School of Pharmacy, University of Utah, Salt Lake City, UT, USA.
The Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre), UCL Social Research Institute, University College London, London, UK.
BMC Public Health. 2021 Sep 16;21(1):1682. doi: 10.1186/s12889-021-11688-7.
There is increasing evidence that COVID-19 has unmasked the true magnitude of health inequity worldwide. Policies and guidance for containing the infection and reducing the COVID-19 related deaths have proven to be effective, however the extent to which health inequity factors were considered in these policies is rather unknown. The aim of this study is to measure the extent to which COVID-19 related policies reflect equity considerations by focusing on the global policy landscape around wearing masks and personal protection equipment (PPE).
A systematic search for published documents on COVID-19 and masks/PPE was conducted across six databases: PubMed, EMBASE, CINAHL, ERIC, ASSIA and Psycinfo. Reviews, policy documents, briefs related to COVID-19 and masks/PPE were included in the review. To assess the extent of incorporation of equity in the policy documents, a guidance framework known as 'PROGRESS-Plus': Place of residence, Race/ethnicity, Occupation, Gender/sex, Religion, Education, Socioeconomic status, Social capital, Plus (age, disability etc.) was utilized.
This review included 212 policy documents. Out of 212 policy documents, 190 policy documents (89.62%) included at least one PROGRESS-plus component. Most of the policy documents (n = 163, 85.79%) focused on "occupation" component of the PROGRESS-plus followed by personal characteristics associated with discrimination (n = 4;2.11%), place of residence (n = 2;1.05%) and education (n = 1;0.53%). Subgroup analysis revealed that most of the policy documents (n = 176, 83.01%) were focused on "workers" such as healthcare workers, mortuary workers, school workers, transportation workers, essential workers etc. Of the remaining policy documents, most were targeted towards whole population (n = 30; 14.15%). Contrary to "worker focused" policy documents, most of the 'whole population focused' policy documents didn't have a PROGRESS-plus equity component rendering them equity limiting for the society.
Our review highlights even if policies considered health inequity during the design/implementation, this consideration was often one dimensional in nature. In addition, population wide policies should be carefully designed and implemented after identifying relevant equity related barriers in order to produce better outcomes for the whole society.
越来越多的证据表明，COVID-19 揭示了全球健康不平等的真实程度。控制感染和减少 COVID-19 相关死亡的政策和指导被证明是有效的，然而，这些政策在多大程度上考虑了健康不平等因素尚不清楚。本研究的目的是通过关注全球范围内戴口罩和个人防护设备（PPE）的政策，衡量 COVID-19 相关政策反映公平性考虑的程度。
在六个数据库中对 COVID-19 和口罩/PPE 相关的已发表文献进行了系统检索：PubMed、EMBASE、CINAHL、ERIC、ASSIA 和 Psycinfo。本综述纳入了 COVID-19 相关的综述、政策文件、简报以及与口罩/PPE 相关的文件。为了评估政策文件中纳入公平性的程度，使用了一个名为“PROGRESS-Plus”的指导框架：居住地、种族/民族、职业、性别/性别、宗教、教育、社会经济地位、社会资本、Plus（年龄、残疾等）。
本综述共纳入 212 项政策文件。在 212 项政策文件中，有 190 项（89.62%）政策文件至少包含一个 PROGRESS-plus 组成部分。大多数政策文件（n=163，85.79%）侧重于 PROGRESS-plus 的“职业”组成部分，其次是与歧视相关的个人特征（n=4，2.11%）、居住地（n=2，1.05%）和教育（n=1，0.53%）。亚组分析显示，大多数政策文件（n=176，83.01%）侧重于“工人”，如医护人员、太平间工人、学校工人、交通工人、基本工人等。在其余的政策文件中，大多数是针对整个人口（n=30，14.15%）。与“以工人为中心”的政策文件相反，大多数“面向整个人口”的政策文件没有 PROGRESS-plus 公平性组成部分，这使得它们对社会具有限制公平性的作用。
我们的综述强调了即使在设计/实施过程中政策考虑了健康不平等问题，但这种考虑往往是一维的。此外，在制定面向整个社会的政策时，应在确定相关公平性障碍后仔细设计和实施，以产生更好的社会效益。
