NYC is as vulnerable as Indigenous communities - prove it. To do so, you'll need to show that they have similar rates of chronic illness and socioeconomic factors that make Indigenous communities as vulnerable as they are and inflate the potential risk factor.
Or you can admit that you don't actually think NYC as a whole is more vulnerable, and that you just think resources must be concentrated on larger populations and outbreak hotspots regardless of relative vulnerability.
NYC as a whole right now is more vulnerable than most places because it is already overwhelmed. Are any of the first nations in the US currently in the same situation?
That isn't what a vulnerable population means, dude. We just went over this. First, you asked for a definition, and you've now proceeded to ignore it twice. So let me make it very clear:
A vulnerable population is one with significantly elevated risk factors that increase the chance of morbidity from disease. Those factors include heart disease, lung disease, diabetes, obesity, cancer, and hypertension for COVID-19 - and they're all massively overrepresented in Indigenous communities.
You want to assert NYC is a vulnerable community
, as defined. So do it - prove it. No one is disputing NYC is a hotspot, but that doesn't mean that it's suddenly had an explosion of the factors that inflate the fatality rate. Or, again, you can just admit that it isn't a more vulnerable community and that you'd rather focus on the fact it's a hotspot or a larger community. This isn't hard, dude.
I don't know, and neither do you. But the experts seem to think it will - so why shouldn't we listen to them?
Do they though? Sticking to just the US, because that's where this debate started, the first two articles you posted were mostly just wanting that $40 million aid to actually get pushed through to where they can access it. Only in the Australian article, where you massively shifted the goalposts, were things as basic as tents requested.
There was no shift in the goalposts, dude. That would require me to be arguing for a suddenly different standard, where I am instead consistently arguing that these communities need to have their requests met to reduce the risk of devastation. If you follow the other articles I've posted, there are also calls for water access, additional staff, PPE, testing kits, and ventilators. So yes - I'd say that the experts seem to think more aid is needed.
Do you, by contrast, have a single piece of evidence for Indigenous communities not being more vulnerable? Any who are saying 'yeah no we don't need additional resources, we're confident this won't hit us like a sledgehammer compared to the general population'?
I see. So it's a lost cause because there isn't enough to go around and therefore discussions on where it should go are... a lost cause? Is that the logic here? Because I'm struggling to see how that explains why it's a lost cause to send the relatively small amounts of aid requested to Indigenous communities.
Why can't these remote communities isolate? Why can't people in more populated areas use existing services?
They're doing both, dude. They're still calling for aid even as they do. They're locking down borders in a way that settler communities simply aren't in many areas, but that doesn't magically mean that if the virus gets in it won't have a severe impact.
Again, I can't do that, and you can't show that they won't. But the experts in the field all seem to agree that the resources are especially needed in Indigenous communities because they're especially vulnerable. Why shouldn't we listen to that advice?
Are they saying that? They're especially vulnerable but they're also not currently pilling bodies in the streets, so perhaps they should continue with the prevention steps using the resources they already have.
Yes, they're saying that. Have you not been reading the articles that I've posted, which are expressly calling for more aid?
Yes. And that's why the discussion about where that aid should go is important. 'Well, there's not enough aid to go around!' does not mean that the position that more vulnerable communities should receive more of it is garbage. It is in fact one of the core elements of that position. Let me break it down for you thus:
1. There is a major outbreak that, disproportionately kills those with a number of chronic illnesses and the elderly;
2. There aren't enough supplies to go around
3. Those supplies should be used where they will do the most good (however defined)
4a. Some communities have disproportionately larger numbers of the chronically ill and/or elderly at risk people;
4b. Preventing the deaths of these people is a good, thus;
5. These supplies should be distributed to help protect those communities at disproportionate risk of elevated fatalities.
You see why pointing out part 2 exists doesn't negate parts 3, 4 or 5, right? You need to establish that either 3 doesn't apply or 4 is invalid. Asserting 2 is just - yeah, no shit. It's the entire basis of the following argument.
3. The supplies should continue to go to areas where there are the most potential victims as should additional nurses because if things get any worse in these areas the potential for harm is far worse than if some 250 person village in the middle of nowhere gets the disease.
Okay, so. You want to define things in terms of the 'most potential victims'. From your example, I take it you want to talk only about raw population since you leave out the issue of disproportionate illness. But that's a mistake.
It's a mistake because COVID-19 is more lethal to certain groups. Let's take our earlier example of a city of 10 million healthy young people. By a raw population metric, if the disease strikes that city, it could kill millions! But that population group has the lowest fatality rate. That population is the least at risk even in a completely uncontrolled outbreak. The city next door, with 1 million people of mixed health, has a higher rate. It needs more aid than the city of 10 million, not less, because the people are both more likely to get sick and more likely to die if they do. Raw population as the metric, though, would prioritize our fabled city of the perfect youth over the city of the grumpy coughers - even though the disease will strike the latter worse than the former.
I wonder if it's because you're unaware of just how much higher the risk factors for increased COVID-19 morbidity are in regional and rural Indigenous communities and reservations? Because when we're talking total number of victims, that
is why there's special alarm for Indigenous communities. Let's take one of the most common, diabetes. It raises your morbidity significantly (7.3% versus 2.3% according to the CCDC), so that's not great. Native American populations have twice as many diabetics as white populations and exceed the rate for both African American and Hispanic populations - something on the order of 16% rather than 8% of the population (or even higher if you listen to the PCORI). This diabetes also usually has more complications and worse management than it does in White folk (and here I specifically refer to Whites rather than all settlers as African-American communities (leaving aside the complex politics of settler privilege on that front) also experience worse outcomes on that front), which means that the level of complications it's going to cause COVID-19 will be disproportionate to those among Whites.
What about another common one, hypertension? Well, you don't want hypertension and the Vid at the same time. 6% over the 2.3%. What about relative proportions? 27.2% of the Native American population has hypertension, versus 24% of Whites. Heart disease (probably the single biggest risk factor for COVID-19 morbidity other than advanced age)? 8.6% versus 5.6%. Chronic health issues of the exact kind that raise morbidity are an epidemic among Native American populations, and the situation is similar in First Nations peoples north of the border, the Maori of Aotearoa, and Aboriginal and Torres Straight Islander peoples here. These rates worsen in the remote communities and reservations, too - so the already elevated level of chronic illness rises even higher over that of the general Indigenous population in the specific communities we're discussing.
So let's look again at this idea of the most potential victims. Vulnerable communities - those with these health issues and limited infrastructure - have more potential victims per capita as a result of these factors. These communities have substantially elevated risks of death. So when you go 'well, we have to focus on saving as many people as we can, it has to be about where has the most potential victims' and you don't take these factors into account, you treat those with insignificant risk exactly the same as those of elevated risk. And you wind up with the earlier example of looking only at how many will die overall, and not the per capita rate and the way that figure masks devastation. This is why the calls for more supply are so serious - the death rate will be higher because of the disproportionate health risks these communities already possess.
4. In areas where the disease has already hit they're currently letting these at-risk people die, why should we devote extra resources to saving people that many regions are currently palliating?
Because you can still prevent the outbreak from striking them with the resources being requested, dude. That's why they're asking.
The intention is specifically to try and contain and minimize the spread as much as possible to avoid the at-risk being infected, but since there's a much larger segment of the population at-risk, it's a harder task.
Okay Jub. I'm going to be over here listening to the people calling for extra aid who actually know what they're talking about, while you can be over there ignoring them for... reasons? Because they think their communities are at extra risk but aren't giving you cost-benefit breakdowns?
Hint, everybody thinks their community is at extra risk, ask doctors in an area like Vancouver right now and they'll tell you that additional supplies will help them save our city's at-risk population. When everybody is screaming for their share of limited resources each side needs to prove that their cause saves the most lives. Given you're the one asserting that natives need extra supplies you need to provide the proof that these supplies will do the most good there.
In short, put up or shut up.
My position is that vulnerable communities need more supplies to try and counteract the effects of the virus and that Indigenous communities are particularly vulnerable. Do you dispute that Indigenous communities are more vulnerable? I am aware that you dispute that we should provide extra supplies to vulnerable communities, but we'll get to that below.
The expert opinion on the matter seems pretty clear. Is there anyone saying 'no, Indigenous communities aren't more vulnerable, they don't need more supplies, those supplies will be wasted'? Because all I see so far is plenty of experts agreeing that they need more supplies and are at substantially higher risk of absolute devastation. Neither of us is otherwise qualified to provide a benefit analysis on sending masks to these communities versus others (unless you're secretly an epidemiologist?), so as far as I'm concerned, we need to listen to the expert opinions when they say 'this will make a difference'. What we then do is a matter of morality and ethics.
You know, I note that you don't actually defend your position about 'equal value' here either. Are you abandoning that position, or do you just dispute that people at special risk deserve special protection?
I dispute that we should devote extra supplies to a population that many regions are currently forced to let die, especially on the grounds that they're somehow special because of knowledge they should have already been passing on.
They already have been passing on that knowledge, dude. It doesn't happen instantaneously - it takes time, especially in the aftermath of a genocide. But more than that, the argument isn't just to do with the knowledge they have. The argument is this:
1. Indigenous communities have greater vulnerability generally to the coronavirus because of the general state of health in these communities;
2. This means many more members of these communities will die compared to settler communities if they are exposed, and this should be avoided;
3. Many of those who die will be elders, who possess currently irreplaceable knowledge; this should also be avoided.
Cultural vulnerability is only one part of why Indigenous communities should receive more aid. The other part is, quite simply, that they will be worse impacted. They will experience more deaths. They will lose more people. I think this should be avoided, and I'll make it very clear why. My moral position is that those of greater vulnerability to the disease need more protection. They are not to be sacrificed to a greater good, because they possess an inherent human value.
This includes Indigenous peoples. But it also includes those with disabilities, the elderly, the immunocompromised, refugees, prison inmates, the homeless, and other marginalized groups. Those at the highest risk of transmission, and the highest risk of death, are the ones who need extra resources to avoid exposure, and to survive it if it comes. Those in good health who nonetheless wind up in the most severe category of illness need to be helped as well - but to prioritize those in good health pre-emptively is to write those at greater risk off to die.
By doing so, you are
abandoning the 'all lives have equal value' line. Because the thing about abandoning entire population groups that are at special risk is that you don't think they're equal, because if they were genuinely of equal value then you would invest additional resources to give them the same chance as everyone else. The human tragedy of what's going on is horrific - but to point to the fact that the elderly died elsewhere to justify not taking additional measures to protect the most vulnerable is utterly fucked from where I'm standing.
Think of it this way. There's a classic illustration of equity with three people trying to see over a fence and three boxes. There's a tall fella who can see without difficulty, a short fella who can nearly see over, and a really short fella who can't at all. If you give the shortest fella two boxes, he can. If you give the short fella one, he can. The tall fella could already see, so he doesn't need a box. If we treat them equally, the shortest fella still can't see, and the tall fella has a box he doesn't need. If we treat them as though each has equal value, then we hand the shortest fella the two boxes, the short fella one, and they all get to see. This is equity, rather than strict equality, but it produces an equal outcome - it's the way to actually treat all three as having equal value, by recognizing that different people have different needs and vulnerabilities.
What we're talking about here is harder to balance, because no matter what we do, people will die. But the same basic principle applies. If we want to actually treat everyone's lives as having equal value, we cannot preemptively write off entire communities with special requirements when they ask for additional supply, nor can we send the same amount as everyone else. The first might be practical, but it does not treat their lives as equal to those of others. The second might be equal in its treatment, but by failing to take into account the special requirements of a community, it does not produce actual equality or equity. It doesn't give them the same chance of survival as everyone else.
You may, if you wish, continue to argue that we should sacrifice populations with special vulnerability, whether actively or just by denying them the extra supplies needed to give them the same chance of survival as everyone else. You might justify that as a utilitarian good, if you like. But it does not treat everyone's lives as having equal value. It treats the lives of those who need more help to have the same chance of survival as less than the lives of those who need less.
I won't try and convince you not to think that, because bluntly, I can't. There is no magic formula to resolve the utilitarian versus deontological issue, and once we reach this point of fundamental ethics, we move into the purely normative domain, and normative beliefs are notoriously hard to prove or disprove. Mine is that we need to focus our resources on minimizing fatalities by protecting the most vulnerable communities where we can, precisely because if an outbreak strikes them they're the first to die, the ones most at risk. This is the position you define as garbage. Your position is that when the disease strikes, these groups will die anyway, so we shouldn't expend extra effort to protect them from that. Yours may have merit in making decisions in the actual ICU, but to adopt it when there's still a chance of containing and excluding the outbreak in the communities that need help to do it and who will be devastated by it? This, to me, is garbage.
"Doctors keep their scalpels and other instruments handy, for emergencies. Keep your philosophy ready too—ready to understand heaven and earth. In everything you do, even the smallest thing, remember the chain that links them. Nothing earthly succeeds by ignoring heaven, nothing heavenly by ignoring the earth." M.A.A.A