When an evidence-based approach entrenches inequalities

The curfew and further COVID control measures that were announced today have had me thinking about how a narrow approach to what constitutes evidence can exacerbate health inequalities.

As Prof Catherine Bennett points out, reducing the reproduction rate of the Delta variant to 1.2-1.3 has itself been a major achievement.

However, because COVID spreads based on inequalities – insecure work, where people live, housing conditions, inability to isolate – a targeted approach based on epidemiological data alone can lead to interventions that reinforce inequities. Interventions like curfews, limiting people to one hour outside the home, and increased policing are unlikely to have an influence on COVID transmission. If anything, they’re only likely to lead to increased criminal justice engagement and charges. They’re also not based on public health evidence.

Because these measures are only being imposed in the poorer parts of Sydney where COVID is circulating most, they’re entrenching determinants of health inequity.

Eighteen months ago, when I was still trying to figure what COVID was all about, I wrote:

There is likely to be a social gradient in transmission, i.e. the poor are more likely to get COVID-19, at least at first. This is a concern that some have already flagged in the U.S.

If there is a social gradient in the disease, there needs to be a social gradient in our response. The most affected locations and communities should be the focus of the health system’s initial response (we can’t just assume this will be the case). If antiviral therapies are found to be effective, or if a vaccine is eventually developed, consideration should be given to deploying them to poorer areas first.

“The first wave hits the poor, the second wave hits the rich”: Lessons from the 1918 pandemic

Now is the time for that social gradient in the response to finally start.