An Equity-Focused Health Impact Assessment of the COVID-19 pandemic and associated response

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.

Chief investigators

• Associate Professor Fiona Haigh HERDU, UNSW
• Dr Esther Alloun HERDU, UNSW
• Dr Christopher Standen HERDU, UNSW
• Ms Miriam Olliek, HERDU, SLHD
• Ms Jude Page, HERDU, UNSW
• Associate Professor Marilyn Wise, HERDU, UNSW

Project Rationale

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).

Project Aim/s

1. Systematically identify potential health equity impacts of COVID-19 and associated responses, and identified evidence of effective actions to reduce the likelihood of inequity
2. Identify evidence of systemic actions that can be taken by the health sector to protect vulnerable populations from the current and future pandemics
3. Work with stakeholders to embed positive, evidence-based actions in the current pandemic response and develop strategies for implementation by the SLHD.

Project Design and Method

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.

Contact

Fiona Haigh
Email: f.haigh@unsw.edu.au

Key Partners

Sydney Local Health District

Funding

Sydney Local Health District

Publications

• Haigh F, Alloun E, Standen C, Olliek M, Page J, Wise M. (2022) An Equity-Focused Health Impact Assessment of the COVID-19 Pandemic in Sydney Local Health District. Summary Report. Sydney, SLHD and UNSW.
• Haigh F, Alloun E, Standen C, Olliek M, Page J, Wise M. (2022) An Equity-Focused Health Impact Assessment of the COVID-19 Pandemic in Sydney Local Health District. Technical Report. Sydney, SLHD and UNSW.
• Haigh F, Alloun E, Standen C, Olliek M, Page J, Wise M. (2022) An Equity-Focused Health Impact Assessment of the COVID-19 Pandemic in Sydney Local Health District. Supplementary Material. Sydney, SLHD and UNSW.
• Haigh, F., Alloun, E., Standen, C., Olliek, M., & Wise, M. (n.d.). An equity-focused health impact assessment of the COVID-19 pandemic and associated response. Population Medicine, 5(Supplement). doi:10.18332/popmed/163941