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International Health News Brief: Special Issue on COVID-19 and Equity

News period covered: April–June 2020

This special issue of International Health News Brief examines how the COVID-19 pandemic has affected people who are vulnerable to health inequities: members of racial or ethnic minorities, people with low income, migrant workers and political refugees, and Indigenous or native populations. We also look at how some people are more likely to experience mental health distress than others during the crisis. Our focus is on the experiences of people living in the 10 countries that take part in the Commonwealth Fund’s annual international survey.

Mental Health Distress Is Disproportionately Experienced by Those Most Vulnerable During the Pandemic

Stay-at-home orders and business closures during the COVID-19 pandemic have taken a toll on mental well-being in a number of countries. At the same time, access to mental health services was disrupted for many, as health care deemed “nonessential” was often restricted.

Some people are more vulnerable than others to these negative impacts. A French survey conducted in April showed that mental health distress was more common among women, individuals with chronic illness, people lacking social supports, people living in overcrowded housing, and those whose financial situation had deteriorated. The survey was part of a project that is evaluating the effects of physical distancing on mental health over the course of the pandemic.

In addition to high death rates from COVID-19, older adults in nursing homes are also experiencing high levels of distress. In the Netherlands, when nursing homes were first closed to visitors to protect residents from the coronavirus, the Ministry of Health developed a pilot project to allow visitation, within strict guidelines, to alleviate social isolation and loneliness. Results from a follow-up study showed not only that the program had a positive impact on residents’ well-being, but there were also no new reported infections.

Children also have felt ill effects. The impact of lockdowns and school closures on mental well-being and development may last into adolescence and adulthood, some experts predict. Disruptions to children’s normal routines, as well as the potential for abuse or exposure to domestic violence, can be especially distressing. Educators can play a key role in identifying at-risk children, while schools are important for food security. France’s education minister called the need to reopen the country’s schools a “social emergency,” stating that lack of schooling has “increased social inequalities.”

Policy Takeaway

  • It’s important for policymakers to take steps to support mental well-being, particularly for vulnerable populations, alongside efforts to implement social distancing measures.

Negative Impacts of COVID-19 More Likely to Be Felt by People of Lower Socioeconomic Status

Social isolation measures and business closures introduced during the pandemic have had greater impacts on essential workers in lower-paying jobs. For these individuals, working from home is usually not an option, and commuting by public transportation is often necessary. Without social protections in place, many suffer greatly upon losing their jobs. Several countries have reported socioeconomic disparities in health outcomes during the pandemic, though not all.

A U.K. study showed that during the first months of the pandemic, age-standardized rates of deaths related to COVID-19 in the most deprived areas of the country were more than double rates in the least deprived areas.

Similarly, in Stockholm, residents of economically vulnerable areas experienced higher COVID-19 infection and death rates than residents of other areas of the city did. The Swedish Delegation Against Segregation, a task force formed in 2018, is committed to monitoring the impact of the pandemic on income inequities across the country.

By contrast, no income inequities in mortality were observed in the Netherlands during the first six weeks of the pandemic. A government report released in May warned, however, that economic inequities may yet widen. It suggested ways to safeguard social protections, including job security and equality in virtual educational access.

Policy Takeaways

  • Social protections are important for preventing the exacerbation of income inequities.
  • A recent United Nations report recommends that governments seek to strengthen social protections, including unemployment support, sick pay, family and child support, measures to address social exclusion and loneliness, housing support, and food security.

Native and Indigenous Communities Seek COVID-19 Solutions Tailored to Local Needs

Indigenous communities may be disproportionately vulnerable to the negative impacts of the coronavirus pandemic. There are a number of reasons: higher rates of underlying chronic conditions, often limited availability of health facilities and providers, discrimination face when seeking care; and less ability to socially distance. Across the world, many of these communities have taken matters into their own hands to ensure culturally appropriate responses.

In Australia, Aboriginal communities have been less affected by COVID-19 than first anticipated. For example, the Northern Territory, where 30 percent of the population identifies as Aboriginal, has experienced no COVID-19 deaths to date. Aboriginal-led public health practitioners and leaders were quick to communicate health risks and information to communities in their native languages. Aboriginal people living in cities returned to their native lands to isolate, and those living together physically distanced to protect their elders. Communities also shut down their borders before the federal government did.

In New Zealand, the National Māori Pandemic Group, Te Rōpū Whakakaupapa Urutā, provides information to the public and advice to policymakers about how to support Māori during the pandemic. This group comprises the country’s leading Māori medical and health experts and iwi (tribe) leaders.

Policy Takeaway

  • Pandemic responses that are culturally appropriate and community-led can help ensure health and safety among Indigenous communities.

Data on Racial and Ethnic Disparities Are Robust in the U.K. but Scarce in France and Germany

The availability of data detailing differential impacts of the coronavirus on racial and ethnic groups differs among the largest countries in Europe, including the United Kingdom, France, and Germany.

A Public Health England investigation of disparities in COVID-19 risk and outcomes found that the mortality risk for residents of Bangladeshi ethnicity was twice as high compared to the risk for those of white British ethnicity. The risk for residents of Chinese, Indian, Pakistani, Other Asian, Caribbean, and Other Black ethnicity was between 10 percent and 50 percent higher. The research suggests that the virus’s disproportionate impact on minority ethnic groups may be the result of structural factors, such as overcrowded households and jobs with higher exposure risk. The agency issued seven recommendations — including mandatory collection and recording of data on race and ethnicity — for improving the lives and experiences of minority ethnic groups. These insights will inform next steps for the U.K.’s work on monitoring and reducing COVID-19 disparities.

In France, an understanding of which ethnic groups are being impacted by COVID-19, and why, has been largely hindered by a national ban on the collection of data on race, ethnicity, or religion. Some have argued that France’s lack of collection of data by ethnicity — a reaction to the deportation of individuals of Jewish descent to Nazi concentration camps during World War II — could impede the country’s ability to identify and protect vulnerable populations in the event of a second wave of infections.

However, a recent report by the French National Institute of Statistics and Economic Studies (INSEE) took a first step toward bridging this gap by documenting COVID death rates by ethnic origin. The report showed that the rates doubled among people of sub-Saharan African descent during the height of the pandemic (March–April 2020).

For the same historical reason as France, Germany also has banned collecting data by ethnicity. But in the wake of protests reacting to the killing of George Floyd in the United States, a debate was sparked across the country to question this policy, and an independent census was launched to document the experiences of people from Black and ethnic minority backgrounds.

Policy Takeaway

  • Collecting data on race and ethnicity alongside numbers of COVID-19 cases, hospitalizations, and deaths is essential to measuring and remedying structural inequities.

Migrants and Refugees Experience Cultural and Linguistic Barriers to Care During the Pandemic

Recent migrants and refugees may face language and cultural barriers to accessing regular care and information on reducing COVID-19 infection risk. Working conditions and living in multigenerational households also may make social distancing difficult.

In the Netherlands and Sweden, COVID-19 infection and death rates have been higher among people of immigrant backgrounds. A Swedish study found that individuals born in Somalia, Syria, and Iraq had increased excess mortality compared with those born in the European Union, Nordic countries, or North America. To increase access to information on the risks of the coronavirus and how to prevent infection, Sweden established a national hotline, published information online, and distributed public health fact sheets in up to 22 languages spoken by refugees and migrants.

Some parts of Australia also moved to make information readily available in multiple languages and ramped up coronavirus testing in multicultural areas.

On World Refugee Day, celebrated on June 20th, the World Health Organization and the United Nations emphasized that health systems should recognize the value that refugees and migrants can bring to COVID-19 relief efforts, including serving as cultural mediators and translators.

Policy Takeaways

  • COVID-19 responses should include making culturally tailored information available in languages spoken by recently arrived refugees and immigrants.
  • Despite increased vulnerability, refugees and migrants can contribute to the pandemic response by being engaged as cultural mediators and translators to help facilitate relief efforts.

Editorial Team

Authors: Roosa Tikkanen, Molly FitzGerald, Katharine Fields, Reggie Williams

Editors: Roosa Tikkanen, Reggie Williams

Country Correspondents

World news — Roosa Tikkanen

Australia — Sonĵ Hall

Canada — Fredika Scarth

France — Angèle Malâtre-Lansac, Véronique Raimond

Germany — Michael Laxy

Netherlands — Marit Tanke, Umar Ikram

Norway — Christer Mjåset

Sweden — Ulrika Winblad

Switzerland — Lars Hemkens

United Kingdom — Adam Briggs, Nason Maani

Publication Details

Publication Date: October 20, 2020

Experts

Roosa Tikkanen
Senior Research Associate, International Program in Health Policy and Practice Innovations, The Commonwealth Fund
Molly FitzGerald
Senior Program Associate for Fellowships and Research, International Program in Health Policy and Practice Innovations, The Commonwealth Fund
Katharine Fields
Program Assistant, International Program in Health Policy and Practice Innovations, The Commonwealth Fund
Reggie Williams
Vice President, International Health Policy and Practice Innovations , The Commonwealth Fund