Research Institute of Social Sciences (INCISO), Faculty of Social Sciences, Universidad Mayor de San Simon, Cochabamba, Bolivia.
Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
Int J Equity Health. 2023 Oct 23;22(1):225. doi: 10.1186/s12939-023-02032-z.
The COVID-19 pandemic exposed the health equity gap between and within countries. Western countries were the first to receive vaccines and mortality was higher among socially deprived, minority and indigenous populations. Surprisingly, many sub-Saharan countries reported low excess mortalities. These countries share experiences with community organization and participation in health. The aim of this article was to analyse if and how this central role of people can promote a successful pandemic response.
This analysis was partly based on local and national experiences shared during an international and Latin American conference on person-and people-centred care in 2021. Additionally, excess mortality data and pandemic control-relevant data, as well as literature on the pandemic response of countries with an unexpected low excess mortality were consulted.
Togo, Mongolia, Thailand and Kenya had a seven times lower mean excess mortality for 2020 and 2021 than the United States of America. More successful pandemic responses were observed in settings with experience in managing epidemics like Ebola and HIV, well-established community networks, a national philosophy of mutual aid, financial government assistance, more human resources for primary care and paid community health workers.
Since trust in authorities and health needs vary greatly, local strategies are needed to complement national and international pandemic responses. Three key levers were identified to promote locally-tailored pandemic management: well-organized communities, community-oriented primary care, and health information systems. An organized community structure stems from a shared ethical understanding of humanity as being interconnected with each other and the environment. This structure facilitates mutual aid and participation in decision making. Community-oriented primary care includes attention for collective community health and ways to improve health from its roots. A health information system supports collective health and health equity analysis by presenting health needs stratified for social deprivation, ethnicity, and community circumstances.
The difference in excess mortality between countries during the COVID-19 pandemic and various country experiences demonstrate the potential of the levers in promoting a more just and effective health emergency response. These same levers and strategies can promote more inclusive and socially just health systems.
新冠疫情暴露出国家内部和国家之间的健康公平差距。西方国家率先获得疫苗，社会弱势群体、少数族裔和土著居民的死亡率更高。令人惊讶的是，许多撒哈拉以南非洲国家报告的超额死亡率较低。这些国家在社区组织和参与卫生方面有着共同的经验。本文旨在分析这种以人为中心的角色是否以及如何促进成功的大流行应对。
本分析部分基于 2021 年国际和拉丁美洲关于以人为本和以人民为中心的护理会议上分享的地方和国家经验。此外，还查阅了超额死亡率数据和与大流行控制相关的数据，以及关于超额死亡率意外较低的国家大流行应对的文献。
2020 年和 2021 年，多哥、蒙古、泰国和肯尼亚的平均超额死亡率比美国低七倍。在有应对埃博拉和艾滋病毒等流行病经验、建立良好的社区网络、国家互助理念、政府财政援助、更多初级保健人力资源和有薪社区卫生工作者的国家，大流行应对更为成功。
由于对当局的信任和健康需求存在巨大差异，需要制定地方战略来补充国家和国际大流行应对。确定了三个促进本土化大流行管理的关键杠杆：组织良好的社区、以社区为导向的初级保健和卫生信息系统。有组织的社区结构源于一种相互关联的共同伦理理解，即人类与彼此和环境相互关联。这种结构促进了互助和参与决策。以社区为导向的初级保健包括关注集体社区健康以及从根源上改善健康的方法。卫生信息系统通过为社会贫困、族裔和社区环境分层呈现健康需求，支持集体健康和卫生公平分析。
新冠疫情期间各国超额死亡率的差异以及各国的各种经验表明，这些杠杆在促进更公正和有效的卫生应急反应方面具有潜力。这些相同的杠杆和策略可以促进更具包容性和社会公正的卫生系统。
