Striving for Health Equity: The Importance of Social Determinants of Health and Ethical Considerations in Pandemic Preparedness Planning

Abstract

Since the WHO’s “Influenza Pandemic Preparedness Plan” in 1999, pandemic preparedness plans at the international and national level have been constantly adapted with the common goal to respond early to outbreaks, identify risks, and outline promising interventions for pandemic containment. Two years into the COVID-19 pandemic, public health experts have started to reflect on the extent to which previous preparations have been helpful as well as on the gaps in pandemic preparedness planning. In the present commentary, we advocate for the inclusion of social and ethical factors in future pandemic planning—factors that have been insufficiently considered so far, although social determinants of infection risk and infectious disease severity contribute to aggravated social inequalities in health.

Differences in the Pandemic? Qualitative Study of Gender as a Social Determinant

“…According to Holst et al [21,22], women are significantly overrepresented in the four interpersonal labour force classes and in the two lower administrative labour force classes; men, on the other hand, dominated mainly the technical labour force classes and the upper administrative as well as independent labour force classes. These factors were given little consideration in the pandemic mitigation measures [23,25,31,41,45]. The associated effects become clear in the individual experience of the respondents.…”

“…At the same time, studies make it clear that the effects significantly influence inequalities: for example, socially disadvantaged people have a higher risk of infection with COVID-19 and a more severe course of the disease [6,13], the possibility of mobile working is unequally given [1], and low-income workers experience above-average income losses [24]. Relevant social determinants of the individual risk of infection are cramped living conditions, poor housing quality, low income, low education and a disadvantaged socio-economic situation [23]. Occupations with a potentially increased risk of exposure are those that are characterised by interpersonal contact and cannot be easily practised from home, such as retail, health or rescue workers [23].…”

“…Relevant social determinants of the individual risk of infection are cramped living conditions, poor housing quality, low income, low education and a disadvantaged socio-economic situation [23]. Occupations with a potentially increased risk of exposure are those that are characterised by interpersonal contact and cannot be easily practised from home, such as retail, health or rescue workers [23].…”

Impact of Social Deprivation on Hospitalization and Intensive Care Unit Admission among COVID-19 Patients: A Systematic Review and Meta-Analysis

“…Providing at-home test kits and mobile clinics could improve equitable access to healthcare services, as transportation is often the major barrier to underserved populations ( 46 , 47 ). Furthermore, primary prevention to reduce incidence and prevalence of underlying comorbidities and prioritization of vulnerable populations for vaccinations also play an important role in mitigating strain on healthcare systems ( 48 , 49 ).…”