HERDU undertook a concurrent, equity-focused health impact assessment (EFHIA) of the potential health equity impacts resulting from COVID-19 and associated responses in Sydney Local Health District (SLHD). The EFHIA took as its starting point, the time at which the first evidence emerged that the COVID-19 virus had reached Australia, and focused on the health and health equity impacts of the virus and of the government and health responses (in particular) over the following two years.
The ways in which the COVID-19 pandemic has affected the communities, reflects the broader mechanisms by which health inequities are created and sustained. SLHD recognised at an early stage, the potential for people living in situations of vulnerability to be disproportionately affected by not only by the pandemic, but also the associated response.
Actions taken to reduce the transmission of COVID-19 undoubtedly saved lives. However, they also had negative impacts on health. For example, the temporary stopping of services and the suspension of some home visits, limited early detection, triage and treatment of child development and wellbeing issues. Pandemic responses that may have improved health outcomes overall, may also have created, perpetuated and, in some cases, amplified health inequities.
A need was identified for a more systematic overview of the potential longer-term equity impacts resulting from COVID-19 and the actions taken in response to the pandemic. A proposal for HERDU to carry out an equity-focused health impact assessment (EFHIA) of the COVID-19 pandemic in SLHD was approved by the District’s Chief Executive (July 2020).
Following standard steps, the EFHIA focused on three areas: risks and consequences of COVID-19 infection, changes to health services and changes to work.
Data collection involved: developing a community profile; using local date analysing how the risks and consequences of COVID-19 infection varied across population groups within the area; 18 semi-structured interviews; five focus groups with a mix of health professionals and service users; five literature reviews; six evidence briefs/checks; and a grey literature and policy review. We triangulated, synthesised and critically assessed the evidence to describe health equity impacts. Impacts were characterised according to direction of impact, likelihood, severity, level, and timeframes of impact. Findings were reviewed and validated by topic specialists, participants and steering group, as well as experts on HIA and health equity.
The EFHIA identified multiple health and health equity impacts arising from the pandemic and associated responses. This EFHIA report concludes with 22 equity-focussed recommendations directed at what worked well, what the health district needs to do more of and what to do differently to support health equity within the Local Health District and more widely.
Sydney Local Health District
Sydney Local Health District
Action for Equity