A framework for identifying and mitigating the equity harms of COVID-19 policy interventions
A framework for identifying and mitigating the equity harms of COVID-19 policy interventions
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DOI：
10.1016/j.jclinepi.2020.06.004
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发表时间：
2020-12-01
影响因子：
7.2
通讯作者：
Welch, Vivian
中科院分区：
文献类型：
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作者：
Glover, Rebecca E.;van Schalkwyk, May C. I.;Welch, Vivian
背景：2019冠状病毒病（COVID-19）是一种全球性大流行。各国政府实施了各种严格程度的“封锁”措施，包括关闭学校和工作场所、取消公共活动以及限制内外流动。这些政策干预是为了保护高危人群，防止国家医疗系统不堪重负，或者通俗地说，“使曲线变平”。然而，这些政策干预可能带来身心健康危害、群体和社会危害以及机会成本。这些政策可能特别影响到弱势群体，不仅加剧了已有的不平等，而且还会产生新的不平等。方法：我们制定了一个概念性框架来识别和分类COVID-19封锁措施的不良影响。我们的框架基于Lorenc和Oliver关于公共卫生干预措施不利影响的框架和PROGRESS-Plus公平框架。为了测试其应用，我们有目的地从世界各地抽样了COVID-19政策示例，并评估了每个PROGRESS-Plus公平领域的潜在身体、心理和社会危害以及机会成本：居住地、种族/民族、职业、性别/性别、宗教、教育、社会经济地位、社会资本、附加（年龄和残疾）。结果：我们发现，在每个PROGRESS-Plus公平领域，每个COVID-19封锁政策示例的不利影响分布不均，按低收入或中等收入国家和高收入国家分层。我们确定了旨在减轻这些不利影响的已知政策干预措施。同样的危害（焦虑、抑郁、粮食不安全、孤独、耻辱、暴力）似乎在许多群体中重复出现，并因几项COVID-19政策干预措施而加剧。结论：我们的概念框架强调了这样一个事实，即COVID-19政策干预可能产生或加剧互动性和多重公平性损害。应用这一框架可以在三个方面提供帮助：(1)确定政策干预可能产生不公平不利影响的领域；(2)通过促进对相关证据的系统审查，减轻政策和实践干预；(3)规划全球解除COVID-19封锁和政策干预措施。(C) 2020爱思唯尔公司版权所有。
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-in come 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. (C) 2020 Elsevier Inc. All rights reserved.