The session on ‘Mitigating COVID-19’s impact on health inequalities: Investing in an equitable and resilient recovery’ organised by EuroHealthNet, the Health Foundation and Trimbos Instituut, and the Netherlands Institute of Mental Health and Addiction, resulted in a storm of ideas. At first, it seemed a bit overwhelming to try to find one clear path through the jungle of intertwined micro and macro risk factors on health inequities, which have been nowadays magnified by the COVID-19 pandemic. Caroline Costongs set the scene by citing Bambra et al.’s paper, which describes COVID-19 as a syndemic pandemic: “inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health” .
One clear conclusion from the debate: health inequities are increasing as a result of the COVID-19 pandemic.
The direct and indirect impacts of COVID-19 – worsened physical and mental health status, decreased access to healthcare, economic crisis, job losses, to name a few – are impacting the most vulnerable and less-privileged the hardest, as Nico Dragano raised during the discussion. Those earning the lowest wages. Those in precarious employment. Those with poor housing conditions. Those suffering from racial discrimination. But also women, an ‘elephant’ that was not discussed during the session and brought up only at the end by Tim Elwell-Sutton and Bart Vanhercke.
Other conclusions were somewhat less clear: what do we need to do to mitigate COVID-19’s impact on health inequities?
Several ideas were brought up, including the need for an intersectoral approach by Pilar Aparico Azcarraga; increased funding by Dana Burduja; or better collaboration among EU Member States by Bart Vanhercke. Nonetheless, it was Laura Shields-Zeeman and Ghazala Mir who shed light onto what, in my opinion, may be a paved path through this jungle: a social determinant approach to managing public health emergencies.
Laura Shields-Zeeman emphasised the importance of going beyond the health sector to tackle the high burden on mental health, which has considerably increased during the pandemic; and of collaborating with allied sectors to address the roots of social determinants of health, such as housing or employment. Ghazala Mir’s speech offered an in-depth perspective. She highlighted the current focus on micro-factors, such as biological or physiological factors, to explain differences in infection rates between communities, and argued instead for a greater emphasis on the impacts of structural determinants of health, particularly racial discrimination for which there was more evidence. The light was on. Dr Mir’s interventions went right to the heart of the problem: we need a social determinant approach to mitigating COVID-19’s impacts on health inequalities.
So, now, what? Will we dare thinking outside the box and use the paved way through the jungle, an intersectional and social determinant of health approach to manage epi/pandemics?
Innovative and concrete suggestions to apply such approach were brought up during the session: addressing structural determinants of health when managing a crisis and preparing for the next; increasing the representation of overlooked communities in discussions on the response but also within decision-making organisations; and ensuring accountability when addressing inequities.
My take-home message from this session in particular, and the European Health Forum Gastein in general, is that we desperately need an intersectional and social determinant of health approach for countries to recover from COVID-19. Further, beyond this pandemic, preparedness and response plans need to move from a biomedical lens to embrace this ‘new’ approach to ensure that we can prevent – rather than just recover from – unnecessary suffering and a widening of health inequities.