World Health Day: Putting equity at the heart of COVID-19 recovery

COVID-19 has affected us all, but some have fared worse than others simply because of the jobs they do and the insecurity of their living conditions and livelihoods.

People who have been hit the hardest are also among those least protected by national policies and systems, and the pandemic has brought their precarious situation into sharp focus.

“Why is it that some people have felt the effects of COVID-19 more acutely? Quite simply, the cards have been stacked against them in terms of jobs, housing, community, social support and health care. It’s time for everyone to be dealt a fair hand, and time for us to rebuild from the pandemic, setting our sights not merely on surviving but on thriving”, said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

This World Health Day, WHO is calling on leaders to address health inequities and ensure that everyone has:

• secure living and working conditions that enable them to live a healthy life and to thrive; and
• access to quality health services when and where they need them, without experiencing financial hardship.

COVID-19’s long shadow

Our world was already unequal when COVID-19 hit.

Existing inequities have deepened, particularly for people experiencing multiple insecurities due to poverty, gender, ethnicity, education, occupation, migrant status, disability and discrimination, and new risks have emerged. For example:

1. Deprivation is a risk factor for COVID-19 infection and early loss of life. We have seen that those most at risk of infection or testing positive include people at risk of poverty or social exclusion, living in deprived areas. For example, in Sweden, 30% of residents of a low-income area tested positive for COVID-19, compared to only 4.1% in high-income areas.
2. Gender inequities. Globally, women make up 70% of the health and social care workforce, and they are more likely to be frontline health workers. Recent data from Germany, Italy and Spain show that confirmed COVID-19 cases among female health workers are two to three times higher than those observed among their male counterparts.
3. Race and ethnicity. People in Black and minority ethnic groups have experienced a disproportionately high risk of serious infection and premature death during the COVID-19 pandemic. For example, 34.5% of critically ill COVID-19 patients in the United Kingdom were from a Black, Asian and minority ethnic background.
4. People in detention and receiving care. New evidence is emerging of heightened risk for people in detention and being cared for in institutional settings. A particular risk factor for COVID-19 mortality is residency in a nursing home. Between 42% and 57% of COVID-19 deaths occurred in long-term care facilities for older people in Belgium, France, Ireland, Italy and Spain.

Drivers of health inequity holding people back in life and in health

Action is urgently needed in the health sector and across government to remove the barriers to a fairer and healthier life for all. A 2019 report by WHO/Europe pinpointed the five main drivers of health inequities in the WHO European Region:

• Health systems: barriers to access, poor quality, financial hardship caused by out-of-pocket payments
• Financial security: poverty and not being able to make ends meet
• Living conditions: lack of decent housing, food, fuel; living in underdeveloped, unsafe neighbourhoods
• Social and human capital: isolation, powerlessness and lack of education and training opportunities
• Employment and work: lack of decent work and poor working conditions.

Putting equity at the heart of recovery

Governments and communities can work together to tackle the root causes of inequities and put inclusiveness and equity at the heart of all recovery responses to create a fairer, healthier world.

84% of Europeans believe that reducing inequities should be at the top of their government’s agenda.

When the right policies are implemented, results can be achieved very quickly.

Resetting our world

Inequities in health are not only unfair – they are preventable. Giving both girls and boys an equal, good start in life and promoting health across the life course is essential for the well-being and resilience of today’s society and for future generations.

The European Programme of Work, WHO’s vision to ensure healthy lives and well-being for everyone in the European Region, is shaped around the goals of leaving no one behind and reinforcing the capacities of health authorities. Monitoring and strengthening equity in health and health systems will therefore be a core element of WHO’s work over the next 10 years.