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It’s through the Cracks That the Light Shines: Opportunities and Challenges for Improving Health Equity during COVID-19

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 November 2022) | Viewed by 27885

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Special Issue Editors

Prof. Dr. Cath Chamberlain

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Guest Editor

1. Centre for Health Equity, The University of Melbourne, Melbourne, VIC 3010, Australia
2. School of Nursing and Midwifery, La Trobe University, Melbourne, VIC 3086, Australia
3. Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, WA 6150, Australia
4. The Lowitja Institute, Melbourne, VIC 3053, Australia
Interests: public health research; Indigenous Health; health equity; evidence synthesis; participatory research; applied mixed methods; reproductive and perinatal health; tobacco; diabetes; trauma

Dr. Simon Graham

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Guest Editor

Peter Doherty Institute for Infection and Immunity, Melbourne Medical School, University of Melbourne, 792 Elizabeth Street, Melbourne, VIC 3004, Australia
Interests: public health; health equity; quantitative research; sexually transmitted diseases; Indigenous health

Prof. Dr. Naomi Priest

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Guest Editor

1. Centre for Social Research and Methods, Australian National University, Canberra, ACT 2601, Australia
2. Murdoch Children’s Research Institute, Parkville, VIC 3052, Australia 3. Centre for Health Equity, The University of Melbourne, Melbourne, VIC 3010, Australia
Interests: lifecourse and social epidemiology; health inequalities; mental health; cardiovascular disease; child and adolescent health; Indigenous health; migrant health; racism and health

Special Issue Information

Dear Colleagues,

The COVID-19 pandemic does not affect people equally and has highlighted – and widened - health inequities and unequal access to social determinants of health. We may be in the same storm but we are definitely not all in the same boat. As the pandemic has overwhelmed our health, social and economic systems, some communities and individuals have higher risks of contracting and transmitting COVI-19, greater social consequences of public health measures (e.g. lockdown), and significantly worse physical, social and emotional health outcomes. These impacts interact and can compound risks, which further compound inequities.

In starkly illuminating health inequities or ‘cracks’ in our health, social and economic systems, the COVID-19 pandemic also offers an urgent and profound opportunity to identify, understand and develop solutions for a better future going forward – including to be better prepared when the next outbreak or pandemic occurs.

We invite quality articles which examine these ‘cracks where the light is showing through’ - opportunities and challenges for improving health equity during COVID-19. We are particularly interested in empirical articles that document the engagement of impacted communities in response to the current crisis, across community and system level, structural change, in order to achieve health equity.

Prof. Dr. Cath Chamberlain
Dr. Simon Graham
Prof. Dr. Naomi Priest
Guest Editors

Manuscript Submission Information

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Keywords

COVID-19
coronavirus
equity
empowerment
equality
marginalised
minority
access
vaccination

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Published Papers (8 papers)

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Research

17 pages, 938 KiB

Open AccessArticle

Inclusion of Cultural and Linguistic Diversity in COVID-19 Public Health Research: Research Design Adaptations to Seek Different Perspectives in Victoria, Australia

by Lisa Gibbs, Alexander J. Thomas, Alison Coelho, Adil Al-Qassas, Karen Block, Niamh Meagher, Limya Eisa, Stephanie Fletcher-Lartey, Tianhui Ke, Phoebe Kerr, Edwin Jit Leung Kwong, Colin MacDougall, Deng Malith, Katitza Marinkovic Chavez, Deborah Osborne, David J. Price, Freya Shearer, Mark Stoove, Kathryn Young, Yanqin Zhang, Katherine B. Gibney and Margaret Hellard Show full author list Hide full author list

Int. J. Environ. Res. Public Health 2023, 20(3), 2320; https://doi.org/10.3390/ijerph20032320 - 28 Jan 2023

Cited by 3 | Viewed by 3184

Abstract

Participation of people from culturally and linguistically diverse (CALD) communities in public health research is often limited by challenges with recruitment, retention and second-language data collection. Consequently, people from CALD communities are at risk of their needs being marginalised in public health interventions. This paper presents intrinsic case analyses of two studies which were adapted to increase the cultural competence of research processes. Both cases were part of the Optimise study, a major mixed methods research study in Australia which provided evidence to inform the Victorian state government’s decision-making about COVID-19 public health measures. Case study 1 involved the core Optimise longitudinal cohort study and Case study 2 was the CARE Victorian representative survey, an Optimise sub-study. Both case studies engaged cultural advisors and bilingual staff to adjust the survey measures and research processes to suit target CALD communities. Reflexive processes provided insights into the strengths and weaknesses of the inclusive strategies. Selected survey results are provided, demonstrating variation across CALD communities and in comparison to participants who reported speaking English at home. While in most cases a gradient of disadvantage was evident for CALD communities, some patterns were unexpected. The case studies demonstrate the challenge and value of investing in culturally competent research processes to ensure research guiding policy captures a spectrum of experiences and perspectives. Full article

(This article belongs to the Special Issue It’s through the Cracks That the Light Shines: Opportunities and Challenges for Improving Health Equity during COVID-19)

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15 pages, 675 KiB

Open AccessArticle

Lessons Learned during a Rapidly Evolving COVID-19 Pandemic: Aboriginal and Torres Strait Islander-Led Mental Health and Wellbeing Responses Are Key

by Patricia Dudgeon, Jemma R. Collova, Kate Derry and Stewart Sutherland

Int. J. Environ. Res. Public Health 2023, 20(3), 2173; https://doi.org/10.3390/ijerph20032173 - 25 Jan 2023

Cited by 3 | Viewed by 3143

Abstract

As the world journeys towards the endemic phase that follows a pandemic, public health authorities are reviewing the efficacy of COVID-19 pandemic responses. The responses by Aboriginal and Torres Strait Islander communities in Australia have been heralded across the globe as an exemplary demonstration of how self-determination can achieve optimal health outcomes for Indigenous peoples. Despite this success, the impacts of pandemic stressors and public health responses on immediate and long-term mental health and wellbeing require examination. In December 2021, Aboriginal and Torres Strait Islander mental health and wellbeing leaders and allies (N = 50) attended a virtual roundtable to determine the key issues facing Aboriginal and Torres Strait Islander peoples and communities, and the actions required to address these issues. Roundtable attendees critically reviewed how the rapidly evolving pandemic context has impacted Aboriginal and Torres Strait Islander mental health and social and emotional wellbeing (SEWB). This paper presents an overview of this national collaborative consultation process, and a summary of the key issues and actions identified. These results build on evidence from other roundtables held in Australia during 2020, and the emerging consensus across the globe that Indigenous self-determination remains essential to Indigenous SEWB, especially during and following a pandemic. Full article

(This article belongs to the Special Issue It’s through the Cracks That the Light Shines: Opportunities and Challenges for Improving Health Equity during COVID-19)

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17 pages, 5488 KiB

Open AccessArticle

Working with Data in Adult English Classrooms: Lessons Learned about Communicative Justice during the COVID-19 Pandemic

by Margaret A. Handley, Maricel G. Santos and María José Bastías

Int. J. Environ. Res. Public Health 2023, 20(1), 696; https://doi.org/10.3390/ijerph20010696 - 30 Dec 2022

Cited by 3 | Viewed by 2546

Abstract

Throughout COVID-19, health officials have relied on data visualizations to communicate urgent messages about the spread of the virus and preventative measures. Relatively few efforts have employed participatory engagement with communities who have experienced a disproportionate burden of COVID-19 illness to shape these communications. Sociologist W.E.B. Du Bois viewed data visualization as an approach to changing the way people think about themselves. This paper describes a community-engaged approach to data literacy skill-building with bilingual Latina learners in an adult English program in Northern California, Bay Area. The curriculum combines data visualization activities with language instruction and preventive health themes. Early work on COVID-19 in 2020–21 emphasized improving health knowledge and message interpretation but later shifted to a critical data literacy perspective, focusing on myth-busting, improving risk messaging in their own social networks, and supporting learners to see the power of their own experiences in data story-telling processes. This pedagogical approach, guided by Charles Brigg’s idea of communicative justice priorities, locates adult learners’ data visualization work as part of a broader effort to be included in the perspectives that shape knowledge production in today’s healthcare system. This approach can be used to examine disparities in information access in linguistically minoritized communities and guide future education interventions. Full article

(This article belongs to the Special Issue It’s through the Cracks That the Light Shines: Opportunities and Challenges for Improving Health Equity during COVID-19)

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13 pages, 320 KiB

Open AccessArticle

“You Can’t Replace That Feeling of Connection to Culture and Country”: Aboriginal and Torres Strait Islander Parents’ Experiences of the COVID-19 Pandemic

by Michelle Kennedy, Tess Bright, Simon Graham, Christina Heris, Shannon K. Bennetts, Renee Fiolet, Elise Davis, Kimberley A. Jones, Janine Mohamed, Caroline Atkinson and Catherine Chamberlain

Int. J. Environ. Res. Public Health 2022, 19(24), 16724; https://doi.org/10.3390/ijerph192416724 - 13 Dec 2022

Cited by 6 | Viewed by 3731

Abstract

This Aboriginal-led study explores Aboriginal and Torres Strait Islander parents’ experiences of COVID-19. 110 Aboriginal and Torres Strait Islander parents were interviewed between October 2020 and March 2022. Participants were recruited through community networks and partner health services in South Australia, Victoria, and Northern Territory, Australia. Participants were predominantly female (89%) and based in Victoria (47%) or South Australia (45%). Inductive thematic analysis identified three themes: (1) Changes to daily living; (2) Impact on social and emotional wellbeing; and (3) Disconnection from family, community, and culture. COVID-19 impacted Aboriginal and Torres Strait Islander families. Disruption to cultural practice, and disconnection from country, family, and community was detrimental to wellbeing. These impacts aggravated pre-existing inequalities and may continue to have greater impact on Aboriginal and Torres Strait Islander parents and communities due to intergenerational trauma, stemming from colonisation, violence and dispossession and ongoing systemic racism. We advocate for the development of a framework that ensures an equitable approach to future public health responses for Aboriginal and Torres Strait Islander people. Full article

(This article belongs to the Special Issue It’s through the Cracks That the Light Shines: Opportunities and Challenges for Improving Health Equity during COVID-19)

16 pages, 1352 KiB

Open AccessArticle

A Culturally Responsive Trauma-Informed Public Health Emergency Framework for Aboriginal and Torres Strait Islander Communities in Australia, Developed during COVID-19

by Simon Graham, Ilias Kamitsis, Michelle Kennedy, Christina Heris, Tess Bright, Shannon K. Bennetts, Kimberley A Jones, Renee Fiolet, Janine Mohamed, Caroline Atkinson and Catherine Chamberlain

Int. J. Environ. Res. Public Health 2022, 19(23), 15626; https://doi.org/10.3390/ijerph192315626 - 24 Nov 2022

Cited by 1 | Viewed by 6105

Abstract

The Coronavirus Disease 2019 (COVID-19) pandemic impacted peoples’ livelihoods and mental wellbeing. Aboriginal and Torres Strait Islander peoples in Australia continue to experience intergenerational trauma associated with colonization and may experience trauma-related distress in response to government responses to public health emergencies. We aimed to develop a culturally responsive trauma-informed public health emergency response framework for Aboriginal and Torres Strait Islander peoples. This Aboriginal and Torres Strait Islander-led study involved: (i) a review of trauma-informed public health emergency responses to develop a draft framework (ii) interviews with 110 Aboriginal and Torres Strait Islander parents about how COVID-19 impacted their lives, and (iii) a workshop with 36 stakeholders about pandemic experiences using framework analysis to refine a culturally responsive trauma-informed framework. The framework included: an overarching philosophy (cultural humility, safety and responsiveness); key enablers (local leadership and Eldership); supporting strategies (provision of basic needs and resources, well-functioning social systems, human rights, dignity, choice, justice and ethics, mutuality and collective responsibility, and strengthening of existing systems); interdependent core concepts (safety, transparency, and empowerment, holistic support, connectedness and collaboration, and compassion, protection and caring); and central goals (a sense of security, resilience, wellbeing, self- and collective-efficacy, hope, trust, resilience, and healing from grief and loss). Full article

(This article belongs to the Special Issue It’s through the Cracks That the Light Shines: Opportunities and Challenges for Improving Health Equity during COVID-19)

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19 pages, 373 KiB

Open AccessArticle

Caring for Older People during and beyond the COVID-19 Pandemic: Experiences of Residential Health Care Workers

by Veronica Sze-Ki Lai, Sui-Yu Yau, Linda Yin-King Lee, Becky Siu-Yin Li, Susan Sin-Ping Law and Shixin Huang

Int. J. Environ. Res. Public Health 2022, 19(22), 15287; https://doi.org/10.3390/ijerph192215287 - 19 Nov 2022

Cited by 5 | Viewed by 2232

Abstract

Older people and health care workers in residential care homes are particularly vulnerable to the adverse impacts of the COVID-19 pandemic. As COVID-19 has been spreading around the world for more than two years, the nature of care delivery has been substantially transformed. This study aims at understanding the long-term and ongoing impacts of COVID-19 on the delivery of care in residential care homes. It investigates how the delivery of care has been transformed by the COVID-19 pandemic and how health care workers adapted to these changes from the perspectives of frontline health care workers. Semi-structured interviews were conducted from February to December 2021 with a purposive sample of 30 health care workers from six residential care homes in Hong Kong. Thematic analysis identified three themes, including (1) enhancing infection prevention and control measures; (2) maintaining the psychosocial wellbeing of residents; and (3) developing resilience. Discussions and implications were drawn from these findings. Full article

(This article belongs to the Special Issue It’s through the Cracks That the Light Shines: Opportunities and Challenges for Improving Health Equity during COVID-19)

17 pages, 361 KiB

Open AccessArticle

“I Just Don’t Know What to Believe”: Sensemaking during the COVID-19 Pandemic among Criminal Legal Involved Communities

by Rochelle Davidson Mhonde, Breonna Riddick, Aayushi Hingle, Cameron Shaw, Danielle Rudes, Harold Pollack, John Schneider, Xiaoquan Zhao and Faye S. Taxman

Int. J. Environ. Res. Public Health 2022, 19(22), 15045; https://doi.org/10.3390/ijerph192215045 - 15 Nov 2022

Cited by 3 | Viewed by 2124

Abstract

During the COVID-19 pandemic in the United States, those involved with the criminal legal system experience disproportionate vulnerability to infection, transmission, and mortality, facing additional systemic barriers due to criminal legal involvement (CLI) (e.g., prior incarcerations or probationary status affecting employability or housing security). We use Weick’s (1979) model of sensemaking as a theoretical framework to inform our examination of CLI individuals’ experiences during the pandemic. The primary objective of this paper is to explore the process of sensemaking amid misinformation, trust/mistrust, and vulnerability during the pandemic among CLI communities in three central states (Illinois, Louisiana, and Arkansas). We conducted seven online focus groups (n = 44), between December 2020 and January 2021, from the targeted communities about their awareness of misinformation, trusted or distrusted sources, attitudes about COVID-19 health behaviors (including testing, protective behaviors such as mask-wearing and social distancing, and vaccination), and experiences with the criminal legal system during the pandemic. The concept of equivocality was at the core of the narratives shared among participants, with uncertainty emerging as a meta-theme across all focus groups. The findings of this study should prove useful for those who are developing messaging to combat mis/disinformation and overcome mis/distrust with the medical system and government institutions among those who are disenfranchised. Full article

(This article belongs to the Special Issue It’s through the Cracks That the Light Shines: Opportunities and Challenges for Improving Health Equity during COVID-19)

16 pages, 1173 KiB

Open AccessArticle

Equity Analysis of Repeated Cross-Sectional Survey Data on Mental Health Outcomes in Saskatchewan, Canada during COVID-19 Pandemic

by Nazeem Muhajarine, Daniel A. Adeyinka, Vaidehi Pisolkar, Md Sabbir Ahmed, Natalie Kallio, Vithusha Coomaran, Tom McIntosh, Nuelle Novik and Bonnie Jeffery

Int. J. Environ. Res. Public Health 2022, 19(21), 13808; https://doi.org/10.3390/ijerph192113808 - 24 Oct 2022

Cited by 5 | Viewed by 2866

Abstract

This paper aims to understand the impact of COVID-19 on three mental health outcomes—anxiety, depression, and mental health service use. Specifically, whether the associations between social and economic variables and these outcomes are exacerbated or buffered among equity-seeking groups in Saskatchewan. We analyzed secondary datasets of Saskatchewan adults from population-based national surveys conducted by Mental Health Research Canada (MHRC) on three occasions: cycle 2 (August 2020), cycle 5 (February 2021), and cycle 7 (June 2021). We examined temporal changes in the prevalence of anxiety, depression, and service utilization. Using the responses from 577 respondents in cycle 5 dataset (as it coincides with the peak of 2nd wave), we performed multinomial logistic regression. The policy implications of the findings were explored empirically through a World Café approach with 30 service providers, service users and policy makers in the province. The prevalence of anxiety and depression remained steady but high. Mental health services were not accessed by many who need it. Participants reporting moderate or severe anxiety were more likely to be 30–49 years old, women, and immigrants who earned less than $20,000 annually. Immigrants with either college or technical education presented with a lesser risk of severe anxiety. Factors associated with moderate or severe depression were younger age (<50 years), low household income, as well as immigrants with lower levels of education. Racialized groups had a lower risk of severe depression if they were under 30 years. Students and retirees also had a lower risk of severe depression. Canadian-born residents were more likely to require mental health supports but were not accessing them, compared to immigrants. Our analysis suggests mental health outcomes and service utilization remain a problem in Saskatchewan, especially among equity-seeking groups. This study should help drive mental health service redesign towards a client-centred, integrated, and equity-driven system in Saskatchewan. Full article

(This article belongs to the Special Issue It’s through the Cracks That the Light Shines: Opportunities and Challenges for Improving Health Equity during COVID-19)

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