Equity Lens on Canada’s COVID-19 Response: Review of the Literature

Document Type : Review Article

Authors

1 Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada

2 Department of History, Faculty of Liberal Arts & Professional Studies, York University, Toronto, ON, Canada

Abstract

Background 
A growing literature has documented how the secondary effects of the COVID-19 pandemic have compounded socioeconomic vulnerabilities already present in society, particularly across social categories such as gender, race, class, and socioeconomic status. Such effects demonstrate how pandemic response policies act as structural determinants of health to influence not only direct health outcomes but also intermediary outcomes, such as access to education or income.
 
Methods 
This review aims to scope research that analyzes pandemic response policies in Canada from an equity perspective, to identify common themes, recommendations, and gaps.
 
Results 
Fourteen studies were thematically analyzed, the majority being qualitative policy document analysis, applying critical frameworks and focused on effects on select priority populations. Analysis of economic and labour policies indicates a lack of consideration for the specific needs of priority populations, and those engaged in precarious, informal, and essential labour. Analysis of social policies illustrate the wide-ranging effects of school and service closures, particularly on women and children. Furthermore, these policies lacked consideration of populations marginalized during the pandemic, include older adults and their caregivers, as well as lack of consideration of the diversity of Indigenous communities. Recommendations proposed in this review call for developing policy responses that address persistent social and economic inequities, pandemic response policies tailored to the needs of priority populations and more meaningful consultation during policy development.
 
Conclusion 
The limited number of studies suggests there is still much scope for research recognizing policies as structural determinants of health inequities, including research which takes an intersectional approach.

Keywords

References

  1. Paremoer L, Nandi S, Serag H, Baum F. COVID-19 pandemic and the social determinants of health. BMJ. 2021;372:n129. doi:1136/bmj.n129
  2. Abrams EM, Szefler SJ. COVID-19 and the impact of social determinants of health. Lancet Respir Med. 2020;8(7):659-661. doi:1016/s2213-2600(20)30234-4
  3. Trout LJ, Kleinman A. COVID-19 requires a social medicine response. Front Sociol. 2020;5:579991. doi:3389/fsoc.2020.579991
  4. Statistics Canada. COVID-19 in Canada: A Two-Year Update on Social and Economic Impacts. Statistics Canada; 2022. https://www150.statcan.gc.ca/n1/pub/11-631-x/11-631-x2022001-eng.htm. Updated March 10, 2022. Accessed April 1, 2023.
  5. Connell R. COVID-19/sociology. J Sociol. 2020;56(4):745-751. doi:1177/1440783320943262
  6. Miller A. Almost Half of Canadians May Have Caught COVID. CBC; 2022. https://www.cbc.ca/news/health/omicron-immunity-canada-covd19-vaccines-1.6428536. Accessed April 14, 2023.
  7. Shadmi E, Chen Y, Dourado I, et al. Health equity and COVID-19: global perspectives. Int J Equity Health. 2020;19(1):104. doi:1186/s12939-020-01218-z
  8. Burton ÉC, Bennett DH, Burton LM. COVID-19: health disparities and social determinants of health. Int Soc Work. 2020;63(6):771-776. doi:1177/0020872820944985
  9. Horton R. Offline: COVID-19 is not a pandemic. Lancet. 2020;396(10255):874. doi:1016/s0140-6736(20)32000-6
  10. Schröders J, Wall S, Kusnanto H, Ng N. Millennium development goal four and child health inequities in Indonesia: a systematic review of the literature. PLoS One. 2015;10(5):e0123629. doi:1371/journal.pone.0123629
  11. Tyler I, Hassen N. Priority Populations Project: Understanding and Identifying Priority Populations for Public Health in Ontario. Ontario Agency for Health Protection and Promotion (Public Health Ontario); 2015.
  12. Liburd LC, Hall JE, Mpofu JJ, Williams SM, Bouye K, Penman-Aguilar A. Addressing health equity in public health practice: frameworks, promising strategies, and measurement considerations. Annu Rev Public Health. 2020;41:417-432. doi:1146/annurev-publhealth-040119-094119
  13. Women and Gender Equality Canada. Action Plan on Gender-Based Analysis (2016-2020). https://women-gender-equality.canada.ca/en/gender-based-analysis-plus/resources/action-plan-2016-2020.html. Published April 2021. Accessed April 2023.
  14. Government of Canada Justice Laws. Canadian Gender Budgeting Act. S.C 2018, C. 27, S. 314. https://laws-lois.justice.gc.ca/PDF/C-17.2.pdf. Accessed April 10, 2023.
  15. Women and Gender Equality Canada. Government of Canada Announces Recipients of $100-Million Feminist Response and Recovery Fund. Ottawa, Ontario: Women and Gender Equality Canada; 2021. https://www.canada.ca/en/women-gender-equality/news/2021/07/government-of-canada-announces-recipients-of-100-million-feminist-response-and-recovery-fund.html. Accessed April 2023.
  16. Tricco AC, Lillie E, Zarin W, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467-473. doi:7326/m18-0850
  17. Munn Z, Peters MD, Stern C, Tufanaru C, McArthur A, Aromataris E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med Res Methodol. 2018;18(1):143. doi:1186/s12874-018-0611-x
  18. Esses V, McRae J, Alboim N, et al. Supporting Canada’s COVID-19 resilience and recovery through robust immigration policy and programs. Facets. 2021;6(1):686-759. doi:1139/facets-2021-0014
  19. Béland D, Dinan S, Rocco P, Waddan A. COVID-19, poverty reduction, and partisanship in Canada and the United States. Policy Soc. 2022;41(2):291-305. doi:1093/polsoc/puac002
  20. Pin L, Levac L, Rodenburg E. Legislated Poverty? An intersectional policy analysis of COVID-19 income support programs in Ontario, Canada. J Poverty. 2023;27(5):404-425. doi:1080/10875549.2022.2113590
  21. Stall NM, Johnstone J, McGeer AJ, Dhuper M, Dunning J, Sinha SK. Finding the right balance: an evidence-informed guidance document to support the re-opening of Canadian nursing homes to family caregivers and visitors during the coronavirus disease 2019 pandemic. J Am Med Dir Assoc. 2020;21(10):1365-1370.e7. doi:1016/j.jamda.2020.07.038
  22. Spence N, Chau V, Farvid MS, White JP, Rasalingam P, Loh L. The COVID-19 pandemic: informing policy decision-making for a vulnerable population. Int Indig Policy J. 2020;11(3):1-37. doi:18584/iipj.2020.11.3.10859
  23. Doucet A, Mathieu S, McKay L. Reconceptualizing parental leave benefits in COVID-19 Canada: from employment policy to care and social protection policy. Can Public Policy. 2020;46(S3):S272-S286. doi:3138/cpp.2020-091
  24. Abu Alrob Z, Shields J. A COVID-19 state of exception and the bordering of Canada’s immigration system: assessing the uneven impacts on refugees, asylum seekers and migrant workers. Stud Soc Justice. 2022;16(1):54-77. doi:26522/ssj.v16i1.2691
  25. Lee RS, Collins K, Perez-Brumer A. COVID-19 violence and the structural determinants of death: Canada's seasonal agricultural worker programme. Glob Public Health. 2022;17(5):784-793. doi:1080/17441692.2022.2053735
  26. Ruckert A, Shedeed E, Hillier S, Labonté R. The Canadian Policy Response to COVID-19: What’s in it for Health Equity? Research Enabling Platform 4. University of Ottawa, York University; 2021. https://global1hn.ca/wp-content/uploads/2021/02/G1HN_Equity-Report_19.01.21_3.pdf.
  27. Smith J, Mũrage A, Lui I, Morgan R. Integrating gender-based analysis plus into policy responses to COVID-19: lived experiences of lockdown in British Columbia, Canada. Soc Polit. 2022;29(4):1168-1191. doi:1093/sp/jxac024
  28. Koebel K, Pohler D, Gomez R, Mohan A. Public policy in a time of crisis: a framework for evaluating Canada's COVID-19 income support programs. Can Public Policy. 2021;47(2):316-333. doi:3138/cpp.2020-117
  29. Katz I, Katz C, Andresen S, et al. Child maltreatment reports and child protection service responses during COVID-19: knowledge exchange among Australia, Brazil, Canada, Colombia, Germany, Israel, and South Africa. Child Abuse Negl. 2021;116(Pt 2):105078. doi:1016/j.chiabu.2021.105078
  30. Combden S, Forward A, Sarkar A. COVID-19 pandemic responses of Canada and United States in first 6 months: a comparative analysis. Int J Health Plann Manage. 2022;37(1):50-65. doi:1002/hpm.3323
  31. Johnston RM, Sheluchin A, van der Linden C. Evidence of exacerbated gender inequality in child care obligations in Canada and Australia during the COVID-19 pandemic. Polit Gender. 2020;16(4):1131-1141. doi:1017/s1743923x20000574
  32. Balakrishnan A. Uncertainty Over Schooling Plans Has Working Mothers Mulling Leaving Workforce. CTV News; 2020. https://www.ctvnews.ca/health/coronavirus/uncertainty-over-schooling-plans-has-working-mothers-mulling-leaving-workforce-1.5022286. Accessed April 14, 2023.
  33. Tan SY, Foo C, Verma M, et al. Mitigating the impacts of the COVID-19 pandemic on vulnerable populations: lessons for improving health and social equity. Soc Sci Med. 2023;328:116007. doi:1016/j.socscimed.2023.116007
  34. Hjálmsdóttir A, Bjarnadóttir VS. "I have turned into a foreman here at home": families and work-life balance in times of COVID-19 in a gender equality paradise. Gend Work Organ. 2021;28(1):268-283. doi:1111/gwao.12552
  35. Smith J, Davies SE, Feng H, et al. More than a public health crisis: a feminist political economic analysis of COVID-19. Glob Public Health. 2021;16(8-9):1364-1380. doi:1080/17441692.2021.1896765
  36. Vásquez-Vera H, León-Gómez BB, Borrell C, et al. Inequities in the distribution of COVID-19: an adaptation of WHO's conceptual framework. Gac Sanit. 2022;36(5):488-492. doi:1016/j.gaceta.2021.10.004
  37. Hankivsky O, Kapilashrami A. Beyond Sex and Gender Analysis: An Intersectional View of the COVID-19 Pandemic Outbreak and Response. Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Health Equity; 2020.

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History

  • Receive Date: 25 May 2023
  • Revise Date: 14 December 2023
  • Accept Date: 25 March 2024
  • First Publish Date: 27 March 2024

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