The health equity in all policies (HEiAP) approach before and beyond the Covid-19 pandemic in the Italian context

A Retrospective Observational Study to Assess the Effect of the COVID-19 Pandemic on Spontaneous and Voluntary Abortivity in the Apulia Region of Italy

The spread of COVID-19 in Italy required urgent restrictive measures that led to delays in access to care and to hospital overloads and impacts on the quality of services provided by the national health service. It is likely that the area related to maternal and child health was also affected. The objective of the study was to evaluate the intensity of a possible variation in spontaneous abortion (SA) and voluntary termination of pregnancy (VTP) rates in relation to the different restrictive public health measures adopted during the pandemic period of 2020. The analysis concerned the data collected on the SAs and VTPs from public and private structures in Apulia that related to the years 2019 and 2020. The SRR (standardized rate ratio) between the standardized rates by age group in 2019 and those in 2020 were calculated using a multivariable Poisson model, and it was applied to evaluate the effect of public health restrictions on the number of SAs and VTPs, considering other possible confounding factors. The SSR was significantly lower in the first months of the pandemic compared to the same period of the previous year, both for SAs and for VTPs. The major decrease in SAs and VTPs occurred during the total lockdown phase. The results, therefore, highlight how the measures to reduce infection risk could also have modified the demand for assistance related to pregnancy interruption.

Factor structure and psychometric proprieties of the COVID-19 prevention behaviours (COV19-PB) scale

We sought to test the COVID19-PB scale's psychometric properties and its dimensionality in a sample composed of 1107 Italian adults aged from 18 to 80 years (M = 39.59; SD = 16.36), 75% (n = 830) females, and 25% (n = 277) males. Exploratory, Confirmatory factor analysis and parallel analysis were used to validate the instrument that resulted from the Ebola Virus protective behaviours scale adaptation. Fear of covid-19 and a 1-item level of adherence to the Covid-19 protection scale were used to test the measure's convergent validity. A four-factor structure emerged from exploratory and confirmatory factor analysis: direct avoidance, avoidance of public spaces, avoidance of social interaction, and talking about the virus as protection. COVID-19 PB was a valuable measure to assess individuals' competencies in assuming correct behaviours during the pandemic.

Geographic and socioeconomic inequalities in the survival of children under-five in Nigeria

Despite a substantial decline in child mortality globally, the high rate of under-five mortality in Nigeria is still one of the main public health concerns. This study investigates inequalities in geographic and socioeconomic factors influencing survival time of children under-five in Nigeria. This is a retrospective cross-sectional quantitative study design that used the latest Nigeria Demographic Health Survey (2018). Kaplan–Meier survival estimates, Log-rank test statistics, and the Cox proportional hazards were used to assess the geographic and socioeconomic differences in the survival of children under-five in Nigeria. The Kaplan–Meier survival estimates show most under-five mortality occur within 12 months after birth with the poorest families most at risk of under-five mortality while the richest families are the least affected across the geographic zones and household wealth index quintiles. The Cox proportional hazard regression model results indicate that children born to fathers with no formal education (HR: 1.360; 95% CI 1.133–1.631), primary education (HR: 1.279; 95% CI 1.056–1.550) and secondary education (HR: 1.204; 95% CI 1.020–1.421) had higher risk of under-five mortality compared to children born to fathers with tertiary education. Moreover, under-five mortality was higher in children born to mothers’ age ≤ 19 at first birth (HR: 1.144; 95% CI 1.041–1.258). Of the six geopolitical zones, children born to mothers living in the North-West region of Nigeria had 63.4% (HR 1.634; 95% CI 1.238–2.156) higher risk of under-five mortality than children born to mothers in the South West region of Nigeria. There is a need to focus intervention on the critical survival time of 12 months after birth for the under-five mortality reduction. Increased formal education and target interventions in geopolitical zones especially the North West, North East and North Central are vital towards achieving reduction of under-five mortality in Nigeria.

COVID-19 as a social disease: qualitative analysis of COVID-19 prevention needs, impact of control measures and community responses among racialized/ethnic minorities in Antwerp, Belgium

BACKGROUND

In high income countries, racialized/ethnic minorities are disproportionally affected by COVID-19. Despite the established importance of community involvement in epidemic preparedness, we lack in-depth understanding of these communities' experiences with and responses to COVID-19. We explored information and prevention needs, coping mechanisms with COVID-19 control measures and their impact on lived experiences among selected racialized/ethnic minority communities.

METHODS

This qualitative rapid assessment conducted in Antwerp/Belgium used an interpretative and participatory approach. We included migrant communities with geographic origins ranging from Sub-Saharan Africa, North-Africa to the Middle East, Orthodox Jewish communities and professional community workers. Data were collected between May 2020-May 2021 through key informant-, in-depth interviews and group discussions (N = 71). Transcripts were analyzed inductively, adopting a reflexive thematic approach. A community advisory board provided feedback throughout the research process.

RESULTS

Participants indicated the need for tailored information in terms of language and timing. At the start of the epidemic, they perceived official public health messages as insufficient to reach all community members. Information sources included non-mainstream (social) media and media from home countries, hampering a nuanced understanding of virus transmission mechanisms and local and national protection measures. Participants felt the measures' most negative impact on their livelihoods (e.g. loss of income, disruption of social and immigration support). Economic insecurity triggered chronic stress and fears at individual and family level. High degrees of distrust in authorities and anticipated stigma were grounded in previously experienced racial and ethnic discrimination. Community-based initiatives mitigated this impact, ranging from disseminating translated and tailored information, providing individual support, and successfully reaching community members with complex needs (e.g. the elderly, digitally illiterate people, those with small social networks or irregular legal status).

CONCLUSION

Study participants' narratives showed how coping with and responding to COVID-19 was strongly intertwined with socio-economic and ethnic/racial characteristics. This justifies conceptualizing COVID-19 a social disease. At the same time, communities demonstrated resilience in responding to these structural vulnerabilities. From a health equity perspective, we provide concrete policy recommendations grounded in insights into communities' structural vulnerabilities and resilience.

Learning from the Past: Pandemics and the Governance Treadmill

Global human health threats, such as the ongoing COVID-19 pandemic, necessitate coordinated responses at multiple levels. Public health professionals and other experts broadly agree about actions needed to address such threats, but implementation of this advice is stymied by systemic factors such as prejudice, resource deficits, and high inequality. In these cases, crises like epidemics may be viewed as opportunities to spark structural changes that will improve future prevention efforts. However, crises can also weaken governance and reinforce systemic failures. In this paper, we use the concept of the governance treadmill to demonstrate cross-level dynamics that help or hinder the alignment of capacities toward prevention during public health crises. We find that variation in capacities and responses across local, national, and international levels contributes to the complex evolution of global and local health governance. Where capacities are misaligned, effective local prevention of global pandemic impacts tends to be elusive in the short term, and multiple cycles of crisis and response may be required before capacities align toward healthy governance. We demonstrate that this transition requires broader societal adaptation, particularly towards social justice and participatory democracy.

Public perceptions and behavioural responses to the first COVID-19 pandemic wave in Italy: results from the iCARE study

BACKGROUND

Italy was the first European country to be affected by COVID-19. Considering that many countries are currently battling the second wave of the pandemic, understanding people's perceptions and responses to government policies remain critical for informing on-going mitigation strategies. We assessed attitudes towards COVID-19 policies, levels of adherence to preventive behaviours, and the association between COVID-19 related concerns and adherence levels.

METHODS

We recruited a convenience sample of Italian individuals from an international cross-sectional survey (www.icarestudy.com) from 27 March to 5 May 2020. Multivariate regression models were used to test the association between concerns and the adoption of preventive measures.

RESULTS

The survey included 1332 participants [female (68%), younger than 25 (57%)] that reported high awareness (over 96%) and perceived importance (88%) of policies. We observed varied levels of adherence to: hand-washing (96%), avoiding social gatherings (96%), self-isolation if suspected or COVID-19 positive (77%). Significantly lower adherence to self-isolation was reported by individuals with current employment. High levels of concerns regarding health of other individuals and country economy were reported. Only health concerns for others were significantly associated with higher adherence to hand-washing behaviour.

CONCLUSIONS

In order to inform current/future government strategies, we provide insights about population's responses to the initial pandemic phase in Italy. Communication approaches should consider addressing people's concerns regarding the health of other individuals to motivate adherence to prevention measures. Provision of social and economic support is warranted to avoid unequal impacts of governmental policies and allow effective adherence to self-isolating measures.

The social determinants of health and health outcomes among adults during the COVID-19 pandemic: A systematic review

Objective

To synthesize the best available evidence on the relationship between the social determinants of health and health outcomes among adults during the COVID‐19 pandemic.

Introduction

COVID‐19 has created widespread global transmission. Rapid increase in individuals infected with COVID‐19 prompted significant public health responses from governments globally. However, the social and economic impact on communities may leave some individuals more susceptible to the detrimental effects.

Methods

A three‐step search strategy was used to find published and unpublished papers. Databases searched included: MEDLINE, CINAHL, EMBASE, and Google Scholar. All identified citations were uploaded into Endnote X9, with duplicates removed. Methodological quality of eligible papers was assessed by two reviewers, with meta‐synthesis conducted in accordance with JBI methodology.

Results

Fifteen papers were included. Three synthesized‐conclusions were established (a) Vulnerable populations groups, particularly those from a racial minority and those with low incomes, are more susceptible and have been disproportionately affected by COVID‐19 including mortality; (b) Gender inequalities and family violence have been exacerbated by COVID‐19, leading to diminished wellbeing among women; and (c) COVID‐19 is exacerbating existing social determinants of health through loss of employment/income, disparities in social class leading to lack of access to health care, housing instability, homelessness, and difficulties in physical distancing.

Conclusion

Reflection on social and health policies implemented are necessary to ensure that the COVID‐19 pandemic does not exacerbate health inequalities into the future.

Ethical Dimensions of Public Health Actions and Policies With Special Focus on COVID-19

During pandemics, the ethicists, public health professionals, and human rights advocates raise a red flag about different public health actions that should, at best, be addressed through integrated, global policies. How to rationalize the healthcare resources and prioritize the cases is not a recent challenge but the serious concern about that is how to achieve this while not increasing the vulnerability of the disadvantaged population. Healthcare professionals use different scoring systems as a part of their decision-making so the medical teams and triage committees can allocate resources for predictable health outcomes and prognosis as well as to appropriately triage the patients accordingly. However, the value of the existing scoring systems to manage COVID-19 cases is not well-established yet. Part of this problem includes managing non-COVID patients with chronic medical conditions like non-communicable diseases and addressing their medical needs during the pandemic complex context in a way to avoid worsening their conditions and, on the other hand, avoid hindering the establishment of comprehensive standards for dealing with COVID-19. In this article, we discuss this dilemma as well as how preexisting ethical standards were challenged by COVID-19. We also discuss how monitoring the consistent application of ethical standards during the medical trials of new medications, vaccines, or unproven medical interventions is also a critical issue.

Global health education for medical students in Italy

BACKGROUND

Global health education (GHE) in Italy has spread since the first decade of 21st century. The presence of global health (GH) courses in Italy was monitored from 2007 to 2013. In 2019, a new survey was proposed to assess the availability of educational opportunities in Italian medical schools.

METHODS

An online survey was carried out using a questionnaire administered to a network of interested individuals with different roles in the academic world: students, professors, and members of the Italian Network for Global Health Education. The features of courses were analysed through a score.

RESULTS

A total of 61 responses were received from affiliates of 33 out of the 44 medical schools in Italy. The national mean of GH courses for each faculty was 1.2, reflecting an increase from 2007. The courses increased nationwide, resulting in a dispersed GHE presence in northern, central and southern Italy. One of the most critical points was related to the nature of "elective" courses, which were not mandatory in the curricula. Enrollees tended to be students genuinely interested in GH issues. Some community and service-learning experiences, referred to as GH gyms, were also detected at national and international levels.

CONCLUSIONS

GHE has spreading in Italy in line with the vision of the Italian Network for Global Health Education. Although progress has been made to disperse GH courses around the country, more academic commitment is needed to include GH in the mandatory curricula of medical schools and other health faculties.

Rapid Scoping Review on the Topic of Ensuring Social Protection and Basic Services to Inform the United Nations Framework for the Immediate Socioeconomic Response to COVID-19

This rapid scoping review has informed the development of the UN Research Roadmap for the COVID-19 Recovery on the topic of “Ensuring Social Protection and Basic Services.” The aim was to provide a robust synthesis of key concepts and existing evidence drawn from a wide range of disciplines to support the identification and appraisal of research priorities. An emergent theme has been the notion that measures implemented in response to COVID-19 merely ameliorate symptoms of entrenched, systemic gender-, age-, and race-based inequity, inequality, and exclusion. Key findings include the critical role of contextual and community-based knowledge for informing the design, development, and delivery of programs, as well as the urgent need for implementation science to move existing knowledge into action. This review also describes how the disruption associated with “shock events” such as the COVID-19 pandemic is often associated with unusually high levels of interest and willingness to invest in programs and policies to strengthen strained systems. As such, an unprecedented window of opportunity exists to leverage measures implemented in response to the COVID-19 pandemic to effect large-scale, sustainable change and thereby increase the resiliency of our interconnected systems for the future.

Treating patients across European Union borders: An international survey in light of the coronavirus disease-19 pandemic

BACKGROUND

In light of the coronavirus disease-2019 (COVID-19) pandemic, how resources are managed and the critically ill are allocated must be reviewed. Although ethical recommendations have been published, strategies for dealing with overcapacity of critical care resources have so far not been addressed.

OBJECTIVES

Assess expert opinion for allocation preferences regarding the growing imbalance between supply and demand for medical resources.

DESIGN

A 10-item questionnaire was developed and sent to the most prominent members of the European Society of Anaesthesiology and Intensive Care (ESAIC).

SETTING

Survey via a web-based platform.

PATIENTS

Respondents were members of the National Anaesthesiologists Societies Committee and Council Members of the ESAIC; 74 of 80 (92.5%), responded to the survey.

MEASUREMENTS AND MAIN RESULTS

Responses were analysed thematically. The majority of respondents (83.8%), indicated that resources for COVID-19 were available at the time of the survey. Of the representatives of the ESAIC governing bodies, 58.9% favoured an allocation of excess critical care capacity: 69% wished to make them available to supraregional patients, whereas 30.9% preferred to keep the resources available for the local population. Regarding the type of distribution of resources, 35.3% preferred to make critical care available, 32.4% favoured the allocation of medical equipment and 32.4% wished to support both options. The majority (59.5%) supported the implementation of a central European institution to manage such resource allocation.

CONCLUSION

Experts in critical care support the allocation of resources from centres with overcapacity. The results indicate the need for centrally administered allocation mechanisms that are not based on ethically disputable triage systems. It seems, therefore, that there is wide acceptance and solidarity among the European anaesthesiological community that local medical and human pressure should be relieved during a pandemic by implementing national and international re-allocation strategies among healthcare providers and healthcare systems.

Policy disparities in fighting COVID-19 among Japan, Italy, Singapore and China

Objective

In order to provide experiences for international epidemic control, this study systematically summarized the Coronavirus disease 2019 (COVID-19) prevention and control policies in Japan, Italy, China and Singapore, and also analyzed the possible inequalities that exist in these response approaches to improve global infectious disease control.

Methods

We summarized the epidemic prevention and control policies in Japan, Italy, China, and Singapore, and analyzed the policy effects of these four countries by using the data published by Johns Hopkins Coronavirus Resource Center.

Results

As of May 27, 2020, the growing trend of new cases in Japan, Italy, China and Singapore has stabilized. However, the cumulative number of confirmed cases (231139) and case-fatality rate (14.3%) in Italy far exceeded those in the other three countries, and the effect of epidemic control was inferior. Singapore began to experience a domestic resurgence after April 5, with a cumulative number of confirmed cases reaching 32,876, but the case-fatality rate remained extremely low (0.1%). The growth of cumulative confirmed cases in China (84547) was almost stagnant, and the case-fatality rate was low (5.5%). The growth of cumulative confirmed cases in Japan (16661) increased slowly, and the case-fatality rate (4.8%) was slightly lower than that in China.

Conclusion

This study divided the epidemic prevention and control policies of the four countries into two categories: the blocking measures adopted by China and Singapore, and the mitigation measures adopted by Japan and Italy. According to the Epidemic control results of these four countries, we can conclude that the blocking measures were generally effective. As the core strategy of blocking measures, admitting mild patients into hospital and cases tracing helped curb the spread of the outbreak in Singapore and China. Countries should choose appropriate response strategies on the premise of considering their own situation, increase investment in health resources to ensure global health equity, and eventually control the spread of infectious diseases in the world effectively.