Considering social inequalities in health in COVID-19 response: insights from a French case study

Abstract

Summary The COVID-19 pandemic highlighted the impact of social inequalities in health (SIH). Various studies have shown significant inequalities in mortality and morbidity associated with COVID-19 and the influence of social determinants of health. The objective of this qualitative case study was to analyze the consideration of SIH in the design of two key COVID-19 prevention and control interventions in France: testing and contact tracing. Interviews were conducted with 36 key informants involved in the design of the intervention and/or the government response to the pandemic as well as relevant documents (n = 15) were reviewed. We applied data triangulation and a hybrid deductive and inductive analysis to analyze the data. Findings revealed the divergent understandings and perspectives about SIH, as well as the challenges associated with consideration for these at the beginning stages of the pandemic. Despite a shared concern for SIH between the participants, an epidemiological frame of reference dominated the design of the intervention. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission. Although the COVID-19 health crisis highlighted the importance of SIH, it did not appear to be an opportunity to further their consideration in response efforts. This article provides original insights into consideration for SIH in the design of testing and contact-tracing interventions based upon a qualitative investigation.

COVID-19 patient experiences in prehospital pathways: a processual approach using life-events calendar method and state sequence analysis shows detrimental delays

“…Health inequalities, which have been the subject of a large number of publications, both on COVID and on the state of health in general. [21][22][23][24] We have identified four key reasons that may explain the delayed hospitalisation in cluster 3 despite the severity of COVID-19 symptoms: 1. Lack of healthcare professionals in the personal network: individuals without close connections to healthcare professionals may experience delays in seeking hospitalisation.…”

COVID-19-related global health governance and population health priorities for health equity in G20 countries: a scoping review

“…They reported that human rights and inequities were undervalued by key governance actors who took decisions to respond to COVID-19, coupled with structural factors (e.g., gender discrimination and racism) that facilitated the exacerbation of such inequities in low-, middle-, and high-income countries [ 8 ]. A recent study conducted in France that explored the social and health inequities in the COVID-19 response found that despite a strategic opportunity to address these inequities, it did not materialise mainly due to a dominant biomedical epidemiological framework adopted during the COVID-19 emergency phase that gave precedence to the virus rather than to the socio-structural determinants of health [ 52 ]. Nonetheless, the COVID-19 pandemic has mobilised international actors to address these inequities, in particular vaccine inequities, through the Access to COVID-19 Tools Accelerator initiative, which aims to expedite the “development, production, and equitable access to COVID-19 tests, treatments, and vaccines” globally [ 53 ].…”

COVID-19 vaccination at a hospital in Paris: Spatial analyses and inverse equity hypothesis

“…Given the scientific knowledge, the local and hospital context of this vaccine strategy [ 9 ], and the fact that vaccination against SARS-CoV-2 is now open to the entire population without any particular restrictions, we hypothesize that people living in the most deprived neighbourhoods were the last to benefit from it.…”

“…Reviews show that people planning infectious disease interventions need to be more explicitly concerned about equity issues [ 7 , 8 ]. These challenges were identified in Paris for the same follow-up and the organization of SARS-CoV-2 tests organized by the hospital network [ 9 ]. However, other arrangements have been organized by the Regional Health Agency (ARS) to promote regional equity, beyond these hospital facilities, without conclusive results.…”

“…At the COVID-19 centre of the hospital concerned by this study, vaccinations were organized from January 2021 onward. Previous qualitative research has shown that this centre’s managers and stakeholders could not consider the challenges of social health inequalities in the screening and follow-up of contact cases of SARS-CoV-2 [ 9 ]. This article aims to study with quantitative data whether the inverse care law has been verified in the context of vaccination against SARS-CoV-2 from a vaccination centre of a hospital in the Paris region.…”