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Radford KH, Karanikolos M, Cylus J. Pandemic preparedness and health system resilience in 14 European countries. Bull World Health Organ 2024; 102:571-581. [PMID: 39070595 PMCID: PMC11276159 DOI: 10.2471/blt.23.290509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/15/2024] [Accepted: 05/15/2024] [Indexed: 07/30/2024] Open
Abstract
Objective To assess national pandemic preparedness and response plans from a health system perspective to determine the extent to which implementation strategies that support health system performance have been included. Methods We systematically mapped pandemic preparedness and response implementation strategies that improve resilience to pandemics onto the Health System Performance Assessment Framework for Universal Health Coverage. Using this framework, we conducted a document analysis of 14 publicly available national influenza pandemic preparedness plans, submitted to the European Centre for Disease Prevention and Control, to assess how well health system functions are accounted for in each plan. Findings Implementation strategies found in national influenza pandemic preparedness plans do not systematically consider all health system functions. Instead, they mostly focus on specific aspects of governance. In contrast, little to no mention is made of implementation strategies that aim to strengthen health financing. There was also a lack of implementation strategies to strengthen the health workforce, ensure availability of medical equipment and infrastructure, govern the generation of resources and ensure delivery of public health services. Conclusion While national influenza pandemic preparedness plans often include provisions to support health system governance, implementation strategies that support other health system functions, namely, resource generation, service delivery, and in particular, financing, are given less attention. These oversights in key planning documents may undermine health system resilience when public health emergencies occur.
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Affiliation(s)
- Kaitlyn Hall Radford
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, LondonWC1E 7HT, England
| | - Marina Karanikolos
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, England
| | - Jonathan Cylus
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, England
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Portela MC, Martins M, Lima SML, de Andrade CLT, de Aguiar Pereira CC. COVID-19 inpatient mortality in Brazil from 2020 to 2022: a cross-sectional overview study based on secondary data. Int J Equity Health 2023; 22:238. [PMID: 37978531 PMCID: PMC10655483 DOI: 10.1186/s12939-023-02037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In Brazil, the COVID-19 pandemic found the universal and public Unified Health System (SUS) with problems accumulated over time, due, among other reasons, to low investments, and disparities in resource distribution. The preparedness and response of the healthcare system, involving the SUS and a private sector, was affected by large socioeconomic and healthcare access inequities. This work was aimed at offering an overview of COVID-19 inpatient mortality during the pandemic in Brazil, exploring factors associated with its variations and, specifically, differences across public, private (for-profit) and philanthropic (private non-profit) inpatient healthcare units, providers, and non-providers of services to the SUS. METHODS This cross-sectional study used public secondary data. The main data source was the SIVEP-Gripe, which comprises data on severe acute respiratory illness records prospectively collected. We also employed the National Record of Health Establishments, the SUS' Hospitalization Information System and municipalities' data from IBGE. We considered adult COVID-19 hospitalizations registered in SIVEP-Gripe from February 2020 to December 2022 in inpatient healthcare units with a minimum of 100 cases in the period. Data analyses explored the occurrence of inpatient mortality, employing general linear mixed models to identify the effects of patients', health care processes', healthcare units' and municipalities' characteristics on it. RESULTS About 70% of the COVID-19 hospitalizations in Brazil were covered by the SUS, which attended the more vulnerable population groups and had worse inpatient mortality. In general, non-SUS private and philanthropic hospitals, mostly reimbursed by healthcare insurance plans accessible for more privileged socioeconomic classes, presented the best outcomes. Southern Brazil had the best performance among the macro-regions. Black and indigenous individuals, residents of lower HDI municipalities, and those hospitalized out of their residence city presented higher odds of inpatient mortality. Moreover, adjusted inpatient mortality rates were higher in the pandemic peak moments and were significantly reduced after COVID-19 vaccination reaching a reasonable coverage, from July 2021. CONCLUSIONS COVID-19 exposed socioeconomic and healthcare inequalities and the importance and weaknesses of SUS in Brazil. This work indicates the need to revert the disinvestment in the universal public system, a fundamental policy for reduction of inequities in the country.
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Affiliation(s)
- Margareth Crisóstomo Portela
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | - Mônica Martins
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Sheyla Maria Lemos Lima
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Carla Lourenço Tavares de Andrade
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Claudia Cristina de Aguiar Pereira
- Department of Health Administration and Planning, Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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Byrne JP, Humphries N, McMurray R, Scotter C. COVID-19 and healthcare worker mental well-being: Comparative case studies on interventions in six countries. Health Policy 2023; 135:104863. [PMID: 37399678 PMCID: PMC10292916 DOI: 10.1016/j.healthpol.2023.104863] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 07/05/2023]
Abstract
Healthcare worker (HCW) mental well-being has become a global public health priority as health systems seek to strengthen their resilience in the face of the COVID-19 pandemic. Analysing data from the Health System Response Monitor, we present six case studies (Denmark, Italy, Kyrgyzstan, Lithuania, Romania, and the United Kingdom) as a comparative review of policy interventions supporting HCW mental health during the pandemic. The results illustrate a wide range of interventions. While Denmark and the United Kingdom built on pre-existing structures to support HCW mental wellbeing during the pandemic, the other countries required new interventions. Across all cases, there was a reliance on self-care resources, online training tools, and remote professional support. Based on our analysis, we develop four policy recommendations for the future of HCW mental health supports. First, HCW mental health should be seen as a core facet of health workforce capacity. Second, effective mental health supports requires an integrated psychosocial approach that acknowledges the importance of harm prevention strategies and organisational resources (psychological first aid) alongside targeted professional interventions. Third, personal, professional and practical obstacles to take-up of mental health supports should be addressed. Fourth, any specific support or intervention targeting HCW's mental health is connected to, and dependent on, wider structural and employment factors (e.g. system resourcing and organisation) that determine the working conditions of HCWs.
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Affiliation(s)
- John-Paul Byrne
- Graduate School of Healthcare Management (GSM), RCSI University of Medicine and Health Sciences, RCSI, Ballymoss Road, Sandyford Industrial Est. Dublin 18, Ireland.
| | - Niamh Humphries
- Graduate School of Healthcare Management (GSM), RCSI University of Medicine and Health Sciences, RCSI, Ballymoss Road, Sandyford Industrial Est. Dublin 18, Ireland
| | - Robert McMurray
- Graduate School of Healthcare Management (GSM), RCSI University of Medicine and Health Sciences, RCSI, Ballymoss Road, Sandyford Industrial Est. Dublin 18, Ireland
| | - Cris Scotter
- Graduate School of Healthcare Management (GSM), RCSI University of Medicine and Health Sciences, RCSI, Ballymoss Road, Sandyford Industrial Est. Dublin 18, Ireland
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Ridde V, Traverson L, Zinszer K. Hospital Resilience to the COVID-19 Pandemic in Five Countries: A Multiple Case Study. Health Syst Reform 2023; 9:2242112. [PMID: 37652669 DOI: 10.1080/23288604.2023.2242112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Since the beginning of the pandemic, hospitals have been central to the COVID-19 response, often experiencing severe financial, material, and human constraints. In this special issue, we present some of the findings of the HoSPiCOVID research project. One of its main objectives was to compare hospital responses to the first and second waves of the COVID-19 pandemic in Brazil, Canada, France, Japan, and Mali. Studying and comparing how nine different hospitals coped with the pandemic in terms of preparedness and response allowed us to: 1) identify strengths and weaknesses of their responses, including challenges for hospital professionals; and 2) produce lessons learned, using a systematic approach to reflect and analyze their potential of resilience to the crisis. In the five countries, research teams conducted in-depth qualitative studies focused on nine large hospitals, using observation sessions, semistructured interviews with hospital professionals, and lessons learned workshops. The empirical work was supported by an original analytical framework on hospital resilience and a heuristic tool focused on configurations. The studies demonstrate that the hospitals were able to absorb and/or adapt to the crisis by deploying different coping mechanisms, which often required extensive involvement of hospital professionals. More extended study periods would be needed to assess the sustainability of these coping mechanisms and discern whether they have transformative potential. These international comparisons of hospital resilience, based on studies of contrasting contexts and epidemiological situations, allowed researchers to identify lessons learned to support hospital decision-makers in thinking more deeply about managing future health crises.
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Affiliation(s)
- Valéry Ridde
- Université Paris Cité, IRD, Ceped, Paris, France
- Institut de Santé et Développement (ISED), Université Cheikh Anta Diop, Dakar, Senegal
| | | | - Kate Zinszer
- School of Public Health (ESPUM), Université de Montréal, Montreal, Quebec, Canada
- Public Health Research Centre (CReSP), Université de Montréal, and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
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5
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Martín-Conty JL, Polonio-López B, Sanz-García A, del Pozo Vegas C, Mordillo-Mateos L, Bernal-Jiménez JJ, Conty-Serrano R, Castro Villamor MA, López-Izquierdo R, Martín-Rodríguez F. COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study. Front Public Health 2023; 10:1076627. [PMID: 36703850 PMCID: PMC9871910 DOI: 10.3389/fpubh.2022.1076627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction COVID-19 has initially been studied in terms of an acute-phase disease, although recently more attention has been given to the long-term consequences. In this study, we examined COVID-19 as an independent risk factor for long-term mortality in patients with acute illness treated by EMS (emergency medical services) who have previously had the disease against those who have not had the disease. Methods A prospective, multicenter, ambulance-based, ongoing study was performed with adult patients with acute disease managed by EMS and transferred with high priority to the emergency department (ED) as study subjects. The study involved six advanced life support units, 38 basic life support units, and five emergency departments from Spain. Sociodemographic inputs, baseline vital signs, pre-hospital blood tests, and comorbidities, including COVID-19, were collected. The main outcome was long-term mortality, which was classified into 1-year all-cause mortality and 1-year in- and out-of-hospital mortality. To compare both the patients with COVID-19 vs. patients without COVID-19 and to compare survival vs non-survival, two main statistical analyses were performed, namely, a longitudinal analysis (Cox regression) and a logistic regression analysis. Results Between 12 March 2020 and 30 September 2021, a total of 3,107 patients were included in the study, with 2,594 patients without COVID-19 and 513 patients previously suffering from COVID-19. The mortality rate was higher in patients with COVID-19 than in patients without COVID-19 (31.8 vs. 17.9%). A logistic regression showed that patients previously diagnosed with COVID-19 presented higher rates of nursing home residency, a higher number of breaths per minute, and suffering from connective disease, dementia, and congestive heart failure. The longitudinal analysis showed that COVID-19 was a risk factor for mortality [hazard ratio 1.33 (1.10-1.61); p < 0.001]. Conclusion The COVID-19 group presented an almost double mortality rate compared with the non-COVID-19 group. The final model adjusted for confusion factors suggested that COVID-19 was a risk factor for long-term mortality.
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Affiliation(s)
- José L. Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain,Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain,Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain,Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,*Correspondence: Ancor Sanz-García ✉
| | - Carlos del Pozo Vegas
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain,Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain
| | | | | | - Miguel A. Castro Villamor
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Raúl López-Izquierdo
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain,Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain,Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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Tille F, Van Ginneken E, Winkelmann J, Hernandez-Quevedo C, Falkenbach M, Sagan A, Karanikolos M, Cylus J. Perspective: Lessons from COVID-19 of countries in the European region in light of findings from the health system response monitor. Front Public Health 2023; 10:1058729. [PMID: 36684940 PMCID: PMC9853016 DOI: 10.3389/fpubh.2022.1058729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/13/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Decision-makers initially had limited data to inform their policy responses to the COVID-19 pandemic. The research community developed several online databases to track cases, deaths, and hospitalizations; however, a major deficiency was the lack of detailed information on how health systems were responding to the pandemic and how they would need to be transformed going forward. Approach In an effort to fill this information gap, in March 2020, the European Observatory on Health Systems and Policies, the WHO European Regional Office and the European Commission created the COVID-19 Health System Response Monitor (HSRM) to collect and organise up-to-date information on how health systems, mainly in the WHO European Region, were responding to the COVID-19 pandemic. Findings The HSRM analysis and broader Observatory work on COVID-19 shone light on a range of health system challenges and weaknesses and catalogued policy options countries put in place during the pandemic to address these. Countries prioritised policies on investing in public health, supporting the workforce, maintaining financial stability, and strengthening governance in their response to COVID-19. Outlook COVID-19 is likely to continue to impact health systems for the foreseeable future; the ability to cope with this pressure, and other shocks, depends on having good information on what other countries have done so that health systems develop adequate policy options. In support of this, the country information on the COVID-19 HSRM will remain available as a repository to inform decision makers on options for actions and possible measures against COVID-19 and other public health emergencies. Building on its previous work on health systems resilience, the European Observatory on Health Systems and Policies will sustain its focus on analysing key issues related to the recovery from the pandemic and making health systems more resilient. This includes policy knowledge transfer between countries and systematic resilience testing, aiming at contributing to an improved understanding of health system response, recovery, and preparedness. Contribution to the literature in non-technical language The COVID-19 Health System Response Monitor (HSRM) was the first database in the WHO European Region to collect and organise up-to-date information on how health systems were responding to the COVID-19 pandemic. The HSRM provides a repository of policies which can be used to inform decision makers in health and other policy domains on options for action and possible measures against COVID-19 and other public health emergencies. This initiative proved particularly valuable, especially during the early phases of the pandemic, when there was limited information for countries to draw on as they formulated their own policy response to the pandemic. Our perspectives paper highlights some key challenges within health systems that the HSRM was able to identify during the pandemic and considers policy options countries put in place in response. Our research contributes to literature on emergency responses and recovery, health systems performance assessment, particularly health system resilience, and showcases the Observatory experience on how to design such a data collection tool, as well as how to leverage its findings to support cross-country learning.
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Affiliation(s)
- Florian Tille
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, United Kingdom
| | - Ewout Van Ginneken
- European Observatory on Health Systems and Policies, Technische Universität Berlin, Berlin, Germany
| | - Juliane Winkelmann
- Department of Healthcare Management, Technische Universität Berlin, Berlin, Germany
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Cristina Hernandez-Quevedo
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, United Kingdom
| | - Michelle Falkenbach
- Department of Public and Ecosystem Health, Cornell University, Ithaca, NY, United States
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anna Sagan
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, United Kingdom
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marina Karanikolos
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan Cylus
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, United Kingdom
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Quentin W, Achstetter K, Barros PP, Blankart CR, Fattore G, Jeurissen P, Kwon S, Laba T, Or Z, Papanicolas I, Polin K, Shuftan N, Sutherland J, Vogt V, Vrangbaek K, Wendt C. Health Policy - the best evidence for better policies. Health Policy 2023; 127:1-4. [PMID: 36669897 DOI: 10.1016/j.healthpol.2023.104708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Wilm Quentin
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Germany; European Observatory on Health Systems and Policies, Belgium, Brussels
| | - Katharina Achstetter
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Germany
| | | | - Carl Rudolf Blankart
- KPM Center for Public Management, University of Bern, Bern, Switzerland; Swiss Institute for Translational and Entrepreneurial Medicine (sitem-insel), Bern, Switzerland
| | - Giovanni Fattore
- Department of Social and Political Sciences and CERGAS SDA, Università Bocconi, Milano, Italy
| | | | - Soonman Kwon
- Graduate School of Public Health, Seoul National University, Korea (the Republic of)
| | | | - Zeynep Or
- Institute for Research and Information in Health Economics, IRDES, Paris, France
| | - Irene Papanicolas
- Department of Health Services, Policy and Practice, Brown School of Public Health, Providence, RI, USA
| | - Katherine Polin
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Germany; European Observatory on Health Systems and Policies, Belgium, Brussels
| | - Nathan Shuftan
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Germany; European Observatory on Health Systems and Policies, Belgium, Brussels
| | - Jason Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Verena Vogt
- Fachgebiet Management im Gesundheitswesen, Technische Universität Berlin, Berlin, Germany
| | - Karsten Vrangbaek
- Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
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MacEachen E, de Rijk A, Dyreborg J, Fassier JB, Fletcher M, Hopwood P, Koivusalo M, Majowicz S, Meyer S, Ståhl C, Welti F. Laws, Policies, and Collective Agreements Protecting Low-wage and Digital Platform Workers During the COVID-19 Pandemic. New Solut 2022; 32:201-212. [PMID: 36262099 PMCID: PMC9582739 DOI: 10.1177/10482911221133796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
In the context of the COVID-19 pandemic, this commentary describes and compares
shifting employment and occupational health social protections of low-wage
workers, including self-employed digital platform workers. Through a focus on
eight advanced economy countries, this paper identifies how employment
misclassification and definitions of employees were handled in law and policy.
Debates about minimum wage and occupational health and safety standards as they
relate to worker well-being are considered. Finally, we discuss promising
changes introduced during the COVID-19 pandemic that protect the health of
low-wage and self-employed workers. Overall, we describe an ongoing “haves” and
a “have not” divide, with on the one extreme, traditional job arrangements with
good work-and-health social protections and, on the other extreme, low-wage and
self-employed digital platform workers who are mostly left out of schemes.
However, during the pandemic small and often temporary gains occurred and are
discussed.
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Affiliation(s)
| | | | - Johnny Dyreborg
- 2686National Research Centre for the Working Environment, København, Denmark
| | - Jean-Baptiste Fassier
- Hospices Civils de Lyon, Lyon, Auvergne-Rhône-Alpes, France.,University of Sherbrooke, Sherbrooke, Quebec, Canada
| | | | | | | | | | | | | | - Felix Welti
- 9178University of Kassel, Kassel, Hessen, Germany
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