How Can we Ensure a Socially Equitable Approach to Deconfinement during the COVID-19 Pandemic?

This document is part of a series of discussion notes addressing fundamental questions about the COVID-19 crisis and response strategies. These documents are based on the best scientific information available and may be updated as new information comes to light.

Written by Jeffrey V Lazarus, Associate Research Professor and head of the Health Systems Research Group at ISGlobal, Trent White, Sonia Hajo and Danielle Guy, part of the Health Systems Research Group.

Soon after the World Health Organization (WHO) recognised that the growing COVID-19 epidemic was becoming a pandemic, governments around the world swiftly imposed confinement and social distancing measures. Fewer than eight weeks later, many governments now face the daunting challenge of transitioning from lockdown to deconfinement, while avoiding massive resurgences of new COVID-19 cases and an economic situation that could become more devastating than the disease itself.

In addition to the morbidity and mortality directly caused by COVID-19, it is important to consider economic and social consequences arising from social distancing and isolation, unemployment, and psychological distress. Owing to a variety of socioeconomic determinants of health, certain populations are at greater risk of these consequences. Such vulnerable populations  include low-income and unemployed individuals, especially those in the informal sector, migrants and minority populations, homeless individuals, people who use drugs, and prisoners. Therefore, the crux of the deconfinement challenge is ensuring social equity while mitigating further health declines and resuscitating economies and health systems.

We propose the following recommendations to governments to mitigate inequities during and following deconfinement:

1. Ensure financial protection for vulnerable populations. Government financial protection measures should target specific vulnerable populations.

2. Strengthen primary healthcare. Governments should strengthen national and subnational primary health services, which can address prevention, treatment, rehabilitation, and palliative care needs at lower costs compared to specialised and complex health services. This can reduce demand on hospital resources and protect population health while easing financial pressures on health systems.

3. Address the health needs of migrants and refugees. Governments should provide physical and psychological health support to documented and undocumented migrants and refugees.

4. Promote housing protection. Governments should promote housing affordability, limit evictions and halt the suspension of utility and telecommunication services.

5. Maintain and expand open and safe public spaces. Vulnerable populations are more likely to live and work in conditions that negatively impact their health. It is essential to preserve access to public spaces for social security, health, and well-being.

Addressing these considerations in deconfinement planning and implementation can safeguard vulnerable groups against further inequities and maintain health, social, and economic preparedness for future crises.