A framework for identifying and mitigating the equity harms of COVID-19 policy interventions

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a global pandemic. Governments have implemented combinations of ''lockdown'' measures of various stringencies, including school and workplace closures, cancellations of public events, and restrictions on internal and external movements. These policy interventions are an attempt to shield high-risk individuals and to prevent overwhelming countries' healthcare systems, or, colloquially, ''flatten the curve.'' However, these policy interventions may come with physical and psychological health harms, group and social harms, and opportunity costs. These policies may particularly affect vulnerable populations and not only exacerbate pre-existing inequities but also generate new ones.Methods: We developed a conceptual framework to identify and categorize adverse effects of COVID-19 lockdown measures. We based our framework on Lorenc and Oliver's framework for the adverse effects of public health interventions and the PROGRESS-Plus equity framework. To test its application, we purposively sampled COVID-19 policy examples from around the world and evaluated them for the potential physical, psychological, and social harms, as well as opportunity costs, in each of the PROGRESS-Plus equity domains: Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, and disability).Results:We found examples of inequitably distributed adverse effects for each COVID-19 lockdown policy example, stratified by a low-or middle-income country and high-income country, in every PROGRESS-Plus equity domain. We identified the known policy interventions intended to mitigate some of these adverse effects. The same harms (anxiety, depression, food insecurity, loneliness, stigma, violence) appear to be repeated across many groups and are exacerbated by several COVID-19 policy interventions.Conclusion: Our conceptual framework highlights the fact that COVID-19 policy interventions can generate or exacerbate interactive and multiplicative equity harms. Applying this framework can help in three ways: (1) identifying the areas where a policy intervention may generate inequitable adverse effects; (2) mitigating the policy and practice interventions by facilitating the systematic examination of relevant evidence; and (3) planning for lifting COVID-19 lockdowns and policy interventions around the world.

Global Food Insecurity and African, Caribbean, and Black (ACB) Populations During the COVID-19 Pandemic: a Rapid Review

“…From all these studies, only one has collected original data involving 1478 adults [ 26 ]. The rest of the studies were comments [ 27 ], theoretical perspectives [ 25 , 28 , 29 ], or just a press release report [ 21 , 23 , 24 ]. While some of the studies focused specifically on ACB population [ 23 , 24 , 27 ], the majority focused on minorities and marginalized communities [ 21 , 22 , 25 , 26 , 28 , 29 ].…”

A Story of Mother’s Struggle in the Rural: The Narratives of Children Learning Mentoring during the Covid-19 Outbreak

“…Social restrictions are initiated for all citizens, including students who are strictly prohibited from leaving home except for the limited purposes permitted by the Orders. Glover et al [1], Yousefpour et al [2] and Nicola et al [3] review each of the policies taken aiming to put a halt to Covid-19, despite the fact that Viner et al [4] found the closure of school services had no major impact, only preventing 2-4% of the total of deaths, far less than other social distance interventions.…”

‘Most at risk’ for COVID19? The imperative to expand the definition from biological to social factors for equity

“…Yet, these recommendations can be implemented most effectively by privileged individuals—those with secure housing, monetary resources, tangible social support, access to medical care, power to self-advocate to receive a test in contexts with limited tests, and white-collar professions that easily transition to remote work for physical distancing ( Valentino-DeVries et al, 2020 ). A recent analysis of COVID-19 policy interventions indicates the extent of their potential inequitable impacts on some population groups ( Glover et al, 2020 ). In addition, the recommendations may not be as applicable to low and middle income countries (LMIC) as to high income countries; context matters ( Cash and Patel, 2020 ; Kelley et al, 2020 ).…”

“…COVID19 is a like a ‘canary in the coal mine’, highlighting conditions that make people differentially susceptible to all diseases ( Navarro and Shi, 2001 ; Sharma, 2017 ). In our prevention and mitigation responses, we must prioritize the most socially vulnerable to begin to reverse disparities and health inequities ( Glover et al, 2020 ; Berger et al, 2020 ; Gostin et al, 2020 ). After all, public health has two moral aims, one to improve population health and second to reduce health inequities ( Powers and Faden, 2013 ).…”