证据继续表明,某些边缘化人群不成比例地受到COVID-19的影响。虽然许多研究记录了COVID-19对社会健康不平等的影响,没有人研究过在加拿大,公共卫生对这一流行病的应对措施是如何展开的,以解决这些不平等现象.我们研究的目的是评估在蒙特利尔(魁北克,加拿大)。
多国研究HoSPiCOVID的一部分,本文报道了在蒙特利尔对COVID-19进行大规模检测的定性案例研究。我们对19个利益相关者进行了半结构化访谈,这些利益相关者参与了大规模测试的计划或在大流行期间与脆弱人群合作。我们使用有关政策设计和规划的现有文献开发了访谈指南和码本,并在NVivo中使用主题分析对数据进行演绎和归纳分析。
我们的研究结果表明,在蒙特利尔进行的大规模COVID-19检测最初并未在其设计和规划阶段考虑到健康方面的社会不平等。考虑到大流行带来的紧迫感,与会者注意到与采用部门间方法和统一的健康社会不平等愿景相关的挑战。然而,逐步适应大规模测试,以提高其可访问性,可接受性,和可用性。来自社区的演员,其中,在支持卫生部门满足特定人口亚组的需求方面发挥了重要作用。
这些发现有助于反思从COVID-19中吸取的教训,强调公共卫生计划必须解决在健康危机期间获得医疗保健服务的结构性障碍。这将是必要的,以确保大流行的准备和应对,包括大规模测试,不要进一步增加健康方面的社会不平等。
Evidence continues to demonstrate that certain marginalised populations are disproportionately affected by COVID-19. While many studies document the impacts of COVID-19 on social inequalities in health, none has examined how public health responses to the pandemic have unfolded to address these inequities in Canada. The purpose of our study was to assess how social inequalities in health were considered in the design and planning of large-scale COVID-19 testing programs in Montréal (Québec, Canada).
Part of the multicountry study HoSPiCOVID, this article
reports on a qualitative
case study of large-scale testing for COVID-19 in Montréal. We conducted semi-structured interviews with 19 stakeholders involved in planning large-scale testing or working with vulnerable populations during the pandemic. We developed interview guides and a codebook using existing literature on policy design and planning, and analysed data deductively and inductively using thematic analysis in NVivo.
Our findings suggest that large-scale COVID-19 testing in Montréal did not initially consider social inequalities in health in its design and planning phases. Considering the sense of urgency brought by the pandemic, participants noted the challenges linked to the uptake of an intersectoral approach and of a unified vision of social inequalities in health. However, adaptations were gradually made to large-scale testing to improve its accessibility, acceptability, and availability. Actors from the community sector, among others, played an important role in supporting the health sector to address the needs of specific subgroups of the population.
These findings contribute to the reflections on the lessons learned from COVID-19, highlighting that public health programs must tackle structural barriers to accessing healthcare services during health crises. This will be necessary to ensure that pandemic preparedness and response, including large-scale testing, do not further increase social inequalities in health.