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

Abstract

Since the declaration of the COVID-19 pandemic, the promotion of health equity including the health of various population sub-groups has been compromised, human rights jeopardised, and social inequities further exacerbated. Citizens worldwide, including in the Group of 20 (G20) countries, were affected by both global health governance (GHG) processes and decisions and public health measures taken by governments to respond to COVID-19. While it is critical to swiftly respond to COVID-19, little is known about how and to what extent the GHG is affecting population health priorities for health equity in global economies such as the G20 countries. This scoping review synthesised and identified knowledge gaps on how the COVID-19-related GHG is affecting population health priorities for policy, programme, and research in G20 countries. We followed the five-stage scoping review methodology promoted by Arksey and O’Malley and the PRISMA Extension for Scoping Reviews guidelines. We searched four bibliographic databases for references conducted in G20 countries and regions and published in English and French, between January 2020 and April 2023. Out of 4,625 references and after two phases of screening, 14 studies met the inclusion criteria. G20 countries included in the review were Australia, Brazil, Canada, China, France, India, Italy, Japan, Russia, South Africa, the United Kingdom, the United States of America, and the European Union. We found insufficient collaboration and coordination and misalignment among governance actors at multiple levels. In most cases, equity considerations were not prioritised while unequal consequences of COVID-19 public health measures on population groups were widely reported. COVID-19-related population health priorities mainly focused on upstream and midstream determinants of health. Our scoping review showed the stark inequities of COVID-19 public health outcomes, coupled with a prevalent lack of coherent collaboration and coordination among governance actors. Moreover, governance as an object of empirical study is still emerging when examining its intersection with global health and population health policy, programme, and research. An urgent shift is required to effectively act upon structural health determinants that include transformative and comprehensive policies for prevention, equity, resilience, and sustainable health.

The Intersections of COVID-19 Global Health Governance and Population Health Priorities: Equity-Related Lessons Learned From Canada and Selected G20 Countries

“…The most common COVID-19 public health measures discussed in the papers included in the scoping review [ 13 ] were social and fiscal measures [ 17 , 21 , 25 – 27 , 29 , 30 ] to non-pharmaceutical interventions (NPI) that include stay-at-home instructions, physical distancing [ 17 – 21 , 24 , 25 , 27 , 28 ], and COVID-19 testing [ 19 , 24 – 26 ]. Control measures such as lockdowns [ 20 , 22 , 23 , 25 – 27 ] and pharmaceutical interventions (e.g., vaccines) [ 20 , 25 , 29 ] were also addressed.…”

“…This policy option is crucial as it has the great potential to stir the direction of population and public health research priorities in Canada through the equity lens. At the G20 level [ 13 ], policy options addressed the necessity for more multilevel and intersectoral coordination and collaboration [ 25 , 29 ]. They also focused on upstream determinants of health that shape public health systems and governance structures, for example, by putting in place such as prevention-focused policies that reduce health inequities among vulnerable populations in France [ 23 ], an intersectional feminist perspective in COVID-19 responses in China, Hong Kong, Canada, and the UK [ 26 ], and gender equity-focused policies to avoid gender blind spots in pandemic responses in South Africa [ 21 ].…”

“…Otherwise, ongoing equity-based research analyses would be missing. Programmatic recommendations at the G20 level [ 13 ] reported included interventions such as community needs assessment and evaluation of COVID-19-related service delivery in the EU [ 19 ] and the participation of population groups living and working in conditions of vulnerability and marginalisation in emergency response development in Brazil [ 18 ]. It was further suggested that prioritising the needs of communities and countries is essential to devise tailored COVID-19 response interventions in Italy, China, Singapore, and Japan [ 27 ].…”

“…Second, for the scoping review [ 13 ], we identified peer-reviewed literature that focused on five concepts: COVID-19, GHG, population health, equity, and the G20 countries. We followed Arksey’s & O’Malley’s five-stage scoping review framework [ 14 ] and PRISMA Extension for Scoping Reviews (PRISMA-ScR) Checklist [ 15 ].…”

Shifting gears: Creating equity informed leaders for effective learning health systems

“…One study that interviewed 35 global and public health experts found equity was not a priority in high income countries like Canada in the first waves of the pandemic. 3 Rather, the focus was on rapid containment of the virus' spread and combatting overall COVID-19 related mortalities. 3 As rates of COVID-19 infection and hospitalization became disproportionately higher for those from equity-deserving groups, 4 some leaders began searching for ways to rapidly convert research into practice to mitigate the inequities sparking these rates.…”