National Collaborating Centre for Determinants of Health, Antigonish, Nova Scotia, Canada.
Glob Health Promot. 2021 Jun;28(2):7-16. doi: 10.1177/17579759211000975. Epub 2021 Mar 24.
Equity and social justice have long been key tenets of health promotion practice, policy and research. Health promotion foregrounds the pertinence of social, economic, cultural, political and spiritual life in creating and maintaining health. This necessitates a critical structural determinants of health perspective that actively engages with the experiences of health and wellbeing among diverse peoples. The inequitable impacts of pandemics are well documented, as are calls for improved pandemic responses. Yet, current pandemic and emergency preparedness plans do not adequately account for the social and structural determinants of health and health equity.
Through five one-hour online conversations held in April 2020, we engaged 13 practice, policy, research and community leaders on the intersections of COVID-19 and gender, racism, homelessness, Indigenous health and knowledge, household food insecurity, disability, ethics and equitable futures post-COVID-19. We conducted a thematic analysis of speaker and participant contributions to investigate the impacts and influence of COVID-19 related to the structural and social determinants of health. We analyzed which policies, practices and responses amplified or undermined equity and social justice and identified opportunities for improved action.
Analysis of the COVID-19 pandemic revealed four broad themes:• oppressive, unjust systems and existing health and social inequities;• health and social systems under duress and non-responsive to equity;• disproportionate impacts of COVID-19 driven by underlying structural and socioeconomic inequity; and• enhanced momentum for collective mobilization, policy innovations and social transformation.
There was a strong desire for a more just and equitable society in a post-COVID-19 world, going 'back to better' rather than 'back to normal.' Our analysis demonstrates that equity has not been well integrated into pandemic planning and responses. Social movement and systems theories provide insight on ways to build on existing community mobilization and policy openings for sustained social transformation.
公平和社会正义一直是健康促进实践、政策和研究的关键原则。健康促进强调社会、经济、文化、政治和精神生活在创造和维护健康方面的相关性。这需要一种批判的结构决定因素健康观，积极参与不同人群的健康和福祉体验。大流行病的不平等影响有据可查，呼吁改善大流行病应对措施的呼声也很高。然而，目前的大流行病和应急准备计划没有充分考虑健康和健康公平的社会和结构决定因素。
通过在 2020 年 4 月举行的五次为时一小时的在线对话，我们与 13 名实践、政策、研究和社区领导人就 COVID-19 与性别、种族主义、无家可归、土著健康和知识、家庭粮食不安全、残疾、道德和 COVID-19 后公平未来的交叉问题进行了接触。我们对演讲者和参与者的贡献进行了主题分析，以调查与健康结构和社会决定因素有关的 COVID-19 的影响和影响。我们分析了哪些政策、实践和应对措施放大或破坏了公平和社会正义，并确定了改进行动的机会。
对 COVID-19 大流行的分析揭示了四个广泛的主题：• 压迫性、不公正的制度和现有的健康和社会不平等；• 健康和社会系统承受压力，对公平没有反应；• 由基本结构和社会经济不平等驱动的 COVID-19 的不成比例影响；• 集体动员、政策创新和社会转型的势头增强。
在 COVID-19 之后的世界中，人们强烈希望建立一个更加公正和公平的社会，即"回到更好"，而不是"回到正常"。我们的分析表明，公平在大流行病规划和应对措施中没有得到很好的整合。社会运动和系统理论为利用现有的社区动员和政策开放机会进行持续的社会转型提供了见解。
