Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran.
Department of Political and Social Sciences, European University Institute, Florence, Italy.
BMC Public Health. 2024 Sep 4;24(1):2400. doi: 10.1186/s12889-024-19594-4.
The effectiveness of crisis response can be influenced by various structural, cultural, and functional aspects within a social system. This study uses a configurational approach to identify combinations of sociopolitical conditions that lead to a high case fatality rate (CFR) of COVID-19 in OECD countries.
A Fuzzy set qualitative comparative analysis (QCA) is conducted on a sample of 38 OECD countries. The outcome to be explained is high COVID-19 CFR. The five potentially causal conditions are level of democracy, state capacity, trust in government, health expenditure per capita, and the median age of population. A comprehensive QCA robustness test protocol is applied, which includes sensitivity ranges, fit-oriented robustness, and case-oriented robustness tests.
None of the causal conditions in both the presence and negation form were found to be necessary for high or low levels of COVID-19 CFR. Two different combinations of sociopolitical conditions were usually sufficient for the occurrence of a high CFR of COVID-19 in OECD countries. Low state capacity and low trust in government are part of both recipes. The entire solution formula covers 84 percent of the outcome. Some countries have been identified as contradictory cases. The explanations for their COVID-19 CFR require more in-depth case studies.
From a governance perspective, the weakness of government in effectively implementing policies, and the citizens' lack of confidence in their government, combined with other structural conditions, serve as barriers to mounting an effective response to COVID-19. These findings can support the idea that the effects of social determinants of COVID-19 outcomes are interconnected and reinforcing.
危机应对的有效性可能受到社会系统内各种结构、文化和功能方面的影响。本研究采用组态方法，确定导致经合组织国家 COVID-19 病死率（CFR）较高的社会政治条件组合。
对经合组织 38 个国家的样本进行模糊集定性比较分析（QCA）。要解释的结果是 COVID-19 高 CFR。五个潜在的因果条件是民主水平、国家能力、对政府的信任、人均卫生支出和人口中位数年龄。应用了全面的 QCA 稳健性测试方案，包括灵敏度范围、面向拟合的稳健性和面向案例的稳健性测试。
在存在和否定形式下，没有一个因果条件被发现对 COVID-19 CFR 的高低是必要的。在经合组织国家，通常有两种不同的社会政治条件组合足以导致 COVID-19 CFR 较高。低国家能力和低政府信任是两种方案的一部分。整个解决方案公式涵盖了 84%的结果。一些国家被确定为矛盾案例。需要对其 COVID-19 CFR 进行更深入的案例研究。
从治理角度来看，政府在有效执行政策方面的弱点，以及公民对政府缺乏信心，加上其他结构条件，成为有效应对 COVID-19 的障碍。这些发现可以支持这样一种观点，即 COVID-19 结果的社会决定因素的影响是相互关联和相互加强的。
